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Practicum Reflection Journal
Erin Kibbey
Week # Date Time Activities # of Hours
1
Monday, Jan. 13, 2014
8:00 am – 12:00 pm Attended simulation operator class 4
Monday, Jan. 13, 2014
1:00 pm – 3:00 pm
Met with preceptor. Discussed practicum plan, as well as Critical Care Internship schedule, learning gaps, plan
for modifications to schedule, and changes needed for internship
2
Thursday, Jan. 16, 2014
11:00 pm – 12:00 pm
Attended meeting with interview committee for Critical Care Internship 1
Thursday, Jan. 16, 2014
3:00 pm – 6:00 pm
Observed and participated as a facilitator in Role Transition Class.
Class topics included: moral distress & caring for the dying patient.
3
Week 1 # of Hours 10
Week 1 Summary
The first practicum opportunity I took part in was a simulation operator class. This class
took place in the simulation lab at Munson Medical Center. It was facilitated by a master’s
prepared registered nurse from staff development. Munson’s simulation lab is equipped with
both the SimMan and SimMan 3G. Since I was the only individual in attendance for the class I
was able to get quite a bit of one-on-one time with the manikins and the computers used to run
the simulation scenarios. The main goal of this particular class was for participants to learn how
to operate the high-fidelity manikins and run a simulation utilizing the Laerdal software. Thus, I
was able to learn how to run the SimMan graphic user interface, change parameters on the
SimMan monitors, run the equipment utilized with the manikins, troubleshoot equipment
problems, locate resources that could be used in the scenario, and review the hospitals policy
related to use of the simulation lab.
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During this week I also met with my preceptor, Patti, and reviewed my practicum plan.
We took a look at the schedule for the new class of interns, which is slated to start March 10.
There were hospital wide changes to hospital orientation for new employees that would have an
impact on the previous set-up for the internship. Thus, we looked at this and discussed ways to
change the schedule and what things needed to be accomplished during the two weeks of
orientation. Patti also brought up several topics of learning needs that she felt (based on
feedback from past interns and preceptors) needed to be highlighted with the next class of
interns.
On Thursday, there was a one hour meeting with the internship interview committee to
review resumes, references, etc. of possible candidates for the critical care internship. There was
representation from each of the critical care units. We briefly discussed the set-up for the
interviews.
Finally, I also attended and participated in my first role transition class that Patti
facilitates. There was a PowerPoint presentation and lecture given by a nurse from the ICU
related to moral distress and caring for the dying patient. The new nurses in attendance at this
class sat at tables with a volunteer facilitator at each of the tables. There were four small groups.
I sat at a table with three other nurses and helped facilitate discussion amongst the group
members on these topics.
Insights/Discoveries/Reflection
I believe the opportunity to learn how to operate high-fidelity manikins in a simulation
lab was a very valuable experience to help prepare me for the role of a nurse educator. During
this class I was able to learn hands-on and actually run through a few scenarios as the operator
with the instructor acting out the scenarios. This provided a realistic opportunity for me to
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actually use the equipment and perform the duties of the operator. I found the class very
interesting and something I hope to use this semester during other practicum opportunities. I felt
pretty comfortable with the technology, however, I would definitely benefit from continued
practice to help build confidence when running various scenarios. I would also like to run the
simulations with a group of students as opposed to one student so that I could see the
difference(s). I felt the facilitator of this class was very knowledgeable and approachable with
questions and I truly appreciated the opportunity to try all of the equipment out.
Meeting with my preceptor went well. I feel she is excited and pleased to have me
working with her and does not make me feel like a burden. She values my input as a preceptor
of the critical care interns and is certainly welcoming to new ideas. One thing I was curious
about was exactly where she obtained her information about learning needs. She definitely has a
lot of ideas about certain skills, hospital initiatives, and critical thinking information that needs to
be implemented into the next internship but I don’t really understand where she came up with
these ideas or if it is primarily from discussion. I jotted the ideas down and figured we will
definitely be coming back to them.
Meeting with the other members of the interview committee was nice. I made some new
contacts with unit educators and introduced myself. It was interesting to review the internship
candidate’s information and hear briefly about them. I also enjoyed listening to how the
committee members spoke with each other and voiced concerns and recommendations for some
of the candidates that they were familiar with. This was a relaxed, open meeting and I felt
comfortable as part of the group.
The role transition class was bigger than I thought it would be. I felt a little bit
uncomfortable at first because I wasn’t sure whether to sit, stand, or go in the corner. My
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preceptor was there and I briefly spoke with her but she didn’t really direct me as to what I
should do. This was not the first class of the series so she knew the individuals in the class.
Eventually I ended up sitting at a table with three other individuals and the class began. I
thought the nurse from the ICU did a great job with her presentation. The class was engaged and
she did a good job of keeping the right pace with the presentation. At various points she stopped
talking and we would have discussions within our small group at the tables. Patti told me to help
facilitate within the group by actively listening and keeping the topic going by asking additional
questions. Some of the discussions were difficult due to the topic of moral stress and death but
overall, I felt they went well. I was slightly uncomfortable feeling that I was sort of thrown into
a facilitator role but I did get over my uncomfortableness pretty quickly. In hindsight, I think it
would have been beneficial to sort of guide me beforehand with what exactly Patti wanted me to
do and accomplish during these times of facilitation. On the other hand, I also know that part of
my apprehension with teaching is the thought of having the spotlight on me, so to speak. I am
not very comfortable in large groups and having to talk. However, I am definitely hoping that
with time this uncomfortable feeling with begin diminishing.
Analysis
The use of simulation technology is rapidly expanding and familiarity with this
technology is important for nurse educators (Jeffries & Clochesy, 2012). This type of learning
approach can be very beneficial for nurses learning critical care due to the acutely ill status of the
patients they are preparing to care for throughout the internship. Learners must be ready for the
complexity of patients and the fast pace of the critical care units, as well as be able to solve
problems and make decisions in order to achieve desired outcomes (Jeffries & Clochesy, 2012).
Now that I am trained to operate the simulation manikins it will be possible to incorporate more
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simulation into the internship curriculum to provide an interactive, practice-based instructional
strategy. In addition to simulation use continuing to be emphasized in nursing education,
according to Shellenbarger and Edwards (2012), simulation activities can benefit graduate nurse
educator students as well. Accordingly, simulation activities can be a useful way for novice
nurse educators to create scenarios for simulation so they can practice the skills of planning,
implementing, and evaluating teaching and learning skills. Thus, not only was it beneficial to
learn the use of this technology for future use but the process of learning it and practicing using it
can help me gain experience in several key areas as a nurse educator.
Since the role transition class was my first attempt at playing the role of facilitator in this
practicum, my first and main focus was on creating the right tone for students to feel comfortable
sharing, especially with the difficult topics that were presented in the class. According to the
National League for Nursing (NLN, 2012), facilitation of learning can be accomplished by
creating an environment conducive for students to learn the desired outcomes. In addition, I
knew it was also important, as noted by the NLN (2012), to display interest and respect for the
learners. I shared stories that demonstrated patience, caring, and integrity.
Week # Date Time Activities # of Hours2
Sunday, Jan. 19, 2014
3:00 pm – 5:00 pm
Read information on NPDS standards of practice, NPD nursing review and
resource manual, and literature related to residency/internship programs.
Researched educational resources that could potentially be utilized in
internship program. Emailed preceptor information and provided some ideas for
what kinds of activities I could help with for the week.
2
Monday, Jan. 20, 2014
12:00 pm – 1:00 pm
Met with preceptor. Discussed plan for the week. Gathered BKAT results to
take home and compile for evaluation of content needs for critical care internship.
Discussed other evaluation methods
1
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used and looked at examples. Formulated a plan to look at the
additional evaluation tools Wednesday. Discussed setting up a physical
assessment simulation for the interns during their second week of orientation.
Brainstormed ideas for this.
Monday, Jan. 20, 2014
2:30 pm – 6:00 pm
Compiled 8 critical classes worth of BKAT results into an Excel spreadsheet.
Looked at pre and post test scores, calculated % change.
3.5
Wednesday, Jan. 22, 2014
11:15 am – 12:00 pm
Met with preceptor to obtain more evaluations from internship program. Discussed data from results that were
compiled so far. Discussed plans/goals for the rest of the week since we won’t
be meeting again until next week.
0.75
Wednesday, Jan. 22, 2014
12:00 pm – 4:15 pm Attended simulation facilitator class 4.25
Thursday, Jan. 23, 2014
11:30 pm – 4:30
Continued developing Excel spreadsheet with group 9 added. Started additional spreadsheet using BKAT score sheet to compile results of critical care content areas that orientees missed from pre &
post-tests.
5
Saturday, Jan. 25, 2014
6:00 pm – 9:30 pm
Continued compiling results of critical care content areas missed from pre and
post BKAT scores.3.5
Week 2 # of Hours 20
Week 2 Summary
This week started with a review of the literature for nursing professional development
specialists. I also emailed my preceptor to maintain and continue a plan for the next few weeks
of practicum activities. Upon meeting with Patti again on Monday, we began a focus on looking
at evaluation methods used for the critical care internship. Patti gave me eight classes worth of
results from the Basic Knowledge Assessment Test for Critical Care (BKAT). This test was
given at the start of the internship program and at the end of the internship. They are 100
question tests for the BKAT-7 and 90 question tests for the BKAT -8 (the most recent test). The
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results of how interns had improved and what content areas they were still having difficulty with
were never placed into any kind of spreadsheet and evaluated. I took the tests home and began
inputting the data into Excel to better evaluate the tests. I was able to calculate the percent
change from the pre-test and post-test results. Once I was done calculating the percent change, I
next began looking at each individual question on the test and what content area the question
pertained to. In scoring the BKAT’s there is an answer sheet and score sheet that tells what
content area the question pertains to (such as emergency situations, EKG interpretation,
monitoring of lines, ventilators, etc.). In meeting with Patti again later in the week, I also
obtained multiple other evaluations from the internship that she allowed me to take home and
review.
The other main practicum opportunity this week was attending the simulation facilitator
class. Again, this class took place in the simulation lab at Munson. The facilitator was the same
as for the operator class. I was in the class with one other individual, the educator of the unit I
currently work. This class had a similar set-up as the operator class in that we first looked at a
PowerPoint related to the facilitation of simulation technology as an educational activity. After
the presentation we practiced acting as a facilitator and as an operator and went through a couple
of simulation scenarios for hands-on practice. Next, we discussed the elements of debriefing and
practiced debriefing based on the simulation scenarios we played out earlier. Finally, we looked
at the process of evaluating facilitator effectiveness and self-evaluation.
Insights/Discoveries/Reflection
I started out this week nervous that I was not going to get enough hours and that I was not
sure about exactly what I should do all week. I was anxious to get past the point of just talking
about our plan and beginning to really tackle some projects, so to speak. The goal of looking at
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evaluation this week, however, resulted in giving me a ton of materials to examine. I was
surprised and overwhelmed by the amount of evaluation data pertaining to the internship that had
been collected over the years. I was also amazed at the lack of compilation of the data. The raw
evaluations were just in a filing cabinet but had never been placed into a usable form. I have to
say that I do not really understand the point of all the evaluations if they are not put into a form
where the data is interpreted in a meaningful way. Thus, I embarked on my journey of
compiling the data. This process definitely took me awhile, although I am pretty fast with
computers and Excel. I also read over some of the other internship evaluations. Some of the
evaluations were filled out by the unit educators, some my preceptors, and some by the interns
themselves. Again, I felt some of the data was useful but it was quite time consuming to read
through the material with the way the evaluations were designed. Compiling the content areas
was also a little more time consuming than I thought it would be, but I felt like it would be a
good starting point for my clinical project of implementation of didactic lessons based on
believed learning gaps. I believe this information will be useful for the future too, if the database
could continue to be updated.
The simulation facilitator class was another great practicum experience. I really enjoyed
and found it useful in putting the information learned from the beginning of the class into action
when assigned to act as a facilitator. Since I had already taken the operator class, I was also able
to run one of the simulations as an operator while the other participant acted out the facilitator
role and the instructor acted out the scenario. I loved the individualized attention in the class and
the chance to practice both roles. I also found the actual chance to debrief and discuss effective
ways to debrief very useful.
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Analysis
Nurse educators must use a variety of strategies to assess and evaluate learning (NLN,
2012). This week’s activities were highly focused on this NLN competency. The main
assessment tool identified and utilized during this week was the BKAT-7 and BKAT-8 that were
completed by the interns before and after the internship. According to Toth (2008), the author of
the BKAT-8, the validity of this test was ascertained by a panel of experts. In addition, the
internal consistency reliability was alpha = 0.88, measured on 48 critical care nurses from five
different states. Toth (2008) also noted that the BKAT can be useful for identifying needed
content and as a measure of learning, however, it is only one measure of basic knowledge in
critical care and should not be used for hiring or firing purposes. Analysis of the compiled data
from the BKAT’s did show that there was average of a 19.3% increase in number of correct
answers on the post BKAT test compared to the pre BKAT test given before the internship. In
addition, scores on the pre-test averaged less than 68% and just over 80% on the post-test. While
the increase in number of correct answers does indicate good growth, according to Toth (2008),
it is expected that after orientation nurses achieve an average score of 84%. I believe this
indicates that there is definitely room for improvement and supports the need to look more
closely at the specific questions on the BKAT to see if there is specific content being missed.
In taking part in the debriefing portion of the facilitator class, we were taught to use the
debriefing assessment for simulation in healthcare (DASH) tool as created by the Center for
Medical Simulation (2013). The tool is based on evidence and theory related to learning and
change through experience. It evaluates the strategies used to facilitate debriefings such as
creating an environment conducive to learning, provoking engaging discussion, and
organization. Additional references including the International Nursing Association for Clinical
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Simulation and Learning (INACSL) simulation standards and sources from the NLN were also
provided by the Munson staff educator for use in learning and practicing facilitation and
debriefing techniques.
Week # Date Time Activities # of Hours
3
Monday, Jan. 27, 2014
9:00 am – 12:00 pm Prepared for facilitating at skills lab 3
Wednesday, Jan. 29, 2014
8:30 am – 12:00 pm
Facilitated at critical care skills lab station pertaining to the analysis of
arterial blood gases.3.5
Wednesday, Jan. 29, 2014
12:00 pm – 4:30 pm
Participated on interview committee for new critical care internship candidates 4.5
Thursday, Jan. 30, 2014
10:30 am – 3:30 pm
Day 2 of interviews for new critical care internship candidates. Chose candidates
after interviews were completed.5
Saturday, Feb. 1, 2014
9:45 am – 11:15,
1:00 pm – 3:30 pm
Finished compiling results of critical care content areas missed from pre and
post BKAT scores.4
Week 3 # of Hours 20
Cumulative Total Wks. 1-3 50
Week 3 Summary
The third week of this practicum started with preparing for being a facilitator for one of
the critical care skills labs. The skills labs are small group sessions with various stations set-up
for critical care interns and nurses that have recently trained to critical care. They are held
usually once a month and are separated by body systems. This particular lab was the pulmonary
skills lab. My assigned station was on arterial blood gas (ABG) analysis. I had obtained some
materials from my unit educator last week to help prepare for this lab. Per an email I received
from one of the staff educators, each group was going to be at each station for about 30 minutes.
Thus I spent several hours reviewing the computer based education that the newly trained critical
care nurses get before attending the lab session. I also made copies from the Pass CCRN book of
several questions related to ABG’s. I also made an outline of learning objectives, important
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points, and pertinent information. I examined some case studies and refreshed my memory on
some of the more difficult analysis interpretations. The next morning, I facilitated the ABG
station at the skills lab to small groups over the course of three and a half hours.
The other two main days of week three were spent participating on the interview
committee for the critical care internship program. There were a total of eight members on this
committee, including me. There were a total of nine candidates slated for only four spots within
the internship program. Interviews ran around 30 minutes a piece with approximately fifteen
minutes in between each candidate to discuss. Each of the candidates had basically the same
questions asked to them. At the end of the two days the committee spent time discussing the
candidates and who their top picks were. The committee came to an agreement and the four
interns were selected, along with one alternate.
Finally, the last of the BKAT results were compiled to round out the week’s activities.
Content areas were tabulated across each of the individuals. In total, I tabulated 26 students that
took the BKAT-8. All 90 questions were examined on both the pre-test and post-test, so this was
quite a bit of data to record.
Insights/Discoveries/Reflection
I felt the skills lab went smoothly. I was nervous at first, once again, related to speaking
in front of a group. However, I did know most of the learners and this made me much more
comfortable. I tried to make the session engaging and useful for actual practice, as I believe this
is the goal of the lab sessions. I also believe that I showed enthusiasm and interest in and respect
for the learners. Once I discussed some of the background information related to analysis I had
the learners individually go through some of the practice examples I had passed out and made
copies of. I felt this worked well by giving them an opportunity to actually practice the
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information. Then we reviewed the answers and discussed some of the questions that were more
difficult. In an email from the staff educator that oversaw the lab session she remarked that the
evaluations were some of the best she has had in some time. She felt this was due to the limited
wait time between stations and the flexibility of some of the facilitators in running their station in
between some of the longer stations. She also remarked that there were especially good reviews
over the ABG and ventilator stations. I felt excited that there was some positive feedback related
to the session and my station in particular. The educator also noted that she was still tallying up
all of the evaluations and would give us all of the feedback once she had it completed. A couple
of the learners also remarked that they found my station helpful and they liked that I actually had
them doing things as many of them had worked a full shift that night and it helped keep them
focused.
As for the interviews, I really enjoyed this process. I felt it was a good experience to be
part of this committee and seeing not only how the interview process worked for the internship
but also what type of knowledge and experience the candidates presented with. Some of the
interview questions were scenario questions and it was interesting to hear what the candidates
had to say and where their thought process was as new nurses. I also noted a vast difference in
knowledge between the candidates from different schools and clinical experiences. Again, I felt
a part of the group and was happy to feel that my opinion mattered throughout this process.
Somewhat surprisingly, there was 100% agreement with the four candidates chosen and there
was only some minor discussion related to the choosing of an alternate.
Analysis
After compiling some resources for use in preparation for the skills lab, my first step was
to create learning objectives. According to Billings and Halstead (2009), it is important that
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content is considered a value to the student and essential to the core curriculum. Thus, in order
to determine some of the most important content areas to be included in the objectives, I looked
at the Essentials of Critical Care Orientation (ECCO) curriculum on ABG analysis. The ECCO
curriculum is the computer based training that the critical care interns and new nurses training to
critical care at Munson currently use. Once the objectives for the lesson plan were created, the
next step in planning my skills session was to create an outline to organize the content.
According to Saunders (2003), an outline forces the educator to consider the organization and
flow of ideas for a class session; outlines also flow directly from the objectives. After broadly
reviewing the literature and resources I had gathered related to ABG’s, I was able to construct an
outline that flowed from the objectives and considered the essential content and how it all fit
together. The next concern in developing the lab session was deciding the teaching strategies
that would be implemented to facilitate learning of the stated objectives. One important
consideration is that one learning style may not be suited to every student. Therefore, a variety
of teaching strategies are usually needed to provide support to various learning styles (Billings &
Halstead, 2009). In addition, although a student may have a preferred learning method, exposure
to multiple teaching methods can challenge the student to think outside of the box (2009). For
this session, teaching strategies were developed to promote the desired learning objectives whilst
considering the content, my teaching abilities, and the learners themselves. Thus, I decided to
use a mixture of informal lecture, handouts, practice questions, and case scenarios to elicit
feedback and active participation throughout the learning session.
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References
Billings, D., & Halstead, J. (2009). Teaching in nursing: A guide for faculty (3rd ed.).
Philadelphia, PA: W. B. Saunders.
Center for Medical Simulation. (2013). Debriefing assessment for simulation in healthcare
(DASH): Rater’s handbook. Retrieved from
http://www.harvardmedsim.org/_media/DASH.handbook.2010.Final.Rev.2.pdf
Jeffries, P. R., & Clochesy, J. M. (2012). Clinical simulations: An experiential, student-centered
pedagogical approach. In D. Billings & J. Halstead (Eds.), Teaching in nursing: A guide
for faculty (4th ed.). (pp. 352-368). St. Louis, MO: Elsevier Saunders.
National League for Nursing [NLN]. (2012). The scope of practice for academic nurse
educators 2012 revision. NY: Author.
Saunders, R. (2003). Constructing a lesson plan. Journal for Nurses in Staff Development, 19(2),
70-80.
Shellenbarger, T. & Edwards, T. (2012). Nurse educator simulation: Preparing faculty for
clinical nurse educator roles. Clinical Simulation in Nursing, 8(6), 249-255.
doi:10.1016/j.ecns.2010.12.006
Toth, J. (2008). The basic knowledge assessment tool, version eight (BKAT-8): For adult critical
care nursing. Retrieved from http://www.bkat-toth.org/BKAT-8.html.
START OF JOURNAL 2
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Week #
Date Time Activities # of Hours
4
Wednesday, February 5,
2014
8:30 am – 11:30 am Attended the monthly Nurse Practice Council meeting with preceptor 3
Wednesday, February 5,
2014
12:00 pm – 4:00 pm
Worked with preceptor on various small projects, discussed my practicum progress/goals, plans for the week, and internship planning.
Preceptor also located the BKAT tests for internship classes 10-12. Began compiling those results into the ongoing spreadsheet.
4
Thursday, February 6,
2014
10:00 am – 3:00 pm
Stopped in library and picked up a couple books on nursing physical assessment/critical care nursing for simulation lab planning. Worked with preceptor. Began teaching plan for simulation that will take place
the second week of internship. Emailed Sim lab coordinator to schedule lab time. Discussed my responsibilities and scheduling with
my preceptor during the 1st four weeks of internship.
5
Thursday, February 6,
2014
3:45 pm – 5:15 pm
Researched evaluation of simulations and developing a simulation on physical assessment. 1.5
Friday, February 7,
2014
10:00 am – 12:15 pm,
12:30 pm – 5:00 pm, 7:45 pm– 8:00 pm
Continued teaching plan for physical assessment simulation lab. Utilized Munson’s planning sheet sent to me by the sim lab coordinator. Reviewed email back from sim lab coordinator confirming lab time. Re-
emailed with additional questions and plan for moving forward.
7
Week 4 # of Hours 20.5
Cumulative Total Wks. 1-4 70.5
Week 4 Summary
I started this week by attending the Nurse Practice Council meeting with my preceptor. This is a
meeting held monthly and is attended by representatives from the various nursing units and is chaired by
the director of nursing. The council discussed various items related to nursing practice, education, and
operations. During this meeting, a proposal for modifications to the Professional Practice Model was
brought up by the director of nursing. The proposal was discussed and a subcommittee was formed in
order to further review and incorporate the changes to the model. My preceptor volunteered both of us to
help serve on this committee.
This week I also was able to get more BKAT results from my preceptor to being tabulating into my
ongoing spreadsheet. I also began working on our idea from week two about adding a physical
assessment simulation lab to the beginning of the critical care orientation. My preceptor and I decided this
would be one of my teaching lessons that I would plan and deliver to work towards my clinical project goal
of implementing at least two lessons into the existing educational materials. Once my preceptor and I
16
established a time and date that we felt would work well with orientation, I facilitated getting the simulation
lab secured for this learning activity. I also began gathering materials to help me in not only designing the
simulation activity, but also in evaluation of the activity and our learning outcomes. I utilized a teaching
outline that the staff development and simulation coordinator sent to me, in order to begin writing my
teaching plan for the simulation.
Insights/Discoveries/Reflection
Overall, I felt quite productive this week. To start, I enjoyed attending the Nurse Practice Council
meeting and hearing more about was going on organizationally. Although I had not included roles and
activities such as this in my practicum planning guide, I did hope that I would have opportunities to gain
competency in the change agent and leadership role for the nursing professional development specialist. I
believe attending this meeting and volunteering to serve on the subcommittee for modifications to the
professional practice model has been beneficial in gaining competency in these roles. It was also really
beneficial to gain a better perspective of how the organization functions and how different projects have an
impact throughout the organization. I liked being able to meet new people, especially those names that I
recognized, and see how they performed their role. Finally, I also thought it was important to see the way
communication flowed in the meeting, how the meeting was facilitated, and how people’s opinions were
valued. For example, one important item that was on the agenda for the meeting was about determining
informational technology priorities for the next fiscal year. Various people discussed their feelings on the
topic and the committee came to the conclusion that the focus would be on not bringing any new projects
forward but just focusing on the issues currently being tackled. I felt this was an important decision
because requests for information technology changes has been taking quite a bit of time and instead of
adding more to that issue it was decided to continue chipping away at the issues the organization already
has.
The rest of the week I was able to work on my clinical project and developing a simulation on
performing a physical assessment. I found the planning outline the simulation coordinator sent me to be
17
very useful. Although beginning designing this lesson did take some time I was able to get a good portion
of this completed and am feeling confident that I will be able to tackle the rest of the planning for this next
week. I was able to come up with learning outcomes, learning objectives, and a pretty good outline as to
how the simulation would run. I was excited about being able to try to create the learning plan on my own,
but I was also a bit nervous about knowing exactly what my preceptor’s intentions and desires were for the
learning. I found that working on some of the teaching plan in my preceptor’s office while she was working
on other items worked well, so that I could bounce questions off of her as I was formulating my plan. Once
I got a good start on knowing the direction for the simulation, I was able to spend a good chunk of time on
the outline and putting everything together.
Analysis
The change agent and leadership roles are important pieces to becoming a competent nurse
educator and nursing professional development specialist (Brunt, 2007; National League for Nursing (NLN),
2012); thus, I believe it is valuable use of my practicum time to attend the Nurse Practice Council meeting
and any future meetings with my preceptor. According to the American Nurses Association and National
Nursing Staff Development Organization (ANA & NNSDO, 2010), providing support and direction in fulfilling
the goals of an organization, using effective communication skills, and influencing change processes are
important elements of practice related to the leader and communicator roles of the nursing professional
development specialist. These elements were observed throughout the council meeting.
In looking at the development of a teaching lesson for simulation, I first focused on the objectives,
outcomes, and competencies of what we wanted the interns to be able to accomplish as a result of the
learning activity. According to Billings (2012), each lesson should state the purpose, outcomes,
assignments, learning activities, and evaluation being used. Since our identified learning gap was
performing a physical assessment on a critically ill, hospitalized patient, our learning outcomes focused on
improving clinical performance and self-confidence. The introduction of the critically ill patient in the
simulation lab, early in the orientation period, was felt to be a safe and less threatening way of learning how
18
to perform a complete physical assessment and become familiar with some of the equipment that would be
seen throughout the orientation period. According to Jeffies and Clochesy (2012), simulation can be a safe
environment conducive to learning skills that require practicing a number of times. The learning outcomes
and placement of this particular simulation learning activity at the beginning of critical care orientation is
also in line with the idea that learning activities should build from level to level and be threaded throughout
the course as they fit with the program outcomes (Billings, 2012). Moreover, the simulation activity could
assist my preceptor and me with a more effective method of measuring the skill and level of comfort the
interns possess before allowing them on the critical care units (Billings, 2012).
Week # Date Time Activities # of
Hours
5
Monday, February 10,
2014
8:30 am – 11:30 am Worked on physical assessment simulation learning outline 3
Wednesday, February 12,
2014
10:30 am – 4:00 pm
Met with preceptor, discussed plans for the week and where she/we were at with various projects and continued internship planning. Went to two of CC units to see when the last class of interns were signed up for annual
discussions. Saw and talked with one of the interns briefly. Went to a meeting with preceptor related to scheduling system issues and the
internship.
5.5
Thursday, February 13,
2014
10:00 am – 3:00 pm
Attended 2 hour nurse manager/operations council meeting. Attended 1 hour peer review meeting for my preceptor and two educators for other hospital units. Looked at and discussed outlines that the interns had
made for their upcoming presentations they will facilitate once they have completed the internship. Preceptor emailed a couple of the interns that still needed additions/modifications with their outline so that we could set
up a time to meet.
5
Friday, February 14,
2014
9:00 am – 12:00 pm,
12:30 pm – 7:00 pm
Made modifications to simulation teaching plan from preceptor suggestions. Emailed plan to Sim lab coordinator. Worked on checklist for outcomes of simulation. Read from library books related to performance of an advanced physical assessment. Read literature about designing
simulations.
9.5
Week 5 # of Hours 23
Cumulative Total Wks. 1-5 93.5
Week 5 Summary
At the start of this week, I continued with the design of the physical assessment simulation and
completing the teaching outline so that I could have it reviewed by my preceptor and then send it to the
simulation coordinator so she could build the scenario into the simulation software. On Wednesday, I was
able to spend a good portion of the day with my preceptor doing various activities as listed above. One of
19
the activities involved meeting with someone from human resources, someone from the information
technology department, the manager of another one of the critical care units, and the manager from the
critical care pool. Since the organization is moving to a system of electronic scheduling there are several
issues related to the critical care internship and how they are showing up in the system and how they are
able to function with this software. The meeting was set to help see the issues everyone was having and
develop a plan to fix the issues.
I was also able to attend a couple of other meetings this week including the nursing operational
council meeting and a peer review meeting for my preceptor and two other hospital educators. The
operational meeting include both nursing managers and nurse educators of the units. The meeting was
chaired once again by the director of nursing and several topics were discussed including the budget for
the next fiscal year, the addition of a central transport unit, opening of an online patient portal, and changes
to the shared governance model. The peer review meeting took place in my preceptor’s office and was in
preparation for annual discussions and evaluating where they were at with their professional practice. The
rest of the week involved reviewing of case presentation outlines from the last group of critical care interns,
working on and reviewing my simulation outline with my preceptor, and developing a competency checklist
and evaluation strategies for the simulation activity.
Insights/Discoveries/Reflection
This week seemed like it flew by. I also felt like it went smoothly and I was glad to spend some
quality time with my preceptor see her function in various roles. I learned a lot about the complications of
technology within an organization and the various forces that really come into play in the functioning of a
hospital educator. I am realizing that it often takes a great deal of time on a daily basis just to get through
email correspondences. It was also helpful to attend the management meeting and see how this council
functions. One thing that I found particularly important to hear from this meeting was the cutting of meeting
20
and education times on units. This really drove home the budgetary and time restraints that come into play
when designing educational activities for staff.
I found the peer review meeting particularly interesting. One thing I noticed is that the other two
educators do not have master’s degrees and that in their review of their competencies related to their
educator role they did not always understand how to evaluate themselves. My preceptor and I actually
talked about this after the meeting was over. She also told me that once she took an educator position a lot
of the job did involve educating herself with the role as there was really no formal orientation. Even though
my preceptor has a master’s degree it was for nurse practitioner so she also noted her own difficulty with
knowing about learning outcomes and how to measure them, creating a curriculum, and evaluation. In
some ways, this knowledge deficit has made it more difficult for me as these were some of the main things I
wanted to focus on in my practicum. However, my preceptor is very open to new ideas, has a lot of
experience, and I think (and hope) we are helping each other muddle through these things with the goal of
improving the internship program.
As for the simulation planning, I have found this to be a great learning experience. I am happy to
have a project of my own that will hopefully prove to be beneficial to the next class of interns. In developing
the simulation teaching outline further, I utilized a lot of resources online and information provided to me
during my simulation training. Looking at other examples of simulation planning was also helpful for ideas
and information about what I wanted to include in evaluating the learning outcomes of clinical performance
and self-confidence.
Analysis
Participating in peer review can be seen as contributing to the competency standard of
professional practice evaluation for the nursing professional development specialist. According to the ANA
and NNSDO (2010), providing peers with feedback regarding their role and interacting with peers to
enhance practice and role performance are examples of measurement criteria contributing to the standard
of collegiality. I can see how this participation in peer review was especially beneficial for the educators
21
that had not had master’s degree education in relation to these standards. During the meeting, the
educators also decided to meet regularly throughout the year with a goal of helping preceptors. They
decided to have a goal for their next meeting of putting together some resources for preceptors. They felt
that preceptors have had additional burdens placed on them and they were interested in providing them
with convenient tools and resources to help alleviate some of their burden. This goal could also be seen as
contributing to the standard of collegiality and the contribution to a supportive and safe work environment
that fosters mutual respect (ANA & NNSDO, 2010).
In looking at the nursing professional development standard of resource utilization, the NPD
specialist must be able to consider factors related to cost of activities (ANA & NNSDO, 2010). Attending an
operational meeting that discusses fiscal year budgets and educational allocations is an important activity
towards being able to meet this standard. In order to function within the educational environment as a
nurse educator, one must also be aware of the various forces that impact their role (NLN, 2012). Taking
part in various meetings and understanding more about the organizational and national health care climate
that the educator must function in are a large part of being able to function within the educational
environment.
Week # Date Time Activities # of
Hours
6
Monday, February 17,
2014
11:00 am –12:00 pm,12:00 pm – 1:30 pm
Attended a subcommittee meeting for PPM. Performed researched related to standards of care with physical
assessment. 2.5
Wednesday, February 19,
2014
9:00 am – 11:00 am, 11:00 am – 12:30 pm,
12:30 pm – 1:30 pm, 1:30 pm – 3:15 pm
Met with preceptor, discussed plans for the week and where she/we were at with various projects. Gave hospital tour to
Denmark nursing student. Attended cardiology case presentation. Worked on simulation competency checklist.
6.25
Thursday, February 20,
2014
7:00 am – 8:00 am, 8:00 am – 11:00 am,
11:00 am – 12:15 pm, 12:30 pm – 1:00 pm, 1:00 pm – 2:00 pm, 2:00 pm – 4:00 pm
Attended Simulation operator meeting with preceptor. Worked with preceptor throughout the day. Finished
designing rubric for evaluation of oral presentations. Met with chair of ethics committee. Met with HR. Met with two interns
from the last internship class. Emailed rubric to interns.
8.75
Friday, February 21,
2014
7:00 am – 7:30 am, 9:00 am – 10:30 am, 12:00 pm – 1:30 pm, 1:30 – 2:00 pm
Reviewed emails. Completed some research related to evaluation of clinical performance. Met with simulation
coordinator to prepare for next week’s skills lab.4
Week 6 # of Hours 21.5
22
Cumulative Total Wks. 1-6 115
Week 6 Summary
This week started with attending the second meeting for the subcommittee working on making
modifications to the professional practice model. My preceptor was out of town, so she I actually attended
the meeting without her. In continuing working on the competencies and evaluation for the simulation
activity I utilized Munson’s intranet and information from the Lippincott reference manual. I was also able to
find some Munson checklists for evaluating competency with assessment and information about ventilator
management that I could utilize for the simulation.
On Wednesday I was able to meeting with my preceptor again and spend the day with her. We
discussed the subcommittee meeting that preceptor couldn’t go to. We discussed how the interns were
given feedback about their upcoming case study presentations. Based on this discussion, I began
developing a rubric that could be used to evaluate the presentations. Later this day, my preceptor and I
met with a nurse and critical care student from Denmark that is hoping to complete an intensive care unit
rotation at Munson. We met with her in the cafeteria and discussed her educational background,
possibilities, and issues. We took her on a tour of the intensive care unit, A2, and A3. We received
permission to allow her to take a picture of an empty room to take back with her to Denmark. Upon
introducing her to the manager of A3, the manager invited us to attend a cardiology imaging case
presentation that she thought might be interesting for the Denmark nurse to see. The case presentation
involved discussion related to ethical care with internal defibrillators at the end of life. At the close of the
conference, my preceptor and I went back to her office and I worked for a little while longer on the checklist
for the physical assessment simulation.
Thursday was another busy day with many meetings. My preceptor and I attended a simulation
operator meeting that discussed data, measurement of outcomes, the simulation website, quality,
equipment needs, and goals. We also met with the chair of the ethics committee regarding an
organizational policy that has caused moral distress on my preceptor and hiring for the internship. In
23
addition, we met with someone from HR in order to update and make changes to the entry requirements for
next hiring class of critical care interns. My preceptor had me work on making changes to the format of the
job posting as it has caused a lot of confusion in the past. I re-wrote the listing and emailed corporate
communications for a picture that had previously been used in relation to the internship program. Lastly,
my preceptor and I met with two individuals from the last critical care internship class that needed some
help with their presentation outline. I stayed and worked with them for an additional hour in retrieving some
articles from the unit’s reference manual and reviewing their PowerPoint. I also gave them the finished
presentation evaluation rubric that I completed earlier in the day, to the two interns and sent the rest of the
interns the evaluation rubric as an attachment via email.
On Friday, I waited for my preceptor outside her office at the specified time we were going to meet.
I was able to retrieve emails on my phone while waiting. I received an email that my preceptor would not
be in until 9 am. I decided to leave and go to the computer lab and work on some non-school related items
until I went back to my preceptor’s office and waited again. While waiting, I read information by Bonnel
(2012) on evaluation of clinical performance. When I still had not heard from my preceptor at 10:00 am, I
emailed again and she eventually replied that she was working from home. I ended up going back to the
computer lab and had lunch until noon when I had a meeting with the simulation coordinator to prepare for
skills lab session on cardiac assessment next week. We ran through the previous simulation, discussed
changes we would like to make since there was only anticipated to be four people at the skills lab. We
decided to add an additional scenario on congestive heart failure that I found in their scenario book. Next,
we discussed what additional things we wanted to do and who would complete the roles of operator and
facilitator. Finally, I retrieved materials from A2’s unit educator on heart tones that had been used at the
skills lab for the station on heart sounds that the simulation coordinator and I decided we were going to co-
teach for the first hour of the skills lab.
Insights/Discoveries/Reflection
24
At the start of this week, I was a little nervous about attending the subcommittee meeting without
my preceptor. However, she had emailed the group and let them know that I would be attending without
her and I felt a little better that she had given them a notice. The meeting ended up being only four of us
for most of it and then the director of nursing showed up for a small portion of it. One thing that was
brought up during the meeting, which was controversial and brought up at the Nurse Practice Council
meeting, was the idea of back rubs being part of our professional practice meeting. My preceptor and I had
already talked about this as being a controversial subject and how opposed to this we were to this being
part of our professional practice model. It was our opinion that this brought the image of nursing back to
the olden days of nurses in heals, etc. and that this just was not a normal practice of nurses at the bedside.
Of course, this subject did get brought up at this meeting and the chair brought up this topic to me. I tried
to nicely describe my opposing feelings towards this idea and the fact that I thought it had the potential to
really irritate nurse at the bedside in light of the shortages, budget constraints, and extra responsibilities
already being placed on the nurse. I personally felt like the idea of adding this to the professional practice
model showed how out of touch some of those not in beside nursing positions really were. While I did not
like that I had to be the one to bring these feelings up to the committee (since my preceptor wasn’t there), it
did go over fine and we ended up modifying it so as to make it an idea for care as opposed to a
requirement.
Wednesday and Thursday left me thinking a lot about law and ethics. It was really interesting to
meet with a nurse from a different country and hear about their differences in education and what
requirements it would take to allow her to complete an orientation period in the intensive care unit. I
learned that her perception of the United States was that people would not receive as much end-of-life care
in the hospital as they do in Denmark although this was the opposite of what I thought her perception would
be. The cardiology case study conference also prompted a lot of ethical questions. Information was
presented about how a third of patients receive painful shocks from the internal defibrillators in the
moments before their death, as a result of doctors not deactivating the devices. While this case conference
25
was not exactly directed towards fulfilling practicum goals, I was really impacted by this discussion. I am a
strong patient advocate and hearing this discussion and how some cardiologists treated this so differently,
really upset me. On Thursday, my preceptor and I also spent some time talking with the chair of the ethics
committee due to an organizational policy that has had an impact on my preceptor. I do not want to share
any more about the particulars of the situation, but I will say that this was a great resource to learn about
and I was able to take a lot away from the meeting. Although I was aware of the ethics program at our
organization, I had never spoken with, or met the chairperson. He was awesome and it was really
empowering to hear his take on things and the tools he was able to provide us with in ethical dilemmas.
Friday started out frustrating since my preceptor did not do a good job of communicating with me
about her plans. Apparently school was cancelled for her kids and her babysitter fell through.
Unfortunately I was already at Munson and waiting for her, so it was somewhat of a wasted morning. The
afternoon, however, was very valuable. In preparing for the skills lab and simulations, it was nice working
with an educator from staff development. She valued my opinion about tweaking the simulations and it was
good being able to practice what my role would entail.
Analysis
In looking at the literature related to supporting the experience of meeting with the nurse from
Denmark, I was somewhat surprised to see the ANA & NNSDO (2010) providing support for this
experience. However, in looking at the role of NPD specialist it was noted that in the current environment
of growing internationalism, nurse educators need to have an understanding of international differences in
educational requirements, competence, licensure, educational facilities, as well as agencies that affect the
NPD specialist. While I had already felt the experience to be valuable, it was great to see the support for
this experience in the literature, validating my experience even further.
In regards to the ethical issues that presented themselves this week, standard five for the NPD
specialist notes the importance of developing decisions and actions that are ethically sound (ANA &
NNSDO, 2010). One measurement criterion for this standard speaks to the ability to seek appropriate
26
ethical consultation as necessary. Thus, my preceptor not only identified accurately identified an ethical
dilemma she had encountered but sought appropriate consultation related to the dilemma. This experience
also showed me the proper routes within the organization, should I encounter an ethical dilemma myself.
Rubrics are a type of rating scale and can be used to help provide a clear direction for grading and
assignment criteria (Bonnel, 2012). Since the case presentations by the interns are an important
evaluation component to the internship program, it was deemed necessary by myself and my preceptor that
a rubric could be utilized to help facilitate a clearer understanding of the expectations for the presentation.
The only direction interns had related to this experience was through verbal communication. Rubrics can
be a convenient form for providing feedback and allows for more discrimination in judging than checklists
(Bonnel, 2012).
Week # Date Time Activities # of
Hours
7
Monday, February 24,
2014
10:00 am –12:00 pm, 12:00 pm –1:00 pm, 2:30 pm – 5:30 pm
Attended another subcommittee meeting about making modifications to the organizations professional nurse practice
model. Met with preceptor. Prepped for teaching of heart tones skills lab and simulation lab.
6
Wednesday, February 26,
20147:00 am – 12:30 pm
Set up simulation lab prior to start of lab. Co-facilitated at heat tones skills lab and was the simulation operator for simulation stations. Observed debriefing and helped facilitate some of the
debriefing discussion. Helped with sim lab clean-up. Briefly looked at simulation evaluations.
5.5
Thursday, February 27,
2014
9:30 am – 11:30 am, 3:30 pm – 7:30 pm
Attended educator meeting. Met with preceptor and helped with looking at resources for next class of intern’s orientation books.
Helped put books together. Reviewed evaluations from simulation and emails forwarded from preceptor related to internship.
6
Friday, February 28,
201412:30 pm – 5:30 pm
Put together an assignment description for internship case presentation requirement to add to orientation book. Finished
physical assessment simulation checklist and added references to teaching outline. Researched info about using a rubric for self-
assessment of simulation and what Patti and I will use for evaluation of the simulation activity itself.
5
Week 7 # of Hours 22.5
Cumulative Total Wks. 1-7 137.5
Week 7 Summary
My preceptor and I started this week by attending what was supposed to be the last subcommittee
meeting for the modifications to the professional practice model. However, it was decided by the group that
we wanted one more meeting after the chair of the group was able to present what we had come up with to
27
the director of nursing. After the meeting, I was able to meet with my preceptor for a short meeting to touch
base with where we were at with projects and internship planning. I also completed some preparation for
the skills lab on heart tones and cardiac assessment simulations by looking up information about heart
sounds and their location, cardiac drugs we are using in the simulation, and the teaching outlines the
simulation coordinator had emailed me after our Friday meeting. On Wednesday, the simulation
coordinator and I met before the skills lab started in order to get the lab ready and run through the
modifications we had discussed. We then facilitated the first skills lab station on heart tones for the first
hour. We ended up having seven individuals instead of four that we taught all at once for the first station.
For the two simulations, we broke them up into one group of three and then two groups of two. The
simulations ran for one hour total for each group. Unfortunately, the facilitators of the other skills stations
ended up taking longer than they were supposed to so we ended up waiting for a while in between our first
and second groups for the simulations.
To complete the rest of the week, I was able to attend an educator meeting that discussed changes
to the meeting due to a change to the shared governance structure. The group discussed still meeting
once a month due to the value of the meeting felt by those in attendance. Information related to a change
in fall risk patients transitioning to yellow socks was also brought up and the education about how this
would be delivered to staff nurses. The educator for vascular access also presented information that was
recently placed on Munson’s intranet related to central lines, nursing care, and patient education. On
Friday, I worked from home on creating an assignment description for the case presentation requirement
for the internship and finishing up the details necessary for the simulation evaluation.
Insights/Discoveries/Reflection
The first half of this week went well. The subcommittee meeting only had five individuals in
attendance, including myself, but we got through what we wanted to accomplish pretty easily and the group
seemed to agree on most things. The skills lab was a great experience towards achieving my practicum
goals. I was once again able to work with the educator in staff development and she is teaching me a lot
28
about facilitation and debriefing in simulation. She has a master’s degree in nursing education and she is
utilizes current research related to best practice of simulation techniques. I was able to not only observe
her as she facilitated the heart tones station but also to jump in on a few things as well. She is open and
made the students feel comfortable. She also did a good job of eliciting active participation during the
station. During the simulation scenarios I mostly acted as the operator and played the voice of the manikin.
However, I was also able to participate in the debriefing by bringing up some questions related to
medications during the scenario. During a break between simulations we were able to look at the first set
of evaluations and brainstorm about ideas for future simulations.
The second half of the week was more frustrating as I was supposed to meet with my preceptor
and spend time with her throughout the day but both days her kids had school cancelled and she had to
work from home. I was able to go to the educator meeting without her but I did feel slightly uncomfortable
at the start of the meeting since I did not know a lot of the people there. However, I did not the co-chair and
she introduced me and made me feel more at ease. Once again, I did find it beneficial to attend this
meeting as it was attended by all the unit educators. Interestingly, the group actually discussed how
valuable they felt the meetings were to them for planning changes due to the feeling that they are really the
ones that are closest to the bedside nurses and understanding how changes should be rolled out the staff.
Analysis
The last stage in developing my lesson plan for the simulation session was determining evaluation
methods. This should be a twofold evaluation, considering evaluation of student learning or outcomes and
evaluation of the instruction or the process (Saunders, 2003). Primary strategies for evaluating and
measuring learning in a clinical setting is through observation, written communication, oral communication,
simulation, and self-evaluation (Bonnel, 2012). Accordingly, Bonnel (2012) notes the importance of
creating a checklist of behaviors and skills to be observed during the simulation or performance so the
potential for direct visualization and confirmation of student performance is easier to evaluate. Thus,
structured observational tools can contribute to a more objective and fair evaluation. Based on this notion, I
29
decided it was best to create a checklist to use during the simulation. In addition, since self-reflection can
provide students with a chance to think about what they have done and promote reflective clinicians, I felt a
rubric evaluating self-confidence would also be important to use (Bonnel, 2012). This would also help us
evaluate our learning outcome of increasing self-confidence.
According to Saunders (2003), evaluation of instruction or the educational process can be done
formally or informally. Informal examples might include remarks from a student or students during the class
session. Formal evaluation forms administered to students are often used by institutions at the end of a
course in order to solicit feedback on various criteria (2003) and could be another way to receive instructor
feedback. It has been shown that student ratings are considered highly reliable as well as positively
correlated with student achievement, however, there remains challenges with the validity and reliability of
the instrument used to evaluate teaching effectiveness (Hayes, 2011). My own reflection and my
preceptor’s reflection and self-evaluations could also additional forms of evaluation related to the learning
process.
30
References
American Nurses Association and National Nursing Staff Development Organization [ANA &
NNSDO]. (2010). Nursing professional development: Scope and standards of practice.
Silver Spring, MD: Nursesbooks.org.
Billings, D. M. (2012). Developing learner-centered courses. In D. Billings & J. Halstead (Eds.),
Teaching in nursing: A guide for faculty (4th ed.). (pp. 160-169). St. Louis, MO: Elsevier
Saunders.
Bonnel, W. (2012). Clinical performance evaluation. In D. Billings & J. Halstead (Eds.),
Teaching in nursing: A guide for faculty (4th ed.). (pp. 485-502). St. Louis, MO: Elsevier
Saunders.
Brunt, B. A. (2007). Competencies for staff educators: Tools to evaluate and enhance nursing
professional development. Danvers, MA: HCPro, Inc.
Jeffries, P. R., & Clochesy, J. M. (2012). Clinical simulations: An experiential, student-centered
pedagogical approach. In D. Billings & J. Halstead (Eds.), Teaching in nursing: A guide
for faculty (4th ed.). (pp. 352-368). St. Louis, MO: Elsevier Saunders.
National League for Nursing [NLN]. (2012). The scope of practice for academic nurse
educators 2012 revision. NY: Author.
Hayes, J. (2011). Student evaluation of teaching. In M. Bradshaw & A. Lowenstein (Eds.),
31
Innovative teaching strategies in nursing and related health professions (5th ed.). (pp.
563-574). Sudbury, MA: Jones & Bartlett Publishers.
Saunders, R. (2003). Constructing a lesson plan. Journal for Nurses in Staff
Development, 19(2), 70-80.
START OF JOURNAL 3
Week # Date Time Activities # of
Hours
8
Monday, March 3
8:00am – 1:00pm,1:00pm – 2:00pm
Met with preceptor. Reviewed case presentation assignment description I created. Worked on putting together orientation
books for new interns. Discussed need for internship program syllabus and what ideas for what should be included. Attended
meeting regarding the content of the pulmonary skills lab. Discussed feedback, learning objectives, and desired
modifications to that particular lab.
6
Monday, March 3
3:00pm – 7:00pm, 8:00pm – 10:00pm Began creating a program syllabus 6
Tuesday, March 4 10:00am – 11:00am
Went to sim lab dress rehearsal for unit’s mega code and procedural sedation competency. Learned operator and facilitator
role so I could help with either or both.1
Thursday, March 6 6:30 am – 12:30 pm
Set up sim lab for mega codes. Facilitated, operated sim man, and helped debrief sessions throughout the day. Cleaned up sim
lab upon completion. Reviewed evaluations.6
Thursday, March 6 1:30 pm – 7:30 pm Continued working on program syllabus 6
Friday, March 7 8:00 am – 1:00 pm Continued working on program syllabus. Emailed completed
syllabus to preceptor for review over the weekend 5
Friday, March 8 1:30 pm – 7:30 pm
Set up sim lab for mega codes. Facilitated, operated sim man, and helped debrief sessions throughout the day. Cleaned up sim
lab upon completion. Reviewed evaluations.6
Week 8 # of Hours 36
Cumulative Total Wks. 1-8 173.5
Week 8 Summary
This week started with meeting my preceptor and looking at what else needed to be accomplished
before the internship started. In looking through what would be included in the internship binders, we
discussed the need for more of a “roadmap” to what all the internship entailed. Thus, I came up with my
next big project of creating a program syllabus. I found that my preceptor did have written program goals
but there was really nothing formal, written, and given out to the interns that described all the things that a
32
normal program syllabus would contain. My preceptor agreed this would be a great item to add to the
orientation binder and agree to let me work on it. We discussed some possible items that we would like to
include and I took notes. I began working on this in her office while she worked on some other items for the
binders, checked emails, etc. Thus, I was able to see what activities she was also working on as I worked
on the syllabus. Later in the day, we had a meeting with the ICU educator and staff development educator
regarding the pulmonary critical care skills lab. We discussed evaluations from the last lab and proposed
modifications with the future labs. After the meeting, I went home and worked on further development of
the program syllabus. I knew I did not have much time to accomplish this task before the first meeting with
the interns, so I worked diligently in getting as much done as I possibly could. In doing this, I also had to
email the EKG class instructor and asked for information about the class to add to the syllabus. I also had
to look at what the American Association of Critical-Care Nurses used for learning objectives related to the
online modules that the internship utilizes for didactic learning. I continued working on the syllabus on
Thursday and Friday and was able to email the finished product by Friday afternoon to my preceptor.
On Tuesday, I attended a one hour dress rehearsal for a simulation. The simulation was on
procedural sedation combined with the annual mega-code competency for the unit I work on. I agreed to
help with this opportunity to further my practicum goal of gaining competency in facilitation of learning
through the use of simulation technology. During the dress rehearsal, I learned the facilitator (including
debriefing) and operator roles for the particular simulation scenario so that on Thursday and Friday, when
the lab was reserved for the simulations, there would be a total of three of us that would be able to rotate
roles in order to keep groups moving on schedule. Thursday and Friday, I helped facilitate and debrief, as
well as operate throughout both of the days. I also worked collaboratively in setting up and cleaning up the
simulation labs. Finally, we also looked at and reviewed the evaluations.
Insights/Discoveries/Reflection
This was a very busy and exhausting week! However, I felt like I really did a lot independently and
was able to gain some valuable experience in working towards my practicum goals. I honestly was
33
surprised that the internship program did not already have a syllabus that outlined learning objectives, how
interns would be assessed, and requirements for the program. I felt this was a huge gap that needed to be
addressed and was excited to work on what I believed to be a very important clinical project. I also knew
that my time for creating another didactic lesson for the internship was looking like a difficult task, based on
how difficult it can be to have extra time outside of all the requirements the interns already are faced with. I
felt this would be a great learning experience for me and would allow me to see the interconnectedness of
the components that make up the internship program. With my preceptor not having a background in
nursing education, I believe this was also an area she was struggling with, so I was hoping that my working
on it would be a big help to her. Having created a syllabus in a previous Ferris class, I did not find this
activity to be too difficult. I basically just started gathering information from what I already knew and looking
at syllabus examples as a guide to getting started. Once I gathered the information and did some
additional research I felt like pieces of the syllabus came together easier than I expected. It was a time
consuming activity and biggest worry was just making sure I could get it done on time to be utilized for the
new class of interns. The fact that I was able to complete the first draft before the weekend made me
personally happy and relieved.
Preparation and helping with the simulation was a lot of fun. I really enjoy this learning activity and
feel it has a lot of value, especially for the particular topic of this simulation. Stephanie did a great job of
creating a poster for using to explain the purpose of the simulation and this made it easy to jump in as a
facilitator when needed throughout the simulation days. She also had a detailed lesson plan with operator
responsibilities and debriefing questions. The simulations overall I felt went very smoothly. A couple of
times we did have to wait between groups. While waiting, however, we were able to go over some of the
evaluations and make any improvements for the next group. I also enjoyed being able to jump in as
needed in the various roles and felt that spending two days in the lab really gave me more confidence with
running the technology in the lab and being able to function in the various roles.
Analysis
34
A syllabus can be seen as an important component to student understanding of what is expected
of them throughout a course. According to Sauter, Nightingale Gillespie, and Knepp (2012), the syllabus
can also be used during review of instructors and effectiveness in teaching. Furthermore, the syllabus
should be reviewed for expectations that are clear and evaluation methods that are detailed. Billings
(2012) also notes that the syllabus sets the tone for the course and should start off by being written in a
welcoming style. In addition she says a title, purpose, description, prerequisites, corequisites, outcomes,
teaching-learning strategies, learning activities, topical outline, policies and procedures, assessment and
evaluation strategies, as well as the grading plan should be standard and essential components in a
syllabus. Keeping this information in mind and the difference between creating the program’s syllabus I
needed to create for the internship to one that would be created for an academic course, I set out to the
task of creating a program syllabus.
The first step was to figure out the course outcomes. Although, my preceptor had already created
some broader program objectives, I felt the syllabus needed to have more specific intern learning
outcomes. Objectives and outcomes specify what students should know, do, value, and determine how
they will be graded (Billings, 2012). Dillard and Siktberg (2012) also note that objectives and outcomes
provide the framework for the curriculum. Learning activities and course objectives should also focus on
the three main domains of learning, the cognitive, affective, and psychomotor domain. Matching objectives
with learning activities allows students to make connections between what the content is and why it is
important, thus, promoting learning. One way to demonstrate that learning objectives match the
assignments is to use an evaluation grid or matrix. Therefore, I did create a grid to demonstrate how the
learning objectives would be assessed. It was also really great to see that in looking at all the various
learning activities utilized in the internship program, that there was a great mix of active and passive
learning approaches.
Week # Date Time Activities # of
Hours“Spring Break”
Monday, March 10,
2014
12:00 pm – 5:00 pm
Met with preceptor. Reviewed syllabus. Made changes per discussion. Discussed plans for week and outstanding tasks that need to be
completed prior to internship starting on Thursday. Continued putting
5
35
orientation books together.
Wednesday, March 12,
2014
10:30 am – 2:30 pm,
2:30 – 3:30 pm
Met with preceptor. Reviewed table of contents to orientation book, decided to modify how some content was presented. Added more
detail and examples to case study assignment description. Created self-evaluation tool for case presentations. Met with staff development
educator to discuss new education that she wants me to help with. I will be putting together content that will be utilized for a healthstream
presentation. My content is related to tachycardia.
5
Thursday, March 13
7:30 am – 4:30 pm First day of internship program 9
Friday, March 14
7:30 am – 4:30 pm Case study presentations 9
Week “Spring Break” # of Hours 28
Cumulative Total Wks. 1-“Spring Break” 201.5
Week “Spring Break” Summary
This week started on Monday by meeting with my preceptor and reviewing the program syllabus I
created the week before. I made changes to the syllabus. We also worked on some additional
housekeeping items that needed to be completed prior to the internship start. This included finishing up the
details to the agenda for the first day, looking at the schedules again, and continuing to put the orientation
binders together. Wednesday was more of these types of activities. Since the binders were essentially
complete we also looked at reorganizing the way some of the material was laid out. This is led to addition
more description to the case study assignment. I went through examples and added those to the syllabus.
In addition, we discussed the benefits of self-evaluation for the case study presentation. This led to me
creating a short self-evaluation tool for the case presentations and adding this to the binders as well.
I ended Wednesday by attending a meeting with the staff development educator. The meeting was
requested on the behalf of the staff development educator. Since I have worked with her several times now
on various items, she was soliciting my help for another project. I agreed to help as I felt it would work
towards my goal of curriculum design. She and a few other educators are working on putting together a
healthstream course for the units that will not be getting their nurses ACLS certified. The education we
would be putting together was approved to allow nurse to still have some background knowledge around
arrhythmias but not be as costly as having nurses obtaining ACLS certification. I agreed to work on the
section of tachycardias. She gave me an example of the section she created on bradycardias. My
36
responsibility for this activity will be to create the content (via a lesson outline) that will then be utilized in
the creation of the healthstream learning program. The healthstream itself will be created by other
individual(s) after we develop all of the content.
Thursday was the first day of the internship. My preceptor and I met with the interns and went
through introductions. We administered BKAT exams and reviewed the syllabus. Next we went on a tour
of the units. When the interns had a break for lunch, my preceptor and I met in her office and discussed
how the day was going. After lunch, we met with the interns again and they had their class picture taken.
Next we discussed stress and self-care. After that we all went to the simulation lab and the staff
development educator gave an orientation to the sim lab. EKG class was discussed as well. Finally, the
day came to a close with an opportunity for the interns to ask questions and have a meet and greet with
unit educators, managers, preceptors, and nursing administrators.
Friday was an entire day of the last class of interns, which had a total of seven interns, giving their
case presentations. The new class of interns were required to watch the presentations. My preceptor and I
evaluated the presentations. Post BKAT exams, program evaluations, and preceptor evaluations were also
administered to the last class of interns.
Insights/Discoveries/Reflection
It was busy Monday and Wednesday with just tying up loose ends and making sure we had
everything prepared before the first day with the interns. I was excited for the start of the next chapter of
my practicum and the opportunity to work with new nurses. I was a little nervous about getting everything
accomplished that my preceptor and I wanted to before Thursday. We still had the orientation books that
were not completed and I still had areas my preceptor wanted me to fix on the syllabus. Overall, my
preceptor was very happy with the syllabus and she had some great ideas about how to modify the design
of it to table of contents in the orientation binder. The various sections were able to correspond to the
sections in the binder and it really seemed to pull everything together to make for a more comprehensive
and cohesive program orientation binder.
37
The first day of the internship was a whirlwind. I was able to observe a slew of emotions from the
interns and see what it was like to introduce them to the program. It was exciting hearing about their
backgrounds and what their impressions, fears, and anxieties are related to the program. I was able to give
the tour on the unit I work and I found their excitement very refreshing. With such a small group, I felt more
at ease with talking to the interns and did not really have the typical anxiety I feel with talking in a group
meeting with people I don’t know. It was also nice to hear that three out of the four interns already knew
each other from either school or working together and that the other intern had already gotten to know the
others through hospital orientation. I observed the group to really get along well and forming a good bond.
The case presentation day was another exciting day. Since I had been a primary preceptor for one
of the past interns and gotten to know several of the interns through the critical care skills labs, it was really
rewarding to hear them discuss some of the knowledge they had obtained throughout the internship
program. My preceptor and I utilized the case presentation rubrics for evaluating the presentations and we
also passed out the self-evaluation tools I had created. I did find it somewhat difficult to evaluate the
intern’s presentations using the rubric because I would have liked more room to write comments. Although
I think the dimensions on the rubric were pertinent and useful for evaluation, I wanted to make sure the
feedback was also specific and detailed if I noticed their presentation was particularly good in one area or
lacking something in another area. Since I have not had to provide feedback on presentations like this
before I also felt like needed to watch all of the presentations to have a comparison to evaluate them
against one another. After the presentations, I had a chance to talk with the new class of interns and hear
their perspectives about the presentations and their first two days in the program. It was good to hear that
even though the interns felt very overwhelmed after the first day, that they felt more at ease after listening
to the presentations. I tried to encourage them and was happy to hear that they were feeling less
overwhelmed.
Analysis
38
Planning effective learning strategies for a new group of students should take into consideration an
understanding of the unique perspectives and learning needs of the individual students themselves
(Burruss & Popkess, 2012). In meeting the four interns, I was able to assess that all four of the interns are
representatives of Generation Y. According to Buruss and Popkess (2012), this generation is generally
described as optimistic, team-oriented, high-achieving rule-followers, and accustomed to living highly
structured lives planned by their parents. Additionally they noted that it is important for the nurse educator
to understand that this generation is accustomed to immediate feedback and classroom structure and that
ensuring safety within the clinical experience is important. Moreover, this generation is technologically
capable and places a greater importance on doing over knowing.
Student case presentations can provide teachers with the opportunity to probe for more detail
regarding a student’s understanding, or lack thereof (Bonnel, 2012). In addition, they can help learners
improve their presentation skill and evaluate their thoughts and approaches related to various aspects of
patient care. The use of a self-evaluation tool for the interns following their presentations can also promote
critical thinking. The evaluation rubrics were given to the interns prior to the presentations, and according
to Bonnel (2012), help convey assignment expectations, provide clear direction for graders, and can
increase reliability between graders.
Week # Date Time Activities # of
Hours
9
Monday, March 17,
20144:00pm – 6:30pm Prepared and reviewed resources for ecco skills lab on cardiac
output measuring for Thursday’s skills lab. 2.5
Wednesday, March 18,
2014
8:00 am – 3:00 pm,3:00 pm – 4:00 pm
First day of familiarization for interns. Rotated between units with preceptor and met with interns and preceptors. Facilitated learning
& socialization to units. Met with staff development educator for dry run and review of simulation I will be helping with in a few
weeks for new hospital orientees.
8
Thursday, March 19,
2014
7:30 am – 10:30 am, 11:00 am – 3:00 pm
Set up for hemodynamics skills lab. Helped with mega code simulation facilitation at one of the skills stations. Independently
facilitated cardiac output station. Cleaned up. Independently went to units and met with interns for the rest of the day.
7
Friday, March 20,
2014
7:30 am – 10:00 am,10:00 am – 11:30am, 12:00 pm – 4:00 pm
Independently went to units and met with interns. Independently set up for physical assessment simulation. Facilitated, operated, and debriefed physical assessment simulations independently for
first 1.5 hours. Reviewed evaluations.
8
Week 9 # of Hours 25.5
39
Cumulative Total Wks. 1-9 227
Week 9 Summary
This week started off with preparation for the skills lab I will be teaching on Thursday. I reviewed
the teaching outline for my section and looked for some images to utilize for my station. I looked at
Lippincott’s standards for the procedure and the checklist I would be utilizing for completion of the skills
station. I reviewed additional hemodynamic information related to cardiac output that I was planning to
teach about during my station.
Wednesday morning I met with my preceptor and we began by rotating through the various units
and meeting with the interns for their first day of familiarization on the units. We stopped in to discuss and
issues, make sure they were getting experiences desired, and that everything was going well. After
spending the day going to the various units, I met with Lauren, one of the other staff development
educators for a dry run of a simulation scenario I said I would help her with. She needed an operator for a
simulation planned for April 2, during hospital orientation. We had a dry run of the simulation planned and
what my responsibilities would entail.
Thursday I went to the simulation lab to set up for my cardiac output skills lab station. I was also
asked to help with the mega code simulation station since there were only a couple of individuals coming to
the lab today. I agreed to help with that since I was only just waiting for the individuals to come to my
station anyways. I helped with facilitating the mega-code and debriefing. Next the individuals came to my
station and I facilitated the lesson on cardiac output. I demonstrated proper method for shooting a cardiac
output and had individuals perform the skill back to me. My preceptor ended up having to leave before I
was even done with skills lab because she had gotten a phone call that her child was sick. She asked me
to complete rounding on the interns and make sure everything was going okay. Once I was done in the
skills lab I did just that.
Friday morning I also came in and rounded independently on the interns as my preceptor was not
able to come in until 1:30. I went around to all the units and checked in with the interns and preceptors.
40
After a few hours, I headed to the simulation lab and set up for the physical assessment simulation I had
planned. I coordinated obtaining a ventilator to utilize in debriefing. The interns joined me in the sim lab
and I discussed the learning objectives and expectations for the simulation. The interns then came in to the
simulation one at a time and I presentation the scenario as the facilitator and then ran the 3G manikin while
the interns independently ran through the scenario. At the completion of the scenario, I individually
completed a short debriefing. Two of the interns completed the scenario before my preceptor showed up.
Once my preceptor showed up, she joined the simulation scenario and took on an observation role. She
also was able to act for the manikin in carrying out additional parts of the neurological assessment. After,
the last two interns went through the simulation, my preceptor and I separately discussed our observations
while the interns finished up charting their assessments in the other open lab. We decided it would be best
for me to act as a patient and for her to demonstrate a proper head-to-toe assessment. We ran through
this demonstration and allowed the interns opportunities to ask questions. Finally, we finished up the
learning session by utilizing the other manikin that I had intubated and demonstrated additional assessment
items required of a vented patient. We obtained written evaluations for the simulation and I gathered up the
results.
Insights/Discoveries/Reflection
Preparation for the skills lab is getting easier. I know more about what to expect and the topic I
was in charge of teaching this time was one I am very familiar with. One thing that I did find a little difficult
was that when I actually got to the lab to set up one of the other facilitators was confused about what my
role would be. I guess the last time she did her station she covered the material I was planning on
covering. I explained what outline of materials I was given to facilitate with and how I believed our stations
would be. We worked out the details and the lab seemed to run smoothly overall. There was also
confusion about who was going to help with the mock code simulation. I volunteered and this seemed to
alleviate the confusion. I did feel the preparation and communication surrounding this particular lab could
have been better. There was only one email to the group about the lab and then other people had
41
responded about issues and concerns but there was no confirmation before the day of the lab. Knowing all
of this, I went into the lab with the attitude that I would just be flexible with whatever anyone wanted me to
facilitate, help with, or not do. I just tried to be as open as possible with what I had been told and let
everyone know I was willing to do whatever was necessary. After communicating with facilitators prior to
the start of the lab, I felt we were all able to sort out who was doing what and come to an agreement.
Going to the various units and meeting with the interns and preceptors was a lot of fun. I
thoroughly enjoyed these times and am looking forward to developing in this role. I love hands-on teaching
and the excitement the interns have when going to the various units. I liked being able to go around with
my preceptor the first time so I could be more comfortable going on the units I am more foreign to. It was
nice meeting preceptors on the various units and hearing about the patients the interns are working with.
Being able to go around on Friday by myself was exciting and a little scary at the same time. Of course, I
felt the most at ease on my unit and started my rounding here. Going to the ED was probably the unit I had
the most apprehension about. Although I have only been to the ICU and A3 a handful of times, I had only
been to the ED twice. It feels very big and I worry that I will get lost! I found it awkward to walk around
looking for the intern and thinking that I look stupid wandering around. In the end, it was not that bad at all
and after doing it, I actually felt much more comfortable and ready to continue in this role.
The simulation was really a big project for me and I was actually really excited to finally get to this
day. I was nervous that the interns would think it was stupid or not very beneficial. As I began running the
simulations, I gained more confidence. Debriefing went smoothly and I noted that the interns were more
prone to point out all of the things they needed to do better. Based on this, I tried to offer positive
reinforcement and encouragement for the things they did well. Looking at the evaluations, the interns rated
the simulation highly and said they felt it was a very worthwhile activity. This definitely made me feel good
about all the work I put into the simulation. My preceptor was also impressed and gave me positive
reinforcement on all my work in putting the simulation together.
Analysis
42
In analysis of this week and the start of familiarization and clinical orientation of the internship
program, I reflected on what the literature says about how to promote effective learning. For example,
Bradshaw (2011) states:
The best ways faculty can bring about effective learning are by recognizing students as individuals,
with unique, personal ways of knowing and learning, by creating learning situations that recognize
diversity, and by providing empowering experiences in which students are challenged to think. (p.
14)
According to the National League for Nursing (NLN, 2005), nurse educators are responsible for using
various strategies to assess and facilitate learning and outcomes. Based on my assessment of the interns
and my responsibilities as a nurse educator, I believe multiple strategies will need to be used in order to
meet the learning needs of the interns. According to Burruss and Popkess (2012), once I know the
preferred learning style(s) of my interns, I can begin coming up with a plan to promote successful
outcomes. I could tailor my interns’ needs to assisting them with improvement of study habits, deciding on
a work/study environment that meets their learning needs and planning my implementation of various
content in ways that meet the learner needs and specified outcomes. In terms of teaching strategies, a
variety could be used to appeal to various learning styles (Burruss & Popkess, 2012).
A study by Forneris and Peden-McAlpine (2007) found that dialogue in developing a process of
critical thinking in practice was important. So even if the student doesn’t know the answer to a question off
the bat, using conversation and dialogue between the student and teacher in order to develop processes
for thinking through the question is just as important if not more so. The study concluded, “nursing
education should focus on facilitating critical dialogue (i.e. encouraging students to challenge perceptions,
asking questions beyond expository or declarative knowledge) making visible the nature of thinking to
broaden perspectives and reframe thoughts and insights” (p. 419). In an article by Scanlan (2001), it was
also noted that clinical teachers use their own experiences and the way they were taught in order to form
their teaching style. However, Scanlan argued that clinical teaching is a difficult skill and a greater
43
theoretical foundation is needed to assist novice clinical teachers in learning the process. In addition, the
study found that as instructors became more familiar with teaching they were able to reflect and make more
meaningful connections about ways to be effective and not just rely on exemplar experiences. As an
educator, I believe I will need to understand various ways and methods to teach so that I can appeal to
various learning styles and be able to change my teaching as required to meet the needs of the students.
These are the types of strategies I am really trying to think about and consider during my facilitation of
clinical learning activities and rounding with the interns.
Week # Date Time Activities # of
Hours
10
Sunday, March 23,
20149:00 pm – 9:30pm Read intern e-journals from first week. 0.5
Wednesday, March 26,
2014
8:00 am – 12:00 pm, 12:00 pm – 4:00 pm
Attended nurse executive council meeting. Met with preceptor and interns on various units for the start of their 2nd week of
familiarization8
Thursday, March 27,
2014
9:30 am – 11:30 am,1:00 pm – 4:00 pm
Attended nurse educator/clinical nurse specialist meeting with preceptor. Independently went to various units and met with
interns and preceptors.5
Friday, March 28,
2014
7:30 am – 11:00 am,11:00 am – 12:30 pm
Met with preceptor and went to units to meet with interns and preceptors. Post conference & debriefing with preceptor and
interns.5
Week 10 # of Hours 18.5
Cumulative Total Wks. 1-10 245.5
Week 10 Summary
This week started by attending the first nurse executive council meeting. My preceptor was not
able to attend, so I went on my own. I learned more about the new shared governance structure at Munson
and how this council will function. After the meeting my preceptor and I were able to meet and then went to
the various units and met with the interns and preceptors for their second day of week two of unit
familiarization. This was the first time we were able to visit all the interns on the various units this week,
since both of us had to work on our own units on Tuesday and the interns still had one day of general
orientation on Monday.
Thursday, I attended the nurse educator/CNS meeting with my preceptor. I actually presented at
this meeting for the first half hour about my scholarly project. The rest of the meeting I learned about how
44
the hospital was doing with the EMR changes to the discharge process and reviewed new education
related to the process. There were also reps that came in to introduce some new IV products that units
would be trialing. After the meeting I had a break for lunch and my preceptor went to her office to work on
writing some test questions she is hoping to administer to the interns in the next few weeks. She asked me
to go around to the units and round on the interns.
On Friday, I met with my preceptor in the morning. We discussed some last minute housekeeping
tasks before she will be leaving for vacation tomorrow. I obtained the post-BKAT results from the last class
of interns and the results from the pre-BKAT for the current class of interns. Reviewed how the last class
did and some of the concerns with missed questions. I made some copies of real EKG strips (with names
blacked out) and discussed with my preceptor a plan to pass out sample strips for evaluation each week.
We discussed my observations and concerns that had come up during some of my conversations with
rounding on the interns. After our meeting, we made our way to the various units and met with the interns.
This was a short day for the interns and we finished the day with a post-conference with the four interns,
my preceptor, and myself.
Insights/Discoveries/Reflection
I really enjoyed reading the internship e-journals and after writing journals for my own practicum
experiences I can see the value in it. I also think that it was be nice to have the journals to reflect on before
the interns make their decision about ranking the units they are most interested in ending up on. The rest
of this week I was able to gain more confidence and experience in facilitation of learning and learner
development and socialization by rounding on the interns in the various units. I feel I am getting better at
asking the right questions to understand more about what they are learning and addressing possible
issues. One thing that did come up in one of my meetings with the interns was that one of the preceptors
was being very short and rude to the intern. Unfortunately, the intern did not tell me about it on the day it
was actually occurring and when I rounded on her it appeared that everything was going well. However,
the next day she mentioned it and I was able to talk to my preceptor about it. In post-conference we
45
addressed conflicts and handling these types of situations. I also emphasized to the interns that with Patti
(my preceptor and the internship coordinator) being gone next week, that they need to keep me informed if
this is an issue again. Patti also emailed the educator of the unit where this was an issue with the intention
of not placing any of the interns with this preceptor in the coming weeks. I am also glad to know that even
though my preceptor will not be around next week, that she is available by phone and email to help me with
any concerns. Since I have had the last two weeks with the interns, I feel I have a good rapport with them
and am excited for the responsibility of rounding on them on my own next week.
Analysis
According to French and Greenspan (2011), socialization to clinical practice occurs during
preceptorships and may be the first exposure students have to clinician roles, responsibilities, and
accountabilities. Thus, if students are exposed to staff that are lazy, incompetent, unmotivated, uncaring,
or any number of other less-than-desirable qualities, this is setting up a poor socialization experience for
students to the world of nursing. French and Greenspan (2011) also pointed out that students may have a
difficult time balancing learning between academic and work environments without their familiar support
and social systems. “The work of learning, performing in a new role, balancing new and old roles, and
making meaning of new work is an exhausting process that requires high-energy consumption by the
learner and significant support from the preceptor” (p. 439). If role models are poor it is unlikely students
are receiving the support they need during this difficult learning period.
In an article by Happell (2009), it was noted that literature has consistently shown that nursing
students value positive environments, and have a desire to be welcomed, supported, and included. In
addition, “They seek preceptors who are consistent and professional; who understand the level students
are at; and are able, and willing, to provide regular feedback regarding the student’s performance” (p. 375).
Thus, I really don’t think there are any benefits to exposing the interns to preceptors that have a bad
46
attitude during this crucial learning period. As the literature has suggested, students really benefit from
positive learning environments (French and Greenspan, 2011; Happell, 2009). Consequently, I will do my
best to mitigate any of these issues during this important time.
References
Billings, D. (2012). Developing learner-centered courses. In D. M. Billings & J. A. Halstead (Eds.). Teaching
in nursing a guide for faculty (4th ed.). (pp. 160-169). St. Louis, MO: Elsevier Saunders.
Bradshaw, M. (2011). Effective learning: What teachers need to know. In M. Bradshaw & A. Lowenstein
(Eds.), Innovative teaching strategies in nursing and related health professions (5th ed.). (pp. 1-19).
Sudbury, MA: Jones and Bartlett.
Bonnel, W. (2012). Clinical performance evaluation. In D. Billings & J. Halstead (Eds.), Teaching in nursing:
A guide for faculty (4th ed.). (pp. 485-502). St. Louis, MO: Elsevier Saunders.
Buruss, N. & Popkess, A. (2012). The diverse learning needs of students. In D. Billings & J. Halstead
(Eds.), Teaching in nursing: A guide for faculty (4th ed.). (pp. 15-33). St. Louis, MO: Elsevier
Saunders.
Dillard, N. & Skitberg, L. (2012). Curriculum development: An overview. In D. M. Billings & J. A. Halstead
(Eds.). Teaching in nursing a guide for faculty (4th ed.). (pp. 76-91). St. Louis, MO: Elsevier
Saunders.
Forneris, S., & Peden-McAlpine, C. (2007). Evaluation of a reflective learning intervention to improve critical
thinking in novice nurses. Journal of Advanced Nursing, 57(4), 410-421. doi:http://0-
dx.doi.org.libcat.ferris.edu/10.1111/j.1365-2648.2007.04120.x
47
French, B. & Greenspan, M. (2011). The preceptored clinical experience. In M. Bradshaw & A. Lowenstein
(Eds.), Innovative teaching strategies in nursing and related health professions (5th ed.). (pp. 437-
457). Sudbury, MA: Jones and Bartlett
Happell, B. (2009). A model of preceptorship in nursing: Reflecting the complex functions of the
role. Nursing Education Perspectives, 30(6), 372-376.
National League for Nursing [NLN]. (2005). The scope and practice for academic nurse educators. NY:
author.
Sauter, M., Nightingale Gillespie, N., & Knepp, A. (2012). Educational program evaluation. In D. M. Billings
& J. A. Halstead (Eds.). Teaching in nursing a guide for faculty (4th ed.). (pp. 503-549). St. Louis,
MO: Elsevier Saunders.
Scanlan, J. (2001). Learning clinical teaching: Is it magic? Nursing & Health Care Perspectives, 22(5), 240-
246.
48
START OF JOURNAL #4
Week # Date Time Activities # of
Hours
11
Monday, March 31,
20147:30 am – 4:30 pm
Preceptor on vacation this week. Independently went to various units for third week of intern familiarization. Met with interns and
preceptors, coordinated OR observations for interns.9
Wednesday, April 2, 2014
7:30 am – 12:30 pm,12:30 pm – 4:00 pm
Independently went to various units and met with interns and preceptors. Simulation operator for simulation sessions that are
part of hospital orientation.8.5
Week 11 # of Hours 17.5
Cumulative Total Wks. 1-11 263
Week 11 Summary
This week I worked independently with the interns since my preceptor was on vacation. I was able
to spend quite a bit of time with all of the interns on Monday. One of the interns in the ED was able to see
two patients come in that had coded. Since this was his first day in the ED I did spend extra time working
with him to see how he was handling everything, especially amidst all of the chaos. I was also responsible
for coordinating the operating room observations as the individual that usually does this for the interns was
on vacation so I had said I would do this as well. I checked on preceptor pairings for the week and made
sure everyone was set up with appropriate preceptors. On Wednesday I also spent some time in the
simulation lab again to help with one of the staff development educators. I was able to help facilitate and
operate for one group that ran through three different simulations. The first simulation was having to utilize
the Narcan protocol. The second simulation was starting a blood transfusion. Finally, the last simulation
was a transfusion reaction. All of the simulations flowed from one to the next but each of the participants
switched roles and there was a debriefing in between each of the simulations.
Insights/Discoveries/Reflection
49
I feel I am continuing to gain confidence in my role as an educator. I am more comfortable going to
the various units and meeting with the intern. I feel I have a good rapport with the interns and they are
coming to me with questions and issues. They are also doing a great job keeping up with all of their extra
work outside of clinical time. On Wednesday when I went to talk with one of the interns I did find out that
she was placed with the preceptor that had been previously rude to a different intern. Before my preceptor
had left for vacation she had written an email to the unit’s educator asking that no intern be placed with the
preceptor until she came back from vacation and was be able to address the preceptor. Unfortunately the
email was ignored for whatever reason. When I met with the intern I spent quite a bit of time with her to
decipher whether there was an issue or not. She reassured me that things were fine and that she was not
having any problems with her. I asked her to please contact me if there was an issue and she said she
would. I separately saw the preceptor and asked how everything was going and she said everything was
going well. I did not sense any issues and felt comfortable with the situation after assessing for a while.
The simulation was another experience I was grateful to be a part of. I was able to see another
way that simulations could be broken out so that everyone could participate in different roles. It was nice
because it was only a group of three but each of the scenarios were about thirty minutes each. So we
spent time facilitating before each scenario and debriefing after each as well. As previously mentioned, I
had not seen a situation where the scenarios ran back to back with the same group but changing the
situation for the next learning objectives. The evaluations for the scenario were very good and since these
were newer nurses with about six months of experience, I felt they were great topics for them to be learning
about in the lab since they were critical competencies that are not seen that often.
Analysis
According to Knowles (1980) theory of adult learning, adults prefer learning that is practical,
promotes self-esteem, utilizes past experiences, demonstrates respect and allows self-direction, and
synthesizes new ideas with previous knowledge. The principles of adult learning provided a strong
foundation for leading my clinical instruction when meeting with the interns during familiarization. When
50
meeting with the interns, I had to keep these principles in mind and be able to communicate appropriately
with the interns in order to achieve learning goals. According to McKinley (2008), communication is
essential to the success of any role but even more so for that of an educator. Moreover, McKinley (2008)
notes that unclear, indirect, inefficient, and poor communication techniques can result in frustration and
failure. Another important consideration when communicating with learners is that too much information
can result in overload and shutting down communication (McKinley, 2008).
Additional communication strategies utilized during this time focused on the use of personal
attributes. Accordingly, the National League for Nursing (NLN, 2012), facilitation of learning competency,
notes the importance of using personal attributes such as caring, confidence, patience, integrity and
flexibility. This strategy is also supported by studies that have found faculty considered the most successful
by students when they possessed attributes such as enthusiasm, flexibility, a sense of humor,
approachability, and respectfulness (Penn, Wilson, & Rosseter, 2008). Key to promoting a positive learning
environment is the fostering of collegial working relationships with the personnel in the clinical learning
environment (NLN, 2012; Gaberson & Oermann, 2010).
Week # Date Time Activities # of
Hours
12
Monday, April 7, 2014 8:30 am – 4:30 pm Met with preceptor. Went to units and met with interns for final
week of familiarization 8
Wednesday, April 9, 2014 8:30 am – 4:30 pm Preceptor not in today. Went to units and met with interns and
preceptors independently. Emailed preceptor at end of day. 8
Thursday, April 10,
2014
8:00 am – 9:00 am, 9:00 am – 4:00 pm Unit selections meeting. Familiarization 8
Friday, April 11, 2014 7:00 am – 11:00 am Met with preceptor. Familiarization. Meeting to receive unit
assignments. 4
Week 12 # of Hours 28
Cumulative Total Wks. 1-12 291
Week 12 Summary
This was the final week of familiarization for the interns. I started the week by first meeting with my
preceptor and going over how things went while she was gone. We discussed how one of the interns was
placed with the preceptor she had asked for the interns to not be placed with. She ended up having a
51
meeting with the educator and discussing this with her. My preceptor did not want me to go to this meeting
so I went to the various units and checked on the interns. Once she was done with her meeting she went
with me to the units again and we met with the interns again. Wednesday, I once again spent time with the
interns and emailed my preceptor at the end of the day with how things went. There was a code in the
hospital during this day and I was able to grab two of the interns and take them to witness this. Thursday
morning was the meeting to determine where the interns would be placed for the remainder of the
internship. After the meeting we rounded with the interns on the units. Finally, on Friday I met with my
preceptor in the morning and read the emails the interns had written about their unit preferences and why.
We discussed how the meeting was going to go since the interns were not all getting their top choices of
where they wanted to go. We briefly went to the units and reminded the interns where the meeting to
receive their unit assignments was at and to make sure there were no current issues.
Insights/Discoveries/Reflection
When my preceptor came back and heard that one of the interns was with the preceptor she
specifically asked for the interns to not be with, she was very upset. I felt bad because I was not sure if
there was something else that I should have done differently. As soon as I found out the intern was with
the preceptor, though, I did everything I could to assess that the situation was okay. Not once did I receive
any indication that the intern was in a bad situation or that I should have pursued contacting my preceptor.
However, in seeing her reaction to the situation I questioned whether maybe I should have. She told me
she did not think I did anything wrong and that she was mostly upset because the educator did not follow
her request and put the intern and me in that position while she was gone. I think once she was able to talk
to the intern and hear that the situation really was fine, she did feel better, but she was upset that her
request for one week while she was gone, was not followed. After her meeting she also told me that the
unit is having a difficult time getting people to precept and that was part of the reason the request was not
followed.
52
This was a difficult week for the interns. After three weeks of familiarization, all of the interns
expressed their desire to be done with traveling to various units; they were ready to have a set destination.
I could definitely sense the anxiety from them as the end of the week got closer and it was difficult to see
them on Thursday and Friday and not tell them where they were going to end up. The reason my preceptor
waits until the last thing on Friday is because in the past interns have been upset with their placement.
Knowing not all of the interns got their first choice, my preceptor and I were worried that one of them was
going to be upset. From my preceptor’s perspective she felt bad and was also anxious to have to deliver
the news, knowing the intern might cry or just be upset. Neither of us were looking forward to this potential
situation. My preceptor did share tips with me about what she tries to do in this situation and how she tries
to word things. Unfortunately there were some tears shed at the unit assignment meeting. This was
difficult but I’m glad I got to see how well my preceptor handled it.
Analysis
The ability to help students’ master essential skills and knowledge in order to become professional
nurses is so paramount that the need for preparation and development of individuals taking on teaching
roles is an important issue (Stokes & Kost, 2012). Therefore, through a variety of experiences in this
practicum, both observational and experimental, my learning and knowledge about facilitation grew,
allowing me to become more comfortable with teaching. Thus, despite this being a difficult week for both
the interns and my preceptor, I feel really good about the progress I have made as a facilitator. Research
has identified effective teachers as knowing how to teach, being clinically competent, supportive, patient,
friendly, and having the ability to maintain collegial relationships with students and staff (Stokes & Kost,
2012). Educators must also have the ability to deliver knowledge in an effective manner (2012). Through
observation, reflection, and experience I was able to gain knowledge and skill in effective clinical teaching.
Week # Date Time Activities # of
Hours14 Friday, April
25, 201411:00am -12:00pm Met with preceptor. Gave copies of projects worked on throughout
practicum. Received evaluations. Discussed how interns were doing.
1
53
Saturday, April 26,
20148:00 am – 5:00 pm Attended critical care conference with interns. Thanked interns
and set closure to my working with them. 9
Week 14 # of Hours 10
Cumulative Total Wks. 1-14 301
Week 14 Summary
This was my final meeting with my preceptor. I returned all of the BKAT tests and compiled all the
files and projects I had worked on throughout the practicum. I also gave her a thumb drive with all the
computer files of the projects to make sure she had copies. I received her evaluation and the evaluations
from the interns. We discussed how the interns were doing on their first two weeks of their assigned units.
Finally, on Saturday, I spent my last day with the interns at a critical care conference. My preceptor was
not able to attend but she wanted me to be at the conference with them. This was a great conference and
the interns really enjoyed it. It introduced them to professional development opportunities outside of work
and provided formal education on topics ranging from alcohol withdrawal and hemorrhagic shock to gift of
life and end of life resuscitation efforts.
Insights/Discoveries/Reflection
I was glad to wrap everything up with my preceptor and provide her with copies of everything I had
done. I was happy to see that the evaluations from both my preceptor and the interns were excellent. I
thoroughly enjoyed working with my preceptor and the interns. I felt like they all made the experience that
much better. I feel I have accomplished my goals for the practicum, plus a whole lot more. I was able to
see how the educator role fits in to the rest of the organization and all of the behind the scenes work that
has to be done in order to carry out a successful program. I was able to be involved in organizational work
and practice leadership and collaboration skills. Finally, there were several difficult issues and challenges
that came up throughout the experience that allowed me to practice effective problem solving skills and
ethical decision making.
Analysis
54
According to Penn et al. (2008), faculty mentors and professional development opportunities that
promote learning about the teaching environment and opportunities to enhance teaching skills should be
encouraged for novice educators. Although the conference I attended was not focused on teaching skills, I
was able to utilize the experience to observe and analyze how effective the various speakers were in
delivering their educational materials. In addition, I was able to help the interns, during the break between
each of the speakers, to understand some of the critical care concepts that they did not understand during
the learning session. This was a great way to also promote professional development by showing the
interns the importance of attending these types of experiences. Finally, attending the conference allowed
me to gain further critical care knowledge that is needed to help prepare learners for contemporary nursing
practice (NLN, 2012).
References
Gaberson, K. & Oermann, M. (2010). Clinical teaching strategies in nursing (3rd ed.). NY: Springer
Publishing Company.
Knowles, M.S. (1980). The modern practice of adult learning. Chicago, IL: Follett.
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McKinley, M. (2008). Walking on water and other lessons learned as a clinical educator. AACN Advanced
Critical Care, 19(4), 388-395.
National League for Nursing [NLN]. (2012). The scope of practice for academic nurse educators 2012
revision. NY: author.
Penn, B., Wilson, L., & Rosseter, R. (2008). Transitioning from nursing practice to a teaching role. OJIN:
The Online Journal of Issues in Nursing, 13(3), 1-14.
Stokes, L. G. & Kost, G. C. (2012). Teaching in the clinical setting. In D. Billings & J. Halstead (Eds.),
Teaching in nursing: A guide for faculty (4th ed.). (pp. 311-334). St. Louis, MO: Elsevier Saunders.