Nursing the Nurse: Teaching Students to Take Charge of Their Own Well-Being

In one of her nursing classes, recent graduate Rebecca Fawver made a lanyard clip to serve as a visual reminder that caring for herself is key to caring for her patients.

Her clip includes a photo of her with her fiancé; a reminder to use breathing exercises―Inhale 1-2-3-4, hold it 1-2-3-4, exhale 1-2-3-4―to de-stress; and one of her favorite quotes, from The Help: “You is smart. You is kind. You is important.”

Making lanyard clips is just one way faculty in the College of Nursing help their students craft coping strategies for a career that is physically, mentally, and emotionally demanding.

“Nurses just give, give, give,” said Dean Victoria Niederhauser. “But it’s like they tell you in an airplane—if you don’t put your oxygen mask on first, you’re going to run out of steam.

“We need to teach this generation of nursing students how to take care of themselves so they can have a long, wonderful career as a nurse, taking care of others.”

Condition: Critical

Because of the rigors of the job, “nurses tend to have a lot of guilt about taking care of themselves,” said Allyson Neal, clinical associate professor and assistant dean of graduate programs, who is a trained psychiatric mental health nurse practitioner. 

They give up their day off to fill a shift. They feel guilty about taking breaks, even bathroom breaks. They skip lunch to see patients. 

At the same time, she said, health care is more challenging than ever.

People are living longer than in the past, and many struggle with chronic illnesses. Environmental issues like poor air quality exacerbate ailments. Poverty continues to force some patients to choose between buying food or medicine. And workplace violence is a growing threat to health care professionals.

And then there was―is―COVID-19.

“The pandemic really stretched health care to the brink,” Neal said. 

Citing a 2022 survey of more than 53,500 RNs and LPNs across 45 states, the Journal of Nursing Regulation reported that 50.8 percent of nurse respondents felt emotionally drained, 56.4 percent felt used up, 49.7 percent felt fatigued, 45.1 percent felt burned out, and 29.4 percent felt at the end of their rope a few times a week or every day. The issues were most pronounced among nurses with 10 years of experience or less. 

Experts agree that the already-critical nursing shortage is in danger of getting even worse.

The college is trying to close the gap by increasing its enrollment―this fall could see the largest-ever entering class, with about 300 new BSN students. But even the first steps of a nursing career are challenging. “Nursing school is, in itself, pretty traumatic,” said Shelia Swift, executive associate dean of academic affairs. “It’s hard. It’s a lot of hours in clinicals and studying.”

So how does the College of Nursing, which receives about 4,000 applications each year, choose a diverse set of students who are likely to succeed as nurses?

“Traditionally our college has relied heavily on academic metrics for admission,” said Jada Russell, the college’s executive director of academic advising and enrollment management. “Now we’re exploring a more holistic approach.”

Russell said faculty say students with leadership skills and self-confidence who have set long-term goals for themselves and who value community involvement seem to thrive in nursing school―and in nursing.

Treatment Plan

“Our students are highly capable, highly motivated,” Russell said. “However, this may be the first time they’ve been academically challenged or even emotionally challenged.”

First-year nursing students are encouraged to take a First-Year Studies class designed just for them. It provides information about campus resources like the Student Success Center and the Student Counseling Center and lets students get to know college administrators.

De-stressing techniques are part of the curriculum.

“We incorporate small little things that they can use over and over,” Neal said. “Our goal is for them to start building these things into their daily living.”

For instance, many nursing faculty lead students in moments of mindfulness before difficult exercises or exams. Classes touch repeatedly on healthy behavior, including good nutrition and getting enough sleep, and offer tips for taming escalating emotions. Earlier this year, college faculty, staff, and students gathered for yoga on the Ayres Hall lawn. 

Faculty and staff also keep their eyes open for signs of crisis. 

Russell’s office has created a student alert form that faculty can use to report concerns about a student’s academic performance, attendance, or general well-being.

When a report is filed, the student is invited to meet with their academic advisor. They are reminded about campus resources, and staff members offer to accompany them to the Student Counseling Center to receive immediate assistance if needed. 

Niederhauser said nursing faculty are also urged to be role models, showing students how hobbies and a healthy work–life balance can keep stress at bay.

Faculty have gathered to decorate Valentine’s Day cookies and paint flowerpots. They’ve started a pickleball group, and they’ve enjoyed trivia night at a local pizzeria. Niederhauser holds periodic Walk with the Dean events in nice weather.

Well Taught

Fawver, now a labor and delivery nurse at Fort Sanders Medical Center in Knoxville, said the college’s emphasis on self-care helped her move from the classroom to the real world with greater confidence.

And when she starts feeling overwhelmed, she refers to the advice on her lanyard clip.

Inhale 1-2-3-4, hold it 1-2-3-4, exhale 1-2-3-4.

“I know that going into practice is very different than being in school,” Fawver said. “But the experiences I had in nursing school really prepared me.”

The Heart of a Vol Nurse: Learning to Care for People, Families, Communities

“When I grow up, I’ll be a nurse to help you when you’re sick. I’ll do the nicest things for you to make you better quick.”

Shelia Swift, executive associate dean of academic affairs, recited that rhyme at career day when she was in kindergarten.

In the years since, she’s learned that being a nurse―and training the next generation of nurses―is not that poetically simple.

Nurses need knowledge. Skills perfected through practice. Real-world experience.

But beyond that, explains Dean Victoria Niederhauser, being a good nurse also requires a host of qualities that are difficult to teach in any traditional way.

“Nurses care for people in their worst moments. Small gestures, like reassuring words giving permission to feel afraid, frustrated, angry, mad, and sad, or therapeutic touch, like holding a hand, can ease the emotional turmoil of a difficult situation. We strive to teach our students the importance of proving safe and effective nursing care with empathy and compassion.” 

Caring for people

From the time they begin nursing classes in their junior year, UT nursing students spend a lot of time honing both their skills and empathic approach to caring. In the college’s various learning labs they encounter strategically devised scenarios that involve low-fidelity mannequins (noncomputerized or capable of limited actions), high-fidelity mannequins (computerized to mimic physiological responses), and standardized patients (actors working from scripts).

The newest lab, for the UT Medical Center Nursing Scholars, a new cohort of the traditional BSN program, will open this fall in the Innovation North facility at Cherokee Farms. Made possible through the collaborative partnership between UT and UTMC, the lab will house a 12-bed psychomotor skills lab and a four-bed high-fidelity lab that will look and feel like a hospital floor. The high-fidelity lab is where students and UTMC staff will practice routine and advanced medical–surgical care and support specialty skills from mother–baby care to critical care.

Susan Hébert, assistant dean of simulation, said the labs provide opportunities for nursing students to work through situations they may never encounter during their clinicals—such as a cardiac patient going into distress, a postpartum patient who begins to hemorrhage, or a patient having a schizophrenic episode. Students also experience interacting with people of diverse cultural backgrounds, sexual orientations, and temperaments.

Simulated practice helps students hone their medical skills. It also provides opportunities to practice interpersonal skills as they encounter challenging “patients” and their families and interact with other health care providers.

“We are committed to providing realistic and intentional learning experiences. In doing so, we provide students unique opportunities to challenge their critical thinking and ability to practice safely and communicate with empathy,” Hébert said.

Students’ sessions in the simulation labs are often video recorded so they can watch themselves at work, reflect on their performances, and think about what they’d do differently next time. Hébert said the simulation labs provide safe places where students can make mistakes and get second chances as they learn to think, talk, and interact like nurses.

UT’s simulation program is more extensive than those at many colleges and universities, and it is accredited by the Society for Simulation in Healthcare.

Hébert said the simulation spaces are also used by researchers to develop tools and applications that could revolutionize health care and health care education in the future.

Caring for the Community

Each semester during their junior and senior years, nursing students engage in at least 30 hours of academic service–learning at a community agency.

The college has 45 to 50 community partners, ranging from after-school programs to agencies that serve the poor and homeless to facilities that care for older adults. Students stay with their partner agencies for the duration, allowing them to build relationships.

“It’s a win-win-win,” Swift said. “Students are exposed to something that will enrich their professional nursing. It’s a win for the community partner because they have consistent help. And the clients benefit too.”

Swift said academic service-learning activities aren’t necessarily health related. And that’s OK, because students are learning soft skills like face-to-face verbal communication, time management, and problem-solving. By writing reflections about their service–learning, they also practice their written communication skills.

Students work in college programs like Vine School Health Center in Knoxville’s Vine Middle School, which provides health care to underserved children throughout Knox County, and the Precious Prints Project, which has provided more than 2,000 sterling silver fingerprint pendants to parents who have lost a child.

As associate dean of practice and global affairs, Professor Nan Gaylord oversees the Center for Nursing Practice, which encompasses both programs.

Gaylord helped found the Vine School Health Center in 1995. Now funded by federal grants and self-sustaining, the clinic logged more than 7,000 visits last year and saw students from every school in Knox County. College of Nursing faculty and two licensed clinical social workers staff the clinic. Undergraduates interested in pediatric nursing rotate through the clinic, working alongside the nursing staff.

The Precious Prints Program, a service project of the Student Nurses’ Association, is now operational in all Knoxville hospitals and in hospitals in several surrounding communities. There is an outreach effort to West Tennessee, and the program is being used as a model for a similar program in Las Vegas.

Gaylord said student nurses train hospital nurses in using Precious Prints kits and organize the annual Sprint for the Prints 5K, all of which helps student nurses gain empathy, bolster organizational skills, hone professionalism, and demonstrate leadership. Working with people in the community also helps them learn to prioritize, take responsibility, and recognize when they need to change tactics, raise a red flag, or ask for help.

“It teaches our students the characteristics we want them to develop as nurses,” she said.

Gaylord said caring for the underserved, whether it’s in the Knoxville area or halfway around the globe, also shows students that health care isn’t just care provided in the hospital.

“It’s fresh air, clean water, and access to health and prevention services, which make a difference in the health and well-being of our communities,” she said. “What we need to do as nurses is to provide care to our communities from a public health perspective.”

Caring for the World

During spring break 2023, recent graduate Margeaux Maerz traveled to Belize with a group of UT nursing students to do outreach and run health clinics with local providers.

“The Belize trip provided my first experience triaging and managing cases on a rolling basis,” Maerz said. “It was also a great opportunity to practice and hone my physical assessment skills. Learning to ask the right questions and the right follow-up questions to understand what the patient needed help with was crucial.”

The Belize trip is one of a growing number of international trips organized by the college to help students gain new perspectives on what it means to care for people around the globe.

Maerz attended UT as part of the Health Resources and Services Administration Nurse Corps Scholarship Program. Now that she’s graduated, she must work for two years at a hospital facing a critical staffing shortage. She’s currently serving as a nurse in the intensive care unit at Providence Alaska Medical Center in Anchorage, Alaska.

In another international experience, a group of nursing students went to Panama in January on a fact-finding mission funded by a grant from UT’s One Health Initiative―which seeks to improve local and global health by bringing together experts from various fields to find practical solutions to issues like food insecurity, loss of biodiversity, environmental contaminants, and substance abuse.

At the end of July, five students will travel to Nyeri, Kenya, where they will partner with WAKA Medical Training Institute and Hospital.

“They’ll be paired with one of their students and provide nursing care in the hospital with those other students for five days,” Gaylord said. “They’re going to be exposed to lots of things they haven’t been exposed to before.”

In August, three students will take an inaugural trip to Peru to work with a local agency that serves mountain people and teaches area women to provide minor health care when other medical care is unavailable. The students also will visit with a local traditional healer to learn health care customs.

Through international experiences, students learn how rudimentary health care can be in other places. They learn to slow down, have patience, communicate empathetically, and be creative and open-minded.

“They see that America doesn’t always have all the right answers to health care,” Gaylord said. “We have many, many resources that other countries don’t have, but Western medicine is only one way to take care of things.”

She said students also learn that health care often happens outside traditional hospitals and clinics.

For Maerz, who is just beginning her career, traveling to Belize showed her that nursing is both a science and an art: good nurses must possess traits well beyond their medical skills to care completely for their patients.

“This trip allowed me to appreciate the barriers to health that some populations face, and I realized that those barriers are not unique to Belize,” Maerz said. “Coming back to my clinical placement in the medical critical care unit at UTMC, I saw many of the same ailments and barriers to care—rural living, lack of transportation, mistrust of health care systems, poverty, and lack of health literacy, to name a few.”

CONTACT:

Kara Clark (865-974 9498, [email protected])

2019 Belize Blog: First Impressions

On Friday March 15, 2019, 13 College of Nursing undergraduate students along with Dr. Karen Lasater, Dr. Carrie Baily and Dean Vickie Niederhauser arrived in Belize for an eight day service learning opportunity. Continue reading “2019 Belize Blog: First Impressions”

Student Spotlight: Michael Curtis

 

The UT College of Nursing shines a spotlight on senior BSN student Michael Curtis from Memphis, TN. Curtis serves as Student Body Vice President and will graduate in May.

Michael Curtis

Q: What led you to pursue a degree in nursing?

A: Initially, I was drawn to the career by the application of science and mathematics in the profession–I enjoy learning about the human body and solving complicated mathematical equations. My interest in nursing was solidified when I was diagnosed with Type 1 Diabetes Mellitus. The nurses at LeBohner Hospital were so nice and respectful and considerate of my situation. As an eleven year-old child at the time, they made my complicated condition understandable and helped me realize the great impact of nurses–they can encourage, uplift, and restore through the power of their care!

Q: Tell us about a project or organization that you are involved with at UT or in the community.

A: I am involved with Leadership Knoxville Scholars at the university, which provides an avenue for connection to the Knoxville community. Currently, I am completing a community action project at Ijams Nature Center where I volunteer to maintain the environment by removing invasive species, replanting engendered species to more appropriate areas, and overseeing park cleanliness. I also lead interested groups in community service projects.

Q: What have you learned during your time in the UT College of Nursing that has made a difference to you?

A: The curriculum has challenged my way of thinking. Specifically, the Transcultural Nursing and Maternal Nursing courses have made a significant difference in my perspective of life and the nursing profession. Prior to my experiences in the College of Nursing, I did not express empathy or intentionality to others in need of health care. I also took health care for granted, as I did not have to worry about sickness/disease and its financial implications. I have learned that people need more than just procedures or surgery—they need holistic nursing care including empathy and passion that will help restore and maintain good health. Now that I have a better understanding of the potential impact a nurse can have on a patient and their family, I desire to be the change in health care—always being willing to do more for my patients in all situations.

Q: What do you want to do after graduation?

A: I would like to work in a health care facility for two to three years in one of the following areas: critical care unit, emergency department, labor/delivery, or mother/baby. I would then like to pursue a graduate degree.

Q: Is there anything else you would like to share about your experience at UT?

A: I am grateful for all of my experiences within the College of Nursing, including participation in the Nursing Honors Program and the opportunity to conduct research. I also founded a student organization and am currently serving as Student Body Vice President and these experiences are propelling me to be the individual I that I aspire to be. I am grateful for the faculty and students that I have had the opportunity to work with at UT. Their knowledge, wisdom and compassion has inspired me to do more for the community and the nursing profession. My life will never be the same, and I am grateful for that!