to teach delegation part 4 – getting “street smart” Jan 3 2014

note: be sure to click on the hyperlinks, the highlighted text. A prize awaits….

Street Smart is the goal.

My favorite definitions of Street Smart are to be found on Urban Dictionary. warning: adult language and content at times, but funny. Possibility of not politically correct. Street Smart is always contrasted with “Book Smart”

Delegation is key to NCLEX success

To teach delegation is to teach “Street Smart” skills, only they never call it that.  This series is to share with faculty colleagues my views on how to teach delegation skills.  In a final-semester-before-graduation course, sometimes the curriculum will mash together content from “Issues and Trends”  “Career Development” and “Leadership and Management” – this is a widely disparate clump of content. Add this to the idea that the students may be having “senioritis” during the second half of the semester.  Finally, students often need to be convinced that the course is relevant – they want something like ACLS or PALS or more pharmacology.

In one of the earlier blogs in this series I gave the rationale for all this emphasis on delegation, but it bears repeating.

read this carefully:

Every Nurse Practice Act includes rules of delegation which are based on the definition of nursing.

The NCLEX content is not solely determined by NCLEX corporation. it is dictated by NCSBN, which uses a sophisticated process to determine the “test plan”

NCSBN test plan says that 20% or more of the exam will be on – delegation.

NCSBN defines delegation and also publishes their own documents to support their definition. Working with Others is the main one. Every nursing students needs this!

therefore,

it makes sense to devote time in nursing school to the specific materials from NCSBN. This is not rocket science.

If your class work on “legal & ethical issues” focuses only on  such things as how not to get sued, or defining “beneficence” or “utilitarianism” – you are wasting your students’ time.  You need to focus on what the rules say.

As an aside, I think one reason that faculty go astray is that few of the nurses who actually managing a ward want to  become faculty members. they are paid too well doing what they do!

and now for today’s Pearl of Wisdom

first, as the NCSBN monograph says: The key to effective delegation is to have assertive interpersonal skills in conflict resolution. So – don’t just teach this by lecture or directed reading. Find ways to make up exercises for the students to role play.

second, when a student is new, they just focus on their own assignment, and the goal here is to develop the skills to analyze how the assignments of all the nurses mesh with each other. Predicting not just what will happen with your patient, but predicting how many nurses will be needed by the unit overall. Figuring out how to work together as a team, how to help each other.

Too often this is taught by just assigning  the student to multiple patients, and watching them flounder around – “sink or swim.”  I guess some students will only start to pay attention when they see that they are not as good as they think they are – but a better way is to teach all the stuff I am listing here.

Friday Night at the E.R.

all this leads me to the subject of today’s blog. Friday Night at the E.R. is a resource for nursing students, and I think every nursing student should play it, especially if they are thinking of a hospital career. I see that for January 2014 the company that makes and sells it, has upgraded the game board a bit to make it easier to play.

An Excellent Simulation Learning exercise

we tend to define simulation learning narrowly these days, as if it can only be done with a high-fidelity manikin and a room with a two-way mirror. That is an artificial constraint IMHO.

FNER was developed as an interactive game to teach teamwork and decisionmaking, not necessarily limited to nurses. It is used by people interested in Organizational Development. It is a board game with a gazillion small parts. It’s expensive but worth it IMHO. It does have complicated directions and requires a facilitator who knows what it is about. (the company has a policy of only selling it to people or agencies that have a registered facilitator.) if you are going to use it, you need to carefully manage the logistics of it – for example, if you have a class of thirty students you need eight game boards. for a class of sixty you may need to have half the group do it one week, the other half the next. You need to schedule extra time – it can not be done in just three hours – the debriefing is as important as the game itself. Simply critical to debrief.

The most important thing about this simulation game, is that the students learns things about their own problemsolving, which is a reason why the makers of the game are a bit vague about the exact conduct of it. I went to YouTube to see if there was anything there that might entice you to seek further information.  I found a gem in which the professor seems to be trying to teach the students “the right way” to do it prior to playing – the exact opposite of it’s intended lesson. And better yet – it’s in French!

If you buy the game, you do get a DVD that tells a lot more. The idea behind that strategy is to allow the students to discover certain things for themselves and not over-teach.

Achieving Street Smarts?

When I have done the Friday Night at the ER  exercise with students, they come back to class after a week or two and tell me that up until then they did not know what the manager of their unit, or the house supervisor, actually did during a work day. “Didn’t have a clue” they say.

But now their eyes are opened and they see their own role as part of the larger team.  They are more focused on admission/transfer/discharge. They have a better sense of their own “agency” – ability to shape their destiny. They are more able to describe the parameters of problemsolving. all kinds of good stuff like that.

I would love to hear from others who have used this…..