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When I was growing up, my mother kept a short essay called “I Had the World’s Meanest Mother” displayed in our house. She really loved that essay. What I’m writing today is inspired by that essay. It’s not for mothers but for all those clinical instructors who continue to cultivate the next generation of nurses.
Student nurse giving a patient a metabolism test/Library of Congress
As I sit in the classroom and hear my colleagues talk about their clinical instructors, I remember my own and think to myself that I’m the one who had the meanest clinical instructor: She kept us in clinical for our entire allotted time. Not only that, but she frequently reminded us of the importance of our clinical rotation by saying things like “you are paying for an education,” “this will help you to be successful in your NCLEX preparation,” and “you will become a great nurse.”
In some ways that clinical instructor reminded me of Mary Poppins—she always carried a bag and she seemed to pull an endless number of items out of its depths: NCLEX questions with a list of rationales; an NCLEX blueprint (she had a few copies); concept map templates; a medication book; even snacks for us. I think the snacks were there so we wouldn’t get hypoglycemic and pass out . . . which would cause her more paperwork. Not to worry, I believe the paperwork was in her bag too!
Connecting theory to practice.
My clinical instructor was always making connections and tying theory into clinical. If we were talking about oxygenation, everyone in my clinical group had to know the concept inside and out and we were made to care for every patient with asthma, respiratory infections, and pneumonia on that floor that week. After a long clinical day I would fast fall asleep thinking about the oxygen hemoglobin dissociation curve and signs and symptoms of hypoxia, all the while believing I was still hearing the oxygen saturation monitor alarm.
Every week my instructor would reiterate and ramble on about the question, “How does one problem lead to another problem?” As we sat down to do a concept map, she would ask us to talk about a patient’s symptoms and lab results. And I can still hear her talking about an NCLEX test blueprint as if she were an architectural designer, or telling us, “The nursing process is the foundation to nursing care.”
Asking the important questions.
To make things worse, she asked a million bothersome questions, like “What do you think is the worst thing that could happen to your patient?” and “What are you most concerned about?” These were two of her favorites. However, my absolute favorite was “What would you do differently?” Well, I’d think, I could have stayed in bed . . . .
Way back during my first semester I had an instructor who not only had us clean up our patients, she had us clean the patients’ rooms. I believe her name was Florence. Florence could then go on and quote facts and statistics related to infection prevention. I left that semester knowing way too much about which patients could room with which patients, who needed what precautions. My hands were beet red because I washed them so much.
I had one clinical instructor who was always giving me ways to improve. Her name for it was “feedback,” and we received this on a regular basis. It was odd to me because she was always so nice about it. Once I was doing a dressing and dropped my sterile glove. My instructor just said, “No worries; things happen. Let me go get you a new one.” Medication passes were the worst. After I cited and performed the “five rights” of medication administration, my instructor would actually spend time talking to my patient and double-checking my assessments: “Listen! You can hear a great aortic insufficiency murmur,” she might say. She called her behavior role-modeling and and offering opportunities to learn. To make things worse, she made me ask my patient if my fellow students could come in and listen to his heart.
Years later, after passing the NCLEX on my first try and working in a busy ICU caring for the sickest of sick patients, I thank God I had “mean” clinical instructors—it was from them that I learned the art and science of nursing.
By Jo Anne Foley, DNP, RN, CNE, CNEcl, CCRN, is a professor of nursing at Labouré College, Milton, MA, and a nursing professional development specialist/medical-surgical unit at Boston Medical Center, Boston, MA
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