If there is one “hot topic” in nursing education today, it is “flipping” your classroom.

I am not opposed to the premise of classroom “flipping” and am thankful for those who advocate doing things differently in the classroom.

But it is imperative that nurse educators do not forget the full title of Educating Nurses. It is not a call for a few minor tweaks or a call to “flip” your classroom. It is “A Call for RADICAL TRANSFORMATION”! (emphasis mine)

Is flipping your classroom the same as transforming it? It depends.

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Lessons from Educating Nurses

The essence of a flipped classroom is that the traditional lecture is prerecorded and available for students to review before coming to class (Hertz, 2012). This allows time for active learning strategies such as case studies, discussion, and small group projects to be done during class time.

The educational research findings by the Carnegie Foundation contained in Educating Nurses identified that nursing education, and especially the classroom need to be RADICALLY TRANSFORMED by implementing the following essential shifts of integration:

• Shift from covering decontextualized knowledge and content (textbook) to CONTEXTUALIZING classroom content so it is situated in clinical practice (at the bedside) so students can see why content is relevant.
• Shift from sharp separation of classroom and clinical teaching to greater INTEGRATION of classroom theory and clinical content.
• Shift from an emphasis of critical thinking to an emphasis on CINICAL REASONING. Clinical reasoning is the ability of the nurse to think in action and reason as a situation changes over time by capturing and understanding the significance of clinical trajectories and grasping the essence of the current clinical situation (Benner, Sutphen, Leonard, & Day, 2009).

Strategies to “flip” your classroom MUST be filtered through these three paradigm shifts to determine if they meet the mustard of being a transformational teaching strategy or do they fall short by primarily making learning “fun” or interactive for students?

Lessons from Nature

An excellent example of the radical transformation educators are called to emulate is similar to the metamorphosis of a caterpillar as it transforms into a beautiful butterfly.

The final step of metamorphosis is the butterfly in all its beauty and splendor. Transformation realized! Though it was a process that took time, it was worth the wait because something better and more beautiful was ultimately created and realized.

In the same way, this reality can be realized with a “transformed” classroom!

TMI in Nursing Education

To transformationally “flip” your classroom, educators must FIRST DECREASE the amount of content that is taught.

One of the current problems in nursing education is the vast amount of content that is presented and expected to be mastered by students. Over time, the curriculum becomes ADDITIVE (Tanner, 2004). Instead of revising lectures to reflect current practice, faculty simply add more (Benner, Sutphen, Leonard, & Day, 2009).

This leads to skin-deep learning of a broad body of content, but prevents students from acquiring the DEEP learning of what is MOST important to practice.

DEEP learning of what is most important is a mantra that nurse educators must keep before them to guide everything that is done in nursing education. This needed emphasis is based on essential takeaways from Benner’s novice to expert theory of professional progression and development in nursing.

Students are Novice Nurses

Every nurse educator must have a strong grasp and understanding of novice to expert. As a novice nurse, students see everything taught as relevant (Benner, 1982). This includes all the content in a traditional lecture.

If the same content-heavy lecture is merely repackaged as an electronic download to be reviewed before class, what has been done differently by faculty to emphasize the most important and salient content?

Traditional lectures must be re-tooled to emphasize what is MOST important. I have found that students value the security of having a condensed NEED to know lecture in class that highlights the most important content/concepts.

Transformational “Flip”

My teaching world was rocked after reading Educating Nurses over three years ago. I immediately recognized the validity and wisdom of the research findings and left the comfort of a content heavy lecture to what I would consider a transformational “flip” of my classroom by doing the following:

With a typical fifty minute time block of lecture, I lectured no more than twenty to twenty-five minutes emphasizing NEED to know, students could read the rest.

I used the remaining 20-25 minutes of class with an active learning activity that was a clinical reasoning case study I created that contextualized the content I just taught.

This activity also brought clinical realities to class and emphasized and allowed students to practice clinical reasoning.

My expectations:

• Come to class prepared by reading the textbook BEFORE class.
• APPLY your understanding of the content by working through the clinical reasoning case study I posted one week before class either individually or preferably in small groups.
• Group DIALOGUE of case study in class. I led the discussion, but student response and dialogue was expected with no spoon feeding allowed!
• My role as educator was to facilitate/direct/emphasize salient points of the case study.

Another approach:

• Break classroom into small groups.
• Assign one to two questions from case study to each group.
• Given fifteen to twenty minutes to collaborate using textbooks/each other.
• Each group presented answers to class.
• Role as educator was to facilitate/direct/emphasize salient points of the case study.

Comment question:
What strategies have you successfully implemented to bring transformational change to your classroom?
Comment below and let the conversation begin!

References

• Benner, P. (1982). From novice to expert. American Journal of Nursing, 82(3), 402–407.
• Benner, P., Sutphen, M., Leonard, V., & Day, L. (2009). Educating nurses: A call for radical transformation. San Francisco, CA: Jossey-Bass.
• Hertz, M. (2012). The Flipped Classroom: Pro and Con. Retrieved from http://www.edutopia.org/blog/flipped-classroom-pro-and-con-mary-beth-hertz
• Tanner, C. A. (2004). The meaning of curriculum: Content to be covered or stories to be heard? Journal of Nursing Education, 43(1), 3–4.