Maureen Osuna, MSN, RN
Learning is a partnership between the student and the teacher. Rather than a one-sided endeavor, it is collaboration between individuals with shared interests and goals. Good teaching begins with excellent communication, involves unparalleled levels of compassionate understanding, and thrives in an environment of trust.
My teaching role in the clinical setting has involved mentoring both students and nurses new to the critical care environment. In my experience, students typically express anxiety, uncertainty, a desire to perform to high expectations, and an eagerness to learn. A study conducted to examine stress levels in nursing students found that first-year students have the highest levels of stress, and clinical placements are a significant source of this stress due to a perceived lack of knowledge and skill (Aslan & Akturk, 2018). It is my role to help students bridge this gap, gain confidence, and reduce stress, thereby creating an environment ripe for learning.
I have found the work of both Benner and Tanner to be invaluable guides in developing an effective teaching foundation. Recognizing where the student is on the novice-to-expert continuum sets the groundwork for compassionate teaching that guides rather than criticizes and nurtures rather than demoralizes. In this way, students can be taught the basics in a supportive environment, and build on that knowledge with each clinical experience. Students often feel overwhelmed with the complexities of patient care, and as the guide for their educational journey, it is my job to ensure learning experiences are presented in such a way that they build on prior knowledge without assuming a level of competency that has not yet been attained. For example, teaching a first semester student about non-invasive cardiac output monitoring would be ineffective, but teaching him or her the factors that contribute to blood pressure would be a valuable use of clinical time. By aligning teaching with where the student is on the novice-to-expert continuum, we give them opportunities to shine and, ultimately, build confidence.
Tanner’s model of developing clinical reasoning has provided me a road map for guiding the learner toward excellence. By prompting students to notice, interpret, respond and reflect, we enhance the learning experience, help them develop clinical knowledge and improve their ability to make sound judgments in complex situations (Tanner, 2006). Using out-loud reflection with a novice or beginner nurse is an invaluable tool that can model how this process is utilized to improve one’s nursing practice. Over time, the student begins to collaborate in these reflections with the goal of taking on more independent decision-making as she or he gains skill. In addition, students are often unsure of what to do in this unfamiliar environment, and I have found it helpful to remind them what the essential role of the nurse is: to recognize problems and solve them, to anticipate problems and work to avoid them, and to seek out opportunities that promote wellness and maximize them.
In the clinical setting, the adage “you have to walk before you can run” holds true. Novices require a great deal of patience and guidance, and it is especially crucial that the teacher structure the learning environment in a way that resonates with the student. This means breaking down complex situations into manageable concepts, giving students tasks they can complete successfully, and providing in-the-moment feedback that helps the student connect ideas and apply knowledge to future situations. Collectively, this approach reinforces what the student can do well, gently corrects areas of weakness, and builds confidence and curiosity in the student. There is nothing more rewarding than seeing a student make the leap from seeing just the trees to seeing the entire forest.
In summary, my teaching philosophy draws from the work of Benner’s novice-to-expert theory and Tanner’s phenomenological approach to create a blended methodology that creates change in the learner (Billings & Halstead, 2016). By providing compassionate instruction suitable to the student’s level of professional development and encouraging reflection in action, I act as a guide to help students build confidence, deepen understanding and transform experiences into enduring knowledge.
Aslan, H., & Akturk, U. (2018). Nursing education stress levels of nursing students and the associated factors. Journal of Turgut Ozal Medical Center, 25(4), 660–666. https://doi.org/10.5455/annalsmedres.2018.06.108
Benner, P. (1982). From novice to expert. The American Journal of Nursing, 82(3), 402–407. https://doi.org/10.2307/3462928
Billings, D. M., & Halstead, J. A. (2016). Teaching in nursing: a guide for faculty (Fifth). St. Louis: Elsevier.
Tanner, C. A. (2006). Thinking like a nurse: a research-based model of clinical judgment in nursing. Journal of Nursing Education, 45(6).