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Welcome back. Last episode we talked with Kate Boss to get the pulse on acute care nursing practice and its links to nursing education. Thank you for joining us for this part two. So you know I think kind of related to this is this because Kate you talked about this gap
between academia and practice. It's always been there and we're always aspiring to close it and we always have conversations and academia about national first-time pass rates and passing board and it's a really important metric I agree for a lot of different reasons that we don't even have
time to get into. However, it seems like sometimes from my perspective I think we get distracted by this pretty shiny object of what our NCLEX pass rates, first attempt pass rates are for an institution and that may take away from some of our attention around or on practice readiness,
which is related but different. I think that practice readiness is something that you probably experience a lot firsthand when you get clinical groups there when you have new grads when you're working with folks who are on orientation or just coming off orientation so I'm curious to hear from your experience on the practice side what are some of the practice readiness issues that you're seeing either in students who are about to graduate or folks that are
in orientation or getting ready to come off orientation or just fresh novices off orientation? What are some of those things that we need to be aware of in academia to help prepare and support our practice partners? Yeah. Wow. I think in this post or pre or during pandemic I don't even know what kind of world this is but you know in this, during this pandemic we saw a lot of things supply chain
breakdown for all kinds of things. We had to try to figure out...all of a sudden we didn't have medicine that we needed. I remember trying to give medicine to some hospice patients that really needed it for comfort and oh we don't have, it's just not in stock. I was like wait, what? Like that would never happen. In school we don't necessarily learn about
if we don't have X then what do we do. If this...if we don't have an antibiotic, if we don't have a primary tubing then what do we do? I think the things that could help that and could help bridge that gap is - you're gonna love this - but more sim. I mean, more of that in practice, in a safe place where they can make mistakes because it is a learning environment and they're not going to know what to do. More practicum. Longer practicum. Longer programs. I don't even know if
that's possible. They already seem so long but right now I know we're seeing this like push to get students out and into the field and I think that that's a hindrance to them. It was very obvious that they hadn't put their hands on a patient, they hadn't seen real applications what they were doing and when you have students that aren't as strong in a clinical setting and then they graduate and become nurses...are
they ready? And teaching them the other gaps that I see are lack of and I struggled with it too is that interdisciplinary communication. How to get everybody on the same page. How to get the doctor to communicate with the other doctor.
What is their priority because you're telling them all these things are going on but that's not on their mind they're thinking about something else and it's like, okay, well, what is your goal in trying to and to teach that like but for a new grad nurse that's still trying to learn time management and all these things that's hard for them to kind of grasp? To look at a doctor and be like, okay,
well when are you concerned? What are you concerned about because all these other things in the textbook say that that's not good. This potassium is not good but you're not concerned about that, okay. What are you concerned about? I think that if we could solve that answer we could solve nursing education which would be fantastic. That awesome. Let's do that! I also like Kate what you're saying is finding your voice, like helping a new grad
or a learner find their voice. Like you said, to say well, what is your priority? To speak up and to get that shared mental model, this is what I'm thinking is my priority but what's your priority? And now we can maybe broaden our our shared mental model for this situation, for this patient and really get to some probably better solutions and better patient care ultimately. But if you don't have the tools to activate that voice or even the knowledge
you can really be at a deficit. I didn't come up with that saying, somebody taught it to me it was probably my preceptor, and she said okay, well let's ask them when are you concerned because I'm concerned but when are you concerned because we need to be on the same page and when she taught me that phrase I just felt like so in control. It was such a nice feeling because I felt like oh I'm gonna actually find out what the doctors want to know because their
notes are no events overnight. There are a lot of events overnight! It's like, okay, well, when are you concerned and that started to bridge that gap of communication which then ultimately led to better patient care. And here are my concerns and here's why I think a lot of times we don't share the why. Maybe we don't feel empowered, maybe we don't even know the why, maybe we don't know that
other person, the listener needs the why. We just assume that they understand what you're trying to say but I think sharing that could be really helpful. I would also venture to guess that we should be doing more of that in academia. It may stem from a part of that like you said, they may not know the why because how often are we creating space and holding space in our classrooms to model the thinking? We get so much content creep we have to cover
so much breadth of content. Are we creating space for us to be able to model and make thinking visible, buff up the thinking that is faultier, gets folks in trouble, reinforce the good thinking and it brings me back to when we, so Kate - Michelle and I have had opportunities where we'll poll different educators who are in faculty development workshops with us and one of the questions when we do it
with Sue Forneris and one of the questions is what is not happening in your classroom? Because there's just so much going on and a lot of times the themes come out as it's the space for thinking for reflection for and I would paraphrase it into modeling the thinking which comes back to what we're talking about if we're not doing it there then how do they know how to do it in context when they're in practice? Understanding what's salient and important versus all the noise.
Yeah, I don't know if other programs do this but I know that Maryland with our program during our practicum we had many groups and we would meet once a week and we would talk about our clinical experience and you would break down and get us to think about what's next. What if that didn't work, you know, you would help kind of create that critical thinking. I don't know if other programs did that, but I think opened up that space for that thinking and for
those thoughts. Yeah, those are good conversations. I think so and I think it takes a facilitator to ask those open-ended questions, to generate that conversation to keep that moving because I'm familiar with those small group meetings that you're talking about. It can be very easy again for educators to fall into the, okay you've got like five assignments coming up. What's going on? What's happening next?
What's due when? And you can get very task focused and really miss the point of that opportunity for rich dialogue and I fell prey to that too. But I think a lot of students in a lot of the situations and then just in nursing school I mean you're focused on a grade, you're focused on that paper. Am I going to get that A on test?
Am I going to get...I need a B, I need a B. And so they're focused on the test scores and not necessarily on the learning as a whole because they have to get the scores they can pass which those are important too because it helps us standardize and know like okay they're getting this content so it's a double-edged sword, but I find that a lot of students are very focused on their grade and they don't necessarily care what happens clinically, in
a clinical practice situation. They just want to know did they get the information for their care plan, did they get their information for that paper that they have to write. I said, well, no. Let's talk about what happened today. That was really interesting. What did you learn? You got to see X Y and Z. And they're like, well, but my care plan says that I need to write this, this, and this and I need to go so I can write it.
No...like be more excited about the PICC line you got to see pulled or something like that. I agree, I agree and I think and I always wished that we could hold that practicum time sacred the whole semester or whatever that course that practicum experience could be held sacred for just that practicum practical learning that would be generated and enhanced with dialogue. But a lot of times you've got these assignments.
We can talk about curricula too that could be a whole other conversation but when you look at your curriculum as a whole, where are these papers and where do they need to be and how big do they need to be? Do you need to have a 10-page paper in every semester? Does a paper need to be 10 pages? Do you need to have every class have their own paper or assignment?
What does the work of learning look like across an entire curriculum and are there maybe places in the curriculum that could be held very sacred for the practical learning and the reflection and the dialogue that needs to happen to advance their thinking. This ties back to even beyond practicum early on
and think about clinical post-conferences. For the longest time when I would facilitate a clinical based course I tried to not use the word post-conference because I think we can totally reconceptualize when we have these conversations during the course of an assigned clinical day or clinical time frame. Does it have to be at the end of the day as post-conference and what
do those conversations look like? When I had time sitting as a chair of a curriculum committee, it came to my attention that students were saying, well, we were getting pulled off the unit an hour early so that we could do our concept maps to our care plans. Like wait, wait. We need to have a shared mental model about
what is the purpose of clinical learning. Is it to care for patients and build the thinking in context or is it to sit in a conference room at a hospital and fill out a piece of paper? What is the best use of your time and how do we help facilitate the skills and the thinking that we need to be facilitating? It's a whole other conversation. We're not going to get rid of concept maps though, right? Those are fun.
But yeah, no, I agree. You have to think about what is their priority, what are they concerned about? Going back to that same question of do we want to learn clinical practice or do we want to learn how to fill out this form? Yeah and you know and there's a time and a place for that, right? That's helping us put on paper what we can't see in their brain so that's great. People are going to hear this and be like, Rachel Onello is against care plans. No,
no, no. Not at all. But there's a time and a place, right. It gets back to Michelle your comment about looking at this big picture of curriculum development and and how it scaffolded and how do we strategically place things at different times in the right context so that we're taking advantage of the opportunities to learn.
Yeah, you know one of the courses that I was coordinating we went away from the kind of traditional care planning model and had thinking and action tools that were really designed to put the nursing thinking that happens in real time but on a piece of paper that would cue the learner to you know this is the time, it's good to check your labs and this is a good time to look up your medications and this is the good time to... so it would just help unfold an actual nurse's day.
Then what we would do because that was a real time usable tool we would have the learners turn one of them in or two of them a semester so they weren't doing extra work. They were just turning in their thinking tool to get some feedback on their thinking, not for the purposes of going home and making it shiny and beautiful and typing it. I was like, if it's a hot mess it should be a hot mess but the nurse's day you know has a lot of information and does get messy. So let's
see what that looks like. Yeah, we do something very similar and we call it a brain on paper just to highlight the thinking and the decision making so that it can be modeled and reinforced.
That's interesting. It triggered something in my mind going back and thinking in an academic world we're getting the abnormals and we're getting the medications like okay we can give this this or this because the potassium's this, the sodium's this, and the influence this or the blood glucose is this, but in clinical practice you have to think you have to go to your Mar you have to you know the call bell is calling. You have to there are patients are asking
for orange juice. Your glucose is 500. Like no, I'm not getting that. You know they don't want the diet ginger ale but then you're also having to look up your medications making sure everything is correct and knowing when and when to do all of those things and building that time management is something that you don't learn that I think unless you're in a practicum setting.
Also going back to the first conversation you're having is where you know the concept maps and the care plans - those are all very important to learn and to kind of put all the pieces together but you can't because you can't have this next step until you understand that or you can't use that brain and use the next tool before you can kind of do it in your head already.
They are important I'll agree, but you know in that next step or that next setting holding that practicum time sacred and making it more just about the clinical practice so you can learn when to look up your meds, when to look at your labs, and putting them all together and putting the clinic and going to look at the patient, seeing what the patient actually looks like because I'll tell you I saw a patient that had a glucose of 300 and I was like oh they must be
in like DKA. They're walking, talking, having like no issues and they're like, yeah, this is normal. What? That's not what the book says! And so you know putting all the pieces together and seeing the actual patient in that setting too. I would say that's what students struggle with a lot is realizing that the patients
don't read the textbook, right? Yeah, right, so they have to understand how do we help them transition from very concrete novice level thinking to being able to lean into and tolerate the gray and be able to understand those nuances of thinking in clinical practice that you see all the time. You know patients aren't going
to follow the textbook. I think we're circling back in our conversation now to understanding what's the salient concepts and what's the noise and you learn that in context right and and trying to build clinical judgment so I agree. Well this has been a really amazing conversation Kate, so thank you for your time. Thank you. So grateful. We do have some rapid fire fun questions, okay. So are you ready? Sure let's try it. I don't trust Rachel. I know. Do you want want me to kick
off or do you want to? Yes can you go ahead and kick it off and then I'll throw my audible in at the end okay. You have to define audible for everybody else too okay. Okay for the academic world. All right, so if you were to write a memoir what would you title the book? The Life of a Preschool Dropout. My proudest accomplishment.
Awesome. I kind of I really do want to know more about this because I was also a nursery school dropout and I was teased about it and my whole family would be like you couldn't even finish nursery school and I was like nursery school and I was really little I had two older brothers and I got to play with them constantly and then all of a sudden one day we were in for all intents and purposes like a daycare or nursery
school. Me and my brother were separated and I did not like that and so all I did was cry all day and didn't want to I just would if they would let me go sit with him I'd be fine but then the teachers were like no, no, you really need to like have some separation and to be very clear my brothers were not nice to me. They were
her daughter is poof. I feel for her but you know I just wanted to be around them and so I cried and cried and cried and finally my mom said you know this isn't worth it and I came home. I love it. It's very sweet and look at you now. Look at me now. What is on the top of your reading list right now for fun? Well, with a 10 month old I don't do a lot of reading. I have been listening to some podcasts. I'm gonna start listening to y'alls now.
I listen to The Office Ladies. I'm a big Office fan and y'all kind of remind me of it now so that's kind of cute and but I've been reading a lot of the Guide to Feeding Babies and Toddlers so that's on my reading list and how to get babies to sleep. But there is a new Tom Felton Beyond the Wand. I'm a big Harry Potter fan so I'm hoping to get my hands on that for Christmas and spend some time reading it if I can get the baby to sleep.
What is your favorite quote? Oh my favorite quote would have to be, "Goonies never say die." I was a big Goonies fan. We used to watch it all the time growing up so and that was one of my favorite quotes because it's a good one. If you could have dinner with one person dead or alive who would it be? I know I'm supposed to say somebody really famous or cool or influential but I'd probably see my grandma. She passed away before I got married
and I just would like to see her again. Oh, you know Kate we asked that question of everyone and the vast majority are right there with you. It's somebody who was a family member that they loved that had a huge impact on their life and so my heart goes out to you. Thanks. Yeah, my son has red hair like her so I feel like I've got a little piece of her. I'm glad you shared that. Thank you for sharing that because when I saw a picture of him I'm like, hmm,
that's not Travis's hair. That's not Kate's hair. Where did that hair come from? Dark hair and I was like all right well, I wanted a blonde baby but I knew it wasn't going to happen with Travis having such dark curly hair and then he lost all of that and it started coming back red and me and my mom were like what is happening? So every time I look at him I see her a little bit so that's special. So are you ready for my audible? Oh she made me cry on you know podcast. Sure. Go for it.
All right, so for those who are unfamiliar with an audible it's like when the quarterback calls their own play at the line. I'm gonna call the my own play here. The question, all right, so Aiden we put Hogwarts Sorting Hat on him. Where does he go? Oh with the red hair I feel like he'd be a Gryffindor . [Laughter] but I mean I'm definitely a Hufflepuff so but I think Travis is a Gryffindor so he'd be in between I think somewhere. Okay so he's got
dual like he's got dual citizenship. Dual citizenship. Okay, okay I can do that. Yeah, Kate, I have no idea what you all are talking about but I love it. It's adorable. So Michelle, in your free time you're gonna have to watch Harry Potter. Yes, I know before May because I'm going to Universal Studios evidently. Oh yeah. Isn't there a Harry Potter thing there? There is. I went after nursing school and that's where I wanted to go. My mom said when you graduate what do you want
to do? And I said I want to go to Harry Potter World so she and I went to Harry Potter World and Travis and I had just started dating and as my graduation present he got me one of the wands that like do the magical things there which was pretty awesome so I think that's when I knew he was a keeper. That is so awesome.
Well Kate, it has been an absolute pleasure as someone who has seen you grow from your very first semester in nursing school to a very experienced, confident, wonderful nurse that you are today. I am just so proud of the journey that I've gotten to sit back and watch this journey you're taking and I can't wait to see where you continue to go. Thanks so much for spending time
with us. Thank you. It's been wonderful catching up and just talking with you guys both about things that we're passionate about and I hope this continues. This is awesome. Thanks. 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.