Written By: Audrey Murray, PhD, RN, CNE
So many of our nursing students enter nursing school with high GPAs ready to conquer the world of nursing. Feeling confident that they will be nurses in a few years, they embark upon nursing courses preparing the same way they prepared for their previous courses. To their dismay, their grades suffer with the first nursing exam. Time for an intervention!
One of the first steps in helping students to perform better is to empower them to be self-learners. They must take responsibility for their learning and performance and we have to take responsibility for helping them get there. We need to perform mutual nonthreatening assessments with the students. When students self-assess, look at things they want to continue and make goals to improve things that can make them perform better, we move from enabling students to empowering them to make the necessary steps to improve performance in class and on exams. Because most of our students have been successful in previous courses, they will continue their prior methods for learning and eventually may fail the nursing course.
Faculty teaching concepts for the first time are having difficulty redirecting students on how to effectively prepare for class. Taking the sum of 2 + 2 and expecting it to always equal four does not work when it comes to teaching or learning in nursing. We are hearing consistently that students need to acquire critical thinking skills and that has progressed to clinical judgment. Students are being tested on that level without adequate preparation on how to take those type of tests. Students are quite verbal in saying that they are expected to answer, “application questions and higher” and they have not been taught how. So, what can faculty do? How can we help faculty help students? Once again mutual nonthreatening self-assessments need to be performed to obtain information that can aid faculty in improving skills and acquiring strategies to improve student learning.
Leadership who develops and implements a plan of action for faculty in a safe environment models the behavior for faculty. Providing ongoing training and feedback encourages learning and gets buy in from faculty to improve skills and levels of facilitation of learning. Training includes the same steps that you use with students. In a mock class environment faculty will learn the concept as it normally functions in the body. This could mean pulling out the old anatomy and physiology book and reviewing body systems and functioning. If they take one concept, look at how it functions normally in the body, how do we measure normal, what clinical manifestations are normal, what diagnostics are normal results? There could be other information that would be used in that mock class that faculty will be required to present. When faculty completes this part of the process, abnormalities can be introduced, and exemplars can be used to show the differences and give a better understanding of the concept. Faculty, in the student role, will work through the process, empowering them to help students.
When working with students who have been unsuccessful, I use this process as remediation and requirements to return to their program of study. Students are to use their course calendars and objectives to address the concepts they are responsible for in that course. They must use adaptive learning resources for remediation, obtaining a mastery level of six to eight for each exemplar under that concept. 70% of their exemplars under the concepts must reach a mastery level of eight.
Initially, students are angry and blaming. They are allowed the time to express themselves in a safe environment to establish rapport. From that conversation, we complete an assessment together and determine that they will be empowered to the point that it does not matter how the “teacher teaches”, they will be prepared and will become self-advocates. They have required monthly meetings with me and must produce different exercises. For example, they must write test questions on the concepts and exemplars that they did poorly on that semester. Therefore, no two students will have the same questions. The questions must be higher level questions with rationale for all options. The confidence of the students at the last meeting had grown exponentially. They tell me they are prepared to conquer the next semester. They know they have an advocate with me and the anger has turned into determination. I am still getting assignments and copies of the completion of their assignments over the summer. I am excited about the increase in their performance and how they will perform this fall.