Archive for the ‘Nursing students’ Category

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Essentials for New Clinical Nursing Instructors, Especially Adjuncts

August 22, 2014

There are many things it’s helpful to know when you start work as a clinical instructor—and you might not get a lot of orientation first.

By Maureen Shawn Kennedy, AJN editor-in-chief

“So you’ve accepted the contract for your first part-time clinical teaching assignment and you’re wondering where to start in preparing for this new role. Perhaps you’ve been working in an administrative role, away from direct caregiving. Maybe you’ve been active in bedside nursing but have no formal preparation in clinical teaching. If you take the time to prepare for your teaching assignment, you can confidently lead your students through a meaningful clinical experience.”

Clinical instructor Betsy Moorhouse (second from right) reviews the contents of a pediatric code cart with her nursing students at Miles Memorial Hospital in Damariscotta, Maine. Photo © Getty Images.

Clinical instructor Betsy Moorhouse (second from right) reviews the contents of a pediatric code cart with her nursing students at
Miles Memorial Hospital in Damariscotta, Maine. Photo © Getty Images.

So begins “Starting a Job as an Adjunct Clinical Instructor,” the second article in our quarterly column, Teaching for Practice (published in AJN‘s August issue, the article is free until the end of September).

When I was working as a clinical nurse specialist, I was also adjunct faculty for a local school of nursing, working with students in the acute care setting. Fortunately, I had taken an education minor in graduate school—otherwise, I would have felt lost when faced with setting objectives, planning pre- and postclinical conferences, and student evaluations. Read the rest of this entry ?

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Revisiting Reality Shock – What’s Changed for New Nurses?

July 28, 2014
julie kertesz/ via flickr creative common

julie kertesz/ via flickr creative common

By Maureen Shawn Kennedy, AJN editor-in-chief

Last month, we highlighted on Facebook a blog post I had written in 2010, “New Nurses Face Reality Shock in Hospital Settings – So What Else is New?” (It seemed timely in terms of all the June graduations.)

I wrote that original post in response to a study that had just been published in Nursing Outlook (here’s the abstract) describing the experiences of new nurses. Generally, these newbies felt harried, unprepared, overworked, and unsupported—all similar concerns voiced by nurses in Marlene Kramer’s 1974 book, Reality Shock: Why Nurses Leave Nursing. (Here’s AJN’s 1975 review of the book. It will be free for a month; note that you have to click the PDF link at the article landing page to read it.)

My post back in 2009 noted how nothing much seemed to have changed since the publication of Kramer’s book. Now, once again, this post has generated many comments, a number of them on our Facebook page as well as on the original blog post.

Here are a few. I’ll start with Facebook:

I’m almost a 20yr RN and have experienced [this] in a new job. I’ve developed skills to deal with this over the course of my career, so it doesn’t impact me like it did as a new nurse…but to new nurses out there: just know that bullies have some personality disorder that extend[s] beyond the workplace (even if you never get to see it). Learn, be happy, and go on your way. It’s them, not you.

It’s up to nursing leaders at all levels to set the expectations and role model professional behavior.

The real problem is that we will no longer want to work as nurses . . . it has become so difficult for so many reasons. So at the end of a long shift you wonder, “Is it worth it? Is it?”

And some comments from the blog: Read the rest of this entry ?

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Nursing Students and Then Some – In Opryland, Revisiting AJN’s Long Connection With NSNA

April 14, 2014

Revisiting AJN’s long connection with this vibrant student nursing association. 

By Maureen Shawn Kennedy, MA, RN, editor-in-chief

Opryland critters

Opryland critters

I’ve said it a number of times over the years, most recently in my editorial in the April issue of AJN: the National Student Nurses Association (NSNA) is a vibrant organization and produces one of the most well-organized annual meetings in nursing. This year, it broke attendance records, drawing approximately 3,200 students and faculty advisors to the Opryland Hotel in Nashville, where I spent part of last week.*

Supporting NSNA since its founding. The American Journal of Nursing has been a supporter and and sponsor of the NSNA since the organization began in 1952. The NSNA offices used to be part of the AJN offices at one time, and before NSNA had its own publication (Imprint), AJN published “The Student Pages.” We sponsor Project InTouch, an award given to the student who recruits the most new members for the organization. This year, winner Joanna Laufer from East Carolina University, Greenville, North Carolina, recruited 130 new members; overall, this initiative brought in over 1,600 new members this year. Impressive.

Impressive, and sharp dressers too! The students I met—mostly junior and senior nursing students—were also impressive. They were enthusiastic, eager to learn, and professional. I have to say this group as a whole was better dressed than many attendees I’ve seen at other nursing conferences—they clearly got the message about what business casual meant; I rarely saw anyone in jeans.

The students’ major concern was of course, finding a job in this tight market. And there were few recruiters other than the military services among the couple of hundred exhibitors—most were schools of nursing and companies with educational products for passing the licensing exam. Many speakers reinforced the message that the tradition of working in a hospital for a year before working in other settings is not necessary (and likely never was), and students seemed a bit relieved to hear that. But more jobs will be opening in primary care settings and preventive care services; senior care centers and long term care will grow along with the aging population, so jobs will be there, too. And while it might be tough now to get a job in a hospital, the market will be very different in a few years as older nurses retire. Read the rest of this entry ?

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What Advice Would You Give a New Nursing Student? Our Readers Respond…

April 9, 2014

KarenRoushBy Karen Roush, MSN, RN, FNP-C, AJN clinical managing editor

My daughter Kim is starting nursing school next month, so last week I asked AJN’s Facebook followers for the best piece of advice I could give her. The response was overwhelming: over 600 people offered wisdom, encouragement, and tips for success. I went through and read them all and the following is an attempt to synthesize the advice.

Of course, with so many responses, there were many valuable pieces of advice I had to leave out, from the practical to the profound, such as:

sit in the front of class, stick to your principles, invest in good shoes, choose clinicals that push you out of your comfort zone, be early for everything, celebrate the small victories, get a really good stethoscope up front, believe in yourself, pick the hardest patient you can at clinical, audiorecord the lectures, be truthful and committed to your work, eat healthy, get to know your instructors, coffee and chocolate!

And finally: look into the eyes of your patients and be sure they know you care. Every patient, every time.

(Oh, and not to leave out the lighthearted—Don’t hold your nose in clinicals. The teachers frown on that.)

Below are five areas of advice that stood out:

1) “Take a good picture of your friends and family and put it on your desk, because that’s all you’ll be seeing of them for the next two years.” There were many variations on the idea that nursing school “takes 100% dedication.” You need to warn your family and friends that they won’t be seeing you for a while, get rid of your TV, sleep when you can, learn good time management, and be prepared to spend Saturday nights with your books . . .

2) “Study, study, study, and study some more.” Respect the quantity and degree of difficulty of the material you will have to learn. There were a lot of ideas about how to optimize your studying—chief among them was to get in a study group and to study NCLEX questions from the beginning. Others were to read ahead, not procrastinate, use flashcards, attend practice and review sessions, and have a study partner or buddy system. Having a study buddy, though, is only a small part of the importance of friendships with your fellow students . . . Read the rest of this entry ?

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Don’t Write Off Community College to Start a Nursing Career

March 26, 2014

By Karen Roush, MSN, RN, FNP-C, AJN clinical managing editor

KarenRoushMy daughter is about to start her nursing career. She’s got all her prereqs out of the way and she’s waiting to hear from the half-dozen colleges she applied to. Among them is the community college where I started my career 35 years ago. That’s right—a community college that confers an associate degree.

I hope she gets in.

Community colleges are seen by many as the bottom of the ladder of desired schools of nursing. Not only do they offer only a two-year degree, but they’re not seen as being as selective as four-year colleges and they don’t have the big name professors.

But community colleges can and do produce great nurses. Programs are rigorous, so a more liberal admission standard at the onset doesn’t necessarily change the caliber of student who graduates at the end. And once they graduate, they must meet the same standards as students from four-year schools to attain licensure as an RN—everyone takes the same NCLEX. At the time of my graduation, my school had a 98% pass rate, one of the highest in the country.

Community colleges even have some advantages over a lot of four-year programs. They may not have the big names—but really, how many of those big name professors actually teach full courses? At community colleges, teaching is the focus. Community colleges are affordable; students don’t leave burdened with astronomical debt to start a career that, while setting them down firmly, and often permanently, in the middle class, can also saddle them with a burden of debt on top of all the expected financial struggles. And in many places, community colleges are truly embedded in their community; this can provide a level of support and open up opportunities for students that is not possible at larger detached universities.

I agree that all nurses should have a BSN, eventually. There is a lot of evidence that it improves patient outcomes. But the two-year community college can be a great place to start—two years of reasonably priced education that gives you a solid base of skills and knowledge to practice while you continue to take courses toward a bachelor degree. I remember when I returned to school for my bachelor’s: the wonderful sense of discovery that I was not just a nurse but a professional, and part of a profession with its own history and body of knowledge.

We need more nurses. All the experts agree that there is a shortage just waiting for the rest of the Baby Boomer nurses to hang up their stethoscopes. An education that starts at a community college can take a nurse far. I know mine has, from acute care staff nurse to long-term care educator, from oncology to urgent care to the IV team. Here in the U.S. and in India and Africa. As a nurse scholar at the WHO in Geneva, Switzerland, and as an NP in the Adirondacks of upstate New York.

Read the rest of this entry ?

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Three Nurses and a Doctor Go Sailing – Some Notes on Communication Style

March 24, 2014

Julianna Paradisi, RN, OCN, writes a monthly post for this blog and works as an infusion nurse in outpatient oncology.

Untitled from the series, Pareidolia. Charcoal and graphite on paper, 12" x 9," by julianna paradisi

Untitled from the series, Pareidolia. Charcoal and graphite on paper,
12″ x 9,” by julianna paradisi

There’s an old joke about the personality differences among nurses of different specialties. It goes like this:

A medical–surgical nurse, an ICU nurse, an ER nurse, and a doctor go sailing. The doctor stands at the bow of the boat and shouts to the nurses, “Trim the sail!”

The med–surg nurse asks, “How do you want it?”

The ICU nurse replies, “I’ll trim, okay. But I’m doing it my way.”

The ER nurse shouts back at the doctor, “Trim the sail yourself!”

ICU style. The joke is a generalization, of course. However, I was a pediatric intensive care nurse once upon a time, and I have to admit that the ICU nurse characterization resonates with my own experience. Like the nurse in the joke, I always have an opinion, and rarely mind sharing it. In the ICU, if another nurse, a physician, a pharmacist, or respiratory therapist didn’t agree, conversation ensued. My colleague, equally opinionated, would state her or his position. Data was consulted, and then, more often than not, consensus occurred.

And I often learned something from sharing information. It made me a better nurse. I learned to dig in on a position only if patient safety or my license was at risk. Everything else was pretty much negotiable, face-to-face. From this perspective, our ICU team was similar to a marriage—it would have been unrealistic to expect there would never be disagreement within our team. In fact, if there was never disagreement, someone probably wasn’t being honest about her or his feelings—an approach that can lead to passive-aggressive behavior.

I don’t know if it’s because I no longer work in ICU, or if nursing culture in general has changed, but lately I’ve noticed some confusion about the difference between open, honest communication and bullying. There’s a difference. Read the rest of this entry ?

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Are Hospitals Doing Enough to Help Newly Licensed RNs?

November 18, 2013

CalloutNewNursesVoices

Staff retention is a big issue in hospitals. There can be advantages in hiring newly licensed RNs, but some hospitals and workplaces may pay insufficient attention to helping new nurses with the challenging transition from classroom to clinical practice. In our November issue, some of these issues are brought more clearly to light by an original research article called “Hearing the Voices of Newly Licensed RNs: The Transition to Practice.”

“The first few months of employment is a crucial time in a nurse’s career,” write the authors of this small study. According to interviews with newly licensed RNs conducted by the authors, the following factors can make a big difference:

  • The quality of the preceptor—is the preceptor knowledgeable, adequately experienced, and nonjudgmental?
  • Professional growth and the development of confidence over time in terms of time-management, communication skills, and learning from experience.
  • A sense of being nurtured by the program, the preceptor, and peers.
  • The thoroughness and effectiveness of orientation.

Read the article, or listen to an author podcast on our Web site. What worked in your own transition to practice? What didn’t work? Or how do you help others with this transition? We’d love to know. —Jacob Molyneux, senior editor


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