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Each month, HospitalSoup.com will feature a health care professional in our monthly series: "A Day in the Life." The series aims to provide readers with a realistic view of what working as a health care professional entails, and will allow readers to get to know some of the dedicated professionals that work in the health care industry.

This month, HospitalSoup.com focuses on the experience of a Clinical Nurse Educator from a New Mexico Hospital as she became involved in a new critical care nurse internship program designed to help relieve short staffing needs during a particularly difficult time when beds were full, staffing was short, and nursing applicants weren’t showing up to apply for jobs.

Our editors were so impressed after hearing about the nurse internship program, that they decided to break this month's monthly feature into two segments.

Segment One which is immediately below, provides an overview of a critical care nurse internship program, which was implemented in a New Mexico hospital.

Segment Two is the HospitalSoup.com regular feature... "A Day in the Life.." If you know a health care professional whom you would like to nominate for a Profile in the "Day in the Life" section, please e-mail us at dayinthelife@HospitalSoup.com. Please include your nominees name, telephone number, profession, as well as your name and telephone number, and a brief message about why you think your nominee should be featured in an upcoming issue.

Segment One: About the Nurse Internship Program

As many areas of the country deal with a nursing shortage, perhaps this article will provide some insight and suggestions for how other facilities could approach the problem of nurse staffing. This interview was conducted back in December of 1999.

Q. What was happening in your facility that led your hospital to decide to implement a critical care nurse internship program?
S.P. "Last winter was the winter from hell at our hospital. Lots of patients had the units bulging at the seams, but staffing was short and we weren’t getting new people to apply for our openings. We had patients backed up in the recovery and emergency departments, waiting for beds, so whenever one was emptied, there was someone waiting to fill it. We were working lots of overtime and taking more patients than we could feel safe about taking WAY too much of the time. Then to make things worse, winter in the ICU didn’t end till around June or July."

The Director of Nursing met with managers from all the critical care areas of our hospital to discuss potential options, and collaboratively, came up with a plan to offer an internship program for nurses. The next step was to take it to the financial people to get it funded, and finally, the plan was brought to the clinical educators for the critical care areas. Although we didn't have much time to prepare: educators were told of the program in mid June, and were expected to implement the program by the last week in August, overall I thought it was a terrific experience. We had 23 applicants apply for the program, and out of the 23 potential interns, 18 were selected to intern at our facility.

Q. How was the interviewing done?
S.P. The directors of the Emergency Room, Telemetry, Intensive Care Units , and Recovery Areas were involved in the interview process. Of the 18 original interns, two hadn’t received board results yet, one didn’t pass, and two dropped out by the third week. We had one woman who moved from Albuquerque to enter the program, and although she had been working as a nurse somewhere else for three years, she had never really been oriented to a job. She was at the point, where she picked up the newspaper that Sunday, and said to herself. Ok, if there’s nothing here today, it’s beauty school! She saw our ad, called Monday morning and took the job.

Q: What was the typical day like for a nurse intern?
S.P. They worked two twelve hour shifts in clinical in addition to spending two eight hour days in classroom each week. It was actually a brutal schedule, we tried various approaches to help with the amount of material that we needed to cover and to make it interesting. To accomplish this goal, we incorporated some game playing and other learning activities requiring teamwork. There were a total of about 350 hours in clinical and about the same amount of time in the classroom. The interns were rotated between the Emergency Room, ICU, Telemetry and the Recovery Room—all the areas that receive critical care patients. Interns were exposed to material in class and in the skills lab which provided them with the experience they needed in order to work with equipment on the units.

Our program was largely pathophysiology based. Since we didn’t have the time, nor experience to build a program from scratch, we purchased an orientation program from the American Association of Critical Care Nurses (AACN). This was supplemented with materials from the Emergency Nurses Association (ENA) and additional sources such as hospital policies, procedures, and protocols.

One of the most valuable parts of the program, I felt was to have the interns become involved in their own teaching projects. They researched a topic and then taught the class about the things they learned from journal articles and other sources.

Other positive aspects of the program were the relationships developed between the interns and existing staff. One of the things I remember about my own nursing education program—a diploma program, was that we did a lot of staffing, and we learned how to work together and to count on each other. I think the same thing happened for our interns, they learned that they can come to their instructors or staff when they start working on the unit. They don’t have to be afraid that someone will say, "You should already know that." We had a very enthusiastic group of interns, and now, I’m happy to say, our staffing is back where it belongs.

Q. How did Administration respond to the program?
S.P. Our hospital was very committed to a new graduate internship program and supportive of hiring new graduates and providing them with the classroom and clinical time that was needed.

Q. What response did your preceptors have to the program?
S.P. We had an excellent response from preceptors. I think this had a lot to do with the fact that even though the preceptors were working with the interns on the unit, there was always an instructor available whom the interns could call if they needed additional help. We will be trying to strengthen our preceptor program, because it’s important for preceptors to avoid burnout, and it's definitely hard work. To do one's job as a preceptor and make sure that one's own workload doesn't suffer is difficult. We're aware of this and hope to continue to make adjustments so that our preceptors aren't overloaded.

Q. How About Costs of the program?
S.P. It was expensive. However, according to figures I was given, it is no more costly than hiring travelers, especially over a three month period. Each intern made a commitment to work for the hospital for one year in exchange for the training they received. This one year commitment is much more than you get with a traveler, who leaves at the end of their contract.

Q. What else can you tell us about the program?
S.P. "We all learned a lot, about ourselves and about what individuals can accomplish when they set out with a goal in mind. This applies to both instructors and students!" It was wonderful to see the interns change and develop. There was one intern who initially "knew" that the Emergency Room was the only place to work, but buy the end of the program, this intern was actually interested in exploring different clinical areas.

It'’s really been great, the tension has eased already as our first interns graduated from the program. We already have extra staff who can function appropriately in their particular areas. Prior to this program, we had a float pool, but typically when a nurse from a float pool comes in, we would give them the lightest load, and they wouldn’t really have experience with the things we were doing on the units. Now, we have a critical care float pool who can pull sheaths, work with diabetic patients and work with pulmonary artery catheters. Staff also has a good idea of which interns have the capabilities of handling particular types of loads.

S.P. Quote: "Tomorrow we have 15 people who begin work as regular members of the Critical Care Float Pool. They are able to care for most of the critically ill patients we see in our hospital, knowing that they have worked, throughout their internship, with staff who will support them when they need support. They can read monitors, having passed a dysrhythmia course as part of their program, and interpret blood gases, having also had lots of practice with that, and many other things." S.P.

The End...Segment One

Take Me to Segment Two

Segment Two : A Day in the Life.....

Name: Sarah J. Perry, RN, CCRN
Title: Registered Nurse, Clinical Staff Educator
Place of Employment: Memorial Medical Center, in Las Cruces, New Mexico.
Educational Background: Diploma in Nursing and M.A. in English

Sarah has been a registered nurse since 1967, and now works as a Clinical Staff Educator at Memorial Medical Center, in Las Cruces, New Mexico. She has a diploma in Nursing as well as an M.A. in English, and has been a nurse since 1967.

Q. What made you choose nursing as a career?
S.P. I was always surrounded by nurses. My mother was a nurse as well as several others in my family. My thought when I chose to enter nursing school was no matter what happened, I'd always have a job!

Q. Specifically, as a nurse educator, describe what you do.
S.P As a Clinical Staff Educator, for the last few months I've been involved in the new internship program at our hospital. Prior to my involvement with the nurse internship program, I was working about half of the time as an educator and half of the time as night shift charge on the unit. The education part of my job consists of keeping staff up-to-date, making sure they are informed about changes in protocols & procedures, conducting monthly presentations in staff meetings with QI., and I also do a 2 hour continuing education class for 2 hours of CE credit for staff preparing to write the CCRN exam .I'm also responsible for following up with staff to make sure that they are fulfilling the requirements for JCAHO, in addition to conducting classes and keeping staff members up to date on procedural and policy changes and working with the unit orientation committee to orient new employees and makes sure that new hires work with preceptors on the unit. I try to make certain that new staff are not placed Into a situation that is particularly difficult--feeling like no one has the time to show them how things work or where items are located. This, I feel can lead to people getting burned out and staff turnover, which we try to avoid.

Q. Give us an example of what a typical day on the job might be like as a clinical nurse educator.
S.P. Well, my job is constantly changing to fit the demands of our hospital. The end of January of 2000 we're getting ready to start six new orientees as nurse interns, so I'll be involved in helping with the internship program again. These new orientees are all new graduates as well as one foreign graduate, so their orientation will be adjusted accordingly. The new orientees will spend about 36 hours a week in the units, working three 12-hour days a week, along with preceptors, who will help them to obtain the clinical skills that they need. They'll also spend four hours a week in the classroom, over a 10 week time period, and will take dysrhythmia classes, and they'll study respiratory illnesses and respiratory pathophysiology in the classroom. They'll work with a lot of ventilator patients, learning blood gasses, etc and applying their knowledge in the clinical area.

Q. Explain how a nurse educator's role differs from that of other nurses?
S.P. Well, I've been a charge nurse on the same unit since 1982. I did a lot of bedside teaching with new nurses, a whole lot of question/answer/demonstration type teaching and then getting a return demonstration from the nurse etc. The difference now, is that I can plan learning activities in my day, instead of just doing these things on the fly. What a wonderful thing, to plan for staff education needs based upon the input I receive from staff. They can come to me and say, we need this, and I can adapt to their needs, and spend time researching what's happening in the field of healthcare and what should be happening, based upon what the literature shows. One of my goals is to increase the amount of researched based practice that we do, not just have staff getting into the habit of doing things one way because we've always done them that way.

Q. What type of education is necessary to prepare for a role as a nurse educator?
S.P Experience first of all is very important, and education is equally important. I have my application in to go back to graduate school right now to enter a MSN program.

Q. What is the most positive aspect of your job?
S.P I have a great boss, and when he gave me this job, he said, make it what you want it to be. I've had a lot of freedom to try things, and when we did the internship program we were given the freedom to make the program work. We had follow up and support from administration, not interference, which was wonderful, providing the nursing staff with the building blocks we needed to build the internship program.

Q. What is the most challenging aspect of your job.
S.P Trying to get everything done that I need to get done. Juggling and keep a lot of balls in the air.

Q. Are there growing opportunities for nurse educators?
S.P. Most education departments are moving towards providing educational opportunities at a unit level, largely involving orientation, and keeping staff supported in their educational needs. Makes more sense to me to be performing education on a unit level, needs are noticed. If I have something going on in the Intensive Care Unit, it isn't going to be same emphasis that another educator who works on the Medical/Surgical Department may have with staff on that particular unit. I also think it's easier to coordinate and deal with learning needs quickly, if you do not have to coordinate through an education department. In our hospital, unit educators meet monthly, sit down at lunch once a month, and discuss what's going on their areas, which are strictly unit focused. This helps keep the lines of communication open and reduces duplication of efforts.

Q. How about room for advancement?
S.P. I'm not sure. My own position started out as a part time job and has gone to a full time position. Currently, I work some clinical area part time and expect that I will move into a full time educator position very soon

Q. What's the average salary for a nurse educator?
S.P. About $20.00 to $25.00 an hour

Q. What types of changes in nursing have taken place since you started?
S.P Well, I was a nurse back in the "Dinosaur" days. So many things-- technology has been a big thing. Before we used a stethoscope to check blood pressure, now we use a stethoscope for other things. Our equipment is now "hooked up to our brains" and not just our ears. Some of the specialties: Labor and Delivery, Obstetrics, were not available as specialties when we were in school. I think nurses are different now then they were then. Now, they're less accepting of the status quo.

Q. What would you tell someone who was interested in becoming a nurse educator?
S.P Make sure you ask yourself if it sounds like a job that you may do for the rest of your life…there's always something to learn and someone to teach. Sometimes always having a job can be a strength, and other times it may make you feel penned in. In my career I've done management, outpatient dialysis, bedside nursing and now work as a nurse educator. Each step that I've taken previously has led me on to the next one. It's always interesting!

Q. What would you tell someone who was interested in nursing as a career.
S.P. There are a lot of ways that someone can go into nursing. It is no longer a career where we are handmaids to doctors. We are independent, although not completely--as a nurse you use your heart and your brain in equal amounts!

This concludes HospitalSoup.com's interview with Sarah J. Perry, RN. HospitalSoup would like to thank Sarah for contributing her time, knowledge and experience for this article!