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Welcome to this episode of the NLN podcast Nursing EDge Unscripted the Surface track and thank you for joining us. I would like to formally introduce my colleague Dr. Jenny O'Rourke. She is sitting in for our co-host Dr. Rachel Onello for some time so thank you Jenny for
joining us in this conversation. This episode is entitled, "Celebrating the Year of the Nurse Educator - Revolutionizing Clinical Education Through Partnership," where we will discuss the key role nurse preceptors serve in the transition and socialization of nurses into
their professional roles. We will explore opportunities and examples of how to extend the role of preceptorship beyond serving as a mere pipeline into practice but rather as a bridge to partnership and a pathway to a stronger workforce development. And to help us today we have a very special guest, Nicole Beeson. Nicole is the senior vice president for patient care services and the chief nursing officer at the University of Maryland St. Joseph Medical Center in Towson,
Maryland. Nicole's experience in leadership spans over 15 years and includes work in transplant care and critical care nursing. Nicole was the co-executive lead on the development of the Academy for Clinical Essentials, or ACE program, a program that is redefining the clinical education model by advancing the role of bedside nurses to dually serve as clinical educators. Welcome Nicole, thank you so much for joining us. Thank you. Oh you know I'm really looking forward
to this conversation. When you and I met last week we immediately hit it off. You said the word preceptor and I was done. I was like, yes, this is going to be fantastic and our conversation just started rolling from there. So I'm really looking forward to digging into this with you a bit. And you know, what I wanted to talk about to kind of set us up a little bit is you know there's a wide
continuum of transition to practice. When we say transition to practice it feels like there's just a huge range, right, so it can range from what learners first step put into the classroom to when they transition to their new grad residency programs and then even beyond because there's even a transition so if you were to change into a different nursing specialty or a different clinical area. That's a whole other transition
even if you're an experienced nurse. So I think this transition to practice can be huge and I think there's also several roles that kind of touch this transition of practice along the way. And those roles can be anywhere from academic nurse educator to clinical instructor preceptor and then your professional development clinical educators. And so because this is so big I'd like to just narrow down a little bit to talk about two of these roles, so preceptors
and clinical instructors. And in these two roles we kind of see clinical instructors as being more on the academic side of things and then preceptors being more on the practice side of things. So I'd like to just, if you can just share, just kind of start us off sort of in a broad context, share how you see these two roles and maybe how they intersect if you think that they do.
Absolutely. Thanks for the opportunity. I love talking about this stuff because it really is going to redefine our path forward for our our entire industry and how we, how we bring people into the culture within the hospitals organizations for nurses. And so you use the exact word of continuum and a recognition that it takes a tribe of many resources to ensure our newest members are
set up for success. And so what it felt like is we started to really evaluate how do we really transform our partnerships with our university partners but how do we transform our experience of our newest team members to make sure we're setting
them up for success? Because with vacancies and shortages of staffing and resources so depleted, we wanted to bring team members into the, into the departments, do it well, and set that team member up for long-term success and optimize the outcomes with their patients from day one. And so in doing that, we needed to look at every person, every role that had an intersection with that newest team member to make sure we're setting them up for success from day one.
What we realized is day one wasn't onboarding. Day one started back when they were in nursing school and they were having clinical experiences and that's why we say these preceptors truly are the strength of all educational programs. And maybe we've not been paying as much attention as we maybe should have to this group of people because they are really the the tip of the spear in how we're bringing and investing in our newest team members.
That's fantastic, and I love your analogy of being tip of the spear because again, if you think about this continuum, there's a lot of different people that touch this transitioning role, but the preceptor is like right at the
connection of patient care. Yeah. You know, they're the ones that are just making that final right yeah they are bringing and translating all of the things that we hope to have embedded in the educational model and then they're taking it, dilating into the very final taking it over the finish line and bringing it to that patient and transitioning to a practice where they are independent in their practice.
They have so much to tell us about how that education went though and how often are we tapping into them as the resource and learning from, what it actually looks like when we start translating to ownership of their practice and being on their own there. And you know, but I think about how important this role of being a preceptor and making this connection for the person that's transitioning into their practice to make this connection to patient care.
I think about how sometimes preparation to help our preceptors learn. How to educate can really be sort of sometimes an afterthought and not by any fault of anybody or any program or any organization, but their primary role is patient care, right. So the education piece kind of starts to feel a little peripheral. I mean, how do you, how do you see that in your, in your role or in
your program? Yeah, that's critical and first I'd say that what we're doing right now is taking a look at it's not just about how we educate, but it's how we engage with each learner in a very unique way based on the style of that learner. And these are the soft skills. I don't know that we've necessarily put the resources or the time into developing those with the preceptors that they really understand how to engage differently depending on how the learner really is going to be
optimized. And this is where our partnerships with our university and programs can really help us because that's the expertise on that side, but our preceptors, their expertise is in that department. They understand that area and they understand how to deliver the care. They don't necessarily all understand how to modify the way they're teaching or onboarding based on the very unique learning styles of the different students. Yeah.
So that's you know where you can be a great nurse. We talk about this this a lot, right. You can be a great nurse, but it doesn't mean you're a good educator or a good preceptor or a good any leader, right. So how do you identify like the skill set for who might be the champion preceptors on these units? What are the things you look for in those nurses? Absolutely and I want to be really
transparent. Resources are really depleted and what that used to look like may look very different now because it used to be someone who is a very tenured nurse and maybe very much with lots of clinical expertise and that has shifted so much with how much our staffing across the nation has been depleted. And so now what we're doing is we're saying what are the communication style? Is this someone who seems to have a temperament
to be a strong communicator? Do they have a solid practice standard that we do trust and do they have a willingness into developing you know the tools and the skills of another? And so we're less inclined to pick necessarily always the most tenured team member and we've really decided that we're going to be very willing to look at people less tenured but have strong clinical practice skills and communication skills.
It's shifting and we've had to evolve our mental valleys so to speak that we used to have. You know, I would probably lean on picking the the preceptor that asks the most questions, right. So it's not you know role modeling that you don't know everything and that you know to ask the question that you know where to find the answer. You know who to ask, who to engage can really I think be a huge benefit. And again, you're talking about these you know what's historically
been called soft skills. I feel like we probably need a new name for them because they're pretty critical that's what we do and how we care for our patients, never mind how we teach. But we'll have to have a second podcast talking about brainstorming new words for this.
Absolutely and you know, I just want to call out that while you have a preceptor, honestly, the entire department is onboarding and really has to have buy-in for the success of every single new team member and it's that collaboration that is going to optimize the environment really. That's powerful. Yeah. What are some challenges that you've, you know, you've seen with either of the roles of the instructor or the preceptor?
So just kind of staying with the conversation around the preceptor, first a key thing that we see is exhaustion. These guys are precepting in rapid sequence. We have some people that have been onboarding and precepting consistently for the last two years and so we have to take a look and say what does precepting look like? What additional resources can we get to that space so the full
burden is not on the actual preceptor? And with turnover in general, we know that they they're tired and so you keep calling on the same people. You know, they say no good deed goes unpunished, so the really strong preceptors just keep getting tagged and so we have to be very thoughtful on how we level load that responsibility because it's
profound to do it well. It's a huge responsibility no doubt and so you know there's that there's also in general and how we're intersecting with the clinical instructors and how do we become both clinical instructors and preceptors, which was really the goal of this ACE program is because even the clinical instructors are stretched then. And so how do we optimize the environment for the instructors, the preceptors, and the students that everybody feels successful?
And that really does take the entire organization both the institutional academic institution but also the hospital setting to partner to wrap all of our resources around all the people involved, which does require a high level of collaboration, transparency of what's not working well, how do we do different check-ins in a way to make sure we know how things are going, not just what we think but we actually understand the experience people are having, and giving the
clinical instructors a pathway to communicate when they see something that's just not going well with their students, that they're bringing there. And those really respectful and collaborative relationships are instrumental to optimize these partnerships overall. And for long term and I think in doing that we're modeling at a micro level of what we're trying to do at a macro level across the whole country with our partnerships,
with our academic partners. That's wonderful and you know, what also comes to my mind is how do we help you know our direct patient care nurses not feel like they need to leave the bedside to teach? Yes and so maybe that's where like another intersection could be to keep our you know our best nurses being the best nurses and also exploring teaching and kind of maybe being able to have a clinical ladder in education, much like we also I've seen have a clinical ladder towards
leadership as well. Absolutely. And they can kind of connect, right. I mean, yeah. So you know, Nicole, if you could, that kind of brings me, I heard you mention the ACE program and you know, I think to kind of again give a little bit of context here the clinical education has been pretty static for quite some time. Yes, and it's not changed. You get a clinical instructor on the
academic side. You get eight students. Pair them up, find some assigned units, send them, teach them back, and hopefully everything's great. And you know, there's not a whole lot of literature or you know research that has shown
that that model has worked well. So I just wanted to ask you if you could share a little bit about the ACE program that I've heard you mentioned and also thinking that may be somewhat of a solution that you and your leadership team has come up with to help reinvent the clinical education in
your in your local area. Absolutely. I'm happy to talk about this program and you know I'll start by saying the last two years have proven to us that you have to just try and fail and try again and it's okay because continuing to do the same thing and expecting different results is just we've seen
where that where that gets us all the time. And so you know we were pressure tested and we have over these last two years pressure tested this process of how we onboard and educate and there's been some significant gaps in instructors, in preceptors, all the things and we've seen in the state of Maryland a significant decline in number of nurses applying for licensing
because of our depleted resources. And so you know, Dr. Rowan and Dr. Kirschling, their partnership really has modeled our opportunity with the University of Maryland School of Nursing and the University of Maryland system for us to come together. And they challenged us to say how do we leverage this partnership in a way no one has done this before? Something completely innovative. And so to your point, there's not been a pathway where we said you don't have
to leave the bedside. You can stay on the department you can be part of that team that you feel is your family and you'll hear nurses express that my department is my family they shouldn't have to leave that family to have growth and development. And so with the ACE, or Academy of Clinical Essentials, we've said you are a resource you are an educator and we want to use you to support the onboarding and teaching
of a whole clinical cohort. And so in doing that that one nurse who is a nurse that's employed on that department takes four to six students and those students take a full patient assignment they are there for the full 12-hour shift with that nurse and their students and that they are fully integrated into the model of care delivery on that department.
It's different than anything else you know and the first cohort that we had at St. Joe's I went and saw him and I said how are you doing? It was like their third shift and they said, wow, these 12-hour shifts I'm really tired. I said I know and they said but you know what, we're so lucky we got picked to be in this and I'm so happy we did because I feel like I'm part of the department. They don't feel like they're
visitors. They feel very ingrained in the space and so in doing that because the nursing instructor who is an employee of that department has they can move in a fluid way and they have the relationships there with the team, that the full team embraces this clinical cohort in a different way than a traditional model. That is really exciting, Nicole, and I'm so glad
that you're sharing this with us. You know, when I was in the classroom with learners I taught and coordinated clinical experiences for sort of the adult health middle of the program course and I would explain to the learners so in fundamentals you came in here your first year in the program and here I would draw a map for them. I'm like here you are here's how much you knew you knew this much and it's like a little microscopic dot on the on the whiteboard. And then I would
say, you know, but you've come a long way. You've had some clinical experiences and now here you are in the middle of the program and now you're a bigger dot and then I would explain to them well here's where you're going you know when you get to your practicum experience, where you have this experience with a nurse and you're following the nurses whole patient assignment you're going to get now like a slice of a pizza
pie of experience now. So you're still not getting the whole pie, you're only getting a slice, but and I would say that but now this program how you're describing it I would have to change everything I would say about it because now these learners that I think you're exposing in this program they're getting more of that pizza pie earlier, right. They're getting to see the full spectrum of the nurses role, their
responsibilities. We're pulling back not we you guys are pulling back the curtain a little bit further to help really I think socialize the nurses, these students, into their role, which I think is fantastic.
I'll add to that you know as I one of my hats is simulation that I wear and I often hear the students come out of stimulation and I'll be like wow, that was the first time I felt like a nurse you know because sometimes their clinical opportunities are sometimes they have to be an observer, sometimes they can't do everything that we want them to do in that clinical, but it sounds like through this experience they actually are getting to be the nurse right from
the get-go right and they're living, they're having that lived experience. They're working the whole shift. They're seeing you know the role, the role model of their preceptor instructor, which again I don't think students see that whole side when when they're just working with the nursing instructor versus someone on the floor, so that's really to me very exciting to see the opportunities for the students to like live that experience from day
one. So I can't wait to see the the outcomes as we study this in a longitudinal way to see you know after they've gone through this several times over the course of their their you know two years in the new the intensive program, but they do they get the full gamut all the things, pull back the curtain, and let's deal with reality as it is. And I see them walking around feeling pretty proud of the work that they're doing the instructor but also the students.
Yeah. Yeah. That's fantastic how if you can share a little bit about what have you been hearing from the nurses perspective in their role as kind of preceptor clinical instructor, where this kind of intersects? How are they feeling about it? Absolutely. Well, I think true to our profession, I was surprised but I'm now I'm not surprised as I as I listen to them, but the level of responsibility they feel for this group of clinical students, they are fierce advocates
for the experience. They want to make sure things are going perfectly well. I mean, they are leaning in and embracing the full gamut for that semester and to hear them say you know I'm so glad it's
going that that it's going well. I just feel so much responsibility to make sure it goes well for the students and they own them fully and so when I hear that I'm like, we've done the right thing because we've really given them some responsibility but also the respect for their role and what they have to offer for the group and so that's the first thing is just their level of responsibility, their sharing of how deeply invested they are in the outcomes is really ...
makes me so thrilled to see that. The other thing you know initially there were concerns around the ability for a nurse to have a clinical group of four students and also take care of four patients because that's a lot and this is where the partnership was so important because we needed to PDSA this process a bit make sure
we were setting them up for success. And so now we have a little bit of almost a one week lead time on the front to get things calibrated a bit for them to know the students learn the students learn each other a bit as opposed to just throwing them
right in. And so we're kind of evolving this model but that's and we are building the airplane while we're flying it so to speak, but the instructors are really open to it and by having the the weekly check-ins where our whole group with Dr. Rowan, myself, the other leaders that are leading this initiative, we check in with them and would meet and say how's it going? What do we need to do? How what should we change what's not working?
And we did that on the call with the school of nursing partners as well so that they could hear it on their back end and say okay, what do we need to do on our side to modify our approach? And that's the thing is when you do come up with innovative solutions you also have to not be so wedded to the solution but wedded to the longer term outcomes and be willing to kind of change and
shift as needed. That's fantastic and I think what you're demonstrating is this true definition an example of partnership where you know this wasn't just the hospital organization trying to fix a problem and it wasn't just the academic side just fixing a problem, it really was a solution that came together from the start and then it continues to grow it sounds like and be evaluated together and that I think really helps to cross the aisle
to make this really, like you said, something with really outstanding outcomes that will
continue to evolve and change. And you know, I want to commend you and and your team because I can imagine it's hard to keep you know your head above water when the waves like keep coming and coming and coming but you've been able to really I think extend yourself to be able to really look ahead to start solving these problems of you know short staffing and workload workforce development issues in a very proactive way and I just think that's fantastic so yeah .
Thank you for that and you know it speaks to in leadership the real need to develop strategies to continue to push things forward. It's really easy to get into the grind and keep your head down, but when you're leading people are looking for you to show us the path forward and what is what does our future look like, how do we have some control over our future? The good news is nurses do that
stuff all the time. We're really good at, we're really good at engineering solutions, right and so this is just another example of it, and to go to my leaders at St. Joe's and say hey guys, I know you're precepting all these new hires. I know you're doing all these things, but here's this program and could we find three instructors as well you know and they did it they did it and now they're saying
we're so glad we did. And so my goal is to continue to push things forward a bit and creating this energy and momentum around innovation with our partnerships with the schools of nursing and shifting it because the principles of a partnership that's so invested in the outcomes of every single nursing student are going to be
the path forward. We have a, I mean an imperative for our community that both the schools and the hospitals show this commitment because the community needs the care and the first year turnover rates are a shared responsibility, not just for the hospital, but also for the school as we have this partnership to serve our community.
That is fantastic it'd be really interesting to see, you know, how many of these nursing students end up staying within that organization because I would bet that that experience is so impactful that you are an added benefit as you are growing the next generation within that facility so that would that would be interesting to see and then also
yeah good I yeah. I would expect that but then also, you know, looking at the nurse preceptors just to really, like, you're growing this leadership capacity in them, right, which is just another added benefit and I know many nurses would say we're not lenders we're just nurses right even if they wear the charge hat roll they're still like I'm not, I
don't want to go that leadership route. It's not for me, but you're really like facilitating that growth in them without them even recognizing that. That's what they're doing. They're becoming leaders so that would also be interesting just to see you know after this experience as the confidence in these nurses and their in their own leadership
capacity so it's really exciting. I love that you know we talk about empowerment and in my mind's eye for this year empowerment is creating the pathway for them to really have control and impact the future state because it's felt like for the last two years maybe some
of that power was removed a bit. Yeah. And this is an example of a program that can do that, give them back the keys to their kingdom, which is the future state of nursing by giving them first-hand ability to intersect with our students and they're owning it. It's pretty awesome.
That's fantastic. Well, thank you very much Nicole for sharing your thoughts on preceptors, clinical instructors, clinical education, this wonderful initiative, very innovative initiative the ACE program that was really all born and centered in born out of and centered in partnership so and that's really what we wanted to celebrate in this episode and the other episodes that are part of the Year of the Nurse Educator series. So thank you for
sharing everything and I do thank you. Yeah, definitely. Thank you. And we do have some rapid fire questions that are fun because you know we need to have some fun too when we're doing all this good hard work. If you were to write a memoir what would you title the book? Re-evaluate the Definition of Success Often. That's that PDSA cycle again. Yeah, both personally and professionally you know the marker gets moved and that's okay.
That's fantastic. What is on top of your reading list right now for fun? So I always have two books, one fiction and one non-fiction. And so I'm a big fan of Ryan Holiday and so the one I'm in right now is Courage is Calling. Almost done that book. And then for fiction I've got Paula Hawkins A Slow Fire Burning on my desk right in front of me. Yeah. That's great. You know, we asked these questions so we can build our own libraries and we can steal
good reading ideas so thank you. What is your favorite quote? Never trust your fears. They don't know your strength. Love that. It sits, it's right above my desk actually. Beautiful, beautiful, thank you. And if you could have dinner with one person dead or alive who would it be? Oh that's easy,
Amelia Earhart. I would love to talk to her because you talk about an outlier and fearless pursuit of challenging paradigms and turning everything upside down and doing it her way so I'd love to talk to her about that. That is fantastic. Well thank you for your leadership and your fearless example of just contributing to nursing education and how
it's done and redone and reimagined. It's really just very it's an honor to hear your ideas and to have you come join us for this conversation so thank you so much. My pleasure, nice to be here with you guys. Thanks for the opportunity. Thank you for joining us on this episode of NLN Nursing EDge Unscripted Surface. We hope you join us next time. Until then, remember, whether your water is calm or choppy, stay connected, get vulnerable, and dare to go beneath the surface. [Music]