I recently posted an online survey to see how I could more effectively meet the needs of students & nurse educators, I received 145 responses.

Of the 10 questions I asked, this one was the most revealing: “What is your biggest struggle right now as an educator?”

I identified four primary content themes of struggles that had significance because they were shared by so many educators. Today I will start with the theme that had the largest number of responses: Struggles with students.

Topic of todays blog: Students who demand to be spoon fed content vs. doing the needed work to think (feed) themselves!

Infants or Adults?

Are students acting like infants or adults in nursing education? Based on the results of my survey, many want to be treated like infants and be spoon fed, and some educators are unfortunately enabling this behavior by their willingness to do the feeding!

This struggle and frustration was represented by the following comments:

• “Students don’t want to work! They want you to hand them only the info they need and spit it back.”
• “Some students today just ‘don’t get it.’ As we have all heard ‘JUST TELL ME WHAT I NEED TO KNOW.”
• “Student expectations that the instructor will give them everything they need to know in order to pass an exam.”
• “My biggest struggle is to get the students to do the required work with a minimum amount of complaining.”
• “Getting students to buy into flipping the classroom. Other instructors have spoon fed the students making it difficult to transition to anything differently.”

Remember Erikson?

Based on what you know of child development (remember Erikson and autonomy vs. shame & doubt?), it is healthy, normal, and expected for a child 2-4 years old to be increasingly independent and demonstrate this by clothing and feeding themselves.

To see a child >4 years old wanting to be spoon fed is a cause of concern! In the same way, the insistence to be spoon fed content as an adult learner is also unhealthy and merits further investigation regarding the reasons for this developmental regression.

Reasons for Regression

My survey and my own observations as a nurse educator make it clear that students are under high amounts of STRESS in a high-stakes major, and they feel the burn of not having enough time to balance the spinning platters of work, family/children, and nursing education.

Therefore something has got to give! For some students this may explain the mantra, “TELL ME WHAT I NEED TO KNOW.”

For others though, this mantra is an excuse for laziness and wanting to do minimal amount of work just to get by. Therefore, before we make assumptions as educators regarding student motives for wanting to be spoon fed, let’s make the effort to get to know each student well enough and recognize which students need encouragement and support, and which ones need a kick in the pants!

Educators: Modern Day Pharisees?

Every educator must also reflect and determine if we are part of the problem that is making an already stressful major, overwhelming and burdening to our students.

Jesus condemned the Pharisees of his day by stating that they “tie up heavy loads, hard to bear, and place them on men’s shoulders” (Mathew 23-1-5).

By placing an unrealistic and not always relevant “heavy load” of CONTENT on our students that is “hard to bear” (ask your students for feedback!) is breaking the backs as well of the hearts of many.

Patricia Benner and her co-authors (Educating Nurses: A Call for Radical Transformation) identified this same problem in their research findings in nursing education. One of their findings was that nursing curriculum is ADDITIVE over time. Instead of reworking classroom lecture content, the faculty simply incorporate more (1).

Benner summarizes succinctly this concern:

Classroom teachers must step out from behind the screen full of slides and ENGAGE students in clinic-like learning experiences that ask them to learn to use knowledge and practice thinking in changing situations always for the good of the patient (1).

Too much content is a current barrier for our students to identify what is truly most important to practice. The problem with a content heavy curriculum is that students get only a “skin deep” learning that makes it difficult to apply at the bedside.

Our goal as nurse educators must be to filter the ever increasing amount of content by emphasizing DEEP learning of what is most important.

Educators have a responsibility to filter all content from a textbook through the lens of basic clinical practice: Keep and emphasize the NEED to know. Minimize or ignore the NICE to know!

Nurse Thinking=SAFE Patient Care

But more importantly, students must know in no uncertain terms the high stakes that are inherent with the responsibility of caring for others who require professional nursing care by posing this question to your students:

What is the ultimate consequence when a graduating student is unable to THINK like a nurse?

Outcomes for their patients will be impacted, and some patients will even die due to FAILURE TO RESCUE by not recognizing a change of status until it is too late! Therefore spoon feeding content to students limits the ability to apply knowledge, which will adversely impact patient care and patient outcomes!

For more details on this important topic please see my prior blog post “I see dead patients…” 

Creating a Culture of “Nurse Thinking”

When “To Err is Human: Building a Safer Healthcare System” came out in 1999 by the Institutes of Medicine (IOM), it revealed that 44,000-98,000 patients were dying from preventable safety errors annually in the US. Since this study a “culture of safety” has been established in healthcare to decrease this tragic toll of human life. Bar code scanning for med administration, SBAR, and timeouts are but a few of the many changes in healthcare toaccomplish this objective.

In the same way, a culture of “nurse thinking” must be created in every academic institution that is essential to create a similar culture of safety within nursing education.

The tenets of this needed cultural change should include the following:

• SPOON FEEDING NOT ALLOWED! …Expect and provide tools that allow students to PRACTICE and APPLY their knowledge in your classroom. (Check out my unique clinical reasoning case studies!)
• DECREASE CONTENT…Slash 40-50% of your current PowerPoint lectures by emphasizing NEED TO KNOW and let students read the rest. Use this freed up time to engage students with applied active learning strategies.
• Emphasize CLINICAL REASONING as needed “nurse thinking”

When students as well as faculty recognize what is at stake and see nurse thinking as a patient safety issue, there should be no problem for those who are properly motivated to become caregivers to embrace the extra work that is required to readily APPLY knowledge to the bedside and feed themselves with the expert guidance of nursing educators!

Question

“What have you done to encourage your students to feed themselves in your program? What has been the response? What lessons did you learn?

Respond in the comment section below and let the conversation begin!

References

1. Benner, P., Sutphen, M., Leonard, V., & Day, L. (2010). Educating Nurses: A Call for Radical Transformation. San Francisco, CA: Jossey-Bass