Nursing students must juggle competing demands when learning in the hospital setting
The clinical setting can be overwhelming to nursing students. Jumping from the relatively safe confines of the classroom to the noisy, busy, sometimes life-or-death atmosphere of a hospital can cause students to be frazzled. Time management skills, then, are essential.
Realizing the need for time management education, at this year’s National Student Nurses Association annual meeting delegates adopted a resolution “Increased Education Related to Time Management in the Clinical Setting.” The resolution put forth by recent graduate Alexandra Irvin, BSN, Eleanor Mann School of Nursing, University of Arkansas, “encourages the development of nursing curricula to include education and goal oriented activities on time management in the clinical setting and incorporate evidence-based nursing curricula related to this topic.”1
“As I went through nursing school and as I worked as a CNA, I would see the nurses’ workload,” said Irvin. Even after orientation, new grads were overwhelmed and could not manage their time wisely. She continued, “One of things that helped me is that I had worked at a hospital setting before and knew how to prioritize.”
Irvin saw some of her fellow students struggling and that motivated her to write the resolution. She originally presented it to the Arkansas State Board of Nursing and received positive feedback. “Everyone thought it was a good idea” to also present it at NSNA, Irvin noted.
Turning Theory into Practice
Some schools have already incorporated time management lessons into the curriculum. At Irvin’s alma mater, students take a management theory course first semester of their senior year. They learn common time management facilitators, like organization, prioritization, and information literacy, and common time management barriers, like interruptions and not knowing when to say “no.”
At the same time, they are enrolled in a management clinical. “In simulation lab, we implement multi-patient simulations,” said Jaye Henderson, MSN, RN, clinical instructor, Eleanor Mann School of Nursing, University of Arkansas. Students ask themselves, How do I manage this patient assignment? At first, they feel intimidated, but as the class progresses, they feel more prepared. The immersion clinical held second semester senior year takes time management to a higher level. At the end of the course, they are expected to care for a workload of patients under the guidance of a nurse and an instructor.
Delegation is a key part of time management. In the simulation lab and in the clinical setting, students take turns serving in the role of charge nurse. They coordinate and assist in carrying out patient care.
“We try to be proactive from the beginning. It is so critical that students get a good base,” said Lenora Yates, DNP, EdD, MSN, ARNP, MBA, CNE, chair, Generic and Accelerated Option Nursing Programs, Miami-Dade College in Florida. In the second year, students take Med Surg II clinical course. They are assigned two patients the evening before and conduct preliminary research on disease process, treatments, etc. In clinical, the instructor asks questions about the patient and the care plan.
“It gives them a glimpse of what nursing is really like,” Yates explained. They go through stages to learn how to manage their workloads. In the Nursing Leadership course, which is the final course at Miami-Dade College, students increase their patient workload.
“Nurses that don’t have good time management can become overwhelmed,” remarked Henderson. They can burnout managing their shifts and their personal life. “If you practice time management skills from the start of your nursing career, you’re better equipped to handle those long shifts,” explained Irvin.
Nursing students who can’t manage their time well in clinical create burden for instructors, who need to spend more time with them, neglecting other students. Their peers, then, can feel slighted.
Nurses must also be careful managing their time around charting and fulfilling regulations. Those that can’t manage well during their shift can be there late to complete work. Some managers, Yates noted, will not pay overtime rates for extra hours to document.
It’s not just the nursing students who suffer when there is ineffective time management. Patients want things done on time and want their nurse to be confident. “We try to teach students the patient is the reason they are there,” said Yates.
Yet, students can’t get caught up talking to one patient too much. Other patients could need medication, or be in pain and need attention. Beyond the nurse feeling overwhelmed, there are physical dangers to the patients if nurses can’t prioritize.
Prioritizing Patient Care
“With changes in healthcare, nurses will be expected to take care of more patients,” said Henderson. “The clinical setting is not a perfect world.” Patients need to be fed and changed and take medication on schedule, the bed linens need to be changed, the patient can leave the floor for therapy-students need to plan around all these events and other unplanned interruptions. “Instructors help them organize their day to make sure all the treatment and nursing care is delivered appropriately,” explained Yates.
She added, “It can be life or death for patients if workload is not management properly.” Who is bleeding? Who is not breathing well? What are the emergencies?” Those patients take precedence over everyone on the floor. “We teach students how to juggle their time so they have good patient outcomes,” said Yates.
For her part, Irvin would like to see immersion-based clinicals in the majority of schools. “This is something we need to think about if we want to help our nurses,” she said.
1. National Student Nurses Association Resolutions 2015.http://www.nsna.org/Portals/0/Skins/NSNA/pdf/Final%20resolutions%205-2015%20FINAL.pdf. Accessibility verified June 11, 2015.