Lessons Learned ~ "Life is the art of drawing without an eraser. " ~ John Gardner

What have I learned?

That teaching and planning take a great deal of time and study.

That teaching can be fun and terrifying.

That teaching is not static.

That it is a labor of love, a passionate venture.

That teaching involves caring.

That learning never ends.

That experience is a good teacher but guided experience is the best teacher.

That my students much like my patients are now my responsibility.

That I must be wise.

That with God’s help I am able.

That I am entering a whole new world with new and exciting challenges.

That as I teach and guide I am simply standing on the shoulders of all those who have invested their time and effort in me. This humbles me and fills me with gratitude.

And finally that we are all part of something much larger than ourselves, the noble profession of nursing.

       In January I will begin to work full-time as a pediatric nursing instructor with USC Upstate. This is so very exciting. God has ordered my steps and I am grateful. My goal was always to become a nurse educator. However, I had assumed that I would begin by teaching a fundamentals course before I would be able to move into my specialty. "Now to him who is able to do immeasurably more than all we ask or imagine, according to his power that is at work within us..." (Ephesians 3:20). I praise God.

        Finally, I love collecting bits of inspiration. The quote below is from The Quote Garden. http://www.quotegarden.com/index.html 

~ Enjoy ~

~When I think about all the patients and their loved ones that I have worked with over the years, I know most of them don't remember me nor I them.  But I do know that I gave a little piece of myself to each of them and they to me and those threads make up the beautiful tapestry in my mind that is my career in nursing. 
 ~Donna Wilk Cardillo, A Daybook for Beginning Nurses

Charleston Southern University MSN Class of 2011

Oh, Happy Day! Graduation Time...

Friday is pinning and graduation day.

 I will earn my Masters in Nursing Education from Charleston Southern University.
It is almost time to celebrate,
Oh, happy day!

Leading by example...

 

                 Leadership in Clinical Education and Leadership Growth

                                             Creative Clinical Leadership

Jones (2005) proposes that senior nursing students can practice leadership by delegating responsibilities to novice nursing students. She outlines how they must gather patient information and give report to the junior students, as well as, inform them of the  time they are expected to arrive, while also providing directions to the medical facility (Jones, 2005). Most importantly, they must evaluate the patient and student to determine which duties can be delegated safely and within the student’s scope of practice (Jones, 2005). This takes quite a bit of preparatory planning and organization.

Further, Jones (2005) notes that Bos (1998) identified five benefits of this type of delegation; students receive practice in prioritization, critical thinking, technical skills, use of peers as resources, and management. Other authors also relate that this type of peer tutoring increases confidence, personal leadership and personal relationships between students (Jones, 2005).

Kling (2010) had two classes of senior students lead sophomore students on their first and second days of clinical. The purpose of this endeavor was to allow the senior students to be able to participate in an active leadership position (Kling, 2010). This also allowed the students to experience life as an educator and mentor (Kling, 2010). Additionally, numerous other benefits became apparent after the implementation of this project. Friendships and support groups between the students that were initiated during this time period continued (Kling, 2010). Most notably, however, several students reflected that they might consider the possibility of someday aspiring to be nurse educators (Kling, 2010). Lastly, this leadership class took place before the NCLEX exam; this allowed the senior students time to review skills and processes as they explained these to the younger students (Kling, 2010).

In order for this scenario to be successful, students must be prepared, have a good understanding of the expectations and they must be familiar with their state’s Nurse Practice Act (Jones, 2005). If the student does not understand or is not prepared, this learning experience can fail to produce the expected outcomes.

In conclusion, this is an excellent way to introduce leadership with senior level nurses and this could be expanded upon in a number of ways. What if these senior students were assigned a sophomore or junior level student at the first of the year? They could be responsible for many aspects of the student nurse experience. Perhaps they could call a couple of times each month to see how the student is doing and if the student has any needs for tutoring or support. Not only does this provide extra direction and understanding for the novice but it could also increase the empathy level of the senior nurses toward the junior students. Is it possible this type of peer support could eventually impact lateral violence by increasing this sense of caring, collaboration and camaraderie toward other nurses early in the educational experience?

It is possible that this type of activity could be associated with the nursing honor society or the student nurse association where it could be voluntary or it could flow from one class to another. The students that feel comfortable with this experience may desire to continue to mentor the novice students after the year is over. In conclusion, this method of leadership training has tremendous potential beyond the activity itself.

       Final Thoughts on Personal Growth

 Fights (2011) suggests that nurses from the floor to the boardroom need to assess where they wish to be in 5 years, set career goals, discern how to accomplish them, commit to lifelong learning and get involved in policymaking, data collection and planning. She poignantly states, “As nurses, we must measure the value of what we do. Nurses are counted upon; yet if we don’t count what nurses do, nurses don’t count” (Fight, 2011, p. 59). This is very prophetic; nurses must cease to be invisible. How can this be accomplished?

This course has increased my appreciation and understanding for who I am so that I too can effectively lend my voice, vision and energy to the profession I love in an educated and intelligent manner. As Fights (2011) suggested I have been encouraged to set career goals and determine what I must do to accomplish them. This is vital to the growth, empowerment and consequent visibility of all nurses.

As I look back over this last year and a half, my growth as a professional has been incredible. This course and program of study has helped me define leadership and followership; it has helped me identify my personal leadership potential and creativity (Grossman & Valiga, 2009). Further, this course has helped me identify my personal role as a visionary, expert, achiever, critical thinker, communicator and mentor (Feldman & Greenberg, 2005). Additionally, as an educator, it has provided instruction on compelling ways to integrate and teach leadership (Feldman & Greenberg, 2005). This transformation has been subtle, continuous and at times unperceivable, yet as I look back from where I came, I am in awe.

Just a year ago, when we were instructed to write our personal philosophy; I wrote that the development of a philosophy is a process. I reflected, “Someday, I will more intimately know and understand my own personal philosophy. It will move beyond a way of doing and being to a personal philosophy of knowing. The journey has just begun” (Hiott, 2010). This has been accomplished! This class has expanded upon my “ways of knowing” (Jackson, Clements, Averill, & Zimbro, 2009, p.152). I know myself much more fully and have an appreciation for my strengths, my weaknesses, gifts, and passions all the better for participating in this program. I have been equipped, not only to teach, but also to dream and serve! Personal and professional exploration and education has increased my knowledge and confidence. Empirical knowledge helps me define the vision and set goals, while confidence from my personal, aesthetic and ethical knowing supplies the creative energy to embark upon the first step. Tyrrell (1994) shares, “Facilitation of student leadership development is an act of empowerment and an expression of caring” (Aroian, 2005, p.22). Thank you very much, Dr. Kling.

                  References

Feldman, H. R., & Greenberg, M. J. (2005). Educating nurses for leadership. New York, NY: Springer Publishing Company, Inc.

Fights, S. D. (2011). Future of nursing initiative: Nurses are the key. MEDSURG Nursing, 20(2), 58-59.

Grossman, S. C., & Valiga, T. M. (2009). The new leadership challenge: Creating the future of nursing (3rd ed.). Philadelphia, PA: F.A. Davis Company.

Hiott, D. B. (2010, October). Towards a personal philosophy of nursing education.

Jackson, J. P., Clements, P. T., Averill, J. B., & Zimbro, K. (2009). Patterns of knowing: Proposing a theory for nursing leadership. Nursing Economic$, 27(3), 149-159.

Jones, J. M. (2005). Chapter 26: Practicing delegation skills. In H. R. Feldman & M. J. Greenberg (Eds.), Educating nurses for leadership (pp. 279-287). New York, NY: Springer Publishing Company.

Kling, V. G. (2010). Clinical leadership project. Journal of Nursing Education, 49(11), 640-643. doi:10.3928/01484834-20100831-02

 

 

Reflecting on Nursing History

Focus on nursing history and the art of reflection

In the future leadership will be an even more important aspect of nursing education. Feldman and Greenberg (2005) have included several chapters, which demonstrate creative ways to tie this information into nursing classes. Many of these ideas are creative and relevant.

One chapter captured my attention due to its emphasis on nursing history. Lewenson (2005) uses nursing history to illustrate nursing leadership. This is a great way to integrate nursing history, ethics and leadership into any class. Many nursing leaders were revolutionary individuals who bravely stepped outside of the social expectations of their time. Holmes (2008) states, “ It is the vehicle for understanding and appreciating the human situation as it has developed and evolved over time, and without it we can not claim to understand our culture, institutions or practices…” (p.104).This teaching technique engages students with inspiring stories and shows what is possible with passion, persistence and creativity.

Lewenson (2005) recounts the value of our history by quoting Lynaugh (1996) noting this is “our cultural DNA” (p.103). Further, she reflects that Christy (1969a, 1969b, 1969c, 1969d, 1970a, 1970b, 1975) wrote a series about historical nursing leaders; she has used these to inspire students to see what these nurses had to overcome to achieve their goals (Lewenson, 2005). Lewenson (2005) cautions against students using “present-mindedness” however, when interpreting these leaders actions; “present-mindedness” occurs when one judges historical information using a contemporary perspective (p.108). This can be remedied by having the students include information regarding the historical environment at the time. In 1917 the National League for Nursing Education (NLNE) suggested nursing history be added to the nursing curriculum to generate enthusiasm in nursing’s history and in the occupation, as well as, to create an appreciation for the obstacles, which had been overcome; these issues and objectives are still relevant today (Lewenson, 2005).

Lewenson (2005) notes that serendipitously nursing students noted many of the issues related to nursing have not changed, shortages, recruitment difficulties, and entry into practice debates. Further, Kearney (2010) suggests that nurses reconnect with their past to continue to fuel their passion for their daily work.

I feel that the study of history is vital for nurses. Lewenson (2005) indicated the ways which she has integrated history into the classroom, however, I feel that she has just scratched the surface of what can be done with this medium. One suggestion that could be added to this strategy would be to add present day leaders into the class through visiting lecturers, contemporary journal or news articles. While history is important visualizing current events and efforts for improvement at the local and state level can also inspire. I know that I would love to hear of contemporary educators and leaders ideas and visions for the future. Dossey (2010) states that Florence Nightingale would not want us to focus too heavily on the past but look forward to the future; thus we should look back with pride but forward with vision and anticipation.

Another very vital chapter in Feldman and Greenberg’s book was chapter nine. Morgan, Johnson, and Garrison (2005) report on the importance of the use of reflection in teaching nursing leadership. This is such an important concept for teaching, however it particularly applies to leadership. Morgan et al. note that Schon (1982) emphasizes that reflection enhances nursing skills by allowing the student to relive an experience, think about it, evaluate it, and learn from it. This reflective process promotes learning in the cognitive domain, as well as, the affective domain (Morgan et al., 2005). Consequently, reflection promotes prioritization, clarification and understanding of individual nursing practice (Morgan et al., 2005).

Reflection encourages self-appraisal, fosters critical thinking, encourages values clarification and cultivates communication (Morgan, Johnson, & Garrison, 2005). Reflection also helps students recognize patterns, form relationships, generate hypotheses, provide explanations, and draw conclusions (Morgan et al., 2005). Occasionally, students have a tendency to concentrate only on the problems, which occurred during the experience, while this is appropriate, they should be encouraged to name at least one thing that went well (Morgan et al., 2005). Langley and Brown (2010) note that most researchers value the use of reflection and feel this medium provides nurses with numerous opportunities for growth; trust between teacher and student is vital, however. I love this particular type of exploratory writing and feel that the author’s description and usage is appropriate.

While reflection is a beneficial device for students, one could argue that the addition of a rubric would provide parameters to guide the student’s thoughts and measure outcomes. In this same vein asking students to back up their insights and opinions with references from current sources will ensure optimal growth and educated conclusions. Reflection without guidance and educational expectations offers little opportunity for measurable outcomes and the development of critical thinking.

In conclusion, Dossey (2010) emphasizes that nurses must “communicate to a wider audience. This means learning to write clearly and powerfully, not only for our colleagues but also for patients, consumers, and other health care professionals, about how we as nurses integrate caring and healing” (p.223). Practicing the art of reflection can help develop the skill of writing with insight and passion. This will be particularly important as the nursing profession heads into the future.

References

Dossey, B. M. (2010). Florence Nightingale's vision for health and healing. Journal of Holistic Nursing, 28(4), 221-224. doi:10.1177/0898010110383111

Holmes, C. A. (2008). Historical enquiry and understanding our past. Contemporary Nurse, 30(2), 101-105.

Kearney, G. (2010). We must not forget what we once knew: An exemplar for helping nurses reconnect with their history and rediscover their passion for nursing. Journal of Holistic Nursing, 28(4), 260-262. doi:10.1177/0898010110376322

Langley, M. E., & Brown, S. T. (2010). Perceptions of the use of reflective learning journals in online graduate nursing education. Nursing Education Perspectives, 31(1), 12-17.

Lewenson, S. B. (2005). Chapter 8: Using nursing history to educate for leadership. In H. R. Feldman & M. J. Greenberg (Eds.), Educating nurses for leadership (pp. 101-109). New York, NY: Springer Publishing Company.

Morgan, D. A., Johnson, J. G., & Garrison, D. R. (2005). Chapter 9: Reflective journaling: Bridging the theory-practice gap. In H. R. Feldman & M. J. Greenberg (Eds.), Educating nurses for leadership (pp. 110-118). New York, NY: Springer Publishing Company.

Nursing Theorists ~

Today when I checked the stats on this blog, I found I have had over 5,000 visitors! Thanks for visiting!

I notice that a lot of people are looking up the nursing theorist page. So In an effort to be collegial I want to share my nursing wiki that I have developed for teaching. I have a page on my Nursing Class Wiki that covers most of the major theorists. I am fascinated by them. I found several videos on You Tube and have these on this page. So for all you budding nurse theorist enthusiasts, enjoy!

Nursing Class wiki

By the way, this is a photo of the Yale library. Isn't it beautiful? Someday I want to go there... if only to breathe in the beauty...

Mentoring: To be or not to be...

                                         Mentoring: To be or not to be

      Results of mentor assessments

       The results of the mentor assessment were enlightening. On the one hand, it indicated I am 95% ready to be mentored. This I suspected. I have been on the lookout for a mentor but I often feel reluctant and hesitant to ask anyone to commit to such a task. Personally, I would enjoy the wisdom of an older woman in my life, especially since the deaths of my mother and mother in law. I have missed having older women in my life, who are secure in who they are and what they have been through. Harris and DeSimone (1998) propose that mentors can address life and career development (Vance, 2005).

       Often women of the same age can be quite competitive. This is not what I am looking for at all. Grossman and Valiga (2009) write that often the mentor serves as a mixture of “good parent” and “good friend” by providing counsel during stressful moments, encouragement during challenges, and assistance with the development of professional skills (p.169). Optimally, they serve as exemplary role models and provide honest feedback (Grossman & Valiga, 2005).

       The second part of the survey detailed my personal characteristics and what I am looking for in a mentor relationship. This portion of the survey indicated I value partnerships over competition and am overwhelmingly trusting. I like to question more than being told and my teaching style is also largely learner-centered. I am very tolerant but tend toward enjoying social interaction.

       Having a mentor is not having someone to hold my hand as I negotiate the future. I perceive them more as a comrade in arms. Vance (2005) reflects that teaching and learning go together hand in hand and mentoring is also relational. Further, she purports that the mentor inspires, guides, models, encourages, facilitates, and nurtures (Vance, 2005). Mentoring often is reciprocal, with the mentee also committing to mentor others (Vance, 2005). What a beautiful picture.

      Importance of mentors

       Zilembo and Monterosso (2008) report that our current nursing shortage is global; this shortage combined with an aging nursing force and work recruitment and retention difficulties make it imperative that we proactively begin to recruit and mentor. Recently, as I reflected on my RN-BSN program, I felt that additional guidance would have been so helpful as I searched for and applied to graduate schools. This is an area that I would love to propose to explore in a PhD program. Do our RN-BSN students get the additional guidance and encouragement they need to enter graduate school?

       It appears that undergraduate advisors help steer students but second degree nursing students’ or generational students who opt to enter accelerated programs or RN-BSN programs often are not afforded this guidance. These students frequently work full-time, in conjunction with raising families. Though they may be distracted by familial or financial obligations, they may be more inclined to pursue masters or doctoral degrees, if identified and encouraged. They generally have the bedside experience. Methods of identification and guidance could easily be implemented into the academic environment. This early identification could provide mentors to students interested in continuing their education. What are we doing to capture these motivated students? Are there methods of identification in place? In order to continue to ‘grow’ the profession, the best and brightest need to be gleaned from every level of the nursing educational environment. This activity needs to be purposeful. Chance and individually motivated students will not address this looming shortage. Nursing needs to proactively recruit, support, mentor and educate with an eye on the future. 

      Views supported

       The literature supports the benefits of mentors. Dattilo, Brewer, and Streit (2009) note that new educators need an orientation to the educational environment and after they are acclimated, they need a mentor to help them with their professional goals. Sauter, Johnson, and Gillespie (2009) also report on the need for these same measures. Zilembo and Monterosso (2008) further expound upon the benefits of knowledgeable preceptors who demonstrate leadership skills. And finally, Murphy (2007) proposes that partnering with other faculty can help the novice nurse educator attain success. The literature overwhelmingly points to the benefits of mentors.

       In addition to the benefits of mentors, Vance (2005) points to Erikson’s theory of human development and the stage called generativity to demonstrate that the concept is supported by theory. Jung also purports that the first part of life is spent on an outward journey and the second half of life is spent on an inner journey (Wiggs, 2010). Further Wiggs (2010) quotes Schachter-Shalomi and Miller (1995) as noting:

Many of us are rich without knowing it, because we have not permitted ourselves to examine and take delight in the successes that we planted in the past. When we harvest our lives, we receive return on our investment in the form of inner riches. We see that our work wasn’t in vain; that our relationships have brought forth rich fruit; that our struggles for meaning and value have been worthwhile; and that even our failures, stumbling, and ill-conceived actions unwittingly have led to unexpected successes and to wisdom that is beyond any price tag. (pp. 53–54)

                  Steps to find and become a mentor

       Consequently, it is my goal to continue to look for a mentor and I believe that God will provide. While this may sound simplistic, the literature supports the need for the relationship to be the right fit, so I will be patient (Vance, 2005). Grossman and Valiga (2009) suggest that nurses who wish to find a mentor should reflect upon their strengths and weaknesses and examine their vision, goals, abilities, character and persistence. This I have done. They note that the individuals should be willing to take responsibility, respect confidences, provide feedback, accept constructive criticism and move through the logical phases of a mentoring relationship (Grossman & Valiga, 2009). I am ready for these steps.

       In the mean time, I will continue to help those who ask me for assistance and direction for their plans with school. I will continue to apply myself at work and at school to increase my leadership potential and abilities. I will forge ahead with the plans I have made and follow God’s lead. Lastly, I will continue to enjoy my peer pals, guides and sponsors and try to continue to be the same to those in need (Grossman & Valiga, 2009).

References

Dattilo, J., Brewer, M.  K., & Streit, L. (2009). Voices of experience: Reflections of nurse educators. The Journal of Continuing Education in Nursing, 40(8), 367-370.

Grossman, S. C., & Valiga, T. M. (2009). The new leadership challenge: Creating the future of nursing (3rd ed.). Philadelphia, PA: F.A. Davis Company.

Murphy, J. (2007). Role transition: Using partnerships and cognitive apprenticeship to become a nurse educator. In Moyer, F. (Ed.), Nursing education: Foundations for practice excellence (pp. 265-281).

Sauter, M. K., Johnson, D. R., & Gillespie, N. N. (2009). Educational program evaluation. In D. M. Billings &J. A. Halstead (Eds.), Teaching in nursing: A guide for faculty (3rd ed., pp. 467-511). St. Louis, Missouri: Saunders Elsevier.

Vance, C. (2005). Chapter 7: Leader as mentor. In H. R. Feldman & M. J. Greenberg (Eds.), Educating nurses for leadership (pp. 80-97). New York, NY: Springer Publishing Company.

Wiggs, C. M. (2010). Creating the self: Exploring the life journey of late-midlife women. Journal of Women & Aging, 22, 218-233. doi:10.1080/08952841.2010.495574

Zilembo, M., & Monterosso, L. (2008). Nursing students' perceptions of desirable leadership qualities in nurse preceptors: A descriptive survey. Contemporary Nurse, 27(2), 194-206.