CHAPTER 9

Reflections of a Clinical Educator in a Hospital Setting

Meggen Platzar

This quote is hanging on a wall in my work cubicle to serve as a reminder why I became a nurse and why I want to be a nurse educator. As soon as I became a nurse, I also became an educator. I believe all nurses are educators because we help our patients and our fellow coworkers by constantly collecting and sharing knowledge. We quickly learn that in the world of nursing practice, knowledge must be shared.

I was a blank slate when I entered the field of nursing. I did not know anyone who was a nurse and did not have an accurate depiction of what a nurse did. My original desire to become a nurse stemmed from my experiences surrounding the birth of my son. I observed my labor and delivery nurse start my IV, hang my IV fluids, titrate my drips, and provide my husband and me with emotional support. I was so inspired by her intelligence and compassion that I myself became inspired to pursue a nursing career. As I reflect on this time, I cannot think of a higher honor anyone can achieve than to inspire another into his or her chosen field. I wanted to do my part and make my mark on humanity.

Shortly after the birth of my son, I started nursing school. My studies were challenging and rewarding. I worked as a nurse’s assistant in a long-term care facility during my second year of school. I chose this setting because I felt a connection with the geriatric population because of visiting my great-grandmother in her facility. However, I quickly learned that the long-term care setting, as opposed to acute care, was not my passion and so this became a short-lived job. I spent the rest of the time waitressing through college. My clinicals were where I obtained the majority of my exposure to the inpatient culture. I instantly loved the environment.

After graduating from nursing school, I only wanted to work at one hospital—the Cleveland Clinic. I started on an inpatient internal medicine unit. I had completed several clinicals there and was amazed at the complexity of patients, as well as the skill of the nurses. I felt a sense of pride and commitment to the organization and the nursing profession. For the first time in my short span of life, I felt like a true professional.

My early experiences in an RN role largely influenced my later career choice to become a nurse educator. This started during my orientation, which was accompanied by many positives and some negatives. The positive characteristics of my orientation were made possible by a preceptor who was strong clinically, adhered to policy strictly, and advocated for patients. I learned so much simply by role modeling these behaviors in my own practice. The orientation program was strong and guided by clinical instructors who touched base with us frequently in casual meetings; so, by the end of my 12 weeks, I had a manager and coach telling me that I was ready to practice without a preceptor.

What would we learn if we just focused on the strengths of programs and not the opportunities for improvement? This orientation period seemed pretty typical, but I found myself feeling alone and isolated in my feelings of anxiety. What if I make a mistake? What if I cause harm to a patient? What if the staff does not like me? People tell me I am doing a good job, but what does “good” mean? A lot of this anxiety was due, in large part, to the “watch one, do one” mentality. I was left to do a lot of things on my own and was expected to know when to come and get someone if I needed help. However, I was looking for more direction and support and wanted to be “coached” as I was completing tasks. I did not want to share my anxieties with anyone because I did not want them to think that I could not handle the workload. I spent a lot of time talking to my husband, who was trying hard to understand my medical lingo. This did not ease my anxieties. To make matters worse, I had missed a mandatory class that I was supposed to attend. My manager reprimanded me at the nurses’ station in front of my colleagues. This small act diminished my confidence and I looked at my manager as someone whom I should avoid at all costs lest she find more inadequacies in me. Right there, I had lost another resource. All of this anxiety became amplified once I was out of orientation. I was wondering if I had what it took to be a nurse, if I was intelligent enough, strong enough, and assertive enough. I wondered if I was completely insane for wanting to get into a field that came with such high stakes.

As time passed, I got past my initial anxiety and actually started to enjoy the art of nursing. I was getting positive feedback from patients. I was handling a variety of clinical situations on the medical unit. I kept hearing people say that my unit was a “great unit to start out on.” I would look back and agree with everyone. I dealt with patients who had everything from chest pain and sepsis, to multiple sclerosis and sickle cell anemia. My clinical knowledge exploded within a year and I started to feel more confident.

After orientation, I was encouraged to further my clinical knowledge with education. I became ACLS (Advanced Cardiovascular Life Support) certified and took skin care classes, all of which helped boost my confidence. I was asked to be a “champion” for our unit’s conversion to electronic documentation. I felt honored and valued as a team member.

DECISION TO BECOME A NURSE EDUCATOR

My decision to leave the clinical unit and become a nurse educator was an easy one. I felt like I was born to fulfill the educator role. Unbeknownst to me, my journey toward becoming a nurse educator started when I was asked to become a preceptor for a new nurse graduate. I immediately said, “Yes! I would love to do it!” I think I reacted to the simple fact that I was shocked I was even asked. I took this as a sign that in my own short time in clinical practice, I had shown growth and competence and my leadership team wanted me to share my skills with a new staff member. I later found out that sometimes this is not the case. Preceptors were sometimes asked to mentor simply because there was no one else to do it. Regardless of the reason, I felt extremely honored. Soon, however, my quickness to respond was replaced with feelings of doubt because I still felt new myself. It was at this point that the enormity of the job started to sink in. However, this time, instead of fear, I felt an extreme sense of responsibility to teach this nurse everything she needed to know on how to be successful. I felt like her success as an RN was a testament to my success as a preceptor.

My first precepting experience came with some unexpected rewards. I found a style of education that worked for myself and the RN that I was precepting. I found that questioning her, and allowing her to come up with the answers, helped me to understand her thought processes. At the same time, this helped build her self-confidence. I felt like I was off to a great start as a preceptor because I was able to instill confidence in this new RN. The relationship we built as colleagues was important and I ended up gaining a lifelong friend. I did not just teach her skills and protocols, but I also mentored her. I became a mentor in the sense that I taught her about hospital culture, dealing with patient and family emotions, dealing with difficult staff members, and helping her through the rough new period where she felt she was incompetent. I felt like I had the opportunity to make a positive impact on someone else’s career. I am not sure how she feels looking back on her orientation experience, but I hope that I had a positive impact on her practice. After this experience, I had the honor of orienting many other nurses. Each precepting relationship was unique, yet the same teaching/facilitation principles applied.

Through functioning as a preceptor, I had the opportunity to work closely with our unit-based clinical instructor. The clinical instructor role intrigued and inspired me because it blended clinical nursing and education. It expanded my horizons and provided a different perspective about another nursing role. Our unit-based clinical instructor had hinted several times that she felt I would perform well in her role. She herself was leaving the department and was trying to recruit people in whom she saw potential. I wanted to apply for the role, but at the time, I only had my associate’s degree. This event was a big factor in my pursuit of a bachelor’s degree in nursing.

When I finally graduated with my bachelor’s, an opportunity within our nursing education department opened up. I applied and obtained the position. Walking into the interview, I felt very prepared to take on any assignment or expectation they would throw my way. I had a few years under my belt, had served on multiple committees, and was the primary preceptor for many nurses. I felt ready! However, as the interview progressed, there was a part of me that was becoming slightly apprehensive. The hospital-based clinical instructors were responsible for unit-based in-servicing for many inpatient units, coordinating the orientations of new staff members, responding to rapid responses, codes, CITs [crisis intervention related to a hostile patient], attending department meetings, teaching orientation classes, EKG classes, BLS, ACLS, hospital-based initiatives, participating on committees, and in the end, becoming the expert nurse on their units. My head was spinning on how I could accomplish all that in a 40-hour work week. After reviewing the list of responsibilities, I was concerned that I did not “know enough” to educate colleagues and mentor new nurses. However, I had felt this feeling before and this time, I was much better equipped to deal with it.

STARTING AS A NURSE EDUCATOR

I will never forget my level of anticipation on my first day as a formal nurse educator. Even though the likelihood of me having to educate anyone on the first day was slim to none, I was nervous about starting on this new adventure. This, to me, was like starting a whole new career. I wanted to prove to my new supervisor and coworkers that I had what it took to be an educator. I started by observing my preceptor teaching an in-service for one unit’s night shift staff that was based on a request of the manager and staff. I could not wait to do the same for my units. My preceptor was planning on flexing her hours that day so she started at 6:00 a.m. for the in-service and planned to leave at 3:00 p.m. As simple as this flextime sounds, this was a new concept for me since my life as a bedside nurse had been so structured. I found flextime to be extremely professional in the sense that I was trusted to manage my time while still completing all the work I needed to do.

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