Every year, generous educators and staff development professionals share with me the ideas that make their training most effective. I want to thank them for making a positive difference not only to those they teach, but also to those of us with whom they share their successes. I am sharing some of them with you in this column in 2008.

One of the most important aspects of a staff development role involves orienting and interacting with new graduate nurses. We want to teach and retain the best of the newest graduates we see at our facilities. This column focuses on the unique teaching tool that one instructor is currently using with excellent results. Jessica Castner, MSN, RN, CEN ([email protected]), is a Clinical Assistant Professor in the Department of Nursing at D'Youville College in Buffalo, New York. Jessica has graciously offered to share an idea she uses with nursing students in the clinical setting.

As a clinical nursing instructor, I find the most looming obstacle to effective teaching and learning is anxiety. Nursing students often say that they are afraid they may do something wrong; they are anxious they will miss a finding on assessment; they are nervous that I might be evaluating their performance; and sometimes they are worried about simply touching and talking to patients. All of these uneasy feelings interfere with the ability to process and retain new and useful information.

One teaching tool I enjoy is my "hero exchange." After I've been with the students for a few shifts, I buy a bag of plastic army figures from the dollar store. As I give each student an army hero figure, I tell the student one thing that I witnessed that made him or her a hero. "You helped a patient coping with CHF to balance activity and rest, saving unnecessary stress on his fragile heart." "You accurately assessed and suggested very good interventions on early skin breakdown, potentially saving the patient from pain, suffering, infection, and expense." "You questioned the provider on the appropriateness of giving a patient with an active GI bleed ordered heparin for DVT prophylaxis, potentially saving him from continued or increased bleeding and hypovolemic shock." "You encouraged and stood by the post-op patient while she ambulated for the first time, enhancing her safety and preventing DVT and pneumonia." "You correctly changed a central line dressing that was peeling loose, potentially saving that patient from sepsis." Then the students get a second plastic army figure, pair off, and tell the other student that he or she was a nursing hero by describing a scenario in which the student promoted healing or protected the patient from negative consequences. Acknowledging their interventions in front of a group adds to their confidence and ability to learn. It also sneaks in teaching about the rationale for select nursing interventions. Most importantly, it celebrates and salutes the important role we have as nurses to fight for health and fend off the harm or negative consequences of illness and treatment.

Perhaps someday I'll perform this exercise with a pillowcase safety pinned to the back of my lab coat and a special "S" insignia for super nurse, or a pretend sword to knight the students with[horizontal ellipsis] I just haven't worked up that much courage quite yet.

Thank you, Jessica, for sharing your creative idea. This approach can easily be adapted to show appreciation to current staff members as well. We will all be watching for Jessica coming down the hall with an "S" on her laboratory coat! Thanks again for sharing.