Clinicians and Faculty Partner to Enhance the Competency of Nursing Students

Four years ago, Cleveland Clinic’s Zielony Nursing Institute launched a weeklong immersion program for newly graduated nurses who need assistance making the transition from school to bedside. The program’s focus is on helping nurses recognize a change in a patient’s condition and determine whether it is urgent. With the success of the training program, Cleveland Clinic and its 13 Northeast Ohio nursing school partners in the Deans’ Roundtable Faculty Initiative had an idea: Why not provide nursing school faculty the same tools offered to nurses in the immersion program to help develop students before they move into a clinical setting? So in 2013, the Nursing Institute kicked off its Faculty Immersion Program.

Improving the competency of new nurses

The Nursing Institute recently presented its sixth Faculty Immersion Program on the campus of Cleveland State University. The one-day program, offered at nursing schools, is a hands-on learning experience that provides a framework for building critical thinking in relation to patient problem identification and urgency recognition in the classroom, simulation lab and clinical area.

“It’s a collaborative venture between us and the academic institutions to improve the competency of the new nurse,” says Christine Szweda, MS, BSN, RN, senior director of operations in Cleveland Clinic’s Office of Nursing Education and Professional Development. The goal is to help nurses:

• Utilize hand-off information (SBAR) to anticipate potential problems
• Recognize signs and symptoms related to an acute change in condition
• Differentiate between relevant and irrelevant patient information
• Provide rationale for decisions made
• Determine the urgency of the situation

To do so, the program provides faculty with tools for facilitating the development of clinical judgment in students. (The same tools are taught in Cleveland Clinic’s in-house immersion program for new nurses.) Faculty break into small groups, where clinical instructors first model the concepts the same way they do for new nurses, then share strategies for implementing the tools within the classroom.

Tools for fostering critical thinking

The Faculty Immersion Program is led by clinical instructors, Szweda and Jennifer Van Dyk, DNP, RN, NE-BC, director of nursing education at Cleveland Clinic. They introduce four primary tools for facilitating critical thinking in students.

1. The Dot Method – This method helps with problem recognition and differentiation. Students see a list of data related to a patient, including patient history and signs and symptoms. Next, they’re asked to identify the patient’s problem. Each problem is assigned a different color dot. Then, students look one-by-one at each listed piece of patient information, seeing which projected problem it most closely correlates with and placing the corresponding color-coded dot next to it. The correct problem – the one with the greatest number of dots – is then easily identified.
2. Critical Thinking Questions – Faculty are encouraged to use repetitive, open-ended questions to stimulate clinical judgment. Repetition of the same questions helps cement critical thinking into the nurses’ routine thought processes. For instance, during a patient hand-off, a nurse might consider these three questions: What complication is the patient at risk for? How would I know if the complication was occurring? What information am I going to pay particular attention to when I see the patient?
3. Small Group Facilitated Discussion – This taps into the strengths of the group and peer feedback to aid learning. The Faculty Immersion Program presents this exercise for cultivating group discussions: Everyone in the group writes down the primary problem of a patient they have cared for on a card, then the group stands and holds up their cards. Next, the group prioritizes the patients in order of urgency and shares the reasons behind those decisions. This promotes a team approach to patient care and ensures that rationale for the decisions are understood by everyone.
4. Feedback – Real-time, constructive feedback is important for caregivers to know when their clinical decisions are accurate and when they are not. Faculty are encouraged to ask for feedback on their performance as well as provide it for students. For example, a nursing professor might ask, “What methods could I use to better engage you in the learning process?” When faculty offer feedback to students, they should start with a question that allows students to reflect on their performance: What did you feel was your greatest success today?

A two-way flow of information

The Faculty Immersion Program has been well received by nursing schools. “Many of the faculty have taken pieces away from this program that have enabled them to teach differently, to get students to think more critically, and to get them to ask more questions and provide more answers,” says Patricia A. Sharpnack, DNP, RN, CNE, NEA-BC, ANEF, Dean and Strawbridge Associate Professor at Ursuline College’s Breen School of Nursing, where the program was held in February.

Perhaps more importantly, the program helps strengthen the partnerships between Cleveland Clinic and local nursing schools. “Oftentimes, nursing programs act in isolation,” says Dr. Sharpnack. “Having partners such as Cleveland Clinic supports deans and directors who are trying to transform the educational process.”

It also helps the Nursing Institute elevate its care. “There’s an exchange of information between us and the nursing schools,” says Dr. Van Dyk. “We have changed the way we do things in our new graduate immersion program and the way we onboard nurses because of insight our academic partners have shared with us.”

That two-way flow of information ultimately benefits patients. “The partnership brings hospitals and nursing programs together for the good of the patients in terms of quality, safety and patient outcomes,” says Dr. Sharpnack.