Dr. Kling is Associate Professor of Nursing, Charleston Southern University, Department of Nursing, Charleston, South Carolina.
The author has no financial or proprietary interest in the materials presented herein.
Address correspondence to Vera Kling, DHSc, MSN, RN, BC, Associate Professor of Nursing, Charleston Southern University, Department of Nursing, P.O. Box 118087, 9200 University Boulevard, Charleston, SC 29423; e-mail: firstname.lastname@example.org.
Nursing education programs often lack sufficient clinical resources for students in nursing leadership and management courses to learn the judgment and skills associated with assigning, leading, instructing, directing, supervising, and evaluating the provision of patient care. Even when students are paired with nurse managers or other nurse leaders, learning often occurs more by following and observing than by leading and doing.
Student feedback from a leadership and management course at a private baccalaureate nursing school supports this assertion, as students have expressed interest in more hands-on practice opportunities assigning, delegating, and evaluating patient care, in addition to increased opportunities for teaching, instruction, or facilitation of learning. Instructional methods were sought by nursing leadership and management course faculty that would:
- Provide senior students an opportunity to practice leadership skills, specifically, delegation and supervision of nursing staff providing patient care.
- Reinforce fundamental clinical nursing skills.
- Expose students to the role of nurse educator.
Nursing education literature suggests peer teaching or mentoring is an avenue to assist novice students in adjusting to the rigors of nursing school and decreasing anxiety related to the new clinical experience and environment (Aston & Molassiotis, 2003; Broscious & Saunders, 2001; Owens & Walden, 2001; Yates, Cunningham, Moyle, & Wollin, 1997). This learning approach has also been associated with enhanced critical thinking and an increase in technical skills (Broscious & Saunders, 2001; Gilmour, Kopeikin, & Douche, 2007; Goldsmith, Stewart, & Ferguson, 2006; Lundberg, 2008; Yates et al., 1997). In addition, Daley, Menke, Kirkpatrick, and Sheets (2008) and Isaacson and Stacy (2004) found an improvement in nursing management skills, such as delegation, communication, and time management in the clinical setting as well as an increased comfort in giving and receiving constructive feedback as a result of a paired senior-sophomore student learning experience.
Kolb (1984) has written extensively about modern adult learning and learning styles. Believing that experience is central to learning, Kolb (1984) posits “learning is the process whereby knowledge is created through the transformation of experience” (p. 38). Spence Laschinger (1990) and Coyle-Rogers and Putman (2006) supported Kolb’s theory in nursing education, finding that educational approaches using Kolb’s theory can assist in developing nursing students’ abilities and critical thinking. Spence Laschinger (1990) asserts this enables students to “adapt to rapidly changing environments in today’s health care system” (p. 991).
Using Kolb’s (1984) work as a theoretical model, faculty developed a senior-sophomore student clinical experience as a portion of the leadership and management course clinical component. The course included a 3-hour classroom and a 6-hour per week clinical component focused on baccalaureate nursing leadership and management content. The project experience comprised 20% of the total clinical hours, with students spending the balance of their clinical time with a preceptor nurse manager on a hospital unit. The project experience allowed all senior students to experience the role of nurse leader and nurse educator, directing care for a group of hospitalized patients and working with sophomore nursing students.
Working with course and other faculty, senior students served as clinical mentors and leaders for 2 clinical days, working with sophomore students who were taking their first clinical nursing course. In preparation for the experience, the senior students received a clinical leadership education packet that included a description of the experience, objectives, a list of journal articles about similar projects, their assigned clinical instructor and leader, unit, scheduled days, and reporting time. Students were given the opportunity to ask questions and share concerns and comments.
On the first clinical day, senior students served as assistant clinical instructors and observed the clinical instructor leading students in the clinical experience. The senior students also assisted sophomore students with time management, prioritization, skill technique, task completion, and necessary documentation. During this time, in consultation with the clinical and course instructor, the senior students also applied lecture material about leadership and management styles, learner styles, instructional strategies, time management, effective delegation, and proactive problem solving.
On the second clinical day, under faculty supervision, senior students acted as clinical mentors and leaders, serving as lead clinical instructors. The senior students made clinical assignments; led pre- and postconference sessions; and directed, instructed, corrected, and evaluated sophomore students caring for patients. The experience of being in charge was new, and students were able to process this experience as the day progressed with the clinical instructor and course faculty through one-on-one discussion, group discussion, and directed and freestyle journaling.
This clinical experience has been evaluated by two classes of senior nursing students to help determine the effectiveness of this instructional strategy. Institutional review board approval was not required for this educational evaluation. The senior students completed the clinical education leadership project evaluation anonymously, with 34 of 36 students responding to the optional evaluation questionnaire at the end of the course. Forms were returned to the faculty for assessment.
The evaluation questionnaire asked students to respond to three broad question categories, each with four Likert-type scale statements. The three broad categories addressed:
- Students’ feelings about the project in general.
- Applicability of the project to the leadership and management course objectives, such as delegation, problem solving, and time management.
- Stimulation of interest, by participation in the project, in the role of nurse educator.
Space was provided for students to include any additional comments about the experience on the questionnaire. Students also were encouraged to share their impressions directly with the faculty.
Most of the students (n = 34) completed the evaluation in its entirety. However, there were a few questions left blank by individual students. Because response to the questionnaire was voluntary and anonymous, there is no way to know the reasons behind students’ failure to respond to a particular question. Incomplete student questionnaires were still used by including answered question responses, and the number of students who responded to each question is indicated.
Senior students were asked their feelings about the project overall. Regarding the project overall, 75.5% of respondents (n = 34) reported they had a somewhat positive or extremely positive initial feeling about working with the sophomore students in the clinical area; 23.5% of the respondents reported being unsure. During the experience, on clinical day 1 and clinical day 2, 73.5% and 88.2% of the respondents (n = 34), respectively, were either somewhat positive or extremely positive, whereas 26.4% and 11.7% of respondents, respectively, were either somewhat negative or unsure. At the end of the experience, 91.2% of the respondents (n = 34) had a somewhat positive or extremely positive feeling about the experience; 8.8% reported being unsure of their feelings about the experience.
In terms of the applicability of the senior and sophomore level clinical experience to stated course objectives (e.g., effective delegation, coordination of care, management of work groups, problem solving, decision making, and critical thinking development), all of the students (n = 34) believed the experience helped them learn better how to coordinate care and delegate tasks at least a little bit, with half of the students rating this as very much so.
All of the respondents (n = 34) believed the experience improved their decision making and problem solving skills at least a little bit, with 64.7% of the respondents rating this as very much so. Ninety-seven percent of the respondents (n = 34) believed the experience reinforced basic nursing skills such as safety and infection control, with 94.1% rating this as very much so. Finally, 93.8% of respondents (n = 32) thought the experience assisted them in developing their critical thinking skills at least a little bit, with 71.9% rating this as very much so.
Students also evaluated the experience for stimulation of interest in the field of nursing education and a nursing faculty role at some time in their career. Prior to the experience, only 18.2% of students (n = 34) reported having considered the role of nurse educator a possibility, with 50.5% indicating that they were probably not planning to become a nurse educator and 31.3% reporting that they might be considering that role.
Most (87.8%) of the students (n = 33) believed the experience helped them learn what is entailed in being a nurse educator. As a result of the experience, 85.2% of the students (n = 34) reported having at least some interest in the role of nurse educator, with 35.2% indicating extreme interest. As a result of the experience, 69.7% of respondents (n = 33) reported they might become a nurse educator at some point in the future (15.2% of the students reported it to be extremely likely), and 30% were either unsure or thought it unlikely to happen.
Senior students’ written comments were reviewed for content themes by the author and another faculty member. Students’ comments about the overall impressions of the clinical education leadership project were positive. Themes of reinforcing or refreshing basic nursing knowledge were mentioned frequently, as were the positive themes of being a resource or teacher for someone with less experience. One student commented:
Knowing I was responsible for correct information about nursing care made me review procedures, disease processes, and simple safety and care techniques.
Students were enthusiastic about the experience and their learning. They shared brief stories, noting that they “finally got a chance to do...” and that they were amazed at how much they knew when they “helped the sophomore student to conduct a head to toe nursing assessment” or “figure out why a patient might be getting a particular medication.”
An additional theme was the bonding and relationship development between senior and sophomore students. One student noted:
I really enjoyed working with the sophomores. I felt the experience brought the sophomores and seniors together.
Another student commented:
I really enjoyed spending days at the hospital with the sophomores. Not only did they have a peer that has made it through what they are going through, it was a great learning experience for me.
Several students forged friendships and mentorships across levels and have maintained those relationships even after the senior students graduated.
Students were asked to discuss the applicability of the experience in meeting course objectives, such as communicating, time management, and problem solving as well as coordinating, directing, delegating, and evaluating care given. Students thought they experienced professional growth as a result of the opportunity to practice delegation and supervision of others. Themes identified in this area were increased confidence, learning process, and developed leadership skills. One student noted that the experience had forced her “to be confident enough to correctly delegate tasks” and then ensure the tasks had been completed. Another student commented:
I felt like I was able to put into practice many of the things that were being taught in class. There were many opportunities to exert leadership.
Finally, students wrote and were asked about the stimulation of interest in the role of nurse educator as a result of this experience. Before the experience, many students had not even considered the role of nurse educator at any time during their career. One student commented, “Prior to this exercise, my thoughts were not indicative of being an educator.”
Themes such as new options, stimulated interest, and opened doors were evident in the students’ comments. One student said:
I had never even considered becoming a nurse educator…. However, it’s wonderful to know that you can take a difficult topic and teach it/describe it in a way that can be understood. I am now considering becoming both a nurse educator and an educator in the clinical setting.
Another student commented:
This experience afforded me the opportunity to discover what a nurse educator does, including the challenges she/he must face. It was a rewarding experience and makes me consider the nurse educator role in my own life in the future.
Kolb’s (1984) work encourages nurse educators to value experiential learning and create opportunities for students to experience, experiment, and reflect as they grow as learners and as nurses. This experiential educational project was developed to give senior nursing students the opportunity to experience nursing leadership and management concepts in the clinical setting, as well as to experience the role of teacher, specifically a nursing faculty member. In assisting sophomore students with nursing skills, senior students’ basic nursing knowledge and skills were also reinforced as they approached graduation and the NCLEX-RN®.
To date, the educational project has exceeded stated goals. Working as clinical mentors and instructors has allowed senior students to experience the concepts and theories embodied in a nursing leadership and management course. The senior students experienced and gained skill in effectively managing time, making assignments, delegating, giving and receiving constructive feedback, and providing and evaluating nursing care. As the students worked, they sometimes struggled, but at the same time, they grew more competent as nurses and more confident as individuals. The students were able to see how far they had come as nursing students, and they began to look forward to the myriad challenges and opportunities that awaited them as professional nurses.
This project also afforded senior nursing students the opportunity to experience firsthand the role of the nursing instructor and educator. The success of this component of the project has exceeded expectations. Many students who had never considered the role of nurse educator began to ask faculty about the role and expressed interest in exploring the nurse educator path at some time during their career. Through this experience, senior students saw their role and responsibility change to one of experienced student and mentor. They also began to indicate interest in the role of nurse educator, perhaps as a career choice. At a time in our profession when stimulation of interest in the role of nurse educator is necessary at every level and in every organization, the possibility of such a project assisting in recruiting the next generation of nurse educators is compelling.
Nurse educators continually seek ways to improve delivery of course content and prepare competent nurses for the future of our profession. Nurse educators also seek strategies to stimulate interest in the role of the nurse educator, as more nurse educators are needed to meet the demands of current and future nursing education. The model of instruction described in this article may be useful to nurse educators who seek clinical activities that would allow students to experience the roles of nurse educator and clinical leader, as well as increase students’ ability to provide safe, competent care to patients.
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