Journal of Advanced Nursing, 1979, 4, 327-329
JANFORUM The contribution of dinioai nurse speoiaiists to tiie education of student nurses Evolution of the role In the past years, the role of the clinical nurse specialist has evolved in the USA and elsewhere, and continues to evolve. In addition to heing responsible for administering and directing nursing care, clinical speciahsts have varying educational and administrative joint appointments. These joint appointments may include college of nursing faculty appointments in undergraduate, graduate and continuing education. However, some clinical specialists are appointed as full time faculty members in undergraduate nursing programmes and fulfill this role function extremely well. The clinical specialist commonly possesses a master's degree in nursing with a major area of specialization. She/he appears to exhibit a uniqueness which may be attributed to her clinical expertise and breadth and depth of knowledge, and has been gained through experience and educational preparation. The nursing faculty member who has worked in nursing practice as a clinical specialist and/or who has a variety of nursing experience prior to her preparation as a clinical specialist operates from an optimal vantage point in facilitating the learning process in students in the chnical laboratory. This is possible because of: clinical expertise, ability to more readily relate theory to practice, ability to answer the 'how' and 'why' of situations, and, creative clinical leadership quaUties. The abihty to facihtate the learning process in students in the clinical laboratory is built upon three of the major functions inherent in the role of a clinical specialist: practitioner, teacher, and researcher.
Practitioner Clinical expertise and the abihty to more readily relate theory to practice are derived from fulfilling the role function as practitioner. The clinical specialist is an expert practitioner primarily interested in patient care. She is an asute observer who identifies individual needs of patients as well as common elements in their care. She plans, prescribes, gives, and evaluates nursing care. In addition, she introduces nursing practice innovations, refines nursing techniques and procedures, conceptuahzes new formats of nursing practice, and makes appropriate modifications in particular nursing practices. Because she is an expert practitioner she is able to set standards of clinical nursing practice for the care of patients. The clinical specialist brings these quahties to the teaching-learning process, serving as a role model for students. She therefore provides experiences for students to 0309-2402/79/0300-0327 $02.00 © 1979 Blackwell Scientific Publications 327
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develop these qualities. For example, students are taught from the very heginning the importance of observational skills in the collection of data concerning the health status of patients. They are taught to systematically and continuously assess the patient in order to estahlish his haseline of functioning and identify his individual needs. In so doing, they are ahle to make correct nursing diagnoses and provide appropriate nursing intervention. Furthermore, they are taught to continually evaluate the patient's response to care and make necessary modification. Teacher The clinical specialist's ahility to answer the 'how' and 'why' of situations is exemplified through her teacher role. The role function of the clinical specialist as a teacher include teaching personnel responsible for the care of a specific patient population, individuals and families. Because of her past clinical teaching experiences, the clinical specialist readily recognizes opportunities for 'on the spot' teaching. She utiHzes these opportunities, or creates new ones, to improve clinical competencies of students responsible for the care of patients and to increase their independency and autonomy in problem-solving. She also assists students to achieve greater independence and effectiveness in the nursing process. Nursing judgement and action are facilitated by increased knowledge and understanding of physiologic processes, behavioural patterns, and diagnosis and treatment regimens. This knowledge and understanding leads to care that is individualized to each patient's illness experience rather than focusing on routines or tasks. Students are stimulated to try various approaches to patient care and to evaluate the nursing care administered. Moreover, the clinical speciaHst's skill in identifying and applying principles of teaching and learning in direct patient care enhances her ability in assisting students to selectively teach patients, so that patients may gain a better understanding of their health maintenance requirements. As a researcher, the clinical specialist keeps informed of research studies in nursing and related fields. She participates in ongoing research projects, interprets findings and utilizes results from research studies as a basis for innovative nursing practice. She assists students in scrutinizing and discussing nursing and related research studies analytically. She also assists them to apply findings in solving nursing care problems. Because she is so aware of the importance of nursing research as a basis for the improvement of nursing care, she demonstrates a keen interest in research and fosters a spirit of inquiry. Furthermore, she encourages students to engage in research and assist them in carrying out small research projects. Change agent The clinical specialist appears to possess certain creative abilities and a high degree of imagination. As a teacher, she is able to create for students a mental picture about things she discusses. She also creates a mental picture about things she sees that need to be changed and the manner in which change should be brought about. She exercises creativeness in considering proposals and ideas and
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thinks creatively about the nature of problems. She is able to grasp an idea and see it to full fruition by working through and with others. She is able to communicate her ideas and influence others. There is a dialogue and a free flow of communication between herself and her students. Her leadership frees the flow rather than blocks communication. This free exchange of ideas facilitates the learning process. As a result of the clinical specialist's creative leadership quahties, clinical expertise, teaching ability and interest in research, a positive change in students' behaviour is readUy observable. This change is demonstrated by keen assessment skills, nursing practice based on scientific principles and a high degree of inquiry.
Conclusion Of the many roles in which the clinical nurse specialist may function, one of the most important, most rewarding and potentially with the most lasting results, is that of educator. Clinical specialists are not and cannot be solely responsible for the education of student nurses, but they do make good role models. Having some input in the early stages of the teaching-learning process of the nurses of the future may very well have an impact on the dehvery of health care in which there are so many demands for changes and improvement.
Beatrice V. Adderley R.N. B.S.N. M.S. Assistant Professor and Chairman Howard University College of Nursing, Washington D.C.
Mary Hunter Hill B.S.N. M.S. Associate Professor Columbia University School of Nursing, New York
JANFORUM The contribution of dinioai nurse speoiaiists to tiie education of student nurses Evolution of the role In the past years, the role of the clinical nurse specialist has evolved in the USA and elsewhere, and continues to evolve. In addition to heing responsible for administering and directing nursing care, clinical speciahsts have varying educational and administrative joint appointments. These joint appointments may include college of nursing faculty appointments in undergraduate, graduate and continuing education. However, some clinical specialists are appointed as full time faculty members in undergraduate nursing programmes and fulfill this role function extremely well. The clinical specialist commonly possesses a master's degree in nursing with a major area of specialization. She/he appears to exhibit a uniqueness which may be attributed to her clinical expertise and breadth and depth of knowledge, and has been gained through experience and educational preparation. The nursing faculty member who has worked in nursing practice as a clinical specialist and/or who has a variety of nursing experience prior to her preparation as a clinical specialist operates from an optimal vantage point in facilitating the learning process in students in the chnical laboratory. This is possible because of: clinical expertise, ability to more readily relate theory to practice, ability to answer the 'how' and 'why' of situations, and, creative clinical leadership quaUties. The abihty to facihtate the learning process in students in the clinical laboratory is built upon three of the major functions inherent in the role of a clinical specialist: practitioner, teacher, and researcher.
Practitioner Clinical expertise and the abihty to more readily relate theory to practice are derived from fulfilling the role function as practitioner. The clinical specialist is an expert practitioner primarily interested in patient care. She is an asute observer who identifies individual needs of patients as well as common elements in their care. She plans, prescribes, gives, and evaluates nursing care. In addition, she introduces nursing practice innovations, refines nursing techniques and procedures, conceptuahzes new formats of nursing practice, and makes appropriate modifications in particular nursing practices. Because she is an expert practitioner she is able to set standards of clinical nursing practice for the care of patients. The clinical specialist brings these quahties to the teaching-learning process, serving as a role model for students. She therefore provides experiences for students to 0309-2402/79/0300-0327 $02.00 © 1979 Blackwell Scientific Publications 327
328
Janforum
develop these qualities. For example, students are taught from the very heginning the importance of observational skills in the collection of data concerning the health status of patients. They are taught to systematically and continuously assess the patient in order to estahlish his haseline of functioning and identify his individual needs. In so doing, they are ahle to make correct nursing diagnoses and provide appropriate nursing intervention. Furthermore, they are taught to continually evaluate the patient's response to care and make necessary modification. Teacher The clinical specialist's ahility to answer the 'how' and 'why' of situations is exemplified through her teacher role. The role function of the clinical specialist as a teacher include teaching personnel responsible for the care of a specific patient population, individuals and families. Because of her past clinical teaching experiences, the clinical specialist readily recognizes opportunities for 'on the spot' teaching. She utiHzes these opportunities, or creates new ones, to improve clinical competencies of students responsible for the care of patients and to increase their independency and autonomy in problem-solving. She also assists students to achieve greater independence and effectiveness in the nursing process. Nursing judgement and action are facilitated by increased knowledge and understanding of physiologic processes, behavioural patterns, and diagnosis and treatment regimens. This knowledge and understanding leads to care that is individualized to each patient's illness experience rather than focusing on routines or tasks. Students are stimulated to try various approaches to patient care and to evaluate the nursing care administered. Moreover, the clinical speciaHst's skill in identifying and applying principles of teaching and learning in direct patient care enhances her ability in assisting students to selectively teach patients, so that patients may gain a better understanding of their health maintenance requirements. As a researcher, the clinical specialist keeps informed of research studies in nursing and related fields. She participates in ongoing research projects, interprets findings and utilizes results from research studies as a basis for innovative nursing practice. She assists students in scrutinizing and discussing nursing and related research studies analytically. She also assists them to apply findings in solving nursing care problems. Because she is so aware of the importance of nursing research as a basis for the improvement of nursing care, she demonstrates a keen interest in research and fosters a spirit of inquiry. Furthermore, she encourages students to engage in research and assist them in carrying out small research projects. Change agent The clinical specialist appears to possess certain creative abilities and a high degree of imagination. As a teacher, she is able to create for students a mental picture about things she discusses. She also creates a mental picture about things she sees that need to be changed and the manner in which change should be brought about. She exercises creativeness in considering proposals and ideas and
Janforum
329
thinks creatively about the nature of problems. She is able to grasp an idea and see it to full fruition by working through and with others. She is able to communicate her ideas and influence others. There is a dialogue and a free flow of communication between herself and her students. Her leadership frees the flow rather than blocks communication. This free exchange of ideas facilitates the learning process. As a result of the clinical specialist's creative leadership quahties, clinical expertise, teaching ability and interest in research, a positive change in students' behaviour is readUy observable. This change is demonstrated by keen assessment skills, nursing practice based on scientific principles and a high degree of inquiry.
Conclusion Of the many roles in which the clinical nurse specialist may function, one of the most important, most rewarding and potentially with the most lasting results, is that of educator. Clinical specialists are not and cannot be solely responsible for the education of student nurses, but they do make good role models. Having some input in the early stages of the teaching-learning process of the nurses of the future may very well have an impact on the dehvery of health care in which there are so many demands for changes and improvement.
Beatrice V. Adderley R.N. B.S.N. M.S. Assistant Professor and Chairman Howard University College of Nursing, Washington D.C.
Mary Hunter Hill B.S.N. M.S. Associate Professor Columbia University School of Nursing, New York
