When I was growing up, my mother kept a short essay called “I Had the World’s Meanest Mother” displayed in our house. She really loved that essay. What I’m writing today is inspired by that essay. It’s not for mothers but for all those clinical instructors who continue to cultivate the next generation of nurses.
Student nurse giving a patient a metabolism test/Library of Congress
As I sit in the classroom and hear my colleagues talk about their clinical instructors, I remember my own and think to myself that I’m the one who had the meanest clinical instructor: She kept us in clinical for our entire allotted time. Not only that, but she frequently reminded us of the importance of our clinical rotation by saying things like “you are paying for an education,” “this will help you to be successful in your NCLEX preparation,” and “you will become a great nurse.”
In some ways that clinical instructor reminded me of Mary Poppins—she always carried a bag and she seemed to pull an endless number of items out of its depths: NCLEX questions with a list of rationales; an NCLEX blueprint (she had a few copies); concept map templates; a medication book; even snacks for us. I think the snacks were there so we wouldn’t get hypoglycemic and pass out . . . which would cause her more paperwork. Not to worry, I believe the paperwork was in her bag too!
Connecting theory to practice.
My clinical instructor was always making connections and tying theory into clinical. If we were talking about oxygenation, everyone in my clinical group had to know the concept inside and out and we were made to care for every patient with asthma, respiratory infections, and pneumonia on that floor that week. After a long clinical day I would fast fall asleep thinking about the oxygen hemoglobin dissociation curve and signs and symptoms of hypoxia, all the while believing I was still hearing the oxygen saturation monitor alarm.
Every week my instructor would reiterate and ramble on about the question, “How does one problem lead to another problem?” As we sat down to do a concept map, she would ask us to talk about a patient’s symptoms and lab results. And I can still hear her talking about an NCLEX test blueprint as if she were an architectural designer, or telling us, “The nursing process is the foundation to nursing care.”
Asking the important questions.
To make things worse, she asked a million bothersome questions, like “What do you think is the worst thing that could happen to your patient?” and “What are you most concerned about?” These were two of her favorites. However, my absolute favorite was “What would you do differently?” Well, I’d think, I could have stayed in bed . . . .
Way back during my first semester I had an instructor who not only had us clean up our patients, she had us clean the patients’ rooms. I believe her name was Florence. Florence could then go on and quote facts and statistics related to infection prevention. I left that semester knowing way too much about which patients could room with which patients, who needed what precautions. My hands were beet red because I washed them so much.
I had one clinical instructor who was always giving me ways to improve. Her name for it was “feedback,” and we received this on a regular basis. It was odd to me because she was always so nice about it. Once I was doing a dressing and dropped my sterile glove. My instructor just said, “No worries; things happen. Let me go get you a new one.” Medication passes were the worst. After I cited and performed the “five rights” of medication administration, my instructor would actually spend time talking to my patient and double-checking my assessments: “Listen! You can hear a great aortic insufficiency murmur,” she might say. She called her behavior role-modeling and and offering opportunities to learn. To make things worse, she made me ask my patient if my fellow students could come in and listen to his heart.
Years later, after passing the NCLEX on my first try and working in a busy ICU caring for the sickest of sick patients, I thank God I had “mean” clinical instructors—it was from them that I learned the art and science of nursing.
By Jo Anne Foley, DNP, RN, CNE, CNEcl, CCRN, is a professor of nursing at Labouré College, Milton, MA, and a nursing professional development specialist/medical-surgical unit at Boston Medical Center, Boston, MA
This blog beautifully captures the profound impact clinical instructors have on shaping the journey of nursing students. Thanks to the author of this blog who shed light on the invaluable guidance, support, and relentless dedication these instructors provide. From connecting theory to practice with unwavering enthusiasm to fostering critical thinking through thought-provoking questions, each interaction described paints a picture of mentorship at its finest. This piece serves as a heartfelt tribute to the tireless efforts of clinical instructors everywhere, reminding us of the enduring influence they have on molding the nurses of tomorrow.
I loved this article, it reminded me of the nursing instructors I had in a Diploma program. They were a couple who were hard but kind and understanding. So when I was teaching at a nursing program in a university I was strict but gentle with my students, they always gave me gifts at the end of the semester.it filled my heart with gratitude and appreciation.
I was that mean instructor, too. When I saw that my students (fourth semester of a associate’s program) couldn’t do med math, I gave them a quick 5-question quiz at the beginning of every clinical conference. At the beginning of the semester, the only one of them who consistently got them all right was a Vietnamese immigrant who had an advanced degree in biology in her home country. I taught them an easier way to do these (that multiple list/crossing out/ration and proportions thing confused more people than it ever helped), and gradually they got to everyone getting them all right. I brought this up in faculty meeting once (“Does anybody else notice that the students can’t do med math?) and rather than approval, I got slammed. “Why spend time on that? They all passed pharmacology!” “That’s as may be, but they can’t do simple problems, like, if there’s 500mg in 5cc, how much do you draw up for 350mg.” I learned something that ady– chiefly, how to shut up in faculty meetings.
When I took my turns at lectures, I always gave the student blank note-taking outlines– headers with big spaces. They could use them or not, but they seemed to come in handy for studying (imagine that). Every now and then, I would say, “Why do we care?” Why do you need to know preload and afterload and CHF if you’re working ortho? Why do you need to know about acidosis and ABGs now if you studied and passed the exam on that last year? Well, it’s because it’s always OK to have more than one thing wrong, and if your COPD THR patient starts sliding into failure, you have to be able to recognize it.
My clinical students said their classmates felt very sorry for them, having a meany like me, but by the end of the semester they had figured out that they had learned a lot more than anybody else. They all did very well on their finals and I heard they all passed their NCLEX on the first try (the school had an 82% pass rate).
At the end of the year, the school terminated my position. It seems that rocking the boat like this wasn’t really OK. The kids took me out to lunch and gave me a lovely gift, which meant a good deal more to me.
Thanks to the author for writing this article as it takes me back to my own training some 45 years ago. My, oh my, how time passes. There was one clinical instructor in particular that really made a big difference for me in terms of connecting the theory and practice dots. She was not mean; however, she did garner my respect from the git go. She set the bar high, and back in those days the clinical portion of the course was graded separately with letter grades (no pass/fail). So, naturally I set out to try and get an A. During a typical clinical day, I would be summoned into a small conference room close to the nurse’s station for a private 1:1 conversation with my now beloved Katy Kaiser. She calmly and methodically walked me through my patient’s case and teased out what I knew about the pathophysiology and nursing interventions by asking a series of direct questions. I can tell you one thing: I came prepared–and it paid off–I got an A in the clinical component and went on to pass the medical-surgical portion of the NCLEX with a perfect score. As I recall, it was hard to get an A when Ms. Kaiser was your clinical instructor! Over time, I completed my PhD and taught nursing. As I reflect back, one thing has become clear to me–the pass/fail system for grading the clinical component is failing our students. We need to set the bar higher by awarding grades for the clinical component, with clear rubrics that depict the difference between each grade (A-F). Thank you, Ms Kaiser, for thoughtfully guiding and sometimes strongly nudging me towards nursing expertise.