How clinical faculty and practicing clinicians can collaborate to help students learn professionalism.
Takeaways:
Professionalism (the integration of professional values in the workplace via words and conduct), which is embedded in the Code of Ethics for Nurses With Interpretive Statements and nurse practice acts, creates the foundation for civil and healthy work environments that are safe, empowering, and satisfying. Healthy work environments, which are cultivated through open and purposeful communication among interprofessional groups, support optimal care delivery and ensure positive patient outcomes.
Essential competencies—such as effective, efficient communication and collaboration among interprofessional healthcare teams—have been cited by the Institute of Medicine and others as lacking in many new graduate nurses. Preparing new nurses for practice requires dedicated and coordinated responses from academic and practice organizations. According to Clark, professional skills are similar to clinical skills; both can be learned and improved upon over time using strategies and appropriate role modeling. (See Model behaviors.)
By understanding shared responsibilities and building effective teams, faculty, clinicians, and students can collaborate to instill professionalism and build healthy work environments.
Rather than feeling mentored and nurtured, many students report feeling unwelcome in the clinical environment, which leads to isolation, emotional distress, depression, and fear about their career future. Unhealthy work environments pose a threat to nursing student learning, new graduate transition, job satisfaction, employee retention, professional development, and patient safety. We stand little chance of breaking the chain of workplace incivility if the next generation of nurses believes this type of behavior is acceptable. Reasons behind our current dilemma are multifaceted, and everyone—clinical faculty, nurse managers, staff nurses, and students—plays a role.
Clinical faculty, even when they’re on the unit, may not always be “present” for students because students may feel their instructors are unapproachable. This frequently is a result of perceived incivility. For example, some faculty may reprimand students in the presence of others, leaving students feeling insecure and belittled. In addition, faculty may be responsible for eight to 10 students at a time, which can be overwhelming, especially during medication administration, creating stress that can carry over to how faculty respond to students.
Different nursing programs have varying numbers of clinical hours and objectives. With several clinical groups assigned to one unit, nurse managers may struggle to keep track of them, creating a hurdle when managers need to speak to instructors about student issues. In addition, some nurse managers may not trust faculty, may believe students are disruptive to unit workflow, and may not see themselves as having a stake in educating future nurses. And if nurse managers speak inappropriately to or discipline staff or students, they foster the impression that incivility is allowed.
Staff nurses may not see themselves as stakeholders in educating future nurses. Staff may believe that teaching professionalism is the clinical instructor’s job, not theirs, making them less likely to participate in the process.
Students may have an idealized view of nursing and struggle when reality doesn’t fit that view, which can be a barrier to open communication.
When clinical faculty and clinicians use the form, storm, norm, perform, adjourn method of team formation, they can collaborate to create a partnership built on professional standards and a shared vision, while teaching students professionalism.
Initially, clinical staff may be unclear about their roles and responsibilities with regard to nursing students or view their work with them as an unpaid burden. At this first stage of team development, clinical faculty and practicing clinicians must be clear about tasks and debunk the myths (for example, about how nurses only follow physicians’ orders, that learning ends when you get your degree, and that male nurses are needed mainly for the heavy work) that contribute to unprofessionalism. (See Tips for forming faculty-staff teams.)
At this stage, conflict may exist between faculty and staff team members. Some staff may even rebel against assigned tasks because they don’t trust the faculty member’s clinical skills and they aren’t certain of a student’s ability to safely care for patients. Open communication is essential to create an atmosphere for sharing ideas, building mutual respect, and solving problems. Because approximately 80% of communication is nonverbal, everyone must be coached to be mindful not only of verbal communication, but also of body language (for example, facial expressions and posture) when collaborating with each other and caring for patients.
Everyone also should learn to use conflict constructively; it should never become personal. Instead, for example, if conflict arises about how to approach a learning experience, staff, students, and the clinical instructor should brainstorm to establish alternative, mutually agreed upon plans. TeamSTEPPS®, a tool created by the Department of Defense’s Patient Safety Program in collaboration with the Agency for Healthcare Research and Quality, can help identify possible reasons for conflict and support the team through this stage. (See The perfect storm.)
The perfect stormEveryone—clinical faculty, students, staff nurses, and nurse managers—has a role to play in establishing a team that prioritizes and models professionalism and collaboration to promote effective communication and problem-solving.
Tips for clinical faculty
Tips for students
Tips for staff nurses
Tips for nurse managers
Generally accepted procedures and communication patterns are established during this stage to promote bonding and group identity. The team begins to identify each member’s strengths and build on them together, and everyone understands their roles and begins working together for the greater good—investing in nursing’s future and ultimately improving patient outcomes. As committed partners, the team is relentless in pursuing and fostering true collaboration.
The team begins to focus all of its attention on achieving shared goals. Everyone is close and supportive, open and trusting, resourceful and effective. Leaders meaningfully recognize and celebrate the accomplishments of the whole team, which fully embraces the imperative of a healthy work environment—authentically living it and engaging others in its achievement.
At the end of the student’s clinical experience, all team members should have the opportunity to reflect on the experience, objectively critique successes, evaluate areas for improvement, and identify best practices for the future.
Incorporating strategies to develop professionalism into every aspect of clinical education has far-reaching, positive implications. Not only can healthcare teams pre-empt problems before they arise, but also teamwork prepares students for a future in which they model professionalism, work to create and sustain healthy work environments, and learn the skills to diffuse conflict. Teaching professional behavior also prepares students for practice by helping them realize and accept the full breadth of nursing, including the values, morals, and attitudes embraced by the profession. Socializing future nurses into the profession, which is the responsibility of clinical faculty and practicing nurses, benefits nursing and patient care in a variety of ways. Students will:
Some clinical faculty or staff may be unable or unwilling to adhere to the team-building process because of staff shortages, increased patient acuity, limited knowledge of learning outcomes, or an unwillingness to participate. However, without consistency and collaboration between clinical faculty and staff, the team-building process will lack cohesiveness and continuity. The National League for Nursing proposed promoting academic partnerships to enhance collaboration between faculty and clinical staff, ensure all team members feel valued, and establish clear roles. Clear communication, mutual respect, and faculty willingness to support students and staff facilitate a cohesive work environment.
Creating healthy clinical work environments leads to more engaged nurses, decreased burnout, reduced turnover, and better patient care. In addition, staff nurses will recognize themselves as mentors and stakeholders in preparing future nurses for practice. As the saying goes, today’s students are tomorrow’s colleagues.
Kimberly Dimino is an assistant professor in the department of nursing at William Paterson University in Wayne, New Jersey, and a nurse scientist at Hackensack Meridian Health in Hackensack, New Jersey. Joset Brown is an assistant professor in the department of nursing at William Paterson University. Bea Fernandes is a nurse manager at St. Joseph’s Children’s Hospital in Paterson, New Jersey.
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