has this ever happened to you at the hospital?
you start the day with the best of intentions, but then – a student arrives late who didn’t call. somebody else lacks the written preparation that is part of the class. You need to remind the whole group to put their hair up. A staff nurses takes you aside to tell you that the student in room 316 left the bed “up” with the side rails “down.” The nurse manager takes you aside to tell you that the staff has noticed that your students don’t follow the hand washing protocol. Oh and by the way, when they did pre-clinical prep the day before, they did not have a name tag and brought their lunch to the nurse’s desk.
All of these things disrupt the good karma of the day, and they prevent you from living up to your potential as the warm, wise, collegial faculty member you set out to be when you decided to teach. You wanted to be able to spend time talking about the higher-level things…. showing the students something unique about the patient assigned to them perhaps, and yet – you never quite get there because you find yourself nagging.
The history – reacting against ritualism and militarization at school
We have all heard the jokes about strict nuns at Catholic Schools (not limited to nursing schools – elementary schools were included!) who expected a set of ritualistic behaviors and stopped at nothing to obtain them. For the first hundred years or so, nursing school was like that. In some parts of the world, it still is. Nursing school was like Marine Corps boot camp for many young women. When I take beginners to the hospital, I put this issue on the table. “Are nurses educated? or trained?” There needs to be a balance. The fact is, there will always be a group of teachers who think that it is somehow beneath them to give the students feedback on simple stuff – because the teacher is reacting philosophically against the harsh quasi-militaristic traditions in which nurses formerly needed to learn to do things a certain way.
These faculty are young and idealistic and they mean well. Paradoxically, their students are sloppy and the ward staff complains about them more. This is a fact of life. and the faculty says “you would think the students would be grateful that I am such an enlightened faculty member.” Nope. You need to model the right micro-behaviors from the beginning, over and over.
The fact, the sad fact, is that the student does not know any better. Don’t get into the negative spiral of blaming the student for your lack of control. All they know is, stuff keeps happening, and there seem to be an endless set of rules that nobody told them about. If the clinical experience consists of getting nagged at from all sides, students learn to dread clinical when they ought to be learning to love clinical. I wrote a previous blog on the subject of “the unwritten rules of a student nurse job description” – this blog is a continuation of that same theme.
Believe it or not, you can have clinical time in which you truly do focus on the actual patient instead of “the rules” – Don’t wait until clinical to start teaching these little micro-behaviors. You can be in control without being controlling.
the secret? use your learning lab as if it was the hospital. Establish rules at lab; enforce them; explain them there; and follow them at lab always. The lab is more than just the place where skills are learned; it is also the place where professional work behaviors are taught.
we start off the first day of Lab saying ” you think you are at the lab, but this is actually University General Hospital and we will teach you certain ritualistic behaviors that are used in any hospital.
The rule is,
If there is something you would be doing in the hospital, do it here; if there is something you would not be doing in a hospital setting in front of patients, don’t do it here.“
always wear name tags at lab.
always wear a uniform at lab. We have the clinical uniform (scrub suit) but in lab we use the “polo shirt uniform” – green polo with logo on it and khaki trousers. Faculty wear the uniform too. closed-top footwear ( no slippers – something we need to enforce in Hawaii but probably not an issue if you teach in North Dakota…)
no food in lab
adjust height of bed high when working; low when away. side rails accordingly.
all mannikins have a wristband, and it is checked as part of every procedure.
all mannikins have a chart and there is an order in it for every skills we practice. the order is checked.
begin each run-through of any given skill by washing hands and introducing yourself to the patient.
lounging on the bed is not allowed
horseplay is not allowed
use the over-the -bed tray to promote body mechanics.
always spend the last ten minutes cleaning up the lab for the next class.
we do make two exceptions: we don’t don clean gloves all the time (too wasteful since we are not actually in contact with anything) and we don’t always pull the drapes (so the faculty can observe everything)
In other words, professionalism in lab will pay off in clinical. you get the nagging out of the way, so that the expectations are known before you get near an actual patient.
The Nurse’s Brain
oh and by the way, you can also remind each student to add these little things to their “brain” – see the previous entry on Nurse’s Brains….
I rationalize it by saying that though I do not wish to promote ritualistic behavior, there are certain habits that are best learned by repetitive reminders and that just because the student is getting feedback, does not reflect on whether they are a good person. “you will thank me later.” repetitive behaviors can be “evidence-based.” go watch a clarinet player sometime: they learn how to move the fingers by practicing each finger thousands of times. The basic skills can only become second-nature if you practice them as if they were your clarinet.
this is all explained in a handout we give students at the beginning of lab. send an email to firstname.lastname@example.org and I will send it to you as a Word document.
I will devote a future blog to a mini-theme of mine – How to use low-fidelity mannikins to enhance your high-fidelity sim-Man experience. If your school has the $$$$$$ hi-fi mannikins, you can really boost your performance by changing the way the students interact with the low-fidelity mannikins. It’s true!
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