NURSING AT McLEAN
Building collaboration between nursing students and nursing staff
by Lori Solon MSN, PMHCNS-BC
Boston College School of Nursing
Boston College places many nursing students at McLean, so no matter the season – the students are coming! Let's be honest. On any busy psychiatric unit, students in nursing or other disciplines are a burden to staff. They ask a ton of questions, they can't administer medications or do checks, and they need time with staff to understand the nurse's role. Yet, we know that there is no other way to become clinically trained; theory and knowledge can be acquired through lectures, but clinical training must occur by working with patients. The process is time-consuming, but we are committed to this productive educational method.
Observation of the nursing staff is an important component of student learning. Students observe staff interacting with patients and regularly attend patient groups and team meetings, but they rarely participate actively. One-to-one patient interactions with the students (active learning process) provide an opportunity to gain significant clinical skills. I have found that when students are actively involved in treatment, the better the learning experience. A challenge for nursing instructors is to creatively enhance the learning experience without causing an additional burden to staff. An example of a creative enhancement is the collaboration with the staff of the Short Term Unit (STU) staff at McLean Hospital that resulted in the formation of a student-led group.
Patient groups are sometimes cancelled when the unit is busy or short- staffed. I saw the opportunity for collaboration between the hospital and our students. First, I asked if a group was needed that I could run with the nursing students on a weekly basis throughout the semester. The staff expressed interest. Together, we assessed that a Wellness Group, which would be ideal for nursing students, would benefit patients. I developed didactic material that was approved by the Clinical Nurse Manager and the STU's Expressive Therapist. The group is structured to impart information about what wellness means, and handouts help patients to develop their own wellness plans. The format encourages health promotion and self-advocacy, and facilitates interpersonal learning and communication. My goal is to teach students how to lead a group and to encourage them to take an increasingly active role as their comfort and competence increase.
Students are naturally apprehensive when I inform them about the group, so I assure them that they can participate in leading as they feel comfortable. I encourage students to signal when they are ready for me to assume a more passive role. Of course, students' readiness does vary. The one downside is that running the group is time-consuming, especially at the beginning of each semester, when the students need more of my time. I have six students on two units and run back and forth each shift to supervise. Being organized helps me to get everything done each week. When I feel too rushed, we shorten the group from 45 to 30 minutes.
Each week, we have a pre-group meeting to discuss the patients and to choose a handout to use. I depend on the students to assess this information. After a group session, we process the dynamics, and the students write a summary in the unit's "group book" and verbally communicate information directly to the charge nurse. Three students are assigned to the STU, but I have only two students participate in the group each week so that the staff-to-patient ratio is not too high. The group usually runs for 45 minutes, and we typically spend from 10-15 minutes before and after to discuss the session.
We have just completed the sixth cycle of students running the group, and the results have been gratifying. The staff appreciates that we assume responsibility for a group, while students are excited about learning to lead. They see their own group skills develop throughout the semester. Many students remark that actively learning to lead a group and developing their own leadership styles are skills they will use, no matter what types of nursing they choose. They learn valuable skills about how to encourage a quiet member to participate; how to set limits on a patient who monopolize; and how to facilitate interaction among members. They assume responsibility for documentation and interact with staff in a meaningful way about problems that arise in the group. The staff often concurs with the students' assessments of the patients or expresses understanding of the struggle to facilitate participation in a "quiet" group. This validation has a positive impact on the students. Throughout the semester, they feel that they are collaborating with the staff in treatment, and they develop a real sense of their value on the unit.
The collaboration between nursing students and nursing staff is not an easy or effortless relationship. It needs to be fostered, and all collaborators must feel that they are getting benefits for their efforts. This group experience has helped us achieve an important goal: the nursing students are gaining confidence and competence, and the nursing staff is getting a patient support group, freeing them up for other important tasks.