Surface – Getting the Pulse on Practice: Connecting Clinical to the Classroom – Part 1

This episode of the NLN Nursing EDge Unscripted Surface track is part one of two featuring guest Kate Boss. The discussion centers on bridging the gap between clinical practice and nursing education, highlighting the importance of mentorship and early exposure to educational roles for nursing students. Kate shares her experiences as a clinical nurse and instructor, emphasizing the challenges and rewards of transitioning into educational roles. The conversation explores the need for nurse educators to stay connected with clinical practice to ensure relevant and effective teaching. The episode concludes with reflections on the evolving healthcare landscape and the importance of learning in context to prepare nursing students for real-world challenges.

Dedicated to excellence in nursing, the National League for Nursing is the leading organization for nurse faculty and leaders in nursing education. Find past episodes of the NLN Nursing EDge podcast online. Get instant updates by following the NLN on LinkedIn, Facebook, Instagram, Bluesky, and YouTube. For more information, visit NLN.org.

Transcript

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[Music] Welcome to this episode of the NLN podcast Nursing EDge Unscripted the Surface track and thank you  for joining us. This episode is entitled, "Getting the Pulse on Practice: Connecting Clinical to the  Classroom," and to help us today we have a very special guest, Kate Boss. Kate Boss is a Senior  Clinical Nurse I at the University of Maryland Medical Center's R Adams Cowley Shock Trauma  Center on the acute care floor also known as Four STOP. Kate specializes in precepting new  graduate nurses to the clinical nurse role. Kate continues to mentor new team members as they  advance through the professional advancement model. Kate also acts as a resource to implement clinical  evidence-based practice initiatives that ensure the unit is continuing to address practice gaps.  Rachel and I especially want to welcome Kate to celebrate our own special mentorship relationships  with her. Kate began her professional nursing career path as Rachel's student in the Clinical  Nurse Leader Program at University of Maryland School of Nursing. Rachel continues to mentor  Kate in various aspects of her professional development. I had the fortunate opportunity to  be mentored by Kate when I began teaching clinical to medical-surgical students on her clinical unit. Kate served as a welcoming and informative mentor to me as I had to work to familiarize myself  with the unit policies, culture, and patient care community. Welcome Kate. Thank you for joining us.  Anytime. I'm excited. Thanks for having me. It's great to have you here, Kate. To get us started how  about you share a little bit about where you are at University of Maryland Medical Center, what you  do, and a little bit about how your role intersects with education? Yeah so I'm at Maryland at the  University of Maryland Medical Center at the more specifically the shock trauma center there and I  work on their acute care floor and I've been a clinical nurse there on and off for about seven  years now, which seems crazy but it kind of flew by. I'm a senior clinical nurse  one, just this is our advancement model there and so my focus with that is more education based  instead of like more admin stuff and I focused more on precepting new graduate nurses and working  with some of the student students with instructors as well helping to coordinate their calendar and  things like that so that's kind of how I intersect with education and the academia world.  I'll just share Kate that I have vivid memories of taking students to  four STOP right the shock trauma acute care unit and you were always this breath of fresh  air. I would see you like, thank goodness Kate's here because I just felt as  an instructor I was in good hands with you there because I felt like you understood the role of the  nurse. You also, I felt like, understood my role and I felt  like you were always ready to give a hand or help me navigate the unit and provide the resources  I needed to provide good clinical teaching, I say that because it's...  I shouldn't take it for granted because that's not how every unit and not  certainly not how every nurse receives clinical education. Sometimes there's a disconnect between  what the unit either the unit nurses or the unit culture sort of expects of instructors  and students and sometimes it takes a lot for the instructor to try to navigate that and  and make things, help the students have a good experience and help the nurses understand  we can help and we are here to help and to provide patient care but there's really going  to be a balance between balancing the learning and the work. I never had to really do that  with you because you were just so...I felt like you had a very good and clear understanding of what  the roles are and that was very helpful to me. Oh thank you. That's nice to hear. I think at one point  after I graduated nursing school and started my years as a nurse I started doing clinical  education as well and was a clinical instructor and I do remember that feeling of going on to a  unit where you've never been there. You don't know the staff. You've got your patient  population and you just kind of feel anxious and you're like how can I teach these students,  how can I, you know I don't even know where the chucks are. I don't even know where the  supplies are. Do they use chucks? Are we allowed to do that? Do they use bed baskets? Could I get  the patient out of bed? And so I remember feeling all of those fears and thinking like oh maybe  I'm failing these students because I don't know the unit and the culture and so I think I just  kind of checked that with me as a clinical nurse and knowing that these instructors are coming  in and they're just like the rest of us and just want to make good nurses. Kate, I'm glad you brought up about this transition to being a clinical instructor  because I remember us having conversations early on right when you were thinking about  and starting to transition and I think it might be really helpful to hear your perspective on  what that experience was like and how faculty, full-time faculty who support clinical instructors  how they can help support them and make that transition easier because it is not an easy one.  You've alluded to just some of just the logistical aspects but there's a ton more to transitioning  into that role. I'm just curious to hear your thoughts on what that transition was  like for you and how in academia can we make it better for our clinical faculty who take on  these clinical instructor roles. You mean when you and Dr. Davenport convinced me to finally  do it? Yes! I'm gonna say convinced or like forced because I could see that happening too. It made it  makes a very persuasive conversations. There was some of the Jedi mind tricks in there for sure.  I think they knew it was something that I was interested in and I wanted to do  so it wasn't, I don't think that they had to pull my arm too hard  from what I remember and I really enjoyed it when I was doing it. I hope to one day go back to it  a little bit more full time because I do think that that is something that helps bridge the gap  between clinical practice and education is a strong clinical instructor, somebody that  can kind of help you see what you're learning in the classroom and put it into practice.  I guess how can clinical or how can faculty help  do that is I think, I mean exactly what you did. Just support you like should like kind of  show you that you do know more than you think. I was relatively a new grad, but you're  like no, no, you know what you're doing. You know what you're doing and just continuing to give  me this confidence that I did not think I had and then going into that first day, you're like,  are they gonna know that I don't know what I'm doing? There's something you taught me. You  were like, you don't have to know everything. You just have to say that's a great question. I'll  get back to you and you do. And then you go back and as long as you get back to them they're gonna  understand that you can't ever know everything in nursing. It's impossible.  Just continuing to find the students that promote education and want  to progress the field of nursing and kind of target them and work with them. I  think you guys got me into the guided study sessions while I was a student and into  that tutoring role and into the education world a little bit earlier and so it was kind of ingrained  that I was going to start to do education stuff once I kind of got my feet wet in nursing.  You know, you're saying something really important Kate, which is in my mind you got into  an education track early. You were still a student and you were invited and encouraged to do take  on that educator role within your student capacity. I think with tutoring and peer  support and I think that's so important because I think right now nursing education is maybe already  in or heading for a pretty big crisis with regard to recruiting new nurse educators and  retaining new nurse educators in the field. It's not always been known, I don't think, as a really  something that I think nurses want to do and I think we need to create a narrative that  helps people understand that this is a way to give to the profession and to inform the next  generation of nurses and it's a way to impact patient care. I think that early step is really  important that you just identified and I don't I don't see that happening a whole lot. I mean, do  you Rachel? No, you know I'm just sitting here thinking, what's running for me is it's this  is really speaking to the importance of just getting to know your students, right. So I was  really fortunate I knew Kate well as a student when she was a student and other students and  and I think about how there's students out there that we may not know really well and we don't know  their strengths and be able to connect them in the tracks that really help develop them  and I think that this is going to be really important in thinking about how do  we mentor the next generation of educators whether they're on the side of academics  or on the sign of clinical practice. There's mentoring that can start early on and I think that that can help shape, I know that was done for me I have a mentor who I  attribute being in education because that mentor reached out before I even saw myself as ready and  she saw me as ready and she believed in me and she helped kind of sort of take me under her wing and  gave me that support when I was really in the thick of imposter syndrome, which is Kate, kind  of what you're alluding to. Like what are they gonna figure out I don't know what I'm doing?  We need to be doing more of that in education and on the side  of academia, academic-based education and clinical practice-based education I think. And how you know, I think what I came up against, is where you and I both taught Rachel  in a larger school of nursing our classes were huge. So I think it was hard.  I think a lot of people can be up against that challenge, number one because of just sheer volume.  The other thing I think could challenge faculty is just knowing that they can initiate this question  of like, what is your two-year plan, three year plan, five year plan? Like sure, you're  butt's in the seat right now you're a student but what do you want to do in a few years time and  helping them to look ahead a little bit. I've never even done that really intentionally  on one-on-one conversations but how many one-on-one conversations are you  having in a class of 100? You may not get to see all 100 students  and I want to pull you and Kate on this to hear your perspective as both a former student as  someone who works with students a lot now. I was just at a conference talking about vulnerability  of learning and psychological safety and talking about how do we help, what are the small  things we do in the moment that help really shore up the psychologically safe container and  and address vulnerability and learning? We had this conversation about how often are we  getting to class early and before we stand at the front of the room and wait for the clock to tick,  tick, tick, tick so we can start and everyone's in the seats? How often do we mingle around the  classroom and just have a conversation and greet our learners and have small talk and and just have  a sentence or two to get to know them as a person? I think back on my last 14 almost 15  years in education now and the times I really got to learn and know my students were actually  in those bigger classes or even in that  cohort with Kate, with you I think we had like 50  some students, was getting to know them in those small moments before class started or as we're  leaving the room or when they come to my office or those small acts I think can really  go a long way in getting to know our students. Figuring out what their strengths are and even  if we don't have the resources to help mentor them, connecting them with the people who do. Yeah, that's a great point Rachel.  I'm just thinking, I remember our  program was in my opinion kind of small compared to others.   My undergrad was a tiny school so to me it was a huge class, but now looking at  the bigger perspective, our 50-person class was tiny. Some of my classes in  undergrad were eight students and so coming into a classroom with 50 I was like, I don't want to  talk. My mom asked me the first day did you make any friends. I was like, I didn't speak to anybody. It wasn't until after a few weeks getting more comfortable and  then you guys I feel like really encouraged us to try all of the guided study sessions so we  had cohorts ahead of us that were tutoring us and mentoring us and giving us their experience  and having some of the previous graduates come back and teach as a clinical instructor,  you really got to see, you could see yourself in that role or like okay, I can do this.  Like, I know what I'm doing especially in a time when you're struggling and you're trying  to figure out how to learn all this information and so to me having this, not necessarily  a faculty mentor or anything like that but just a peer mentor where you're somebody that's  doesn't even have to be older, but just somebody that's in a more experienced position than you  that can help guide you to figure out what it is that you want to do with your degree  because there's so many options with nursing. It's overwhelming to think about when you graduate  because everybody just thinks it's clinical, like a clinical bedside nurse. There's so  many more options that people can do that I don't think we really get into in the classroom  at all. It's more focused on clinical but there's so many other things that we could do too. I think what you know by knowing what those options are I think that  would be yet another way to get to know your learners because   I've often thought like when I've had these office conversations  with learners that are maybe struggling because honestly, that's often what generates  an office visit right with your faculty is that there's like some struggle. So I would  talk with them and learn about them that they have this special contribution into nursing and you can only get that by having these conversations and  not everybody is cut out for being a rock star ICU nursing in a in a big medical center, right . There's like you mentioned hospice, and there's community opportunities there's, even like really  community outreach services. There's there's so much out there and our learners don't know unless you have this conversation with somebody and you can unpack what their interest areas are  and where they can really shine. And then you can offer that, hold them up you know instead  of just because they usually walk in the office feeling discouraged deflated and like I can't be  a nurse because I can't pass this test but that's not true. That's not true. There's a place for you.  There's a couple points I wanted to say. I think that in our clinical field and  I definitely felt it in nursing schools when you graduate you need to be an ICU nurse. You need  to be the top of the top and that's apparently the top of the top. I remember getting my  practicum placement and I was devastated because it wasn't the ICU and that's what I'd wanted. I'd  been a student nurse there. You know, that was my track and I remember probably crying to  Rachel and she's like it's fine, you're gonna learn so much. You're gonna see so much and I was just  like okay. And seven years later I'm still on that unit. I've tried to quit a couple times and I have  I keep coming back so there's something about it and I think just knowing that it's not always just  that ICU role. It's that you can be a rock star on a med-surg floor and that's great and good  enough and that's okay because that's nursing too. And the community nurse, like that's nursing too. I just want to go on record as an ED trauma nurse saying I have so much respect for med-  surg nurses who have a patient load of five, six plus. The time management, it's  an entirely different skill set. The ability to communicate and to delegate and it's just  something that is extraordinary and so I think you're hitting on something really important, which  is and we're going down a different rabbit hole right now and I think that's fine, it's  what are the messages we're sending our students in nursing programs, right? So just like you said  Kate, getting this feeling of, oh, to be the best nurse you have to be an ICU  nurse or if you're X Y or Z it has some sort of connotation. What are the inherent messages  we're sending our learners because as the healthcare landscape is drastically changing and  where nurses are working and the types of roles that they're holding is changing, we really need to  break those stereotypes and those connotations and make sure we're sending a different message  to our students in nursing programs so that they don't walk away feeling like that because that is  gonna exacerbate the problem we have now at the bedside. Yeah, I remember during the pandemic there  was this big pull for we need more nurses, we need more nurses and people were coming in and saying  like oh I can do I see you and it's like really? we just need people after they leave the hospital  like in a convalescent place. We need more med-surg basically for all intensive purposes nurses  and you know there wasn't enough of them. There wasn't enough people that could do that skill set  or were willing to do that skill set but everybody was like, no, I can work in the bio containment unit. But when it came to doing something else elsewhere it was like oh,  no, I can't do that or I don't have that skill set. I think that that's pretty important. And you know Kate, this is really helpful hearing this. I was  wondering if you can expand a little bit on that. A lot of nurse educators,  a lot of times you start and you're in practice and then you want to make a transition into  education and for a while you end up doing both. You can stay in practice and teach.  At some point though, educators including myself end up leaning more on the education heavy side  and start really stepping away from practice and sometimes completely and for some time amount of  time that can really create a deficit in our knowledge and our ability to kind of keep our  finger on the pulse per se of what's happening in clinical, especially if you're not clinical  teaching anymore. I was just wondering if you could share in case or any of our listeners out  there, you know how has practice even on your one unit that you've worked on, how  did it change pre-pandemic, during the pandemic, and now as we're entering this sort of post-pandemic  phase, what are some of the changes you're seeing in clinical practice what are the emphasis? That's a really good question and I think to me there's always been some sort of gap between  the academia world and the clinical practice world for the same reasons that you just said.  It's to no fault because you have you can't do both forever. It's exhausting. I was doing clinical  education and working and trying to be a human and it was just too much so I was like one has to give.  It's not the human one, right? That's what I was hoping! a life and you know get married and have all those wonderful things that come with that so  I think I chose right for now, which is really good feeling but I think  that in school you learn about a disease or you learn about an issue and in this perfect  academia hospital you give the treatment, you give the medication, you do the surgical intervention,  and the patient's fixed, they're discharged, it's a nice pretty package, and you move on. Where in  the real world you have compliance issues, you have all these comorbidities that   prevent any healing. You have a lack of supplies, breakdown communication between different teams,  and that all affects the clinical day-to-day. It doesn't even begin to start with the nurse's ratio  and everything that they're responsible for but in that academia world, yeah, you might be  dealing with four case studies but you have this... exactly how to fix it. You can  give this medication to this person, they're fixed. Okay, let's move on. Whereas in the real world you're  going in between rooms dealing with three or four different five in some patient  cases scenarios and different beliefs, cultural beliefs, all of these things that come into effect  and I think in the academic world you don't necessarily  I think we try to do cultural competence and think about all these things and think about  comorbidities, but at the end of the day when we're adding like in our adult health classes  or our med-surg classes we're learning about the interventions and they work and that's great,  but in the real world that doesn't always happen and there's complications from surgery, there's infection, there's all these things that we learn to look out for, but we don't necessarily see. So Kate this is pretty awesome because and what I'm hearing you say is the part that is sometimes  missing is the learning in context piece.  Learning the nursing process with a scenario,  with the situation that's two-dimensional that's on a piece of paper and you might  throw some comorbidities in there to work through that might be a very important step for  a learner in an academic setting, but it is and it is more than that, right. So to scaffold that...  You have to learn that step before you can get to the next step, but yes, we don't  always get to that next step in the academic world. Yep. And this learning  in context just emphasizes the importance of Michelle and I, you know, are  on a quest. Would you say it's a quest Michelle? A life's work, a journey.  We could think of a whole bunch of different words we're gonna have another episode on just  describing what we're trying to do.  We're trying to really  start momentum, get momentum behind something that we should be doing long ago, which is getting away  from these straight lectures and really embracing problem-based learning, unfolding case studies,  and immersive active learning strategies because that's how learners learn in context.   Katie, I don't know how deeply entrenched you are in knowing about the Next Gen NCLEX format  that's coming out and the clinical judgment measurement model, but Michelle and I spent a  lot of time talking and thinking and wrestling with this. Part of it is that layer four. Layer three is the cognitive functions that the Next Gen's measuring,  but that layer of four context. I'm so glad to hear you say this Kate  because it emphasizes the importance for us in academia to really be thinking about  and rethinking and reimagining what does delivery of content look like and it's not  really delivery of content. It's facilitation of learning and facilitation of development  of clinical judgment learning in context. That doesn't happen with someone's  clinched to a lectern at the front of the room talking for three hours. It doesn't happen. We want to be conscious of our time boundaries. This conversation could  go on and it will. We will pick up with our conversation with Kate discussing  practice connections to education on our next episode. We hope you join us next  time with the Nursing EDge Unscripted Surface podcast. Until then, be well.[Music]