Innovative Clinical Experience Empowering the Nursing Student

Overview

The purpose of this innovative clinical experience is to empower nursing students during their nursing clinicals. Typically, the clinical instructor assigns each student nurse to a nurse or care partner (CP). In this activity, the student nurse is required to approach and ask a nurse or care partner if they can work with them for their shift.

How to Use

For this clinical experience, students are empowered to ask the nurse or CP if they can work with them and assist with patient care during the shift. This clinical experience is focused on building students’ confidence and communication skills. The clinical will start with the student nurse taking a report on all patients in the staff’s assignment. The student is responsible for:

1. Patient care
    
2. Creating a plan of care for one patient
    
3. Informing the clinical instructor with the staff member’s name. 

The student nurse will notify the clinical instructor of the selected patient for which the student will create a care plan; the student will provide the patient’s initials and the room number (for purposes of confidentiality/HIPAA). The student nurse is empowered by permitting them to self-select the staff member and identification of the patient for which to perform a care plan. The communication barrier will be dismissed once the student begins conversing with the staff member. (Role-playing may take place in the clinical pre-conference; the student will approach another student or the instructor and start a conversation. This allows for practice in advance of approaching nursing staff/CP). 

Integrative Learning Strategies

The student becomes empowered to speak up and engage with staff. The students realize the nurses are there to help them, which results in less fear/anxiety when working with the nursing staff/CP. When the clinical instructor assigns the student to a staff nurse, the student is often reticent/hesitant to interact with the staff nurse. This activity provides an opportunity to break down this barrier and facilitates the student/nurse connection and rapport building. The student also learns how to take report and complete a care plan on a patient that interests them; therefore, students are more apt to seek additional information and build critical thinking skills. It also creates an opportunity for the student to identify areas of weakness and opportunities to continue their growth in nursing. They learn the responsibility of approaching nurses with more experience for support, and they get to practice participating in (a) bedside report, (b) care plan development, and (c) giving reports back to their clinical instructor.  

Students will:

• Build Their Confidence/ Experience Decreased Fear and Anxiety - student is empowered to approach a staff nurse/CP that will support them.
   
• Practice Accountability - reporting to the clinical instructor the staff nurse’s name, and the patient’s initials/room number for the care plan.

The student will learn more when working on the care plan for a patient's condition that interests them, compared to a patient assigned to them. When students select a patient condition that interests them, they are more apt to engage in the researching of the condition and develop better critical thinking skills (i.e., use of their resources like online databases and their colleagues!) 

Assessment Strategies

Formative: 

• The student nurse will share the name of the staff nurse/CP they are working with for that shift with their clinical instructors. The student will also share the initials and room number of the patient for which they will develop a care plan with their clinical instructor.  
   
• During the clinical post-conference, the student will give report, discuss critical thinking they utilized for their patient care plan, and why they selected the patient, as well as the ways in which they (the student) interacted with the staff nurse/CP.  

Summative: 

• After each semester of clinicals, the student will complete a reflective journal regarding the empowerment, communication, and professionalism that they experienced from their role in identifying a staff nurse/CP to work with and building a care plan for the patient of their choosing. The school of nursing program (INSERT School Name) requires two (2) care plans over the clinical semester. The first care plan is completed by the student nurse and feedback is provided by the clinical instructor; the second care plan receives a class grade as well as feedback.

Note: The students do not appreciate the fact that they must walk up to the nurse and ask if they can shadow them—the first week! It is very impressive that during all future weeks of clinical seminar, the students approach the staff nurse or CP they intend to work with before another student asks! Many of the students have stated that it was intimidating, at first, but it ‘brings them out of their comfort zone,’ and they feel like they are more part of the clinical unit and its culture.  

Exemplar

First semester students are sometimes anxious/apprehensive to ask a staff nurse or CP if they can work with them for the shift. By week two, students are often more comfortable approaching the nurse/CP. The student feels empowered, experiences less anxiety, and ultimately experiences this as a better learning environment. Student comments from prior semesters include the following:

• “I did not feel comfortable approaching a nurse. She was so nice, and I began to feel more comfortable!”
   
• “I can’t wait until next clinical; I know who I am going to ask to shadow.”
   
• “Thank you, Dr. Garringer; you pushed me to ask a nurse to be with, I was terrified, now I want to be here every week!”
   
• “Wow, the nurses really want us to learn” 

Possible Courses

• Fundamentals of Nursing
• Holistic Nursing
• Medical Surgical Nursing 

Additional Resources/Publications

American Association of Colleges of Nursing. (2021). The Essentials: Core Competencies for Professional Nursing Education. Retrieved from: https://www.aacnnursing.org/Portals/0/PDFs/Publications/Essentials-2021.pdf  

David, C, Talbert, R., & Nilson, L. B. (2023). Grading for growth: A guide to alternative grading practices that promote authentic learning and student engagement in Higher Education. Routledge.  

Farzi S, Shahriari M, Farzi S. Exploring the challenges of clinical education in nursing and strategies to improve it: A qualitative study. Journal of Education Health Promotion. 2018 Sep 14; 7:115. doi: 10.410 D: 30271800; PMCID: PMC61491273/jehp.jehp_169_17. PMI.  

Felten, P., & Lambert, L. M. (2020). Relationship-rich education: how human connections drive success in college. Johns Hopkins University Press.  

Ghosh, S. Ramamoorthy, L., & Pottakat, B. (2021). Impact of structured clinical handover protocol on communication and patient satisfaction. Journal of Patient Experience, 8. https://doi.org/10.1177/2374373521997733  

Porter-O’Grady, T., & Malloch, K. (2010). Innovation leadership: Creating the landscape of Health Care. Jones and Bartlett Publishers.  

Taylor, C., Lynn, P., & Bartlett, J. (2023). Fundamentals of nursing: The art and science of person-centered care 10th Edition. Mexico: Wolters Kluwer.  

The Joint Commission (2017). Inadequate hand-off communication. Sentinel Alert Event, 58. Retrieved from https://www.jointcommission.org/-/media/tjc/newsletters/sea-58-hand-off-comm-9-6-17-final2.pdf? 

Posted: October 21, 2024

Submitted by:

Maureen Garringer, Ed.D, MSN, RN, Clinical Assistant Professor, Kennesaw State University

Domain 7: System-Based Practice Domain 9: Professionalism Domain 10: Personal, Professional, and Leadership