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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]