Category Archives: nursing education

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!


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…..



Filed under NCLEX, Nurses Brain, nursing education, Uncategorized

teaching delegation and the Nurse Practice Act, part 3 Jan 1 2014

Third in a series.

Background: How did I get involved with the topic of delegation?

Yes folks, I have fifteen years of critical care nursing  experience, and I am a former ACLS Instructor and ACLS Regional Faculty. I love those subjects, they are exciting and fun.

By contrast, delegation is boring, a sort of grind-it-out, eat-your-spinach-and-take-your-medicine area of nursing.  At least, up until the time you get in trouble with it somehow.

In 2002 I took a faculty job at a school of nursing on the east coast where they were having a low pass rate on the NCLEX exam for first-time takers. At the time of hire I was tasked with re-evaluating course content for the leadership and management class I would teach, to strengthen the NCLEX first-time takers pass rate. (I detest the idea of using in-class time to do review questions.)  After researching this, I found the resources I list here in these blog entries. And by the way, that school on the east coast had a timely and gratifying increase in our pass rates once we gave proper attention to this material.

The first part of the this series dealt with a way to conceptualize the definition of nursing in a way that makes “delegation” easy to understand, using a short YouTube video;

The second part dealt with how a teacher can use certain in-class simulation exercises to show a practical way that nurses implement the Nurse Practice Act every day at work. Summary: give them a list of patients on an imaginary ward and have them make out the nurse’s assignment. then discuss and critique. this takes the content beyond a dry lecture about styles of ward organization. In that blog I recommended the resources from Ruth Hansten, RN PhD, especially her YouTube videos.

Today – the third part of the puzzle. Working With Others from the NCSBN.  This is a 40-page FREE publication of NCSBN that goes into the subject of delegation-  in detail. Originally published in 1998 and updated in 2005.

The next piece from NCSBN is one I recommend highly. it is a package. First a video“Delegating Effectively: Working Through and With Assistive Personnel,” and also a set of overheads. It costs $299. If you click on the hyperlink with the title above, you can see the video broken into five-minute clips on the website. Now I hate to criticize, but the video(s)  are not the most exciting ever. It’s the accompanying overhead package that is valuable. I used to omit presenting the video and go straight to the overheads.

I always preface it with the following disclaimer:

“This is not the most exciting. in fact, it is as boring as things get. BUT, the material comes straight from the NCSBN, and they are the ones who dictate the content on the NCLEX exam. It says in the exam map that 20% or more of the content of NCLEX is “delegation.” If you wanted to do well on the exam, doesn’t it make sense to go to NCSBN, find out what teaching materials they have provided, and then incorporate those exact teaching materials into this curriculum?”

Usually that short speech creates student buy-in.


In the Working With Others paper, there is a section on interpersonal skills, in which the point is made that “the best set of delegation rules will not be effective if the RN lacks the interpersonal and conflict-resolution skills to carry them out.” (sic).   and so the Working With Others paper has a lot of emphasis on communication and interpersonal skills. This is excellent, very practical. In the package with the overheads and video, you will find a set of seven suggested role play exercises dealing with conflict arising out of delegation. These are pure gold. I always use them. they provide excellent fodder for in-class discussion of delegation.

Cultural comfort with perceived aggressive behavior?

As a complete aside, while in Hawaii I volunteer as a guest lecturer for NAMI and friends, a group in Waipahu that works with newly arrived immigrants from the Philippines who attended nursing school there and now wish to prepare for the USA NCLEX. I always provide this content for that group. When I do the role-plays with recent immigrants in the class, they invariably have difficulty showing assertive behavior. There seems to me to be a cultural component in the reluctance to deal with conflict.  this is in sharp contrast with the more-acculturated students of Asian descent who are educated here in USA.

There are also generational implications for this. If the RN is fresh out of school, they may be in a situation where everybody they supervise is older than they are. but that is subject for another blog entirely…..

I have one more entry in this series. why not subscribe to this blog and be sure you won’t miss it?


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Filed under foreign nurses in USA, NCLEX, nursing education, Nursing in Hawaii

How to teach delegation and the Nurse Practice Act, part 2 dec 30 2013

today’s blog is not as fancy as yesterday.

The feature of yesterday’s blog was to drive traffic to a YouTube video on delegation I made in 2011 and dug up out of the past. Alas, I don’t have another YouTube to share today.

Executive Summary:

If you teach management and leadership, and you want the students to do well on the section on NCLEX, you need to get this  book by Ruth Hansten et al. If you aren’t covering this content, your students are missing a chance to score better on NCLEX. Is that important to you? then read on!

Course outline

To teach the management skills for surviving as a staff nurse, I deliver a series of lectures and in-class exercises early on the semester. the sequence is:

1) definition of nursing according to Nurse Practice Act ( see my YouTube link above)

2) delegation. MD-to-RN; RN-to-RN; RN-to-UAP.

3) staffing systems (team, primary, functional) (usually this is straight from the textbook, but for some reason students always think this is boooorinnnnggggg – until somebody shows them it is not) and making out the actual assignment.

Note: I am a devotee of Ruth Hansten, RN, PhD of Washington state, who has written a lot of really excellent practical examples of this in her books. While researching this blog, I came across her 2011 book, Prioritization, Delegation, and Assignment: Practice Exercises for the NCLEX Examination, 3e. I confess I have not read this specific one, but I highly recommend that you check out the 29 reviews on Amazon. If you are teaching this material at a school of nursing you need to own a copy and consider adopting it. Also a copy  of her book Clinical Delegation Skills on your shelf. (1994, which is “old” but a classic).  It’s the clearest discussion of how the Nurse Practice Act translates in to clinical bedside decisions. Dr Hansten’s consultant work on delegation has informed the national dialog on this subject. Her website is

4) conflict resolution ( as inspired by the NCSBN materials on this subject, more on this in a future blog).

5) bed control and unit-to-unit coordination. ( which uses Friday Night at the ER. I will do a separate blog on this gem of a resource, later).

The overall idea is to give the neophyte nurse an idea as to the context by which care is delivered. if they have this, they think only of their own assignment and they don’t develop the predictive ability they need. If students don’t get these, they are less likely to show initiative in these issues, and the preceptor and staff will notice. workload estimation and priority setting are skills that can be learned, and this is a place where it is is the problem. Neophyte nurses can become “situationally aware.”

For each of the areas listed above,  I have an in-class hands-on exercise.

Does your school of nursing do this?

If not, they should. hate to be the know-it-all, tell-you-what-to-do-guy, but – that is who I am today.

I know I am old school, because of the fact that I was a nurse-manager for ten years, have  worked on “charge nurse development” when I was a staff development director, and also spent a lot of time dealing with “house supervision” (which I always disliked).

making out the assignment

so, the Pearl of Wisdom for today is an  in-class exercise you can use. it goes like this:

pre-prep required – write a list of  a dozen or so patient summaries such as would be used during a taped shift-to-shift report. the kind that would be done from charge nurse to charge nurse in the report room. bring blank transparencies, marker pens, and templates for writing the report as it is received.

each student gets a paper that has space for them to copy down the report as they go along.

the class begins with a lecture on types of staffing systems (team nursing, functional nursing, primary nursing) and the rationale for each. I like to do the short lecture on this the week before, and assign the reading so the students will be prepared. Also, if they are doing clinical on a ward that does report this way, to find a copy of the assignment sheet and bring it in so we can see an example of how it’s done. if their ward does nurse-to-nurse report, I tell them to ask if they can attend the charge nurse to charge nurse report for a day.

the students would have already had the content on the Nurse Practice Act as well as the content on UAP delegation.

the class is divided into smaller groups of about six. they are told that the outcome of the exercise is to produce an assignment sheet that uses the principles of delegation, the skills level of the staff, and the available personnel. this is the kind that would be posted on the unit. then I draw a diagram of the floor plan of a 12-bed unit, and  tell how much staff they have.

next is for me to give the verbal report while they copy it down. a pitfall at this step is that the reporter ought to go as fast as would be done in real life. it’s not unusual for the students to miss half the data the first time around. this is a learned skill.  It helps to have an assistant here to make sure the students are doing it – I once had a group where one guy didn’t write anything – tried to make a joke out of it. (not an acceptable work behavior).

then the students work as a group to  make out the assignment. I give them about 20 minutes. I bring blank sheets of transparencies to use on the overhead projector, and each group submits theirs.  one by one we go through the critique of how they did.

interactive discussion of the exercise

The success depends partially on how clever the teacher is. leave room for serendipitous learning. One group once made out the assignment but left off a patient – I.e., no nurses assigned to that patient for that shift (gotcha!). You can expect that one group will choose functional (task-oriented) nursing; that is acceptable (it’s not the preferred way, but it is on the palette of choices). They need to decide whether the charge RN takes an assignment or not;  One group demanded to transfer two patients to ICU, call for a float, and send out for pizza.

The critique is just as important as the choices. Invariably the question will arise as to “what is the correct answer?” – and the reply is “there is no single correct way to do this.” which is a good illustration of dealing with the ambiguity of staffing.

If you can do this exercise, it transforms a boring lecture (“here are the alternative staffing systems, here is how you do it”) into a stimulating and fun group exercise that creates a lot of discussion.

let me know how you make out…..

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Filed under classroom management, NCLEX, nursing education, Uncategorized

How to teach delegation and the Nurse Practice Act, part 1 dec 29 2013

Delegation is important. A dry topic sometimes but important nonetheless.

important for three reasons

1) it’s on the NCLEX exam;

2) it is something nurses in hospital and longterm settings do every day; and

3) you get in trouble if you do not do it properly.

NCLEX exam re delegation.

I blogged on this before. The focus was for students and it was titled “How to increase your NCLEX score by twenty percent.” 

test map of NCLEX

The NCLEX exam is guided by a map. the map tells the NCLEX corporation how to construct the exam – so many questions on infection control, so many questions on pediatrics, so many of lab tests, etc. the map is made by the NCSBN, and you can find the map on the NCSBN website. It’s not a secret.

Alphabet soup?

If you don’t know who the NCSBN is, click here. Each state has their own Board of Nursing, but the Boards in all 50 states work together to make sure their Nurse Practice Acts are similar.  The NCSBN works to make it happen. Since 2011, NCSBN has begun producing their own videos. Here is the link to their video on the Nurse Licensure Compact.  It’s worthwhile to browse their entire site. NCSBN is not a jazzy internet site I suppose – they are a serious group pursuing legislative and regulatory goals, and their materials reflects the overall mission of protecting the public from incompetent practitioners of nursing.

What the map says

The NCSBN says, roughly, that up to 20% of the NCLEX will be on the subject of delegation and leadership.  Here is the link to the map.  I think a mistake people make in NCLEX prep is to be too medically focused, and to ignore this specific cluster of concepts. Remember – the NCLEX tests nursing, not medicine. If you don’t have a firm grasp of the difference between the two, you get confused. And yes, a nurse needs to know an awful lot about medicine, but the focus is not the same.

So – walk with me…..

Teaching the definition of nursing

The NCLEX exam was recently recalibrated, and it’s important to make sure that the test-taker prioritizes their study to match the map. I was going through my sequence of class materials on the subject of delegation, and remembered that two years ago I made a video to cover “the definition of nursing” as a prelude to discussion of delegation. it’s about twenty minutes long. I did it when I was considering relocation to the East Coast, as a sample of my lecturing style. So ignore the references to Vermont. The meat of it is still current and applicable.

please feel free to share widely.

Over the next few entries, I will post practical examples of what exactly it is that I teach to help soon-to-be-graduating students become confident about the ins and outs of delegation. I draw from  a variety of sources, and I will share those. If you want to make sure that you receive these, please look to the right, and click on the “Subscribe” button.

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Ten experiences every nurse needs before graduating from nursing school

Ten experiences each student nurses needs to have before getting out of nursing school

There are two trends in nursing school today that bother me. I know that I am an opinionated curmudgeon at times, but I need to say these out loud, just in case the act of putting it out there makes them go away like magic. In reality, I know that we can’t wave a magic wand and get what we want, but – work with me on this!

The first is a nationwide trend. Every nursing school is full to the max with students and it is harder to get optimal clinical experience. We are substituting simulated experiences for the real thing. We focus on “the standard patient” as if all patients are standard when they are not.

The second is, we are losing the old “what is nursing” battle. By that I mean, there is increased emphasis on medical content. Physiology, pharmacology, surgery, etc. less emphasis on psychosocial implications. This goes hand in hand with the lack of “role socialization” in nursing.

Tip: the NCLEX tests nursing, not medicine. Every question on the NCLEX is either an Assessment, Planning, Implementation or Evaluation question. The Nurse Practice Acts define nursing according to APIE and nursing diagnosis; the “junior doctor” parts are limited to the section on Delegation. Every nursing faculty needs to ask themselves about whether they are teaching nursing or medicine, and to have a clear handle on the difference. If your school is having problems with NCLEX pass rates, it’s probably because the faculty are confused about this specific principle.

Let’s explore the above, shall we?

To begin with, I first taught on a nursing faculty fulltime in 1990. I taught maternity and pediatrics, and took students to a hospital for OBGYN that did about 1200 deliveries a year. That meant an average of one baby born per shift. Sometimes more, sometimes less. In those days I made a pact with the students. If they would be flexible about their hours the day they were in Labor and Delivery, so would I. the goal was to help them have the experience of seeing a baby born. In the three years that I supervised students in L & D clinical, every one of them did see a delivery. One time I hung around until 9 PM. That specific student got the idea of how long it actually takes to deliver a baby. the idea was to get a first hand look at the way all the theoretical stuff translates into what is done in real life.

When we try to simulate every experience, there is a tendency to only present scenarios where the ideal is portrayed, and to sanitize everything somehow.

On a related note, on day one of maternity orientation, I always asked the nurses to save me a fresh placenta or two. We would all don gloves, look at the membranes, the cotelydons, the shiny and dirty side, etc and marvel at it. I always viewed this as an important experience to have. It desensitized the student to the appearance of body tissue, helped them to visualize what we were talking about ( so much of prenatal care is designed to help grow a healthy placenta) and removed some mystery.

Nowadays, I am sure there are people who would look on horror and say “Om My God, it’s exposure to body fluids!” – well – no – not when PPE is applied. even in those days we wore gloves.

Ten. maybe more

There are ten clinical experiences you should have. I sincerely hope that every nurse gets these while still in nursing school, but if you don’t you still need to find them at some point. The advantage of having them in nursing school is, an experienced person can interpret the experience for you. Guidance from a guru is critical to draw the proper conclusions. By proper I mean, conclusion which reflect the role socialization appropriate to nursing.  without the proper guidance any of these can do a number on your head.

1) Coaching a woman through labor and seeing a baby born.
2) Giving a shot to a 2-year-old. Getting a 2-year-old to do anything!
3) Being with a person who is dying from cancer. Two parts: talking to them before hand; and being present at time of death.
4) Seeing surgery
5) Smelling cautery. Or any one of about a dozen distinctive olfactory stimuli peculiar to health care.
6) Having a conversation with a person suffering from delusions or psychosis.
7) Talking with family members of a person having a serious illness, whether it’s acute or home-based.
8) Doing CPR
9) Dealing with a drunk person.
10) Helping a person who is a member of an oppressed minority, whether it is a racial or ethnic group, a group subject to bullying, or perhaps a homeless person.
11) Giving nursing care to a person who is seriously ill but who is your own mirror image in terms of age, social level, education, family etc.

The key to each of the above is, it’s not about the actual experience per se. it’s about incorporating the interpersonal flexibility required to actually be of use to the person receiving the care, and about dealing with your own feelings and reactions. There is only one way to do CPR ( the Heart Association protocols) but it is inevitable that you will have personal thoughts go through your mind when you are doing compressions, and these need to be considered “by hand.”

special note about autopsies

I was once asked by a student how come viewing an autopsy is not something we can arrange, or why we don’t include it or promote it. At the time I thought the student ( a male of course) didn’t quite “get it” and had a sort of voyeuristic quality to his request. “What is the goal?” I asked. Let me emphasize that simply getting these experiences checked off is not the purpose.  The purpose is to develop an overall professional approach that can be generalized to all such experiences that have any aspect of threat to the self-image of the student.

If I had to name a single concept that everyone needs to grasp, it’s “this is not a game, not just a well-paying job, but a critical service offered to society by members of this profession.”  Often by being the one  person in the room who is maintaining composure during a stressful event.  You could look at the above list in that way.

For each of the things listed above, there are certain professional expectations as to how a successful nurse conducts themselves. I could write a blog on each one to detail these, but hey – that is what textbooks are for!

hint: we can develop a simulated experience to go with each of the above, but it will never substitute for the doing of the actual thing for a real person. Not ever. just about every negative experience can be reframed into something positive with proper guidance. (for example, cleaning human fecal incontinence can be viewed as distasteful because it involves feces, or else we can reframe it into helping the person feel better and clean while retaining dignity).

Nursing Diagnosis sayonara

As to the “junior doctor vs actual nurse” argument – I worry. There is a trend by which nursing schools are quietly getting away from the teaching of nursing diagnosis. What does your school do?

I have heard all kinds of rationales – “practicing nurses don’t use it” being the main one. My answer is, “practicing nursing surely do use nursing diagnosis!” though maybe they call it something else. Maybe they have it down so well they it is less obvious, but I guarantee you that no hospital can have a functioning customer service program unless somebody in the nursing service uses psychosocially-based problem-solving. Caring is a learned behavior, and nursing diagnosis is the vehicle by which we teach people how to care. You need more than just warm positive regard for the person you are serving. It’s too hit or miss otherwise.

Hold hands before crossing the street – the lost art of curriculum design

Nowadays in the shortage of nursing faculty, we are pressing into service anybody with a Master’s Degree, including nurses that took a Nurse Practitioner course and never took even one course in pedagogy, test construction, curriculum design, or anything. Such a new faculty person needs guidance in how to be a teacher.

Curriculum Implications

When ever there is a transition from one curriculum to another, or whenever you are designing a comprehensive course of study, it’s useful to think of a “crosswalk.” In the parlance of educational design, a crosswalk is a comparison of two lists. The first is the “old curriculum” and the seconds is the new. Where does a theme of nursing school appear in any given course of study? If it was there before and you are changing your curriculum, where is it now? It is a useful exercise to make a list of things the student is expected to know (we call them “outcomes”) and to actually place them somewhere along the line, in a rational sequence. For example, if a student nurse has never dealt with a normal person having a crisis, why would a curriculum expose that same student to concepts of mental illness first? The crosswalk needs to be analyzed according to how to teach psychosocial needs in a logical sequence. This is simply lost when the coursework focuses on a tour of body systems or medical diagnoses.

Bottom line

To become a fully actuated professional nurse is a lifelong process. When a nursing school teaches you how to care, they are teaching you “how to be a human” – which sounds easy. It’s something we need to think about….. If we only present the “standard case” we are focusing too much on the basic medical care, and not enough on the psychosocial.


Filed under nursing education, Uncategorized

nobody wants to teach nursing

received a provocative link from a colleague.

see below

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It’s Official – Hawaii has an “oversaturated” market for nurses

Update: As of October 30, 2013, the job market seems to be easing.  click here to get to an updated blog.

note: be sure to click on the hypertext links, they are either underlined or else in a different color, and BTW you can also find the surprise

Is this really news?

The Honolulu Advertiser Sunday April 28th, 2013  edition included an article on page D-1 titled Nurses Wait for Jobs. (as of 2014 this is a year old…)

The subtitle?  recent graduates end up competing for a few positions in an “oversaturated” market.

Here is the link, but there is a warning – The Honolulu Star-Advertiser will ask you to buy a subscription in order to read it. Bummer. It is well-written though.

In summary, the Honolulu article describes the recent closure of Hawaii Medical Center East & West, the number of currently registered nurses who are working in jobs that do not a require an RN, the predictions of the Hawaii State Center for Nursing, and the statistic from one of the major hospital groups that they now have 150 recently-graduated RNs on the payroll in non-nursing positions. This latter effort is admirable but it makes you wonder how long it can be sustained.

The article tries to end on a hopeful note, saying that in a year or two things will be better.

National Student Nurses Association

It’s important to get a feel for whether this is just a collection of stories or not. Here is some data.

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this book is about medical missionaries in Nepal. sure to become the number one beach read for summer 2014! go to Amazon and pre-order your copy at

There is a quarterly publication of the National Student Nurses Association named “Dean’s Notes” and their Jan 2013 issue focused on the results of a nationwide survey of new graduates that showed a lot of info about this very subject. click here to find the URL – go to “Jan 13 issue” and it will appear by magic.

UPDATE May 17 – one of the Universities is offering a refresher course in clinical skills this summer for those RNs not employed in the RN role. I think this is a great idea for keeping skills sharp.

I am very curious to know my reader reactions on this subject. please feel free to comment.


Filed under nursing education, Nursing in Hawaii

Nursing Students and FaceBook episode #3,148

social Media and HIPAA

we’ve all heard the warnings about nursing students who posted patient information on Facebook.

Social Media and Job Hunting

I myself wrote a past blog warning students to be careful what they post on FaceBook since future employers nowadays are always reading your stuff. They tend to question your judgment if you post a lot of photos in which you are drinking champagne out of a slipper or displaying ink in places normally covered by clothing.

Social Media and student-faculty interactions

this one is new. and you heard it here first :-)

A couple of weeks ago some students who are about to graduate let me in on a secret. Since the very first semester of nursing school, they have all been members of a secret FaceBook page which is limited to members of their cohort. They have used it to coordinate such things as group assignments, carpooling, social gatherings (of course!), study groups, and the like.

and what was new?

The new part was, this particular group has also shared considerable information about the faculty, such as comments made on evaluations and emails in response to questions asked by members of the group. Every time a class officer asked for clarification on any item, the reply was posted.

It is a longstanding tradition in academia that students “scope out” the faculty, and there are public websites such as where they can post an evaluation. A couple of years ago, I applied for a nursing faculty job and the search committee chair had read my reviews there. It’s part of your portfolio now, whether you like it or not. For that matter, I did a YouTube search on a school of nursing in the northeast, and found a video the nursing students had made as a farewell to their faculty. it was not a slick Public Relations Video but it was a gold mine of information….. In that case, it made me want to work there!

something that surprised me was that a faculty person had sent a student an email describing the student as “rebellious” – a word choice I would have never made, even if I thought it was apt. In context, it seemed to be a putdown. It was there for the entire cohort to read and digest. There were other examples in which a given faculty was disrespectful toward a given student. This was a shock, but it backfired – I just don’t think the faculty expected that the student would share the email with everybody.


for the students: I can’t say I blame you for using a new route to communicate with each other. In fact, you are advocating for yourself in a powerful way. I guess I would hope that you are doing it with a sense of positivity. I actually think every student cohort should do this. I have worked in settings where the staff did something similar using a notebook or other tools. It’s professional nursing behavior. it really is.

Let me expand on that last point: if you are to be a lifelong learner, you will need to figure out ways to mobilize resources, develop theories about the way some new disease works, and test out possible responses. As a professional nurse, when you do this learning-from-your-direct-experience strategy, we call it “praxis” – the essence of development. Teams of nurses do this. Yes they really do.

for the faculty:  some of these are old rules. never put anything in writing for one student which you don’t think will be read by every student. don’t use personal attacks or attribute motivation that would be not correct – focus on specific behaviors instead. A new faculty in particular, needs to learn how to welcome feedback. Realize that the students will be “scoping you out” and organizing themselves this way.

Finally – a question –

have you noticed this at your school? want to share examples?


Filed under classroom management, nursing education

dealing with nurse-burnout, a simple trick

Back to normal

The election is over, and we can all take a bit of time to decompress. I was of course, happy with the outcome, but I also note that a few people dropped their subscription to this blog. Oh well, it’s a voluntary system, people come and people go. The readers are not my prisoners, though of course, it can be torturous to read my writing.

Though I’d share something I have found to be useful when dealing with stressful situations. When I wrote my book about volunteering rural Nepal, I included a reference to this little Jedi mind-trick. People told me that they started using it and it made things better. I did not invent it and I suppose we could discuss what the meaning of “better” might be.

Inner child

The thinking technique is one that derives from the work of Eric Berne, the founder of a movement in pop psychology known as Transactional Analysis. “T.A.,” as it was called, was a way to express complicated theories of personality and motivation in terms that were accessible to the general public, and I think it is the place where references to the “Inner Child” started to become popularized.

I won’t rehash the entire theory, I leave that up to you. we live in the age of the internets, go use them!

But, the short version is, when you anticipate a stressful or upsetting situation about to take place, you take a minute or two to perform this exercise, and it will lead to better execution of whatever things you need to do.  I suppose that some lay persons will respond by saying “hey, when the s^&t is about to go down, take your self away from that place, wherever it is!” – yeah, well, that’s true but it’s not an option if you want to be on the trauma team or if you wish to deal with people in any kind of crisis.

the long term issue is “secondary stress’ which I have written about before. a health professional takes on the stress of helping. entirely understandable.

so here it is:

You visualize your self as a five-year-old, presumably a happy innocent version of yourself, but vulnerable to upsetting things like ghosts stories or anger or abuse. picture that five-year-old version of yourself, the part that would cry if a bee stung you, or that would be amazed to see a butterfly; or that likes milk and cookies.

Then put on the voice of yourself as the all-knowing mom or dad. The all-knowing mom or dad says

“grownup things are about to happen now but you will not need to be part of this. I am going to tell you (the five year old) a story, give you a glass of milk, and put you to bed now, where you will be safe while the grownups do some work. when you wake up, we will laugh and sing. I love you”

You know it is working when your mind is cleared while you run through the ACLS or ATLS protocols.

Mister Spok

A similar technique has been called “going into Spok mode” based on the Star Trek character. Spok was the humanoid from planet Vulcan who had no emotion or nonscientific judgement, and was only able to deal in facts and logic. to go into Spok mode, you just make a decision to do two things: 1) only open your mouth to share something factual; and 2) not respond to anything that is not factual (or at least, evaluate everything that happens as to whether it is fact-based or not).

Christian coping?

and finally, a technique many Christians use. prayer.

the shortest prayer in the Bible. Matthew 14:30  which is of course, a direct plea from the Inner Child…. but also has its place :-)

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Filed under nursing education, Uncategorized