# data[].attributes.attachment_link.title
Preparation of academic nurse educators.

# data[].attributes.headline
Meeting the Professional Development Needs of Night Shift Nurses with a Night Shift Clinical Nurse Education Specialist

# data[].attributes.subject
Meeting the Professional Development Needs of Night Shift Nurses with a Night Shift Clinical Nurse Education Specialist

# data[].attributes.body
This was created by my preceptor!

# data[].attributes.headline
Implementing a Night Shift Clinical Nurse Specialist

# data[].attributes.subject
Implementing a Night Shift Clinical Nurse Specialist

# data[].attributes.attachment_link.readable_text
Night-shift nurses receive fewer educational opportunities and less administrative support than do day-shift staff, tend to be newer, with less experience and fewer resources, and experience greater turnover rates, stress, and procedural errors. In an attempt to bridge the gap between day- and night-shift nursing, a night-shift clinical nurse specialist (CNS) position was created in a midsized, community teaching hospital. The goal was to provide an advanced practice presence to improve patient outcomes, communication, education, and cost-effectiveness. The night-shift CNS participated in nursing education and skill certifications, communicated new procedures and information, and created a communication committee specifically for night-shift nurses. Through regular rounding and on-call notification, the CNS was available to every area of the hospital for consultation and clinical assistance and assisted with rapid responses, codes, and traumas. Providing education during night shift reduced overtime costs and increased morale, positively affecting turnover rates. The night-shift CNS position has improved morale and equalized support for night-shift nurses. More research, most notably in specific night-shift metrics, is necessary, and with the implementation of the role in additional facilities, more can be understood about improving patient care and nursing staff satisfaction during night shift.

# data[].attributes.attachment_link.title
Implementing a night-shift clinical nurse specialist.

# data[].attributes.attachment_link.description
Night-shift nurses receive fewer educational opportunities and less administrative support than do day-shift staff, tend to be newer, with less experience and fewer resources, and experience greater turnover rates, stress, and procedural errors. In an attempt to bridge the gap between day- and night-shift nursing, a night-shift clinical nurse specialist (CNS) position was created in a midsized, community teaching hospital.

# data[].attributes.headline
Night Shift Nursing Education and Effects on Job Satisfaction

# data[].attributes.subject
Night Shift Nursing Education and Effects on Job Satisfaction

# data[].attributes.attachment_link.readable_text
A Capstone Prospectus Presented to the Faculty of the Department of Nursing of Western Governors University In Partial Fulfillment of the Requirements for the Degree of Master of Science in Nursing Education Specialty

Abstract

Continuing nursing education, professional development, and employer-required annual competencies is expected and often mandated to retain employment and/or licensure. This inductive cross-sectional critical action design used mixed methods to examine the effect of offering required education during night time hours on job satisfaction. Voluntary involvement consisted of completing a pre-intervention Likert-scale job satisfaction survey, attendance at two facility-required courses conducted on night shift, and a post-intervention survey. Purposive sampling was utilized to gather nurses whose normal work hours were either evening or night shift. The intervention was attendance at a Basic Life Support Renewal course and a Surviving Sepsis competency review, which are commonly-required courses. The post-intervention Likert-scale job satisfaction survey revealed that attendance did have a positive impact on job satisfaction of the night shift nurses with a confidence level of p<.01. it is recommended that the facility continue to offer required education during normal work hours of night shift. also strongly expand this other facilities.>

Acknowledgements

I would like to sincerely thank student mentor, Michelle Killingsworth, CNM, MSN for her assistance during most of my master's degree program. We were there for each other during some emotionally distressful personal life changes. More recently, Dr. Tori Canillas-Dufau, Jillian Reagan, and Christine Hadsell have been instrumental in the writing process of my Capstone.

To Alison Preston, RN MS; Gloria Castillo, RN MN and many of my colleagues, I appreciate your encouragement as well. To Linda J. Heitel-Dozier, RN MN, you were my first professional mentor. You are the ultimate example of a well-educated nursing professional with an unwavering commitment to academic and clinical excellence. No matter how long it was between our conversations, you always extended an encouraging word. I appreciate you!

My adult children - Davina Johnson, Kenneth Staples, and Charlene Chambers - you kept me motivated during this long process. To my dear friend, Alfred J. Marshall, DD, we encouraged each other through our seemingly unending academic pursuits. Wayne Hemphill, my Champion, I thank you for keeping me focused and making sure I did not get distracted from this goal. Lindzie Martin, my Precious Friend, your input is appreciated. Omega Mills, you kept me laughing when I felt like crying. I love you all!

Last, but certainly not least, I extend a posthumous heart-felt appreciation to my pastor, Dr. Billy G. Ingram, PhD. His constant encouragement to do what I love and his messages to live life to the fullest are the main reasons I made a career change. He truly practiced what he preached! I love you, PB. May you rest in eternal shalom.

Chapter 1: Introduction to the Problem

Introduction

There are many courses for nurses in professional development, continuing education, and employer-required annual competencies that are available. Of all bedside nurses, about half work evening shift from 1500-2330, traditional night shift from 2300-0730 or 12-hour night shift from 1900-0730. Since most of the available live nursing education is only offered during day hours, the evening and night shift nurses find themselves abruptly adjusting their sleep patterns to attend required courses. As a result, night shift nurses often have lower job satisfaction than their co-workers and experience a higher level of job-related stress (Golubic, Milosevic, Knezevic, & Mustajbegovic, 2009). After all, if nearly half the bedside nurses work at night, more required coursework should be made available during their normal work hours. The purpose of this study was to offer some required coursework at night, and showed that doing so had a statistically significant positive effect on job satisfaction, p

Using an inductive cross-sectional critical action design with mixed methods, a Likert-scale job satisfaction survey (see Table 1) was administered to a randomly-selected purposive sample of day shift and night shift nurses. All participants were administered a Demographic Questionnaire (see Table 2). Only the evening and night shift nurses attended two employer required courses during the night shift and were asked to complete a post-intervention job satisfaction survey, and an unstructured interview (see Table 3). The interventions took place over approximately two months with both Basic Life Support ( BLS) and Surviving Sepsis Competency courses presented at times suggested by the majority of the participants. This data supports the prediction that access to required coursework during the normal work hours of the night shift staff would positively impact job satisfaction. Responses from the unstructured questions were utilized to deliver additional employer-required courses during the night shift.

Topic Presentation

The topic for this Capstone was to offer commonly required courses at night and test for impact on job satisfaction. Purposive sampling was used to select participants whose normal work hours are at night from approximately 1900-0730 or evenings from 1500-2330. The researcher obtained participants from a home care company where she is on the Board of Directors, and from a major online nursing website where she is a member. The home care company is in a small coastal community surrounded by a large metropolis. The online nursing forum members live around the world. However, all respondents practice nursing in the United States.

Hospital-based educators and other nursing education providers have a vital role in developing and delivering evidence-based curricula that meets educational and regulatory needs of their clients. Due to the increasing complexity and constant evolvement of health care, educators must find innovative methods to reach and teach their colleagues (Benner, 2012). It can be a daunting challenge to remain relevant with both content and delivery methods. Continuing education is touted by nursing professionals so that nurses can implement best practices and achieve excellent patient outcomes (NursingWorld, 2013). Perhaps the most challenging aspect is for educators to ensure that whatever is taught in the classroom leads to patients becoming and staying healthier (HealthyPeople2020).

With increasing employer demand for nurses to obtain academic advancement and specialty certifications, there has been an increasing demand for educators who are academically prepared, with a graduate degree in nursing preferred among many acute facilities.

Topic Choice

The topic of how night time attendance affects job satisfaction is an intriguing subject to this author. Her first nursing position was on 12-hour night shift, and she needed to attend employer-required classes. Since these classes were not offered at night, she and her co-workers expressed dissatisfaction with the lack of conveniently scheduled classes. During her undergraduate coursework, this author decided to teach one required class at night. Her co-workers were delighted about this. In fact, the response was so positive that this author started an entrepreneurial venture that focused on providing nursing-related courses at night.

Topic Impact

As previously stated, employer-required courses are nationwide. Nearly two-thirds of the State Boards of Nursing require 30 hours of Continuing Education (CE) biannually for nurses to renew their licenses (NCSBN.org). Even with the convenience of online courses, there are many nursing skills that must be demonstrated in person. Many full-time hospital-based Nurse Educators work Monday-Friday 0800-1730. This leaves a sizable portion of the bedside work force with precious little convenient access to courses, which is a given for their dayshift counterparts.

The topic of nursing education and its connection to job satisfaction is important because failure to address these needs contributes to more frequent attrition among night shift (Mayes & Schott-Baer, 2010; Gustafsson, Fagerberg, & Asp, 2010). Night shift nurses feel less valued and isolated from their dayshift co-workers (Campbell, Nilsson, & Pilhammar-Andersson, 2008). The author had some personal empirical results from providing education at night, and decided that the topic merited graduate-level research. She believed that her colleagues would benefit from the study as well.

Problem Statement

Less than one-third of the employers represented in the survey offered Annual Competency in an online format. Only two of the participants attended any live coursework during night hours. Some employers enforced completion of Annual Competencies by suspending nurses from working until courses were complete (Norwood, personal communication, February 2013). Being left with few options to attend classes, the nurses disrupted their already-skewed sleeping patterns to be awake, alert and attempt to master material during daytime hours (Norwood, personal communication, February 2013). Night shift and evening shift employees then often have lower job satisfaction than their day shift counterparts (Gustafsson, et al., 2010; Mayes & Schott-Baer, 2010). Registered Nurses ( RN's) are required to complete Annual Competency coursework to be in compliance with the policies of their employer. Of all the non-managerial nurses working in the acute care environment, one-third work night shift from 1900-0730 (Blachowicz, 2006; Claffey, 2006). Since about a third of nurses work at night, more required courses need to be made conveniently accessible to them.

Rationale and Significance of Study

In the past two years, some night time in-services and skills demonstrations have been provided by the Clinical Nurse Educator of one facility surveyed. However, the consistency, availability and content of these in-services have been sporadic at best. Although there is computerized self-study software in place at that facility, the skill demonstrations must be done in person. Additionally, partly due to paper tracking methods and partly due to other job demands of the Educator, a lot of manpower was involved to ensure courses were delivered to all the per diem and part-time staff (Sousa, personal communication, October 2012). In short, there have been few learner-driven courses and certainly fewer still delivered on night shift when almost half of the bedside nurses are working. The subject area was annual competencies, BLS courses, and disease-specific standards of care. The level was for all professional nurses. The cause of the problem is lack of required courses which are offered during night hours.

Research Questions

The research questions were: How will offering required coursework at night affect job satisfaction? Further, is there a statistically significant difference in job satisfaction between the shifts? Secondly, what kind of courses/training could feasibly be offered during the evening and night hours?

Purpose of the Study

The purpose of this cross-sectional critical action research project was to implement required nursing courses during the normal work hours of the night shift nurse, and to test for significant positive effect on job satisfaction after the intervention. In an initial phase of developing required curricula offered at night, a need was ascertained to investigate types of nursing courses accessed, staff's perception of facility-offered education and the effect of facility-delivered education on job satisfaction. The level of focus is cross-sectional.

Definition of terms

For this study, the following terms are employed: Annual Competency: Skills testing, safety, nursing-related policy & procedure review, restraints; HIPAA, etc. that must be completed annually ( Core Competencies in Nursing | Nurse Competency).

HIPAA: Health Insurance Portability and Accountability Act, Federal law regulating use and disclosure of a person's health and financial information ( HIPAA Compliance: Regulations, Standards, Certification, Training for 2015)

Intervention/Implementation: Nursing profession term meaning what the nurse does for the patient. In this case, the intervention was the education (NANDA.org)

Learning Management System (LMS): Computerized education modules that can often be customized. These also have standardized evaluation tools available (Beavis, Morgan, & Pickering, 2012).

Night shift: Normal work hours starting at 1830-1930 and ending at 0700-0800 (Blachowicz, & Letizia, 2006; Claffey, 2006).

Summary

Lack of access to required education is a major problem for night shift nurses. Studies indicate that night shift nurses have more health problems, lower job satisfaction, and report more stress than their day shift counterparts (Cooper, 2003; Campbell et al., 2008; Keller, 2009). Although there is a great deal of education offered during day time hours, the night shift nurses endure more stress because they must abruptly adjust their sleep schedules to attend available classes. The purpose of this research was to offer required education during the normal work hours of night shift, and test for a statistically significant improvement in job satisfaction.

Chapter 2: Literature Review

Introduction

Professional peer-reviewed journals were reviewed and utilized in this paper. All the articles were relevant to this paper. Some articles were specific to nursing education at night. Although most literature reviewed was not specifically about education at night, it was selected because of common challenges faced by night shift work. Search terms such as night shift, education, training, annual competencies, and job satisfaction were chosen. About half of the sources were within five years old. Older articles were selected because of their relevance to this study. The credentials and affiliations of the authors were examined. Many of the authors had university or fellow affiliations, and a few were frequent contributors to nursing education and advanced practice nursing journals.

Although several of the studies were conducted in the United States and Canada, other countries were also represented, such as Australia, Croatia, Sweden, England, and France. Access to staff development and professional education on night shift is limited in these other countries as well. Therefore, it was considered important to include studies from these additional countries.

Educational Requirements

Boards of Registered Nursing (BRN) requirements for obtaining licensure as an RN vary widely among the states. Some, like California, permit licensure after completing an Associate Degree program. Others like Kansas often have entry-level Bachelor Degree programs (ksbn.org). All states mandate a passing score on the National Council of Licensure Examination (NCLEX) prior to becoming licensed as an RN (ncsbn.org). Additionally, the states differ in their requirement of Continuing Education (CE). For example, California requires nurses to take 30 hours of CE every two years ( Board of Registered Nursing - License/Certificate Renewal). Missouri has no CE requirement ( Board of Nursing). Nonetheless, almost every employer requires biannual American Heart Association (AHA) Basic Life Support ( BLS) as well as Annual Competencies. These can be related to patient safety, fire safety, medication administration, equipment training, etc. The Annual Competencies of one studied facility included HIPAA, several courses to comply with The Joint Commission's (TJC) National Patient Safety Goals ( http://www.jointcommission.org/assets/1/6/2013_HAP_NPSG_final_10-23.pdf), and fire safety procedures ( www.fireengineering.com).

Classroom =/= Clinical

In a landmark study, Patricia Benner reveals that an innovative change in nursing education is needed (Benner, Sutphen, Leonard, & Day, 2009.). This research found that nursing education often did not stay relevant with complexities of bedside practice (Benner, et al., 2009.). These authors recommended increased utilization of simulation, coaching, and one year of nursing residency (Benner, et al., 2009). Further, classroom preparation and clinical reality do not correlate (DNP Interview with Patricia Benner).

Consistent Curricula & Assessment Tools

Several studies reviewed have highlighted an emphasis on competency-based education. Competency-based nursing education has been widely implemented in the United States. Many articles reviewed cited the importance of consistently developed curricula and standardized assessment tools (Barriball & While, 1996; Campbell et al., 2008; Taylor, 2000). For example, AHA BLS uses evidence-based curricula, student skill demonstration and a written test to assess learner competency ( www.heart.org). Further, when education was learner-focused, implementation was faster (McCarthy, 2004; Gustafsson, Fagerberg, & Asp, 2010; Mayes & Schott-Baer, 2010; Stewart, Snyder, & Sullivan, 2010). Perceived usefulness increased and behavior adaptation was longer and observed in more staff than without learner input (Gustaffson, et al., 2010).

Adults need to know the rationale behind the education (Gay, Mills, & Airasian, 2009). Adult learning is also retained longer if the learner can immediately implement what was learned (Gay, et al., 2009). Conversely, staff felt unprepared and uncertain when too much time had passed between education on operation of a new piece of equipment and actually using it (Sousa, personal communication, October, 2012). After mandating education on this new equipment, management decided to use up the supplies from the old machine first (Norwood, personal communication, November, 2012). The nurses expressed frustration that they were not informed of management's decision to delay utilizing this new machine (Norwood, personal communication, November, 2012).

Why Competency-based Education?

An Australian study published in 2012 found that using an online Learning Management System (LMS) simultaneously addressed several needs of the hospitals studied (Beavis, Morgan, & Pickering, 2012). Nursing staff completed their Annual Competencies in record time - 3 weeks vs. 10 months (Beavis et al., 2012). Some of the benefits realized included flexible delivery of the curricula, facilitation of collaborative learning, cost effectiveness, and allowed rapid tracking of scores and completion times (Beavis et al., 2012). Several barriers were also identified which included slow internet access, interruptions at the workplace, and access to computers at the workplace (Beavis et al., 2012). Student evaluations revealed that despite the barriers, the staff enjoyed having some control over when and where they took Annual Competencies (Beavis et al., 2012). Further, the Nursing Education staff discovered that the LMS relieved them from tedious follow-up with the floor nurses (Beavis et al., 2012). Nursing Educators commented that using the LMS was an adjunct to part-time and day hour human educators (Beavis et al., 2012).

Competency-based education has already been widely implemented in the nursing profession as beginning nursing instruction, assuring current practice competency, and in advanced practice as nursing management education (Lenburg, 1999; Paranhos & Mendes, 2010; Pillay, 2010). Further, competency-based education is one method utilized to guide a nurse's professional development (Donley & Flaherty, 2008). For a brief overview of the rationale driving competency-based education at the undergraduate and graduate level, one may visit the website of Western Governors University ( http://www.wgu.edu/why_WGU/competency_based_approach). In short, this approach allows students to demonstrate competency in various subjects and earn their degrees quicker than with other methods ( www.wgu.edu). Not only do competency-based courses allow quick completion, they also motivate the learner to immediately put the material into practice.

Although the general adoption of competency-based adult education is relatively new, the concept was perhaps initially discussed by Benjamin Bloom in 1956. Bloom postulated that a six-level hierarchy of learning exists (Clark, 2013). Competency-based education is focused on the third level, Application, and the fourth level, Analysis. These two levels correspond with the passing level of the NCLEX (ncsbn.org).

An example of a student-focused competency-based learning objective is: Student will demonstrate correct performance of measuring a client's blood pressure. Each of the three learning domains - cognitive, affective, and psychomotor - can be readily evaluated (Clark, 2013). The cognitive domain was assessed by asking the student to describe normal ranges for blood pressure. The affective domain was assessed by having the student discuss the patient's stress-related implications on blood pressure. The psychomotor domain was evaluated by observing the student checking a patient's blood pressure and obtaining results that are within five points of systolic/diastolic readings (McDonald, 2007).

Accessibility

A study by Barriball & While (1996) revealed that night shift nurses attend professional development and continuing education courses less frequently than their day shift counterparts. The authors also found that lack of consistently developed curricula and standardized assessment of educational effectiveness was a deterrent (Barriball & While, 1996). A more recent study highlights the lack of accessible continuing and professional education during night shift (Mayes & Schott-Baer, 2010). The specific learning needs of the night shift worker had not been adequately researched (Mayes & Schott-Baer, 2010). Further, one study indicated that on-duty night shift nurses cannot easily leave their units to attend courses (McCarthy, 2004). McCarthy devised a means to meet this need by bringing night time in-services directly to the night shift nurses (McCarthy, 2004). A Swedish study examined effective methods of educating night shift nurses (Campbell et al., 2008). It also illustrated the importance of teamwork as it relates to bedside nursing (Campbell, et al., 2008).

Slowed Recovery After 12-hour Shifts

In 2003, Cooper discussed the physical impact of working 12-hour shifts (Cooper, 2003). She accurately predicted that, by the year 2010, forty percent of active nurses would be at least 40 years old (Cooper, 2003). The body's ability to recover after working extended hours dramatically decreases after age 40 (Cooper, 2003). A newer study by Keller (2009) also revealed that innovative methods must be implemented to assist nurses to adapt to increasing work demands (Keller, 2009). Keller postulated that retention of older, more educated nurses depends on creative retention strategies (Keller, 2009).

Impact of Education After Dark

One source reviewed highlighted a case study of BLS training offered at night (Mayes & Schott-Baer, 2010). This source described the lack of access to education during night hours (Mayes & Schott-Baer, 2010). Post-education questionnaires revealed that staff was motivated and impressed about receiving required training at night (Mayes & Schott-Baer, 2010). Another article published in 2010 discusses the staff-initiated journal clubs that were attended by night shift nurses (Stewart, Snyder & Sullivan, 2010). This group decided when and how often to meet, as well as collaborated on discussions of evidence-based practice (Stewart et al., 2010). The staff was recognized by management because of their rapid implementation of the evidence-based practice (Stewart et al., 2010).

The Education-Job Satisfaction Connection

One of the international studies supported a theory that higher-educated nurses are more satisfied with their jobs (Golubic, Milosevic, Knezevic & Mustajbegovic, 2009). It supports the assertion that higher educated nurses attend more professional workshops than their less-educated counterparts (Golubic, et al., 2009). A second international study revealed that night shift nurses who felt autonomous, appreciated and supported by management also had higher levels of job satisfaction than those who did not (Gustafsson, Fagerberg, & Asp, 2010). This article as well as two others concur that supportive leadership is a major factor in night shift job satisfaction (Gustafsson, et al., 2010; Blachowicz & Letizia, 2006; Claffey, 2006).

An Australian study also showed a link between education and work attitudes (Johnson, Hong, Groth, & Parker, 2011). This study also pointed out that learner input improved both participation in the research and the continued performance of the material (Johnson, et al., 2011). Besides having more physical ailments than their counterparts, night shift nurses experience fatigue and sleep deprivation more often. (Blachowicz & Letizia, 2006; Claffey, 2006). Both these sources recommend that night workers maintain their sleep schedules, even when not working (Blachowicz & Letizia, 2006; Claffey, 2006).

Summary

While the factors that influence job satisfaction of night shift nurses are varied, convenient access to required education is important. Whatever time education is offered, it needs to have consistent curricula and standardized assessment tools. Education is most effective when the adult learner participates in the planning and teaching process.

Chapter 3: Methodology

Introduction

This chapter discusses the methodology used for this critical action design. It describes the target audience and learners. The role of the participants and the groupings are articulated. The settings are carefully described. The methods, types of data collection, instruments utilized, and kinds of data analysis are also discussed.

Research Design and Approach

Based on the problem, the proposed research questions, and goals, an inductive cross-sectional critical action approach was utilized. Both quantitative and qualitative data were collected. According to Gay, Mills, and Airasian (2009), this study meets the critical action perspective because it was participatory (night shift nurses) and democratic (the participants had input on what times the in-services took place). It was socially responsive because it addressed the learning needs of professional nurses, and it took place in the context of the facility where the participants practice (Gay et al., 2009). In addition, it was relevant to the night shift nurses because it investigated a problem they actually have (lack of convenient access to required courses) (Gay et al., 2009). It was accessible because the study evaluated the participant's use and perceptions of any professionally-oriented courses over the past two years.

Further, the study met the critical action component of examining the general practice of day time content delivery because it adapted curricula to the specific learning needs of night shift nurses and studied the impact on job satisfaction (Gay et al., 2009). Lastly, this study was appropriate for action research because a strategy is presented to guide other nurse educators with launching required course work at night (Gay et al., 2009).

Setting

One setting was a home care company with 42 part-time and full-time nurses. The other utilized the membership of a well-known nursing social media website. The online participants worked in a variety of settings, and are located across the United States.

Sampling techniques and participant demographics

Purposive sampling was used to obtain participants who are nurses whose work schedule is at night (1900-0730) or evenings (1500-2330). Full-time and part-time employees participated. Members' ages were from early 20's to 60+ and consisted of various cultures. Males and females were represented as they existed in the facility's work force. Sample size was 26. The night shift sample was given the job satisfaction survey after the intervention to illustrate significance. The educational level was at least diploma, and included employees with undergraduate or graduate degrees.

Appropriateness of sampling techniques

Purposive sampling was most appropriate because this study was about assessing and addressing the learning needs and job satisfaction of a specific group of people (nurses who work nights) (Gay, et al., 2009).

Research questions

1. How did offering required coursework at night affect job satisfaction?

2. What kind of courses/training could feasibly be offered during these hours?

Data Collection Methods

This study utilized questionnaires regarding the participant's frequency of attendance, perceived bedside usefulness, and attitudes about Annual Competencies. The author prepared the survey using Google docs, and results were automatically tabulated into an Excel spreadsheet. This technique nearly eliminated mathematical error, bias and pre-conceived notions about results. A pre- and post-intervention survey was used to assess job satisfaction of participants. Job satisfaction was queried from a similar number of day shift nurses, and compared to with those of the night shift participants.

Quantitative data consisted of nurse's existing education, plans for pursuit of advanced education or professional certifications, and length of time of employment as a nurse (see Table 2). Qualitative data consisted of opinions about perceived usefulness of facility-required education, job satisfaction, and opinions about management's support of educational goals and keeping staff informed regarding work-related topics (see Table 1). Instruments

A Likert scale using five degrees of satisfaction was used for the job satisfaction surveys (see Table 1). Interviews were conducted to assess participant's attendance and perceived usefulness of mandated education. Additionally, night shift nurses were asked for their input on what job-related education they would like offered in the future and what times would be most convenient to attend these courses (see Table 3). The researcher utilized the two most frequently suggested times to deliver the Basic Life Support ( BLS) Renewal class and the Surviving Sepsis Competency review. A post-intervention job satisfaction survey was conducted with the night shift staff.

Data Collected

Primary data collection methods were used for this query. This method was most useful to obtain the answers to the research questions. Survey research is determined as best when one desires to obtain opinions and beliefs about a topic, such as job satisfaction (Gay et al., 2009). Quantitative data were collected to tabulate what degree or diploma participants had, and how long they have been licensed (see Table 2). Specifically, most of the quantitative data were ordinal, which were converted to interval for ease of analysis. The job satisfaction survey was an eight-item Likert scale using five levels of satisfaction (Table 1). The job satisfaction survey, adapted (NBRII, 2012) and author-customized, was given to a randomly-selected purposive sample of day shift nurses and night shift nurses. Responses from each of the eight questions were calculated within the groups and compared among both groups using a one-way and repeated-measures analysis of variance (ANOVA) (Table 4). The one-way and repeated-measures ANOVA are Table 6 and Table 8, respectively.

A pre-intervention and post-intervention job satisfaction survey was administered to the night shift participants and compared to illustrate improvement in job satisfaction. The data analysis allowed the researcher to compare an individual's change in job satisfaction, as well as compare responses from the two shifts. The researcher desired to test the empirical belief that a difference in job satisfaction existed between the day shift and the night shift employees. Highest possible points on the Likert scale job satisfaction survey was 40 (eight "strongly agree" questions ranked at five points each). This allowed ordinal data to be converted to interval data. The level of significance for this study was arbitrarily determined to be p= .05. An F statistic was calculated, and compared to a t critical value table with df 1, 25. Standard statistical analysis teaches that if the F is greater than or equal to t crit, the null hypothesis is rejected, i.e., offering night classes had no effect on job satisfaction (Thorne & Giesen, 2003). Pre-intervention interviews with participants were conducted to ascertain use and access of continuing education or other required courses (Table 2). The interviews consisted of unstructured questions (Table 3). Qualitative answers to the open-ended questions were coded and grouped into themes.

Post-intervention unstructured interviews were held with participants to clarify researcher concerns, and to explore changes in levels of job satisfaction. Interviews lasted between 10-30 minutes, and were digitally recorded for later transcription. Samples of the open-ended post-intervention interview questions can be found on Table 3.

Research Procedure

Prior to the beginning of this study, necessary facility permissions were obtained from the Vice President of Operations, who was consulted regarding regulatory and logistical concerns (Appendix D). Organizational approval was also received from the Administrator at a respected nursing website (Appendix D). Informed Consent was obtained from all participants (Appendix A).

A job satisfaction survey was given to 26 active full-time and part-time nurses (see Table 1). The study survey was available for approximately 30 days online. After receiving sufficient participants, the link to the survey was closed.

Rationale for Offering AHA BLS Courses

American Heart Association (AHA) Basic Life Support ( BLS) is a bi-annual requirement of almost every health care provider. Materials are evidence-based, pre-packaged and easily teachable. The author has been a BLS Instructor for six years, and attends Emergency Cardiovascular Care updates every two years. The staff attending these classes did not pay any tuition fees, but they did purchase the cards and Student Handbook.

Rationale for Offering Sepsis Competencies

The author has previously utilized protocols from the internationally-recognized Surviving Sepsis Campaign (Ehrig, 2011). These materials are evidence-based ( www.SurvivingSepsis.org). Re-using previously developed materials was a time-saving strategy. When treating patients with sepsis, all facilities visited by this researcher utilized protocols similar to those of Surviving Sepsis. Sepsis prevention and treatment protocols are frequently part of a facility's Annual Competency training. The curricula met or exceeded regulatory requirements.

Timeline

The time from facility and VP approval to participant selection lasted two weeks. Information sessions and Informed Consents took place over two separate weekend nights. Job Satisfaction surveys (Table 1) were given to the selected participants on two separate weekend days, and on two separate weekend nights to the selected night shift nurses at the time of the information sessions. The Demographic Questions (Table 2) were conducted at the time of the information sessions. The BLS Renewal Classes were scheduled a week apart. The Surviving Sepsis courses were offered a week apart on different nights than the BLS classes. BLS and Surviving Sepsis courses were offered at the times suggested/recommended by the majority of the participants. Post-intervention job satisfaction surveys were administered immediately following the last course. From participant selection to completion of the data analysis took about four months.

Researcher's Role and Bias

The researcher's role was to conduct the study according to accepted scientific research principles. She designed the interviews, collected quantitative data on participant's attendance, delivered the coursework during night hours, evaluated and verified results, and implemented the instructional materials guided by the unique learning needs of the participants. One author bias was that she has been a night shift nurse required to attend Professional Development, Annual Competencies, and other mandatory education. Due to the fact that these courses were not offered during night time hours, she and her night shift co-workers needed to abruptly adjust their sleeping patterns to attend during the day. The author and her co-workers expressed general job dissatisfaction because required courses were not available during the normal working hours of a sizable portion of the workforce, which is a given for their day shift counterparts. If nearly half of the bedside workforce works at night, then an equal share of required education needs to be offered at night.

Data Analysis

The purpose of this study was to offer required nursing courses during the normal work hours of the night shift nurse, and to test for significance on improving job satisfaction. Quantitative data was analyzed by using ANOVA. This allows an objective means to review the results from the Demographic Interview (Table 2). Responses to the non-structured Post Intervention Interview (Table 3) were coded and grouped into themes as they developed. Common themes were analyzed by inferential methods. Responses from the qualitative Job Satisfaction Survey (Table 1) were input on a Microsoft Excel spreadsheet. Qualitative data such as Job Satisfaction can be converted to quantitative data by assigning numerical labels to each level of agreement.

The author labeled the response "Strongly Agree" as a 5, "Agree" as a 4, and so on. This method allowed an arithmetic calculation of each person's Job Satisfaction score. In this study, an individual could have a maximum satisfaction score of 40 (eight questions answered as "Strongly Agree") and a minimum of 8 (eight questions answered as "Strongly Disagree"). The author desired to compare pre- and post- intervention scores and test for significance. Therefore, a repeated- measures ANOVA was performed and compared to t crit (Table 8). Further, the author desired to test the belief that a difference in job satisfaction exists between the two shifts. Job Satisfaction ratings were obtained from all participants and grouped by which shift the nurses worked. Then, a one-way ANOVA was used to test this belief (Table 6).

Human Subjects Protection

Informed Consent was obtained from each participant (Appendix A). The purpose of the study, risks and benefits of participation, and freedom to withdraw from the study were discussed in an Information Session that lasted 20 minutes for each of the two in-person groups. The author/researcher's contact information was an integral part of the Informed Consent (Appendix A).

Since this study involved human participants, the author completed the National Institute of Health Office of Extramural Research online training course of "Protecting Human Research Participants" (Appendix B). This author utilized methods to protect the anonymity of the in-person participants. For example, interviews were conducted in private, away from the work area, and participants were requested not to reveal their participation to anyone outside the classes. Of course, during the classes, participants had the opportunity to interact with one another. However, this author will not release any participant's name or other identifying information, such as workplace or unit worked either during or after the study.

Each participant received the exact same Job Satisfaction survey, Demographic Questionnaire, and Post Intervention Interview questions. Day shift nurses did not complete the post-test Job Satisfaction survey or the Post-Intervention Interview. The author did not change or eliminate any responses. In fact, with the online Google docs being automatically imported into a Microsoft Excel spreadsheet, it was impossible for the author to manipulate responses. The link to the survey was closed after sufficient participants were obtained.

All instruments and demographic data were stored on flash drives and an encrypted, fingerprint-secured notebook computer accessible only to this author. Names of facilities or participants will not be revealed at any time. A copy of the Capstone will be made available to the Administrators and Managers of the facilities that the author visited during her research. As a condition of utilizing the membership of the major nursing website, the author agreed to publish her Capstone as an article on that website. Members use screen names, and not their actual names. Online anonymity is protected because the author did not collect any personally identifiable information from the online participants.

Paper documentation, such as in-person Informed Consent, Job Satisfaction surveys and evaluations, will be shredded once the Capstone is completed and approved.

Rationale for Choosing Data Analysis Tools

Coding and organizing into themes is an accepted practice when examining qualitative data (Mills, 2007). This study involved qualitative data. Action research literature highlights several techniques and sources that are used in this study (Mills, 2007). Some of the data occur naturally, such as access to and use of required coursework. Nurses routinely provide this data to licensing boards in states that mandate continuing education, and usually to their employers. When examining quantitative data, many tools are available. A one-way repeated measures ANOVA allows the researcher to calculate the F statistic, which can then be compared to a table showing tcrit with df 1,25, p <.05 or when the t value is less than f researcher rejects null hypothesis in this case attending courses during one normal work hours had no effect on job satisfaction giesen study also employed quantitative data. a repeated measures anova used examining results of with group participants who are exposed to more intervention. intervention night time education. additionally one-way was view survey for day shift and nurses. test comparing from two different groups. author desired whether differed between shifts.>

Interpretation of Results

The results assisted with answering the research questions, as well as suggesting ideas for future study. At the very least, results may be interpreted as sufficient to provide a framework for offering other night shift courses. Further, the researcher has already had discussions with the Vice President of Administration and the Chief Clinical Officer about broadening the course offerings that are scheduled at night.

Summary

While attending mandatory education is the norm for many nurses, few courses are available during the working hours of night shift nurses. There is not much literature available that utilizes this segment of the work force as participants. This study demonstrated the positive impact on job satisfaction when attending required courses during one's usual duty time. Expanding the course offerings to all night shift staff and making required courses available at other facilities is expected to make a positive impact on job satisfaction for this group of workers.

Chapter 4: Findings

Introduction

The data for this Capstone study were collected from in-person interactions and from an online survey created by this researcher. Participants were all currently licensed and practicing RN's who live across the United States. Data were collected over approximately one year. However, the bulk of it was collected during August and September, 2013. This researcher utilized surveys, questionnaires, and interviews to gather data. The majority of data were collected in an online survey that was initiated and reviewed by this researcher. She also gathered data in person at hospital facilities and a home care company where she either worked or had professional relationships with key administrative personnel. The online participants belonged to a major nursing-oriented website with membership numbers of over 750,000. The home care company nurses represented about one-sixth of the nurses employed there.

Once purposive methods were employed to obtain nurses who normally work evening or night shift, all respondents participated on a voluntary basis. In-person respondents were paid by their employer for their time to attend the classes. However, the employer normally pays for employee's time when attending mandatory training. For the online participants, the researcher made a request for participation on one of the topic-specific areas of the website. Members had complete control of whether or not to participate in the survey. Unless those persons happened to be working at the time they answered the survey, they were not paid.

Nursing experience ranged from novice (less than two years) to expert (more than ten years). Cultural and gender information was not collected from the online participants. Job Satisfaction data and interviews were conducted between August and September, 2013. All data were gathered, analyzed, and examined by this researcher. Answers from the online survey on Google docs were automatically imported into a Microsoft Excel spreadsheet, which were analyzed by the author. The responses gathered in person were also only reviewed and analyzed by this researcher. She utilized graphs and both one-way and repeated-measures ANOVA to display results as discussed below.

Analysis of Data

The data from the Job Satisfaction Survey (Table 1) and the Demographic Questionnaire (Table 2) were obtained from the online tool, Google docs and automatically imported into an Excel spreadsheet. The researcher also tabulated the results from the in-person surveys and transcribed them into the same spreadsheet.

Table 1: Job Satisfaction Survey
1. This facility values individual employees.

Strongly Agree--Strongly Disagree
5 4 3 2 1

# data[].attributes.attachment_link.title
Night Shift Nursing Education and Effects on Job Satisfaction

# data[].attributes.attachment_link.description
A Capstone Prospectus Presented to the Faculty of the Department of Nursing of Western Governors University In Partial Fulfillment of the Requirements for the Degree of Master of Science in Nursing Education Specialty Abstract Continuing nursing education, professional development, and employer-r...

# data[].attributes.headline
Transitioning from Staff Nurse to Nurse Educator

# data[].attributes.subject
Transitioning from Staff Nurse to Nurse Educator

# data[].attributes.attachment_link.title
Transitioning Patients From Specialty Care to Primary Care: What We Know and What We Can Do | Article | NursingCenter

# data[].attributes.attachment_link.description
Growing demand for specialty care has resulted in longer wait times for appointments, particularly at US academic referral centers. A proportion of...

# data[].attributes.headline
Characteristics of Effective Clinical educators

# data[].attributes.subject
Characteristics of Effective Clinical educators

# data[].attributes.attachment_link.readable_text
Characteristics of effective clinical educators

One of the most important factors in providing quality clinical education placements is the relationship between the student and the educator.

Characteristics of supervisors that enable effective supervision include:

the ability to form positive relationships and rapport with students

the ability to demonstrate clinical competence

being organised

being a good communicator

possessing strong leadership and management skills

acting as a role model who displays enthusiasm and a passion for learning

consistent and transparent assessment procedures.

(Siggins Miller Consultants, 2012, p.9)

Some additional specific characteristics of effective clinical educators include:

Being available

being aware of their students' capabilities and limits

being respectful

having clear and consistent expectations

having a motivating and positive attitude

being reflective

being empathic and understanding

being actively involved

being encouraging

being welcoming

providing detailed orientation

having a graded program of learning

providing modeling and opportunities for practice

providing quality feedback

having an open and honest relationship.

(Health Education and Training Institute, 2012, p.28)

In this video, two students discuss the characteristics and practices of clinical educators they have experienced.

References
Health Education and Training Institute (2012). The superguide: a handbook for supervising allied health professionals. HETI, Sydney.

Rodger, S., Fitzgerald, C., Davila, W., Millar, F. and Allison, H. (2011). What makes a quality occupational therapy practice placement? Students' and practice educators' perspectives. Australian Occupational Therapy Journal, 58 3: 195-202.

Siggins Miller Consultants. (2012). Promoting quality in clinical placements: Literature review and national stakeholder consultation. HWA, Adelaide.

Back Top

# data[].attributes.attachment_link.title
Characteristics of effective clinical educators - ClinEdAus

# data[].attributes.attachment_link.description
One of the most important factors in providing quality clinical education placements is the relationship between the student and the educator. Characteristics of supervisors that enable effective supervision include: the ability to form positive relationships and rapport with students the ability to demonstrate clinical competence being organised being a good communicator possessing strong leadership and management skills acting as a role model who displays enthusiasm and a passion for learning consistent and transparent assessment procedures.

# data[].attributes.headline
Effectiveness of Patient Simulation in Nursing Education: meta analysis

# data[].attributes.subject
Effectiveness of Patient Simulation in Nursing Education: meta analysis

# data[].attributes.attachment_link.readable_text
BACKGROUND:

The use of simulation as an educational tool is becoming increasingly prevalent in nursing education, and a variety of simulators are utilized. Based on the results of these studies, nursing facilitators must find ways to promote effective learning among students in clinical practice and classrooms.

OBJECTIVE:

To identify the best available evidence about the effects of patient simulation in nursing education through a meta-analysis.

METHODS:

This study explores quantitative evidence published in the electronic databases: EBSCO, Medline, ScienceDirect, and ERIC. Using a search strategy, we identified 2503 potentially relevant articles. Twenty studies were included in the final analysis.

RESULTS:

We found significant post-intervention improvements in various domains for participants who received simulation education compared to the control groups, with a pooled random-effects standardized mean difference of 0.71, which is a medium-to-large effect size. In the subgroup analysis, we found that simulation education in nursing had benefits, in terms of effect sizes, when the effects were evaluated through performance, the evaluation outcome was psychomotor skills, the subject of learning was clinical, learners were clinical nurses and senior undergraduate nursing students, and simulators were high fidelity.

CONCLUSIONS:

These results indicate that simulation education demonstrated medium to large effect sizes and could guide nurse educators with regard to the conditions under which patient simulation is more effective than traditional learning methods.

# data[].attributes.attachment_link.title
Effectiveness of patient simulation in nursing education: meta-analysis.

# data[].attributes.attachment_link.description
BACKGROUND: The use of simulation as an educational tool is becoming increasingly prevalent in nursing education, and a variety of simulators are utilized. Based on the results of these studies, nursing facilitators must find ways to promote effective learning among students in clinical practice and classrooms. OBJECTIVE: To identify the best available evidence about the effects of patient simulation in nursing education through a meta-analysis.

# data[].attributes.headline
Getting the Big Idea: Concept-Based Teaching and Learning

# data[].attributes.subject
Getting the Big Idea: Concept-Based Teaching and Learning

# data[].attributes.headline
Changing to Concept-Based Curricula: The Process for Nurse Educators

# data[].attributes.subject
Changing to Concept-Based Curricula: The Process for Nurse Educators

# data[].attributes.attachment_link.readable_text
1. INTRODUCTION

Complex and changing health care environments require nurses to use effective thinking skills, promoting safety and quality of care for their patients [ 1, 2]. Many nursing programs are revising curriculum from a traditional educational approach to a concept-based curriculum to improve thinking skills. In a traditional curriculum, the teacher provides extensive content and facts to passive students. Presenting extensive information allows minimal time for students to organize and apply the information and usually results in students memorizing and recalling facts. Conversely, the concept-based curriculum provides selective information for students to organize, apply, and store in their long-term memories for retrieval to new situations [ 2].

A concept-based design consists of concepts and exemplars or examples [ 3]. "A concept is an organizing principle, or a classification of information" [ 4]. Faculty choose concepts that reflect nursing practice and organize the concepts in domains such as biophysical, psychosocial, health care systems, and professional practice [ 5]. An example of a concept in the biophysical domain is perfusion and is defined as "the flow of blood through arteries and capillaries delivering nutrients and oxygen to cells and removing cellular waste products" [ 4]. After selection of the concept, faculty choose exemplars or examples to help students understand the concept [ 2, 5]. The exemplars reflect essential clinical knowledge related to the concept. For instance, potential exemplars for the perfusion concept include heart failure, stroke, and shock. Exemplars provide the way for students to gain a deep understanding of the concept. In-depth understanding of the concept and exemplar support the ability for students to transfer understanding to new situations [ 2, 4]. Conceptual learning requires the student to link facts and exemplars to concepts through an active process such as completing case studies, questions, or problem-solving activities-encouraging students to practice thinking [ 2, 5]. Practice thinking in the classroom evolves from a teacher-centered learning to a student-centered learning environment, focusing on clinical practice. However, the development of a concept-based curriculum does not change the teaching practices of faculty and ways students learn. Subsequently, faculty need to learn ways to present concepts and exemplars in classroom activities that require problem-solving, and students need to understand how to connect facts and concepts with exemplars for in-depth understanding [ 6]. However, faculty may voice concerns about the change, such as revising curriculum requires time in their already busy schedules, not recognizing the benefits of implementing a concept-based curriculum, and feeling unprepared in designing curricular and instructional designs. Minimal information exists concerning faculty concerns and potential barriers to implementing a concept-based curriculum [ 5, 7]. Therefore, the following research study explores the perceptions of nurse educators who experienced the process of changing to concept-based curricula, including their insights of teaching practices and their views of the teaching-learning method [ 8].

1.1. Understanding the Level Of Thinking for Future Nurses

For over a decade, nursing education has struggled to meet workforce expectations; subsequently, calls for curriculum reform have been issued [ 9- 12]. Responding to calls for reform has resulted in many educators revising their curriculum from traditional designs to concept-based curricula, as one method to lessen the gap between practice and education [ 13, 14]. Traditional curricula is defined as teacher-centered learning and focuses on memorizing facts and information, transferring large amounts of information to passive students, and limiting time to problem-solve in the classroom. Comparatively, concept-based curricula is described as learner-centered and focuses on understanding concepts using exemplars, facilitating active learning by requiring students to apply concepts in clinical contexts, and allowing students to transfer concepts in unfamiliar contexts: To practice thinking [ 15- 17]. Two landmark reports support the processes of a concept-based curriculum.

The report, The Future of Nursing: Leading Change, Advancing Health, recommended that nursing education transform from current teaching methods rather than adding more information into a saturated curriculum. In addition, nursing education was to focus on teaching fundamental concepts at different levels of learning in various contexts rather than using the traditional method of rote memorization [ 10].

The second report supports the current transformation of nursing education to meet the demands of health care, Educating Nurses: A Call for Radical Transformation [ 18]. Due to the findings of the study, four essential changes were suggested to help nursing programs reduce the gap between practice and education: first, focus on concrete concepts in context and thinking that can be applied to practice; second, extend practice to the classroom; third, expand critical thinking to include multiple ways to think; and fourth, include intentional methods to internalize ways to develop professionally in nursing.

Because teaching in the classroom traditionally consists of transmitting large amounts of information to passive students with minimal time to problem-solve, the practice of thinking in the classroom is limited. Nurse educators are looking for ways to promote thinking in the classroom while using problem-solving skills; consequently, many nursing programs are changing to a concept-based curriculum [ 14]. The processes of changing to a concept-based curriculum include designing conceptual curricular structures, teaching conceptually, and evaluating teaching-learning methods through a conceptual lens [ 6].

1.2. Designing Conceptual Curricular Structures

Managing large amounts of available information continues to be an issue. One way to do so is by using concepts. A concept, or set of concepts, organizes information; therefore, it is easier to understand and remember information compared to a list of facts [ 3]. Exemplars are used to provide specific contexts for a concept, helping students understand the concept more thoroughly [ 2]. The type of exemplar used can increase the level of learning. For instance, the exemplars, adult respiratory distress syndrome and pneumonia, can be used for the gas exchange concept [ 3]. However, caring for the patient with adult respiratory distress syndrome will require a higher level of knowledge and skill compared to caring for a patient with an uncomplicated pneumonia.

1.3. Teaching Conceptually

The concept-based teaching approach employed in concept-based curricula has existed for more than 50 years and focused on the development of complex thinking. Initially, this method was developed by Hilda Taba and was popular during the 1960s and early 1970s in the United States. This corresponded to the implementation of the open classroom in kindergarten (K) to 8 th grades, which reflected team teaching, creativity, and less structured curricula. However, an educational movement in the mid-1970s changed the dynamics of the open classroom. The purpose of this later movement was to promote evaluation of students more accurately using objective tests. These tests focused on segments of information and skills but were incapable of measuring complex thinking skills. The focus of teaching and learning changed, yet again, to meet the criteria of objective tests, and the concept-based method with the emphasis on teaching thinking waned, but the method has resurfaced in nursing programs and in other disciplines today [ 16, 19].

Erickson's work instrumentally demonstrated the benefits of a concept-based curriculum and instruction for the 21 st century. Her work was based on the findings of Hilda Taba. Erickson described the task of developing curricula and teaching students to think. She stated, "Designing curricula to develop thinking is hard work; teaching students to think is even harder work" [ 16].

Similar to pilots, the profession of nursing requires learning knowledge and skills. Benner's model of skill acquisition and application of knowledge in nursing, Novice to Expert, is based on the Dreyfus Model of Skill Acquisition that was developed through studying different types of groups, such as chess players and Air Force pilots [ 20, 21]. This method was based on performances in situations and learning through experiences. The acquisition of skills and the application of knowledge require the practice of thinking in the context of specific situations. Students need a practice environment to support their practice of thinking and performing skills: Active learning activities in the classroom. Active learning activities that are student-centered need to reflect real life experiences happening in health care today. Benner . instructed nurse educators to extent practice to the classroom, preparing students for the health care workforce [ 18]. Extending the practice environment to the classroom is key. This action can be accomplished through implementing concepts and exemplars in case studies, problem-solving activities, and simulations [ 2, 18]. The purpose for active learning activities is to bring the students as close to the real experience as possible in the classroom, which takes time and creativity. Because active learning in the classroom takes time, students need to be prepared before class to practice thinking in the classroom. One way to support student preparation for active learning in the classroom is through flipping the classroom [ 22].

The viewpoint supporting the method of flipping the classroom means students come to class prepared and ready to practice thinking. The preparation may include PowerPoints with voice, video lectures, readings, and quizzes. When students are prepared for class, they are ready to apply concepts and exemplars into real life situations reflective of current practice in health care. The classroom environment becomes interactive with the educator facilitating learning [ 22].

1.4. Evaluating the Teaching-Learning Methods Through a Conceptual Lens

Nearly twenty years ago, higher education began to shift from an instruction paradigm to a learning paradigm. The reason for this shift was that educators recognized that the goal or outcome of higher education should be to produce learning, not provide instruction. The end (learning) should guide the means or the way to get there, not the other way around, with the means (teaching) guiding the end. During this time, most of the focus was on the instruction paradigm, and a shift was slowly moving towards a learning paradigm [ 15].

The instruction paradigm focuses on teaching compared to the learning paradigm, which is about fostering learning. In the instruction paradigm, emphasis is placed on delivering knowledge to passive learners who recall information for a test: The teacher controls the learning. An example of the instruction paradigm is typically described as a lecture format and defines the teacher's job as covering information. This type of teaching is expected to meet the needs of all learners [ 15].

In contrast, the learning paradigm involves students discovering and constructing knowledge, which requires active thinking. Constructing knowledge consists of creating frameworks of concepts and skills that can be applied in different situations. This prepares students with a solid foundation to understand and act and to be able to solve problems in various contexts. Activities are learner-centered and address the idea that students learn in various ways and at different rates. Moreover, the learning paradigm supports any learning method that is successful in meeting outcomes [ 23, 24]. The teacher is the designer of learning and learning methods are continuously restructured to foster learning. The learning paradigm supports collaborative learning with the teacher described as a coach or facilitator of student learning and focuses on education for understanding and learning in context [ 15, 24, 25]. Both the educator and student take responsibility for the students to learn and achieve learning outcomes [ 2, 15]. Learning is about change and taking responsibility and consists of taking action by changing behavior in order to meet outcomes [ 25].

According to Barr and Tagg [ 15], it will take decades before teachers fully apply the learning paradigm and the gradual process will require experimentation for ultimate success. However, trying to apply a part of the learning paradigm to the instruction paradigm is ineffective. In order for the students to become proficient in thinking, they need opportunities to think. Changing to the learning paradigm will require action, hard work on the part of the teacher [ 15]. Concept-based curriculum and teaching conceptually support the learning paradigm.

Because there is limited time in the classroom, students become responsible for their learning. Concepts and exemplars can be used to organize students' learning, helping them transfer learning to other situations: A life-long skill necessary to learn class curriculum and to succeed in their workplace when new problems are encountered [ 4, 24, 25].

The purpose of this qualitative study was to explore the processes of eight nurse educators changing from a traditional curriculum to concept-based. The study included three specific aims: analyze nurse educators' perceptions and behaviors related to changing from traditional to concept-based curricula; explore the teaching practices of nurse educators who have changed to a concept-based curriculum; and examine how nurse educators perceived the teaching-learning process in concept-based curricula [ 2].

2. METHODS

2.1. Participants and Setting

The study used a purposive sample of eight nurse educators who had recently transitioned from traditional to concept-based curricula. Inclusion criteria for the participants coincided with the National League for Nursing (NLN) eligibility requirements for the Certified Nurse Educator Exam [ 26]. Other criteria for participants included the following: experienced teaching in a concept-based curriculum for a minimum of two consecutive semesters, employed full time in a higher education institution, and reflected current assignment of teaching face-to-face and/or online classes. The researcher identified nursing programs that adopted the concept-based curriculum through textbook vendors. After programs were identified, the researcher approached and invited an educator at each university to participate in the study. The educator at each university then recommended other colleagues who met criteria and showed interest in participating in the study. All the interviews were conducted at the participants' institutions of employment.

Educators from two types of nursing programs were selected from two universities: registered nurse to baccalaureate and prelicensure baccalaureate. Although the programs' curricula differed, the focus of the grounded study examined the process for nurse educators changing from a traditional curricular design to concept-based curriculum.

2.2. Ethical Considerations

Approval from Institutional Review Boards from two universities in one Western state was granted. Written informed consent was provided for participants. To ensure subject protection, names were changed to conceal participants' identities, and participants were guaranteed that their names would remain confidential in any data from the study. In addition, participants had the right to withdraw from the study at any time. Furthermore, data from participants remain in the researcher's locked safe.

2.3. Data Collection and Analysis

The data was collected and analyzed by one researcher. The researcher conducted semi-structured interviews with key questions and question prompts. Questions were open-ended and constructed in a way to allow the participants to choose their direction for a response. Length of interview included 60 to 90 minutes per interview. The researcher used a digital device to record each interview, and interviews were transcribed by professional transcriptionists. Interviews generated 130 pages of information; subsequently, the software program, NVivo 10®, was used to help manage and analyze data.

Limited nursing literature exists regarding the processes of implementing a concept-based curriculum; therefore, grounded theory was used in the study, reflecting Charmaz's methods [ 5, 27]. The methods used finding the action in each segment or line. Finding action line by line was a process that helped to focus on analysis and prevent concepts and theories from emerging too soon and risking errors. During this initial phase, gaps were identified; therefore, this phase provided direction to obtain future information. The aim was for the codes to fit the data, not for the data to fit the codes. While coding data, it was necessary to constantly compare the data as each new interview was analyzed [ 27]. This method was inductive using the process of constant comparative methods, and with current data determining what additional data was sought. The second phase of coding, focused coding, identified the most significant and frequent codes and provided criteria to review the data. The purpose of this process was to evaluate the strength of these codes in order to categorize the data. Frequent and significant codes were categorized and identified. Codes with similar meaning were merged. The goal of focused coding or the second cycle of coding was to develop thematic organization [ 27]. The third phase, axial coding, organized previous codes and categorized information into subthemes and experiences, with the subthemes being supported by the experiences. While completing focused coding in the NVivo 10® program, subthemes and experiences emerged along with links that represented a type of axial coding [ 27]. The fourth phase, theoretical coding, illuminated relationships among the subthemes. Theoretical codes identified possible relationships among the subthemes; therefore, themes emerged into a theoretical direction [ 27]. The NVivo 10® program allowed a visual representation of the coding words and displayed the associations with each code and the number of times the code was referenced. Memos were used by the researcher to record reflective thoughts [ 27]. Data represented faculty experiences, as a whole. Selection of participants along with gathering of data continued until no new information emerged or saturation of the data was reached [ 27].

2.4. Standards of Rigor for the Study

Standards of rigor for this qualitative study included credibility, transferability, dependability, and confirmability. Credibility was supported by having participants examine their transcriptions, which allowed for opportunities of clarifications. Furthermore, experts in grounded qualitative research compared data with themes and agreed with findings. Transferability was supported through details of the settings and characteristics of the sample. Dependability was demonstrated by findings being consistent with data and confirmed through an audit trail. Techniques used to establish confirmability included audit trail, triangulation, and reflexivity [ 28, 29].

3. RESULTS

Eight participants selected shared experiences that formed the data: interviews, documents of lesson plans, and demographic questionnaires. Demographics showed participants' age ranges include 31 to 62 years with a mean age of 48.3 ±11.75 years, practice as a clinical nurse spanned 20 ± 10.68 years, and teaching as an educator averaged 12.38 ± 6.44 years. All participants were female-seven Euro-American and one Dominican. The education of participants included four master's degrees in nursing-two currently enrolled in doctoral programs, two doctorate degrees, one nurse practitioner enrolled in a doctor of nursing practice (DNP) program, and one DNP degree [ 8].

For both programs, implementing a concept-based curriculum was not a gradual process. One program had revised all of their courses from a traditional to a conceptual curricular design over a two-year period; whereby, the other program revised their courses over a one-year period. Prior to the study, one nursing program had implemented their concept-based curriculum for two semesters compared to the other program that had implemented the curriculum for approximately eight semesters. Participants who taught the concept-based program longer shared more information about evaluative planning; therefore, these participants were represented to a greater degree when discussing evaluation.

From the participants' experiences, 18 subthemes emerged and were organized into three themes corresponding to the aims of the study: Preparing for the Change (5 subthemes), Teaching in a Concept-Based Curriculum (7 subthemes), and Understanding the Teaching-Learning Process (6 subthemes). These themes were supported by participants' experiences. Participants indicated through their experiences ways they changed to implement a concept-based curriculum. An overarching concept includes support for change. Support is required to effectively find meaning or understand the processes of a concept-based curriculum, and support was needed to prepare for the change, teach in a concept-based curriculum, and understand the teaching-learning process. Through support, participants were able to understand or to find meaning and construct learning to reflect student-centered approaches, foster authenticity by offering real experiences in class, refine change through evaluative methods, and reinforce benefits of teaching.

3.1. Preparing for the Change

The theme, Preparing for the Change, consisted of five subthemes: driving factors for change, planning the change, changing our thinking, supporting the change, and recognizing challenges. The first subtheme, driving factors for change, included meeting the needs of the nursing program by updating the curriculum and solving content overload. Julie explained, "Well, we knew that it [the curriculum] needed [to be] updated. . . . We knew that was going to be a major overhaul and it was going to be a huge learning curve for the faculty, but nevertheless, we went that direction." Lauren discussed, "I think the big thing was that there were just too many diseases, too many pathologic processes, that it became so overwhelming for students."

Second subtheme, planning the change, showed most of the participants served on committees while revising the curriculum. Planning included developing concepts and exemplars while incorporating lifespan development. Julie was on the initial committee that began the change at her institution, and she shared, "I sat on the revised curriculum committee, which was a group of us with community representation that decided how this was all going to work and that was planning the entire process of the curriculum change: from teaching the faculty the new system to setting up the committees that would work on it, determining what the philosophy was and [what] the School of Nursing competencies were, and choosing our philosophical stance for that, as well as kind of a conceptual model to go from. So, that kind of encompassed everything, and then I became part of different committees."

Third subtheme, changing our thinking, showed ways participants' thinking had changed. Participants shared they learned to let go of content and teaching methods. For example, Audrey stated, "I think less about teaching all of the details." Similarly, Sarah tailored her maternal-newborn class to a nurse that may experience a pregnant patient in a setting besides labor and delivery. She stated, "What is it they absolutely must know."

Fourth subtheme, supporting the change to a concept-based curriculum required faculty to communicate and become educated about processes of a concept-based curriculum. Sarah stated, "We had it all so neatly planned out, at least on paper, but then as it gets into reality it gets messy and changes things. I think that to do it well it really does take a great deal of coordination and time on the [part of the] faculty, talking with each other about what they are doing." Besides communication, educating faculty was a main component in supporting the change to the concept-based curriculum and included meeting with experts, reading literature, attending workshops, and self-teaching. These different methods of education helped to educate participants who were at different levels of understanding the processes of a concept-based curriculum.

Fifth subtheme, recognizing challenges, participants' comments included the following: limited time to complete assignments, increased workload, lack of understanding of curriculum design, and lack of experience teaching lifespan development. Sarah summarized the experience succinctly, "We rushed and we had to redo things when we rushed and it was painful." Lauren confirmed that faculty were rushed to meet deadlines; consequently, they did not get enough input from others. A challenge that many participants expressed was the lack of understanding of curriculum development and specifically a concept-based curriculum. Julie voiced, "One of the big challenges I saw was a lot of the faculty did not understand curriculum development." Rhonda discussed the struggles her faculty were experiencing: understanding the difference between a concept and content. Lauren noted that some faculty members thought they could transition the content of their courses into the concept-based curriculum. "A lot of people thought, 'I can just transition my old stuff' and [they] actually found that it did not work. I basically had to redo all of my courses that I had done, even clinical." In addition, she described how faculty had difficulty integrating the lifespan in their course because they did not feel comfortable teaching pediatrics or gerontology. Mary expressed the difficulty of changing to a concept-based curriculum and the refining that is required after the change: "It is not going to be perfect the first time you implement it."

3.2. Teaching in a Concept-Based Curriculum

Participants shared experiences of teaching in a concept-based curriculum, and seven subthemes emerged as follows: choosing concepts, preparing for class, getting students to participate, teaching conceptually, describing student-centered learning, changing to andragogy (teaching adult learners), and comparing online to face-to-face.

First subtheme, choosing concepts, participants described a concept to mean a common thread or overarching word(s) describing content. Rhonda shared, "Many people are so tied to their content that they can't see that they could teach that content while under the umbrella of the concept itself." Participants located concepts by various means and resources such as published texts, articles, the Baccalaureate Essentials document, and National Council Licensure Examination (NCLEX) blueprint.

Second and third subthemes, focused on preparing for class and getting students to participate. Rhonda shared how teaching in a concept-based curriculum focuses on learning, and instruction is based on student participation; consequently, students need to be prepared for class. Rhonda stated, "It is a struggle and sometimes they don't come prepared and then we have a discussion about what we are doing here. In the past, she has stated to her students, "You are not prepared. Go home." A component of conceptual teaching is student-centered learning. This means students become actively involved in learning activities; therefore, it is important to get students to participate in class by giving them a safe environment. Julie shared this can be accomplished by beginning class with an activity that encourages participation and teamwork and creates a more relaxed atmosphere.

Fourth subtheme, teaching conceptually, several participants interpreted the meaning of teaching and learning concepts. Mary discussed, "It means that . . . the student is able to transfer knowledge from the concept to any situation." Lauren agreed about transferring conceptual knowledge and described how she taught conceptually: "You would have exemplars and you would have focal points. . . I could teach that principle [concept] then students could apply . . . if I gave them an asthma care scenario or a chronic obstructive pulmonary disease case." Rhonda shared methods of teaching conceptually by connecting students to real-life experiences, guiding learning through questions, and allowing students opportunities to solve problems by using appropriate nursing interventions. Denise felt that she was somewhat teaching conceptual before, but expressed how concepts streamlined her teaching to stay on track.

Fifth subtheme, describing student-centered learning, most participants described student-centered learning as students being self-directed, participating actively, and learning through actual experiences or simulations while the instructor facilitated learning. In a maternal-child class, Sarah required her students to review the voice recordings with PowerPoints before attending class; thereby, the students were prepared in class to think through case studies and questions. Lauren taught a hybrid medical-surgical course with each week consisting of two hours online before class and three hours in class. The online portion consisted of activities to prepare students for class such as voice recordings with PowerPoints, pre-readings that covered concepts with pathophysiology, and graded quizzes to assess their learning; consequently, students were prepared for class that allowed instructors to focus on nursing management and priorities. In class, case studies were organized in slides requiring student input. These same case studies were included on the exams.

The last subthemes, changing to andragogy and comparing online and face-to-face teaching were mentioned by some participants. Regarding andragogy, Rhonda described how she needs to be prepared for class, "I can't just pull my lecture out and pull out my PowerPoint. That doesn't work anymore. I can't be unprepared because we won't have anything to talk about." Some felt that concepts lose strength online: Audrey stated, "But still, I have a big concern about making the online classes I teach more alive."

3.3. Understanding the Teaching-Learning Process

The theme, Understanding the Teaching-Learning Process, was supported by six subthemes that emerged from participants' experiences: noticing benefits of teaching, expressing enjoyment about teaching, bridging academia and practice, recognizing students' wants and needs, influencing students to change their thinking, and teaching effectively.

The first two subthemes of noticing benefits of teaching and expressing enjoyment about teaching revealed participants enjoyed helping students to learn and found satisfaction in interacting with students. Third subtheme, bridging academia and practice, Lauren shared the following: "We discuss a concept in clinical, they also discuss that same concept that week in class-so they are aligned." In addition, Julie compared memorizing facts and understanding concepts while working with new nurses in the intensive care unit setting. The new nurses had lists of memorized facts to try and trouble shoot problems instead of understanding basic concepts of perfusion such as CO=HRxSV. Julie confirmed that lists "did not work for the real world." Fourth subtheme, recognizing students' wants and needs, Denise shared one obstacle and advantage regarding a policy course, "They do not understand the value of it for them from a clinical perspective sometimes. . . . The whole expansion of knowledge sharing and ability to have even novice nurses have expertise and a lot of insight on a particular concept that perhaps I had not thought of or most times their student peers had not thought of; I think that is satisfying."

Fifth subtheme, influencing students to change their thinking, Mary observed that students were still compartmentalizing their thinking because of the way a concept-based curriculum is taught-"teaching the concept of perfusion and you are really just teaching cardiac." Mary said we should be able to bring up any disease and examine ways it influences perfusion. Sixth subtheme, teaching effectively, participants stated that they allowed student opportunities to think by connecting students to real-life experiences.

4. DISCUSSION

4.1. Implementation of Change Model and Continuous Education for Faculty

Brady . [ 6] discuss the challenges of implementing a curriculum change and successful ways to implement a change model. Over time, faculty rely on the same teaching practices and become attached to particular subjects. Consequently, introducing curriculum changes can cause faculty to feel frustrated, meeting change with resistance [ 5]. In addition, in concept-based curriculum, typically, traditional courses such as adult health, maternal-child health, and mental health, might be combined into one course [ 14]. Faculty may express concerns about teaching across the lifespan and lacking expertise in specialty areas.

Revising curriculum requires well-planned approaches along with effective change strategies for successful change [ 6]. In addition, becoming adept in this teacher-learner role in the active learning environment requires a change in thinking and teaching skills on the part of the educator. Since this necessarily constitutes a change in thinking and behavior, review of a change model is helpful in understanding this process.

Faculty can easily underestimate this process of change; subsequently, a model can guide faculty through the complexity of change [ 6]. A change model, such as Kotter's Eight-Step Change Model focuses on helping people accept and become prepared in their work culture: establishing a sense of urgency, creating the guiding coalition, developing a vision and strategy, communicating the change vision, empowering broad-based action, generating short-term wins, consolidating gains and producing more change, and anchoring new approaches in the culture [ 30]. Sense of urgency helps faculty understand the importance and benefit of the change. The guiding coalition represents a team with strong leadership and experts of conceptual curricular designs, conceptual teaching, and evaluative teaching-learning methods. The vision and strategy guide the change process. Furthermore, thorough and consistent communication promotes the vision and strategy. Empowering broad-based actions focuses on reducing barriers to support the change. Generating short-term wins promotes recognition of improvements. Consolidating gains and producing more change continue the momentum to secure the change throughout the program. Finally, anchoring new approaches, such as concept-based curriculum, becomes the standard for the program [ 30].

Both groups of participants agreed the major driving force for changing to a concept-based curriculum centered on solving the problem of content overload in their curricula. While making the change to concept-based curriculum, educators shared similar barriers such as lack of time, which excluded input from others. In addition, increased workload caused personal and workplace stress for participants. Participants shared they participated actively in the change process by helping faculty move from traditional ways of transmitting information through lectures to focusing on student-centered activities reflective of concepts and exemplars. Content in their courses changed from large amounts of information to selected concepts and exemplars, reflecting what students must know to perform safely as a generalist nurse. Participants needed to learn how to design conceptual curricular structures, implement conceptual teaching strategies, and evaluate teaching-learning methods through a conceptual lens. An observation included when faculty tried to move their content-laden course into a concept-based course, they discovered the transition proved ineffective.

However, participants shared that faculty members showed different levels of understanding in curriculum designs, teaching strategies, and teaching-learning evaluative processes. Participants shared experiences about mentoring other faculty members and becoming frustrated with faculty who did not take the time to understand components of conceptual curricular designs. Because faculty members remain at varied levels of understanding of concept-based curricular designs, conceptual teaching, and teaching-learning evaluative methods, education needs to be ongoing, such as meeting with experts, reading literature, attending conferences and workshops, and receiving peer tutoring.

4.2. Requirement of Concept-Based Curriculum: Conceptual Teaching

Besides developing curricular designs, conceptual teaching is a skill that requires time and effort to learn. Brady . [ 6] hired consultants outside of their program, both nursing and non-nursing disciplines, to educate their faculty on conceptual teaching. Conceptual teaching requires specific components: concepts and exemplars. Participants located concepts by various means and resources. Currently, a benchmark approach for choosing concepts remains available in literature to support educators in this effort [ 4].

Teaching conceptually includes a learner-centered approach with active learning occurring in the classroom. The change can be challenging when a teacher is changing from a teacher-centered approach and focusing on content [ 6]. Participants shared that student preparation remained essential to promote participation in student-learning activities in class. During class, participants facilitated learning through supplying concepts and exemplars, guiding the learning process. They expected students to apply concepts and understanding in other situations-transfer learning. Activities in class reflected problem-solving and thinking exercises. Participants shared preparing for class takes time and creativity. Class time is not a matter of providing a lecture through PowerPoint, rather bringing the students as close as possible to actual clinical experiences through well-developed activities.

4.3. Successful Teaching-Learning Process Through Transferring Understandings to Various Situations

Conceptual teaching helps learners organize information in the long-term memory of their brain for transferring and applying information to new situations. Conversely, when facts are presented, usually they are unconnected and pose a problem for the learner to remember and retrieve for transferring to new situations. According to Giddens, Caputi, and Rodgers [ 2], "a conceptual organization of information is foundational to clinical reasoning." Key to conceptual learning remains the deep understanding that occurs with exploring concepts with exemplars that reflect complex cases reflective of current practice. With deep learning, learners notice patterns and relationships that can be transferred to new situations [ 2]. The classroom becomes an effective environment to transfer deep understandings to new situations-practice thinking.

Participants shared that organization of curriculum showed concepts aligning in didactic and clinical settings. In addition, participants realized problem-solving from memorized lists remains impossible; however, effective problem-solving happens through understanding concepts and exemplars. Furthermore, adult learners bring insights and experiences that differ from others and enrich the learning environment. For nursing-student learners, instead of recognizing the diagnosis of a patient, such as heart failure, students focus on the concept of perfusion and complex issues that surround the concept. A challenge remains to expand students' ways of thinking through using a concept with various exemplars. Participants shared the importance of extending practice to the classroom by presenting real life experiences through case studies, simulations, and problem-solving activities.

4.4. Study Limitations and Recommendations

The data from the study was limited to registered nurse to baccalaureate and prelicensure baccalaureate programs. Delivery of the courses varied such as face-to-face, online, and hybrid (face-to-face and online) formats. In addition, the length of time each program had implemented the concept-based curriculum differed between the two settings: two semesters compared to eight semesters. The exploration of the topic, changing to a concept-based curriculum, was restricted to questions concerning the didactic portion of the curriculum. Recommendations for future studies include assessing students' perceptions regarding concept-based curriculum, implementing teams to support lifespan learning, and comparing teaching conceptually in clinical and didactic settings, including online, hybrid, face-to-face courses.

# data[].attributes.attachment_link.title
Changing to Concept-Based Curricula: The Process for Nurse Educators

# data[].attributes.attachment_link.description
Complex and changing health care environments require nurses to use effective thinking skills, promoting safety and quality of care for their patients [ 1, 2]. Many nursing programs are revising curriculum from a traditional educational approach to a concept-based curriculum to improve thinking skills.

# data[].attributes.headline
How to Give and Receive Feedback Effectively

# data[].attributes.subject
How to Give and Receive Feedback Effectively

# data[].attributes.headline
Strategies for Giving Feedback as a Nurse Educator

# data[].attributes.subject
Strategies for Giving Feedback as a Nurse Educator

# data[].attributes.attachment_link.readable_text
One of the most challenging responsibilities nurse educators face is providing feedback to students that will result in a meaningful outcome when student performance is not meeting expectations. Receiving constructive feedback as a student and as a nurse is essential for personal and professional growth, but for faculty, delivering feedback to students while continuing to nurture the student-teacher relationship can be difficult. Implementing effective communication strategies to deliver constructive feedback can support faculty in this important and necessary work. Failure to do so can negatively impact the learner, act as a trigger for incivility, and have deleterious effects on the professional comportment of new nurses entering the workforce.

Literature Review

The literature suggests that uncivil behaviors are occurring with increasing frequency in nursing education. 1 Triggers for incivility have been linked to communication in several studies. Luparell 3 identified a frequent trigger of incivility results from feedback given by the faculty member to the student because of poor performance. Hunt and Marini 4 categorized subtypes of incivility among nurses in practice, reporting a frequently occurring subtype was retaliation because one feels provoked or offended. Altmiller 5 identified a student perception that faculty behavior fuels student incivility, but more alarming was the belief that incivility was justified when students perceived faculty behaviors as uncivil.

Of late, there is an increased emphasis in the literature suggesting that nurse educators not only address student incivility but also reflect on their own behaviors that may be contributing to the escalating incivility in the academic environment. 6,7 Faculty behaviors identified as uncivil and fueling student beliefs that faculty have negative motivations include subjective evaluation, rigid expectations, and targeting and "weeding out" practices. 8 Demeaning communications from faculty to student, particularly those that occur in front of other students, patients, or staff, are particularly harmful to the student-teacher relationship and thus the learning experience. 2,5,8 In addition, the literature suggests that incivility in schools of nursing can lead to a weakened learning environment and poor workforce behaviors. 7,9

Role of Feedback

Communicating constructive feedback is essential to the teaching and learning process, 10,11 and in health care professions education, direct observation frequently forms the basis for feedback. 12 Constructive feedback should provide an unbiased critique of performance, recounting events as they occurred, with the intention to correct errors and increase understanding. 13 Speaking in first person, using I instead of you, works to keep the narrative factual and enhance teacher credibility. 13,14 When effective, constructive feedback can serve as a motivating factor. 15

Most nurse educators are comfortable providing reinforcing (considered positive) feedback, but significant barriers exist to giving constructive or corrective (considered negative) feedback. Some educators are concerned that it will result in poor evaluations 14 or create conflicts. 13,14 As a result, some educators avoid providing substantive critique. 13 How then can nurse educators provide meaningful feedback to support knowledge and skill development while nurturing the student-teacher relationship?

Techniques to Deliver Constructive Feedback

Giving constructive feedback is a skill that requires practice. 13 Whether positive or negative, it should always be an unbiased reflection of events that provides logical connections. Delivery style plays a key role in whether a student accepts, modifies, or rejects feedback. Past experiences can influence how students respond to feedback, 14 so nurse educators should model the behavior they wish students to adopt. Timely delivery, identifying it as an opportunity for learning, and immediately providing options for improvement increase its effectiveness and teach the student to view it as an opportunity for personal improvement. Should a discussion begin to escalate, faculty should model an appropriate response, maintaining civility in the face of incivility, by speaking calmly and staying focused on the concern being addressed.

Providing feedback indicates one's commitment to another's success and emphasizes the importance of what that individual is doing. 16 Unfortunately, this sentiment frequently gets lost in the message. Beginning with a caring statement clarifies faculty motivations and allows the student to feel safe, decreasing the need for defensiveness. An example is to begin the discussion with "I asked you to meet with me because I care about your success," or "I wanted to talk to you today because I want you to be the best nurse you can be." Educators need to make certain that caring is incorporated into every feedback message as it can strongly influence the student's interpretation and affect the student applying the feedback to future practice.

Nurse educators should frame feedback in reference to course learning outcomes. 14 Verbalizing that the faculty member and student have the same goals of professionalism and success builds a relationship between both parties. Nurse educators should take great care to avoid shaming. Such behaviors include correcting individuals in front of patients, peers, and other health care providers; ignoring the individual; and displaying contempt for a student's lack of knowledge. To set parameters for reasonable expectations, faculty should consider whether 2 or 3 peers could have made the same mistake in similar circumstances.

Using the Socratic Method can assist students to reflect on their abilities. Educators can ask students to see events through the patient's eyes. This reinforces patient-centered thinking. Reframing Constructive Criticism Using Reflection Based on the Quality and Safety Education for Nurses (QSEN) Competencies 17 is an instrument framed by the 6 QSEN competencies that provides examples of a questioning route instructors can use to guide students in extracting a realistic appraisal of their performance. For example, rather than telling students that their practice was unsafe, the instructor might ask the students, "If you were the patient and knew this happened, would you feel that you were receiving safe care?" Using questions to encourage self-reflection allows the student to arrive at the same conclusions that frequently are communicated directly by the faculty member but may be misinterpreted by the student, acting as a trigger for incivility.

Providing feedback to students can be difficult. Nurse educators can develop expertise by incorporating effective communication strategies. Through modeling, faculty can teach these skills to students during prelicensure education so that students can appreciate the value of feedback in their personal and professional development.

References

# data[].attributes.attachment_link.title
Strategies for Providing Constructive Feedback to Students

# data[].attributes.attachment_link.description
One of the most challenging responsibilities nurse educators face is providing feedback to students that will result in a meaningful outcome when student performance is not meeting expectations. Receiving constructive feedback as a student and as a nurse is essential for personal and professional growth, but for faculty, delivering feedback to students while continuing to nurture the student-teacher relationship can be difficult.

# data[].attributes.attachment_link.readable_text
Skilled nurses are essential to functional healthcare systems worldwide, and nurse educators are the driving force behind the training of skilled nursing professionals. Nurse educators are registered nurses who combine their clinical experience and academic expertise to train students in nursing skills. They determine educational curriculum and standards, prepare students to successfully transition out of academia, empower new nurses to thrive in the nursing profession, and improve the systems that uphold nurse education.

Nurse educators can teach in universities, technical schools, hospital-based nursing programs. They can also work as administrators, consultants, or independent contractors in a wide variety of education-focused occupations.

The nurse educator position is going to become increasingly critical as healthcare in the U.S. evolves. Demand for healthcare and skilled professionals in the sector is increasing due to the aging U.S. population and retiring registered nurses leaving the workforce. The U.S. will need an active corps of competent teachers and savvy professionals who can improve and enhance the systems in which that education occurs.

Concerning new job creation, the U.S. Bureau of Labor Statistics (BLS) predicts that there will be a combined 795,000 new jobs created nationally for registered nurses, licensed practical/vocational nurses, nurse practitioners, nurse midwives, and nurse anesthetists between 2016 and 2026.

However, there will also be a significant number of vacancies, as an estimated 700,000 nurses are projected to retire or leave the labor force by 2024, according to the American Nursing Association (ANA). The BLS anticipates that through 2024, there will be a combined 144,590 job openings each year for these nursing positions. In total, by 2026, there will be an estimated 4.2 million nursing positions in the U.S.

Educating a workforce this large will ensure that there will also be an increase in demand for nurse educators. The BLS predicts that the postsecondary nursing instructor and teacher occupation will grow more than three times faster than the national average, at a rate of 24 percent between 2016 and 2026. The BLS anticipates that there will be a total of 84,200 nurse educator jobs available by 2026.

In addition to being in demand throughout the upcoming years, nurse educators can earn competitive wages. As of 2017, the median annual salary for a nurse postsecondary nurse educator was $71,260-90 percent higher than the national average. Postsecondary nurse educators earning in the 90th percentile make up to $124,090 annually.

# data[].attributes.attachment_link.title
What is a Nurse Educator and What Do They Do?

# data[].attributes.attachment_link.description
Skilled nurses are essential to functional healthcare systems worldwide, and nurse educators are the driving force behind the training of skilled nursing professionals. Nurse educators are registered nurses who combine their clinical experience and academic expertise to train students in nursing skills.

# data[].attributes.headline
Breaking Tradition, A Night Shift Educator

# data[].attributes.subject
Breaking Tradition, A Night Shift Educator

# data[].attributes.attachment_link.title
Breaking Tradition, A Night Shift Educator

# data[].attributes.headline
The Importance of a Professional Nursing Portfolio

# data[].attributes.subject
The Importance of a Professional Nursing Portfolio

# data[].attributes.attachment_link.readable_text
Portfolios house evidence of the increased knowledge, experiences, skills, and abilities nurses achieve throughout their careers, displaying their personal mastery and professional maturity.

Editor's note: The following is a lightly edited excerpt from the upcoming book, Building Your Professional Portfolio: A Primer for Nurses.

The concept of a professional portfolio is not a new concept in nursing, but a review of available literature reminds nursing leaders of its value regarding personal and professional development and advancement for nurses.

A well-developed portfolio is a chronological, visual representation of a nurse's professional growth. The portfolio does not replace a nurse's curriculum vitae (CV) or résumé, but rather it is the supporting documentation that validates what is stated on the CV. Whereas a nurse's CV or résumé is an overview of past education, employment, skills and other pertinent professional activities, the portfolio provides a detailed look at a nurse's accomplishments.

Purpose of Portfolios

Portfolios are a visual way to look at all the career experiences nurses have encountered in their lives and across the many paths they have chosen-to celebrate the successes, to learn from challenges, and to enthusiastically anticipate whatever comes next.

Each portfolio is a collection of exemplars, artifacts, and other evidence organized in an electronic or hard-copy binder, for example, for a specific purpose or audience. Each nurse will build his or her portfolio based on its intended purpose, whether personal, academic, or professional advancement.

Creating a master portfolio that can be adapted when needed can provide a foundation for extracting whatever artifacts are required for specifically targeted audiences (e.g., new hire or career advancement). They showcase nurses' knowledge, skills, experiences, and accomplishments related to selected goals or objectives. Portfolios are NOT prescriptive; they are fluid and dynamic, providing past and present evidence (artifacts) demonstrating competence and competency related to experience, professional practices, processes, quality, and relationships.

Benefits of a Portfolio

The primary purpose of a master portfolio is to document, categorize, and showcase knowledge, skills, and abilities (KSA); growth; and progress as an individual, a student, and as a professional. This is especially critical for healthcare providers and nursing students learning and working in increasingly complex communities of education and practice. Building a portfolio invites nurses to engage creatively throughout the process to do the following:

Establish a strategic record of personal, academic, and professional activities and accomplishments over time

Guide critical decisions related to personal choices and volunteer activities, goals for education and training, and professional opportunities

Tangibly demonstrate learning and KSAs in specific areas of study and practice

Validate and improve competence through narratives that connect reflective practice to practice standards and advance relevant and purposeful competencies through continual professional development

Provide more detailed exemplars for performance-based interviews, applications for employment, scholarships, grants, bonuses, or promotions

Speak to specific qualifications required for various positions when entering academia or the workforce and for transitioning into new roles

Document required artifacts to illustrate portfolio-based competency assessments for regulatory agencies, accreditations, performance appraisals or evaluations, or certifications (e.g., VA Nursing Professional Standards Board reviews; American Nurses Credentialing Center certification renewals, American Academy for Preceptor Advancement certifications for Preceptor Specialists)

Explore and map the quality, safety, and expansiveness of personal mastery, academic progress, and professional development (e.g., serving on various committees, projects and task force groups, and interprofessional collaborative teams; completing preceptorships and mentorships)

Guide academic and career planning (e.g., artifacts for progressive career ladders)

Reflect on personal growth and development acquired through study, work, and applications of knowledge to meeting personal goals and gaining wisdom (e.g., show enhanced critical thinking skills and abilities to safely engage in complex projects or activities)

Capture previous work and lived experiences, challenges met, and life lessons learned for academic or work credits

Communicate the highest level of personal mastery and professional preparation through multiple media (e.g., technology) and other artifacts

Portfolios contribute to any conversation nurses will have as they grow and develop personally, academically, and professionally, regardless of the paths they take. Portfolios are significant resources for nurses to showcase competence and practice improvements, with artifacts demonstrating abilities to narrate lived experiences and the insight gained through reflection and reflective practice.
Building Your Portfolio: A Primer for Nurses by Diana Swihart, PhD, DMin, APN CS, RN-BC, P-PCA, FAAN, and Solimar Figueroa, PhD, MHA, MSN, BSN, RN, P-PCA is now available for preorder and expected to publish in May 2019.

# data[].attributes.attachment_link.title
The Importance of a Professional Nursing Portfolio

# data[].attributes.attachment_link.description
Editor's note: The following is a lightly edited excerpt from the upcoming book, Building Your Professional Portfolio: A Primer for Nurses . The concept of a professional portfolio is not a new concept in nursing, but a review of available literature reminds nursing leaders of its value regarding personal and professional development and advancement for nurses.

# data[].attributes.headline
Nurse Educators' Vital Role in the Future of Nursing

# data[].attributes.subject
Nurse Educators' Vital Role in the Future of Nursing

# data[].attributes.attachment_link.readable_text
The nationwide nursing shortage isn't slowing down anytime soon, as the baby boomer population continues to age and average life expectancy increases, building demand for medical care. That's not all-the U.S Bureau of Labor Statistics predicts nearly 1.1 million new registered nurses (RNs) will be needed by 2022 in order to replace 500,000 retirees and fill 100,000 new RN positions each year.

This is good news-and an ideal opportunity to advance your nursing career to become a nurse educator. After all, who is going to train all these new nurses?

Nurse educators play a vital role in ensuring that the next generation of nurses is prepared to meet the growing demand for healthcare services. Nurse educators are also instrumental in shaping the future of the nursing profession, encouraging a focus on holistic patient care and illness prevention, as well as promoting community health. Right now there is a strong need for educators - 83 percent of nursing programs sought to hire new faculty in 2015.

Why are nurse educators so important?
Nurse educators serve an important role within the hospital system. Having professional nurses who are trained to deliver information to other nurses, who understand their challenges and how to convey critical and lifesaving knowledge is essential to a hospital's success. A nurse educator can help mitigate mistakes, streamline processes, shorten new hire ramp time and identify opportunities to improve processes and mitigate risks to the patient, nurse and hospital.

In 2008, the Institute of Medicine released a report recommending that 80 percent of the registered nurse (RN) workforce have a bachelor's degree in nursing (BSN) by 2020, causing many hospitals to reevaluate their criteria for hiring new nurses. Additionally, hospitals aspiring to Magnet status are likely to hire more BSN-prepared nurses, due to better expected patient outcomes.

That's why many hospitals are looking to work with educational institutions such as Herzing University to meet the rising demand of BSN degrees, such as through an online RN-BSN program.
As registered nurses return to school and new students seek entry to BSN programs, colleges and universities are under increased pressure to find qualified faculty to educate and train future nurses. Thus, nurse educators' skills and experience are continually in demand, and essential for expanding the RN workforce to meet the healthcare needs of current and future generations.

How are nurse educators preparing nurses for the future?
Nurse educators are instrumental in shaping the future of healthcare by providing their students not only with the technical skills that they need to be successful in their field, but also the refined skills and depth of knowledge that will help advance quality of patient care.

* The importance of community nursing:
As the focus of patient care shifts from acute care to prevention models, a nurse's role expands to health education and advocacy, community care, agency collaboration and political and social reform. Today's nurses need to understand their evolving role in the community and how to provide holistic care for patients. As a nurse educator, you help nurses understand the principles behind the work that they do and how they can proactively contribute to the health and well-being of the communities they serve.

* Essential leadership skills:
Good leaders aren't born-they're made! Nurse educators help prepare today's nurses for future leadership roles by introducing management and organizational theories that will allow nurses to take initiative in a variety of roles. In addition, nurse educators help students learn how to improve patient-care quality, how to make cost-effective decisions and how to evaluate patient outcomes to improve future practice.

* How to implement evidence-based practice:
Nurse educators can also help nurses learn how to critically evaluate new research. This is an important skill that allows nurses to become more effective decision-makers and problem-solvers and help improve patients' health and well-being.

Becoming a nurse educator:
Becoming a nurse educator doesn't mean that you have to forgo your clinical work; many nurse educators continue to care for patients in addition to their teaching duties. In order to become a nurse educator, you must obtain your MSN. Educational opportunities such as Herzing's MSN-Nurse Educator program empower students to fulfill the ongoing and vital need for quality instructors in the field.
Helping to shape the future generation of nurses is a truly rewarding career, and one that is essential to ensuring quality healthcare for our nation. By choosing to pursue a career in nursing education, today's nurses can help pave the way for a healthier future.

More Nursing News

# data[].attributes.attachment_link.title
Nurse Educators' Vital Role in the Future of Nursing - Daily Nurse

# data[].attributes.attachment_link.description
The nationwide nursing shortage isn't slowing down anytime soon, as the baby boomer population continues to age and average life expectancy increases, building demand for medical care. That's not all-the U.S Bureau of Labor Statistics predicts nearly 1.1 million new registered nurses (RNs) will be needed by 2022 in order to replace 500,000 retirees and ...

# data[].attributes.headline
Using Blooms Taxonomy to Write Effective Learning Objectives

# data[].attributes.subject
Using Blooms Taxonomy to Write Effective Learning Objectives

# data[].attributes.attachment_link.readable_text
What is Bloom's Taxonomy

Bloom's Taxonomy is a classification of the different outcomes and skills that educators set for their students (learning outcomes). The taxonomy was proposed in 1956 by Benjamin Bloom, an educational psychologist at the University of Chicago. The terminology has been recently updated to include the following six levels of learning. These 6 levels can be used to structure the learning outcomes, lessons, and assessments of your course. :

1. Remembering: Retrieving, recognizing, and recalling relevant knowledge from long‐term memory.

2. Understanding: Constructing meaning from oral, written, and graphic messages through interpreting, exemplifying, classifying, summarizing, inferring, comparing, and explaining.

3. Applying: Carrying out or using a procedure for executing, or implementing.

4. Analyzing: Breaking material into constituent parts, determining how the parts relate to one another and to an overall structure or purpose through differentiating, organizing, and attributing.

5. Evaluating: Making judgments based on criteria and standards through checking and critiquing.

6. Creating: Putting elements together to form a coherent or functional whole; reorganizing elements into a new pattern or structure through generating, planning, or producing.

Like other taxonomies, Bloom's is hierarchical, meaning that learning at the higher levels is dependent on having attained prerequisite knowledge and skills at lower levels. You will see Bloom's Taxonomy often displayed as a pyramid graphic to help demonstrate this hierarchy. We have updated this pyramid into a "cake-style" hierarchy to emphasize that each level is built on a foundation of the previous levels.

You may use this graphic for educational or non-profit use if you include a credit for Jessica Shabatura and citation back to this website.
How Bloom's can aid in course design

Bloom's taxonomy is a powerful tool to help develop learning outcomes because it explains the process of learning:

Before you can understand a concept, you must remember it.

To apply a concept you must first understand it.

In order to evaluate a process, you must have analyzed it.

To create an accurate conclusion, you must have completed a thorough evaluation.

However, we don't always start with lower order skills and step all the way through the entire taxonomy for each concept you present in your course. That approach would become tedious-for both you and your students! Instead, start by considering the level of learners in your course:

1. Are lots of your students freshman? Is this an "Introduction to..." course? If so, many your learning outcomes may target the lower order Bloom's skills, because your students are building foundational knowledge. However, even in this situation we would strive to move a few of your outcomes into the applying and analyzing level, but getting too far up in the taxonomy could create frustration and unachievable goals.

2. Are most of your students juniors and seniors? Graduate students? Do your students have a solid foundation in much of the terminology and processes you will be working on your course? If so, then you should not have many remembering and understanding level outcomes. You may need a few, for any radically new concepts specific to your course. However, these advanced students should be able to master higher-order learning objectives. Too many lower level outcomes might cause boredom or apathy.

How Bloom's works with learning outcomes

Fortunately, there are "verb tables" to help identify which action verbs align with each level in Bloom's Taxonomy.

You may notice that some of these verbs on the table are associated with multiple Bloom's Taxonomy levels. These "multilevel-verbs" are actions that could apply to different activities. For example, you could have an outcome that states "At the end of this lesson, students will be able to explain the difference between H2O and OH-." This would be an understanding level outcome. However, if you wanted the students to be able to "... explain the shift in the chemical structure of water throughout its various phases." This would be an analyzing level verb.

Adding to this confusion, you can locate Bloom's verb charts that will list verbs at levels different from what we list below. Just keep in mind that it is the skill, action or activity you will teach using that verb that determines the Bloom's Taxonomy level.

Bloom's Level

Key Verbs (keywords)

Example Learning Outcome

Evaluate
choose, support, relate, determine, defend, judge, grade, compare, contrast, argue, justify, support, convince, select, evaluate.

By the end of this lesson, the student will be able to determine whether using conservation of energy or conservation of momentum would be more appropriate for solving a dynamics problem.

Learning outcome examples adapted from, Nelson Baker at Georgia Tech: nelson.baker@pe.gatech.edu
How Bloom's works with Quality Matters

For a course to meet the Quality Matters standards it must have learning outcomes that are measurable. Using a verb table like the one above will help you avoid verbs that cannot be quantified, like: understand, learn, appreciate, or enjoy. Quality Matters also requires that your course assessments (activities, projects, and exams) align with your learning outcomes. For example, if your learning outcome has an application level verb, such as "present", then you cannot demonstrate that your students have mastered that learning outcome by simply having a multiple choice quiz.

Course level and lesson level outcomes

The biggest difference between course and lesson level outcomes is that we don't directly assess course level outcomes. Course level outcomes are just too broad. Instead, we use several lesson level outcomes to demonstrate mastery of one course level outcome. To create good course level outcomes, we need to ask ourselves: "what do I want the students to have mastery of at the end of the course?" Then, after we finalize our course level outcomes, we have to make sure that mastery of all of the lesson level outcomes underneath confirm that a student has mastery of the course level outcome-in other words, if your students can prove (through assessment) that they can do each and every one of the lesson level outcomes in that section, then you as an instructor agree they have mastery of the course level outcome.

How Bloom's works with course level and lesson level outcomes:

Course level outcomes are broad. You may only have 3-5 course level outcomes. They would be difficult to measure directly because they overarch the topics of your entire course.

Lesson level outcomes are what we use to demonstrate that a student has mastery of the course level outcomes. We do this by building lesson level outcomes that build toward the course level outcome. For example, a student might need to demonstrate mastery of 8 lesson level outcomes in order to demonstrate mastery of one course level outcome.

Because the lesson level outcomes directly support the course level outcomes, they need to build up the Bloom's taxonomy to help your students reach mastery of the course level outcomes. Use Bloom's Taxonomy to make sure that the verbs you choose for your lesson level outcomes build up to the level of the verb that is in the course level outcome. The lesson level verbs can be below or equal to the course level verb, but they CANNOT be higher in level. For example, your course level verb might be an Applying level verb, "illustrate." Your lesson level verbs can be from any Bloom's level that is equal or below this level (applying, understanding, or remembering).

Steps towards writing effective learning outcomes:

1. Make sure there is one measurable verb in each objective.

2. Each outcome needs one verb. Either a student can master the outcome , or they fail to master it. If an outcome has two verbs (say, define and apply), what happens if a student can define, but not apply? Are they demonstrating mastery?

3. Ensure that the verbs in the course level outcome are at least at the highest Bloom's Taxonomy as the highest lesson level outcomes that support it. (Because we can't verify they can evaluate if our lessons only taught them (and assessed) to define.)

4. Strive to keep all your learning outcomes measurable, clear and concise.

When you are ready to write, it can be helpful to list the level of Bloom's next to the verb you choose in parentheses. For example:

Course level outcome 1. (apply) Demonstrate how transportation is a critical link in the supply chain.

1.1. (understand) Discuss the changing global landscape for businesses and other organizations that are driving change in the global environment.

1.2. (apply) Demonstrate the special nature of transportation demand and the influence of transportation on companies and their supply chains operating in a global economy.

This trick will help you quickly see what level verbs you have. It will also let you check that the course level outcome is at least as high of a Bloom's level as any of the lesson level outcomes underneath.

Before you begin constructing your outcomes:

Please read our Learning Outcome : Before and After Examples page.

Additional External Resources:

For a longer list of Bloom's Verbs - TIPS tip: You can also use the "find" function (press: Ctrl-f or command-f on a mac) in your browser to locate specific verbs on this list.

To see how Bloom's can be applied specifically to distance education: Digital Approaches to Bloom's Taxonomy

# data[].attributes.attachment_link.title
Using Bloom's Taxonomy to Write Effective Learning Outcomes

# data[].attributes.attachment_link.description
Bloom's Taxonomy is a classification of the different outcomes and skills that educators set for their students (learning outcomes). The taxonomy was proposed in 1956 by Benjamin Bloom, an educational psychologist at the University of Chicago. The terminology has been recently updated to include the following six levels of learning.

# data[].attributes.headline
6 Tips to Get You Through a Presentation Without Wanting to Vomit

# data[].attributes.subject
6 Tips to Get You Through a Presentation Without Wanting to Vomit

# data[].attributes.body
*please excuse the profanity at the end*

# data[].attributes.attachment_link.readable_text
Four to five minutes of pure terror.

Years and years ago, at the dawn of time probably, a bunch of sour white dudes got together and agreed that every single University degree should contain a class presentation. No matter that it's almost universally loathed, or that everyone else in the class just sits on their phone the whole time anyway. They declared it a necessary course requirement. And then drank their rich wine and did rich, male things.

Yes, class presentations suck. Whether you're amping up to present to your tute in the coming weeks, or just need a general public speaking pep talk, here are our tips.

Sure, we all set out to do work that we're proud of but sometimes we don't quite get there. We leave it to the last minute and race to the submission deadline with nothing but Red Bull and Doritos to fuel our intellectual capabilities.

If you're super nervous about getting up in front of the class, don't leave it to chance. Prepare as far in advance as you can, revise it, edit it and rewrite it. Feeling like you're proud of your work will make you excited to present it to the class and less worried about how potentially embarrassing it could be. Because how could it be embarrassing if it's pure freakin' gold?

Call your Mum, Dad, sister or fluffy cat Nemo into the living room and make them listen to your speech. Sure, they couldn't give a flying fuck about linguistic methods of post-war communication, but they do give a flying fuck about you. So they can gosh darn sit there and listen to your four to five minute yarn.

It's also a good idea to practice in front of the mirror as it familiarises yourself with your facial expressions and frequency of eye contact.

You're doing amazing, sweetie.

As Nick Morgan pointed out for Forbes, "Adrenaline is your body's way of preparing you for crucial moments such as chasing down woolly mammoths and saber-toothed tigers." Your speech isn't a woolly mammoth that's coming to squash you into oblivion. It's just a speech. A few words that you've strung together and have to recite in front of a room of bored people. Remind yourself that there's no real threat to your safety and go from there.

If you turn that sweaty palm, fast-heart feeling from pure vomit nervousness into an excitement to just get it over and done with, you'll be surprised how much better equipped you are to tackle the day. All it takes is a shift in perspective.

Steady your heart rate by breathing deeply in and out. If you need some help, you can listen to this extremely good meditative guide by your girl Amandla Stenberg.

Get your blood pumping to relieve some stress and anxiety. Jump up and down, go for a brisk walk and indulge in a few lunges just before class.

Or if you're a little worried about looking like a dweeb on campus, go for a run before you leave for uni that morning. As Michael Hopkins from Dartmouth's Neurobiology of Learning and Memory Laboratory pointed out, "the positive stress of exercise prepares cells and structures and pathways within the brain so that they're more equipped to handle stress in other forms." There you go. Science.

You know how the tutor always asks if someone wants to go first? You should volunteer! Half of your nervousness is overthinking how nervous you are. Once it's over and done with you can breathe a sigh of relief and never think about that g-damn assignment ever again.

In fact, rip up your speech into tiny pieces for good measure. You did it.
(Lead image: Never Been Kissed/20th Century Fox)

# data[].attributes.attachment_link.title
6 Tips To Get You Through A Class Presentation Without Wanting To Vomit

# data[].attributes.attachment_link.description
Four to five minutes of pure terror. Years and years ago, at the dawn of time probably, a bunch of sour white dudes got together and agreed that every single University degree should contain a class presentation. No matter that it's almost universally loathed, or that everyone else in the class just sits on their phone the whole time anyway.

# data[].attributes.attachment_link.readable_text
Your CV - as its full name, "curriculum vitae," suggests - is the record of your academic life. But it's also a passport through that life, and one you'll have to show to gatekeepers over and over. If you want to get past those gates, your CV had better do its job.

I talk a lot in The Graduate Adviser column about the career prospects of Ph.D.s outside of academe, but this month I turn to the central document of academic life: the CV. Of course a strong CV is built on strong achievements. But you also have to present your record in an interesting and impressive way. And that's where many aspiring academics fall short.

What follows are eight tips to improve your CV.

But first, understand the difference between a CV and a résumé. There's plenty of overlap between the two - it's fair to describe a CV as an academic résumé. But the differences are salient. A résumé tends to be directly purpose-driven. It might start out with an explicit career objective ("a public-relations position that combines analysis and customer relations"), while a CV rarely features that kind of rhetoric.

CVs have specific purposes, too - they're more implicit, that's all. You have to design a CV for the audience it will reach - and you have to attend to the particular readings habits of that audience.

Résumés are typically more compact than CVs. Just about everyone who's written a résumé has encountered the injunction to keep it short. But if a CV is usually more comprehensive, that doesn't mean it should be swollen with watery excess. Keep in mind that every unnecessary item on your vita threatens, by its very presence, to distract your reader from the necessary stuff.

What makes a CV entry necessary? That depends on who's reading, and why.

Always remember: Your CV combines autobiography and salesmanship. It needs to persuade readers to hire you for the job, give you the grant, or award you the fellowship. You have to select the aspects of yourself that will sell you to your specific audience.

Other people read your CV because they have something you want. When you prepare the document for their eyes, keep your specific goal in mind and customize accordingly. If you're sending your CV as part of an application for a grant, you probably don't need to include your campus service work - because unnecessary extras distract the reader. If you're applying for a teaching job at a research university, you'll present your teaching record differently than if you're applying for an opening at a private high school.

In other words, a CV is not just a written record of your credentials. It's an argument in favor of you. Write with that in mind.

Generally speaking, put your educational credentials first. As you make that argument for yourself, follow the prevailing rules. Education is the business most CV-readers are in. Readers of résumés might not care much about where you went to school and what degrees you got, but CV readers almost always look for that information right away. Don't annoy them by burying it.

When you lay out your CV, follow the conventions of your discipline. A CV is not the place to challenge your reader's assumptions. If scientists expect your publications to be presented in chronological order and in a specific bibliographic format, then meet their expectations. If you don't, you'll distract your readers from their most important task, which is to assess your credentials.

Draft your vita knowing it will be skimmed. I keep returning to distraction because it ought to be your greatest concern. Consider that most people going through a stack of applications will spend only a couple of minutes reading each CV - if that. You have to make the most of that brief time.

Worse, most readers don't read a CV carefully. They skim it. You can't change that fact, so accommodate to it instead: Write to be skimmed. Which brings me to my next two points.

Most important, write visually. That's an umbrella term. It means you should attend to the visual balance between text and white space on your CV, use formatting thoughtfully to create emphasis, and, above all, consider the movement of a skimming reader's fast-moving eye.

You may wonder how you can tell where readers are going to look. It takes some practice. You can get it by reading other people's CVs (which are abundant online), and watching where your own eyes travel. Where do you home in? What do you skip? Do your eyes move sequentially from section marker to section marker, or do they jump around?

A good CV uses formatting to catch and direct the reader's attention. Boldface, for example, will attract the reader - as it does you when you read this essay. Underlining does the same.

On the other hand, big bricks of text - i.e., chunky paragraphs - will repel readers. When the skimming reader's eye encounters a long paragraph, it usually just bounces off it and drops downward to the next resting point. Resting points are important because even skimming readers need a place to stop. Indentation and other formatting choices provide visual variety and contrasts, and they also provide section markers to give readers a momentary rest before you redirect them.

Use boldface, underlining, and other attention-getting hooks judiciously. Overuse renders them ineffective, or worse. If a CV assaults the eye with a blizzard of words and a farrago of underlining, bolding, italics, text boxes, and so on, you'll turn off many readers and get less of their precious time.

Front-load your most important entries. This, too, is about keeping in mind your readers' limited amount of time for looking at CVs. If your most impressive credential is the prize you won for your dissertation, then figure out a way to put it before your reader as soon as you can - and flag it so it won't be missed.

You have to do that because reading lengthy CVs gets tiring very fast. Make sure your readers see what you want them to see before they run out of attention, shift into "it's time to finish" mode, and start hitting "page down."

Avoid inside baseball. That's a journalistic term for insider talk. You'll conserve your reader's patience if you present the important stuff intelligibly. Unless you're applying for an opening in a department you're already teaching in, your reference to "Sociology 342" will be lost. Worse, it will be interpreted as a sign that you don't really understand who your audience is - and your readers will take note of that failure.

Use your CV to guide the interview you hope to land. Your CV should include only those things that you want to talk about in the job interview. Remember that an interview is a conversation about you - and your application provides the ingredients for that discussion. Imagine how you'd like the conversation to go, and organize your CV to make that outcome more, not less, likely.

The inverse also holds true: If you don't want to talk about a particular controversy in your field (say, a high-profile sexual-harassment case in your discipline), then avoid names and references on your CV that might lead a reader to ask you about it.

Of course your application comprises more than your CV. If you're applying for a job, your cover letter is at least as important. That'll be the subject of my next column.

Leonard Cassuto, a professor of English at Fordham University, writes regularly about graduate education in this space. His latest book is The Graduate School Mess: What Caused It and How We Can Fix It, published by Harvard University Press. He welcomes comments, suggestions, and stories at lcassuto@erols.com. His Twitter handle is @LCassuto.

# data[].attributes.attachment_link.description
Your CV - as its full name, "curriculum vitae," suggests - is the record of your academic life. But it's also a passport through that life, and one you'll have to show to gatekeepers over and over. If you want to get past those gates, your CV had better do its job.

# data[].attributes.headline
Giving Student Feedback in a Clinical Setting

# data[].attributes.subject
Giving Student Feedback in a Clinical Setting

# data[].attributes.attachment_link.title
Giving Student Feedback in a Real World Setting

# data[].attributes.attachment_link.title
Clinical Teacher Effectiveness | Five Principles of Positive Feedback

# data[].attributes.headline
Toolbox of Teaching Strategies in Nurse Education

# data[].attributes.subject
Toolbox of Teaching Strategies in Nurse Education

# data[].attributes.attachment_link.title
Toolbox of teaching strategies in nurse education

# data[].attributes.headline
Strategies for Teaching Evidence-Based practice in Nursing Education: A Thematic Literature Review

# data[].attributes.subject
Strategies for Teaching Evidence-Based practice in Nursing Education: A Thematic Literature Review

# data[].attributes.attachment_link.title
Strategies for Teaching Evidence-based practice

# data[].attributes.headline
Simulation-Based Learning: No Longer a Novelty in Undergraduate Education

# data[].attributes.subject
Simulation-Based Learning: No Longer a Novelty in Undergraduate Education

# data[].attributes.attachment_link.title
Simulation-Based Learning- No Longer a Novelty in Undergraduate Education

# data[].attributes.body
Simulation Lab