If you want a happy ending, that depends, of course, on where you stop your story.

—Orson Welles, in the Big Brass Ring screenplay

1. Move from a focus on teaching decontextualized knowledge to an emphasis on teaching for a sense if salience, situated cognition, and action in particular situations.

Teaching for a sense of salience means helping students to make connections between acquiring and using knowledge (Benner et al., 2010, p. 94). Making connections between content such as pathophysiology learned in the classroom and caring for a specific patient does not just happen. Clinical nurse educators need to consciously implement strategies to make this happen. Novice students often focus on one thing at a time and specific tasks and may not “see” the clinical situation as a whole. They need guidance and experience from their clinical educators to develop a perceptual grasp of the nature of specific clinical situations (Benner et al., 2010).

Continued situated coaching is needed to help students grasp the changing dynamics of a clinical situation so that they know what is important and what is most important to address first. Nurse clinicians possess the expertise needed to help students integrate new knowledge and skills into a practice context. This is reflected in the pedagogical moments, the tact of teaching, and the Socratic pedagogy strategies discussed in this book. Strategies that clinical educators can use to help students contextualize knowledge during their clinical experiences include the following, which relate to effective clinical evaluation strategies that are discussed in Chapter 4:

•   Share clear expectations for students and obtain their individual goals for learning.

•   Provide frequent opportunities for formative evaluation.

•   Work collaboratively with nursing staff on the unit to ensure they are aware of your goals for the students.

•   Consult with experienced educators to help you in difficult pass/fail decisions.

•   Use clinical journals to provide opportunities for open dialogue between you and the student.

•   Consider ways to use high- or low-fidelity simulation as a nonthreatening platform for practicing clinical skills and fostering self-reflection on performance.

•   Use multiple sources for gathering data about student performance, such as observation, discussion with staff, and document review.

2. Integrate clinical and classroom teaching.

Benner and colleagues (2010), when they visited schools across the country as a part of their research, found a distinct divide between classroom and clinical teaching. For example, students learned skills, such as taking a blood pressure, on healthy volunteers in a decontextualized situation, which was very different from the experience of taking a blood pressure while assessing an anxious and very ill hypertensive patient in the hospital. It is important to identify ways to bridge this gap in know/do learning.

Nurse educators who are teaching in both the clinical area and classroom can plan their classroom teaching activities to extend into the clinical arena, helping students to understand the application of classroom knowledge in diverse clinical situations. This is more difficult for nurse educators who are only in the clinical area. Thus, it is important for classroom and clinical instructors to structure opportunities to share important information for helping students integrate classroom and clinical knowledge and skills. Scheduling meetings with part-time clinical instructors at times that fit their schedules, including telephone or online SKYPE meetings, is helpful in keeping them abreast of classroom objectives and outcomes. Strategies discussed in Chapter 2 for making a difference for students can help them integrate classroom and clinical knowledge:

•   Capitalize on the pedagogical moment.

•   See the pedagogical possibilities in ordinary incidents.

•   Share your own clinical experiences with students.

•   Use a variety of teaching/learning strategies to accomplish the course objectives.

•   Assign challenging patients—just be there to assist your student, if needed.

•   Relate what the students are seeing in the clinical setting with what they are learning in the classroom. Know the curriculum in the school where you teach so you can do this.

•   Do not be afraid to ask questions of the full-time faculty or clinical coordinator. They are there to mentor you and assist you in learning about the school, teaching in academia, and the specific objectives of the course you are teaching. Keep their phone numbers/e-mail addresses handy.

•   Listen to the students. What are they yearning to learn? What are they fearful of?

•   Reflect on your teaching and clinical experiences—we learn through reflection.

3. Expand the focus on critical thinking to an emphasis on clinical reasoning and multiple ways of thinking.

As we discussed in Chapter 6, the term “critical thinking” is often used as a catch-all phrase for the many types of thinking that nurses use in practice (Benner et al., 2010). Benner and colleagues noted that students need multiple ways of thinking to develop the perceptual acuity or clinical imagination needed for professional practice. Clinical reasoning, the ability to reason as a clinical situation changes and take into account the context of the situation, with all of its complexities, is essential for clinical decision making. In addition, clinical imagination is needed, which helps nurses to grasp the nature of patients’ changing needs over time.

Chapter 6 described how nurse educators can help to teach multiple ways of thinking to their students. These approaches are excellent strategies for clinical nurse educators, as they can help students integrate classroom knowledge with a variety of clinical situations, building skills in clinical reasoning and clinical imagination. Strategies to help build these thinking skills include the following:

•   Be comfortable with silence—don’t answer your own questions! Don’t change the question (unless it really just wasn’t clear). Remember that students are always more uncomfortable than you with the silence.

•   It can be good sometimes (not always) to let students think about a question before answering. Give them a chance to talk with each other or to do five minutes of writing in response to a question. For instance, they might write in response to the questions: “What did we see in this video of the patient? What surprised or concerned you about what you saw?” Students could then share their responses, and those responses would serve as the starting point of discussion.

•   If no student volunteers a response to a question, consider calling on a particular student; if that student does not know, most likely another student will help out and rescue him or her. Ideally, “calling on someone in a non-threatening way tends to activate others who might otherwise remain silent” (Garlikov, n.d.).

•   Don’t overplan a class session. Have some idea of content or questions to be covered, but let the conversation flow where it seems to want to go; in this way, students are engaged and learning what they are ready and interested to learn.

4. Emphasize the importance of formation and a sense of identity as a professional.

Benner and colleagues (2010) used the term “formation” to describe changes in identity and self-understanding that occur when transitioning from a lay person role to a professional. Shulman described nursing as a profession with distinctive features that mirror many attributes of other professions but that also has a singular identity of its own (Benner et al., 2010, p. ix). Shulman also noted that the complexity of the nursing profession is paralleled by the complexity of the contexts in which nurses practice (Benner et al., 2010, p. xi). In most professions, practitioners have control over the pace and specific focus of their work, but nurses often need to attend to many clients at the same time, each of whom needs one-on-one treatment. This can be overwhelming for a student who has learned a new skill in the classroom or clinical lab and then needs to implement it in the clinical environment while multitasking and multithinking. This may be especially challenging for students in accelerated programs who are used to thinking in ways needed for their previous professions and now need to learn to “think like a nurse.”

Clinical nurse educators can serve a unique role in helping to shape the development of a student as a professional as they role model what it is like to be a professional practitioner. As novices, students may focus on tasks and skills to be learned in the clinical environment but clinical nurse educators can model for them how these tasks and skills must be integrated into the role of a professional. In the 2010 study by Benner and colleagues, students and faculty often spoke of “a-ha” moments when students suddenly realized what it is to be a nurse, including the moral responsibility of being a nurse. Clinical nurse educators cannot plan these pedagogical moments but they can recognize them and help the students to reflect on the experiential learning that takes place in these situations. The following strategies, discussed in Chapter 3 for creating a caring environment, can help students develop a sense of identity as a professional nurse:

•   Listen actively to students to learn their expectations and concerns.

•   Convey to students a genuine interest and concern for them as individuals and for their learning needs.

•   Provide clear explanations of what you expect from students and encourage their feedback related to these explanations.

•   Schedule individual conferences for students to share perspectives on their experiences and discuss problems they have encountered; schedule group conferences to help students learn to give and receive support from peers and faculty.

•   Structure opportunities for discussion of experiences related to incivility that the students may have encountered.

•   Implement creative clinical assignments, such as weekly journals, to encourage student reflection and sharing of concerns.

•   Consider cultural influences with your students that may impact their learning.

•   Establish effective working relationships with staff members who interact with your students and encourage them to discuss issues of concern with you.

Finally, it is important to think about why you want to transition to a nurse educator role. Is it because you are tired of your present role and want a change? Do you like to teach or feel you have an affinity for teaching? Do you think that the nurse educator role will give you more prestige? Do you feel that this role will allow you to expand your contributions to nursing? It is important to recognize the reason you want to transition into a new role and then to employ strategies for success in your new role.

The following strategies, discussed in Chapter 1, are important in helping you to transition successfully to the nurse educator role:

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