Basics for new nurse educators: Theory and clinical application

By Diana L. Rupert, PhD, RN, CNE

Congratulations!  You have chosen a wonderful career path: a nurse educator. Whether you are a recent graduate, a long-standing bedside nurse, or an advanced practice nurse practitioner moving to nursing education, uncertainty is likely to accompany your new role.  The nurse educator’s responsibility has expanded to include student as well as client.

Being a nurse educator is a unique position in the nursing field.  It requires a departure from having the primary responsibility for client care to a new responsibility of facilitating experiences in theory, clinical, or both, that will help students develop into competent entry-level nurses. Following the categories of Benner’s novice-to-expert theory, new nurse educators need to understand that though they are experts in client-focused care, they are at the novice level in this new role of educator.  The content provided here is general and based upon this theory (Benner, 1982, 2001).

Nursing education is not easy.  Even seasoned educators struggle with how to present the vast amount of information and experiences needed to care for clients.  The educator’s first step is to understand the curriculum and related teaching assignments.  Until you are comfortable with this new role, your primary focus should be completing your portion of the content assigned. In a theory course, this includes developing key points and implementing various strategies to facilitate students’ understanding and application of content to clinical practice.  This also means developing the right balance between instructor guidance and student participation. One way to begin is to review the instructor resources offered within the Lippincott textbook package being used for the course.  Most packages include a variety of expert-developed resources, such as PowerPoint slides, graphics, NCLEX®-style questions, case studies, and even simulation suggestions. All are intended to be used in part or as a whole within the course.  Nursing professional organizations such as the National League for Nursing (NLN) also have developed free resources that can be immediately inserted into courses. Bring your own flair to the content but feel comfortable incorporating these suggestions.  Remember the “edutainment” philosophy of making learning participatory and fun!

Once you have presented and reinforced your key points, you can move to the evaluation of student knowledge.  First, determine how many questions that your evaluation will contain and at what level the questions will be written.  If you or your teaching team have not developed a test blueprint, I would encourage this as a means of organizing the content’s testing points. From the test blueprint, you can develop a test map, including key concepts, style of item, and taxonomy of questions.  An example is below.

If you have not had the opportunity to take a course or receive other instruction on item development, a few basics can help get you started!  There are different types of questions.

1. Content questions: developed at a lower cognitive level (i.e., remembering, understanding) and containing facts. For example:

According to Erik Erickson, which would best foster a healthy self-concept in a school-aged child?

2. NCLEX-style questions: written on the basis of the nurse–client relationship and at the applying/analyzing levels or above in Bloom’s Taxonomy.  The focus here is “What would the nurse do?”  For example:

Which approach would be best for the nurse to initiate to ensure a friendly response from a toddler?

Most questions on the NCLEX are multiple-choice with a stem and four distractors. Exposure to NCLEX-style questions throughout the nursing curriculum helps prepare students for the eventual licensure test. It also allows students to place themselves into clinical situations, which is good practice for the clinical reasoning needed to provide care on a clinical unit.

Other suggestions for item writing include the following:

• Eliminate gender or age of the client unless significant to answering the question correctly.
• Make the stem clear and concise, eliminating nonessential words.
• Write distractors of equal length.
• Ensure all distractors are plausible, but that one answer is clearly correct.

Jump in and write some questions! Have a seasoned nurse educator, ideally with experience in test construction and item writing, review questions and offer suggestions. Item writing is a skill developed over time.

Now let’s talk about developing your nurse educator skills in the clinical setting. Nurses develop clinical reasoning based on their foundation of nursing knowledge and through applying nursing skills. The clinical educator’s role includes assigning appropriate level clients, role-modeling skills, questioning student decision-making (including rationale), and evaluating student performance. This is a hefty educator assignment, especially when multiplied by up to an average of seven to ten students! Organization before and during the clinical experience is a must.  Below are some organizational suggestions:

• Begin by making your own student/client assignments based on the objective for the day and the experiences available. 
• Reasonably consider your ability to meet client needs and elicit help from the primary nurse at the assigned facility.
• Develop a rapport with the nursing staff. Often, the primary nurse is happy to provide guidance in care, and even enjoys the opportunity.
• Keep a flow sheet that identifies completed tasks, which student completed them, and any comments relevant to the experience. Such data can help you at evaluation time.

Clinical educators must be able to provide instruction while maintaining quality nursing care for assigned clients.  Facilities expect that the level of care offered by student nurses will be the same as if completed by seasoned nurses, and the nursing clinical instructor is there to ensure that expectation is met.  Challenges for the new educator arise daily. With time and experience, clinical educators are able to develop a variety of strategies that lead to successful outcomes for students, clients, and facilities alike.

Nurse educators tell students that all nurses are lifelong learners.  As a nurse educator, you will have numerous opportunities to develop teaching and clinical instruction skills.  Consider attending a nursing education conference or Webinar, read publications on these topics, or participate in a research study to expand your awareness and have more information from which to draw as you grow into your new role.

References

Benner, P. E. (1984). From novice to expert: Excellence and power in clinical nursing practice. Menlo Park, Calif.: Addison-Wesley Pub. Co., Nursing Division.

Benner, P. (2001). From novice to expert: Excellence and power in clinical nursing practice (2nd ed.). Upper Saddle River, NJ: Prentice Hall.