HealthMay 17, 2023

Teaching clinical judgment is about the doing

For Tim Bristol, PhD, RN, CNE, FAAN, FAADN, the road to becoming a nurse educator has taken many a circuitous route — all of which informs and drives his resolve to teach nurses clinical judgment skills by doing, which is something of a departure from traditional academic methods such as lectures and demonstrations.

In a video interview conducted by Lisa Bonsall, MSN, RN, CRNP, Senior Clinical Editor of the Wolters Kluwer, Dr. Bristol talks about how he came to be known as “Nurse Tim” (a name he originally labeled himself to help patients distinguish him from physicians and “it just stuck”), his past military experience, his PhD in Education – not Nursing — and exhaustive research behind the Next Generation NCLEX® (NGN), coming in April 2023, which validates the need for more clinical training in nursing education. Following is a summary of the conversation.

Learning to think under fire

In the interview with Bonsall, Dr. Bristol explains his unconventional career path. “High school was a bit rough for me,” which he says caused him to drop out, get a GED, and join the infantry. “I became very good at polishing boots, waxing floors, and shooting big guns,” the latter of which he credits for helping him think under fire.

Of course, it would be years before he would come to appreciate the significance his early military training would have on his nursing career. Following his military service, he told Bonsall he was “really searching” for what to do next and considered becoming either a nurse or a missionary. “I saw nurses on the mission field [and] I was not pastor material,” so he decided to apply to nursing school. Eventually, this would lead to his becoming a nurse practitioner and educator.

Upon completing his NP program, Dr. Bristol told Bonsall he could not find a job in an area that worked for his family. However, he did get offers to teach. “I decided to give teaching a shot,” he says, an experience he described as “bumpy” at best. “I was a bit scattered and not well organized. I had a degree as a nurse practitioner, not an educator, and, the first few years of teaching were so rough, it caused me to do something crazy – get a PhD in Education.” After all that schooling, he says he came to a key revelation: “I finally learned I’d never learned how to learn.”

From critical thinking to clinical judgment

During the interview, he and Bonsall discuss the importance of “learning how to learn” and why, at least in nursing, it entails going beyond critical thinking to develop clinical judgment skills. As an industry, Dr. Bristol explains, “We’ve spent a lot of time focusing on critical thinking, and we stopped at critical thinking.” In contrast, “Clinical judgment is the doing that happens after critical thinking.” He emphasizes that to make the leap from critical thinking to clinical judgment, “The learner has got to do it [clinical care] from Day 1 of nursing school,” which sets the stage for success throughout their entire academic program.

To teach clinical judgment, ‘it’s about the doing’
- Dr. Tim Bristol, Nurse Tim

This involves providing care, often under fire, “not watching someone else do it or seeing it done on a big screen.” Like dodging bullets in a military exercise, students need to feel a sense of urgency, which they will most certainly encounter in a true hospital environment. If at all possible, Dr. Bristol believes that “students have to be teamed with a buddy doing clinical judgment activities every hour of every lecture across the pre-licensure program.”

Preparing for the NGN

To this point, Bonsall asked Dr. Bristol what faculty need to know to best prepare nursing students for NGN. “The Next Generation NCLEX is basically focused on clinical judgment,” Dr. Bristol explains, emphasizing that nursing education based on “doing” is the answer to better prepare new graduates.

He emphasizes that the National Council spent millions of dollars on research developing the new NCLEX. It is one of the most powerful research studies ever done in health, involving over a million subjects. “While there are many different ways to teach clinical judgment,” he concludes, “students have to be providing patient care, they have to be doing clinical judgment. I realize that is a little tricky in some classrooms, [but] ‘doing’ is key “every hour of every class.”

Watch the full video interview with Dr. Tim Bristol:

Nursing Education innovation Summit 2023 Tim Bristol interview video thumbnail
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