ABSTRACT The concept of innovation in nursing education has been
addressed in published literature on faculty-defined and faculty-created
teaching strategies and instructional methods. In this project,
innovation is defined as "using knowledge to create ways and
services that are new (or perceived as new) in order to transform
systems" (Pardue, Tagliareni, Valiga, Davison-Price, &
Orchowsky, 2005). Studies on nursing student perceptions of innovation
are limited, and it is unclear how undergraduate and graduate students
conceptualize innovative learning experiences. This project explored
students' perceptions of their experiences with instructor-defined,
innovative teaching/learning strategies in four types of nursing
education programs. Issues nurse educators should consider as they apply
new techniques to their teaching are discussed.
Key Words Innovative Teaching Strategies--Nursing Student
Perceptions --Innovation--Nursing Education
HOW DO STUDENTS EXPERIENCE FACULTY-DEFINED, FACULTY-CREATED,
INNOVATIVE TEACHING STRATEGIES? Comprehensive evaluation is needed to
determine the effectiveness of innovations in nursing education as well
as student responses to new methods of teaching. The project discussed
here centers on the perceptions of nursing students in four types of
nursing programs. It serves as a call to encourage further
implementation and evaluation of innovative educational strategies.
Background Nursing education is in the midst of transformation
influenced by a number of factors, including the widespread use of new
technologies, the serious shortage of nurse faculty, and the realization
that today's nursing students are a diverse group with multiple
learning styles (Briggs, 2006). Faculty are challenged to capture the
attention of the learner, to focus on what the learner knows, and to
engage students in their own individual learning experiences. Simply
imparting information through lectures is not sufficient (Dryden &
It is important to note that faculty and students may have
different views of what constitutes innovative teaching. For the
National League for Nursing (NLN) Task Group on Innovation in Nursing
Education, innovation is defined as "using knowledge to create ways
and services that are new (or perceived as new) in order to transform
systems. It requires deconstructing (i.e., challenging) long-held
assumptions and values. The outcome of innovation in nursing education
is excellence in nursing practice and the development of a culture that
supports risk-taking, creativity, and excellence" (Pardue,
Tagliareni, Valiga, Davison-Price, & Orchowsky, 2005).
Faculty have created and implemented a number of new teaching
strategies as noted in the following examples from the literature:
* Technological advances, including the use of simulation
(Jeffries, 2005; Nehring & Lashley, 2004) and PDAs (Goldsworthy,
Lawrence, & Goodman, 2006)
* New delivery methods, such as e-nursing education (Neuman, 2006)
and nontraditional delivery methods (Boylston, Peters, & Lacey,
2004; Cangelosi & Whitt, 2005; Grady & Berkebile, 2004; Moore
& Hart, 2004; Seibert, Guthrie, & Adamo, 2004)
* Various teaching-learning strategies (Bransford, Brown, &
Cocking, 1999; Diekelmann, 2004; Glanville & Houde, 2004; Ironside,
2004; Mikol, 2005; Schaefer & Zygmont, 2003)
* Preferred learning styles and approaches (Fearing & Riley,
2005; Johnson & Romanello, 2005).
Studies of nursing students' perceptions are limited to the
educator's role (Schoening, Sittner, & Todd, 2006); teacher
behaviors (Berg & Lindseth, 2004; Viverais-Dresler & Kutschke,
2001); clinical experiences (Cooper, Taft & Thelen, 2005); online
learning (Ali, Hodson-Carlton, & Ryan, 2004); and differences
between undergraduate and graduate students in the use of technology
(Billings, Skiba, & Connors, 2005). No studies were found that
addressed nursing students' perceptions of faculty-defined
innovative learning experiences.
The purpose of this project was to attempt to understand the
definition of innovation as viewed and described by nursing students.
The perceptions of these students can help conceptualize innovation and
lead to the creation of new strategies that take into account unique
program cultures, values, resources, behaviors, and beliefs.
Method Four members of the NLN Task Group on Innovation in Nursing
Education, representing four program types (associate degree,
baccalaureate, RN-BSN, and master's degree), volunteered to conduct
an innovative project. The members of the task group defined the
protocol. Faculty in each program had experienced transformative
challenges resulting from the faculty shortage (open positions in these
four programs ranged from 5 percent to 25 percent of budgeted
positions), technology growth, and changes in the student body. Learners
ranged from 20 to 50 years old or older; most were aged 20 to 29.
Faculty, who saw a need to try something new, identified, defined, and
implemented teacher-created strategies relevant to specific course
objectives; these were viewed as innovative within the context of each
program. Each strategy is presented by program type.
ASSOCIATE DEGREE Eleven students in a capstone medical-surgical
clinical course researched and wrote a patient scenario for a human
patient simulator. The goal of this project was to develop a critical
thinking approach to use in the selection of nursing actions appropriate
for the "rescue" of patients with acute health problems. The
completed project engaged students in nursing care problem-solving
activities that focused on the identification and application of
interventions to prevent complications. Upon successful completion,
students received honors points and a reduction in clinical rotation
days. The project satisfied clinical course outcomes and students
achieved clinical objectives.
TRADITIONAL BACCALAUREATE This innovative strategy differed from
the standard class research project in two ways: a) it added an
experiential component to the research project, and b) it fostered a
collaborative research partnership with nurses at a community hospital.
Two student groups volunteered to collaborate with nurses from two
hospital units. Students and RNs together selected a practice issue
current on the unit. Based on best practices emerging from a research
literature analysis, students developed a best practice implementation
plan. Students presented the results of their analyses and plans to the
respective units and included the nurses' feedback in their final
RN-BSN The innovative assignment was incorporated into a required
health assessment course. Sixteen students worked in self-selected small
groups of four to five to create a project focused on health assessment
of special populations (pediatric, geriatric, or peripartum). While the
instructor functioned as a resource and guide, individual projects were
initiated and developed according to the interests and learning needs of
the students. The students also selected teaching and evaluation methods
that would be used to assess peer learning.
MASTER'S The nine graduate students who participated in the
project were adult nurse practitioner students and nurse educator
students. The students worked with the state nurses association and
traveled to the state capital to analyze different proposals presented
to the legislature on health care reform, improvements, effects of
benefits, and cost containment. The faculty creator of the project
maintained contact with the students and recorded activities in a
written journal. Rather than simply using the Internet as they would
with a standard assignment, graduate students experienced working at the
The students who participated in these teacher-defined innovative
strategies were volunteers. After the strategy was implemented, group
discussions were held to explore students' perceptions. At three of
the sites, the discussions were led by a faculty facilitator (notes were
taken by a recorder or the discussion was taped); at one site, students
submitted written responses.
Student comments were transcribed into four narrative documents.
The documents addressed responses to a series of open-ended questions
designed to seek out how students experienced the innovation.
* What was your experience in taking the [name of] course?
* Describe the ways in which you were able to exercise creativity.
* How did the students learn together?
* How did the teacher demonstrate openness to new ideas/
* What experiences had the most impact on your learning?
* What concerns did you have about participating in this format?
* Describe your time commitment to this learning experience.
* How did the flexible approach compare to traditional course
Results The findings of this project reflect rich student response
data and shared meanings about innovation. The data reflect careful
deliberation, indicating that students appeared to weigh the pros and
cons of the innovative strategies. The Ethnograph 5.08, a qualitative
data analysis software package, provided the ability to read coded
material within the context of the text and reflected both the intensity
of statements and the commonality of responses among group participants.
The data are presented according to the prominent threads derived,
both positive and negative. Sample quotes are provided to illustrate
selected threads. They demonstrate the potential intent of the response
and the shared meaning among different respondents.
Student Experienced Positive Attributes of Innovation STRATEGIES
Strategies were described as worthwhile, enhancing student learning:
"I think this pushed me to do and learn more"; "The
experience left me feeling excited"; "It was informative and
interesting"; "Refreshing--so many other classes are 'sit
Many of the students saw the innovative strategies as adjuncts to
traditional methods: "Lecture and class discussion and exercises
helped to understand the book better"; "I feel like I learned
a lot in a short period of time." A student involved in a research
experience declared: "Overall, I feel I gained more knowledge
through seeking out resources which helped me gain insight and the
ability to synthesize large volumes of new information" A student
in a policy course stated: "This course opened my eyes to the
political arena of health care" One student stated: "I was a
little worried at first because of the time spent. I work a lot of hours
and did not know how I would accomplish this. But anything that takes me
to the next level or challenge--I will not turn down."
CONTEXT Students saw positive aspects of group work: "I am
glad to have been in this group and learned about leadership and team
work"; "It prepares you as a student to how it will be in the
field. Either you get busy and accomplish what you set your sight on or
you fall behind." Students also expressed views about the
contributions of others: "Each student brought new ideas and
different experiences to the table"; "It was good for me. I
like to hear other people's opinions on subjects. It really helps
me grow"; "I always like working with other students because
sometimes they pick up on something I could have missed"; "I
think that each student ... had diverse backgrounds that enhanced our
Others commented that their responses to group work were largely
impacted by the makeup of the group: "Fortunately the group I was
in had some really hard workers that could stay on task and remain
focused"; "Overall the clinical group I was in was a smart
team that worked together to accomplish whatever was needed." One
student described a lack of experience with group work.
The relaxed atmosphere created by the innovative strategies was
also seen as positive. "There was time to let it sink in";
"Students learn together in every class--a lot of ideas helpful--a
lot of perspectives"; "Helped if one had questions--others
could help out.... More apt to ask fellow students--less likely to feel
'stupid.' Could ask about the experiences of other
Other positive comments focused on the flexibility associated with
the innovative strategies, particularly with online discussions:
"The luxury of taking my time to respond and/or make comment about
the other nurses' entries [was a plus]"; "All of us were
able to read [at our leisure] responses of each other and therefore our
knowledge was shared, even if we didn't feel compelled to respond
to all entries"; "I could work at my pace and around my
full-time job commitment." The flexibility was appreciated:
"Flexibility allowed more room to do things--for example, change a
test date--in some courses this is not even considered"; "It
gave us the charge as individuals to work at our own pace and also gave
us wider boundaries to explore different kinds of learning."
RESOURCES Students appreciated the resources available, including
various forms of simulation and interactive equipment: "The dummy
was great. His tongue, heart, lungs, pulses, and blood pressure all
played a role in our scenario"; "Working on the manikin was
great because it honed us on skills that I need to remain in shape"
Students saw the strategies as a way to review for exams and reinforce
skills: "Providing class notes prior to or after the
lectures"; "We did an interactive learning activity via the
ROLES The most commonly shared positive responses were about the
active role students played in the teaching-learning process. Students
referred to the stimulation of their creativity and stated that the
clinical agency experiences, the hands-on skill demonstration, and the
opportunity to apply theory in practice all keyed heavily in their
response to the strategy: "Even though our 'patient' [in
one case scenario] coded, we directed others to add some interesting and
humorous things to hold their interest"; "I got a chance to
actually do some of the things I have only been able to watch up until
now"; "Comprehensive assessment brought everything
together--helped to learn the content"; "The case scenario
development was an experience of bringing knowledge about what we
learned and be able to apply it to practice." Clinical experiences
were described as having the most impact, helping students become
comfortable with critical patients.
As may be anticipated, the human element figured into the
students' responses: "First, having a good preceptor in the
emergency room was the best"; "With the help of amazing nurse
was able to get it the first time"; "I worked with my first
male nurse and was very impressed." Accolades for the
teacher/faculty included such comments as: "Teacher tried to create
a hands-on environment"; "The teacher brought in her
experiences to help make connections"; "She was open to let us
do what we wanted to do." Though a significant amount of time was
devoted to each initiative, the students generally indicated that they
felt rewarded with new knowledge and skills: "It was a more
interactive learning process which allowed me to put myself at the
bedside and make critical thinking decisions on exams:' The
students discussed what it meant to have increased responsibility:
"The teacher set the direction, then students had to figure it
out"; "We were given certain parameters, but were mostly on
Student Experienced Negative Attributes of Innovation STRATEGIES
Students frequently spoke of the stress in their lives and the emotional
issues experienced during their studies. It was difficult to determine
whether these innovative strategies led to this response or if stress
was simply an inherent part of nursing student life.
Some negative comments related to the strategy itself: "Would
have liked the assessments to be more nursing-focused, to include
interventions related to specific assessment findings"; "I
don't think it is going to help on NCLEX"; "Test
questions were unclear."
Students had negative responses to their role in active learning
strategies: "It was difficult to take the role of teacher--tough to
think about how to get others to learn"; "Are we teaching what
the other students need to know?" One student noted: "We
learned by discussion in class, when it should have been lecture."
Students saw the replacement of clinical experiences/time with
other strategies as a negative factor: "I honestly felt a bit
nervous about a pilot program that put me out of my typical clinical
rotation comfort zone"; "I had mixed feelings about missing
hands-on clinical experience in exchange for researching patient
scenarios. I was hopeful that time spent researching with my group would
enlighten me to following algorithms correctly and effectively."
Other students commented on their difficulty learning psychomotor
skills, whether in the clinical area or in the lab setting: "There
seems to be something more to a skill than watching it and talking about
it. I do a lot better with hands-on learning"; "I would have
liked to be 'shown more" i.e., demonstration:' Students
taking the research course felt it was "just not as important"
as courses such as med-surg and pharmacology. Although one student
commented that the evidence base for doing nursing is important for all
nurses, another stated, "If you don't plan on doing research,
you shouldn't have to do it"
CONTEXT Group work was an area of frustration for some students:
"In my opinion everyone should participate in the project and have
assignments ready and then bring them up to the group for discussion. We
struggled as a group"; "The problem seemed to be getting
everyone to show up on assigned days"; "One person in our
group was disorganized and did not complete their portion of the case
scenarios. That affected our group work and the completion of our
Group dynamics figured into the success of the group work: "As
often happens in groups, one member decided to take over meeting times,
delegation of responsibilities, and actions. Many factors of this
'self-imposed leader' were annoying." Other aspects of
group work were seen as negatives: "I did not like the group work
in class. Essentially we missed out on the other groups' topics. I
would rather hear the whole lecture over the topic than learn a small
piece in a group." Group size also was a key factor: "One
computer and PDA requires a smaller group of people"; "Groups
should have no more than four people, six people is too many to
Some participants did not like the time commitment required with
the new learning strategies: "I do feel that this could have been
accomplished in less time"; "Sometimes people would ask
misleading or irrelevant questions that just ended up confusing
me." Students questioned whether the amount of work required was
commensurate with the credit awarded. "It took a lot of time to
make all those trips plus write all papers--for a two-credit
course"; "I had to take off work two days:' Conflicts
with other priorities seeped into the data: "During our
presentation we knew the students were not interested in the scenarios
because of finals"; "I think this [innovative strategy] should
have been saved for younger students with less responsibilities."
The time commitment required for the innovative teaching strategies
varied, and it is difficult to know for sure whether the time invested
differed from courses taught with traditional methods. Generally, these
strategies seemed to take slightly more to much more time than
traditional classes. One student stated: "Due to my lack of
knowledge about the political arena and health care systems, I would
have to express that I put forth a greater amount of time and effort
than I would expect a two-credit course requires" Others commented:
"It was not my priority so I didn't put a lot of time into
it"; "There was not much time during class time for the
RESOURCES Some students stated that they did not see the online
course as having value. One student claimed that in the online
discussions, "The teacher would not know my participation."
Several noted frustration with the equipment and resources: "Two
days the equipment was not charged and the software wasn't
loaded"; "We found out that the manikin program will not do
what we thought it was going to do"; "We continued to have
problems with programming and equipment troubles, which caused a lot of
group frustration"; "I was concerned about understanding how
to use the program and trying to pull it all together." Another
student stated, "My work with the PDA was educational, but once
again I enjoyed my clinicals in the hospital much more."
Equipment issues were coupled with instructor accessibility:
"We came up to school to work on the assigned project, but when
equipment didn't work or problems were experienced, or simply when
the group needed clarification there was no instructor around"
Perhaps most meaningful was the comment, "It seemed like we spent a
lot of time learning how to program [the manikin] and less time learning
clinical information." Students also described having difficulties
with an assigned text.
ROLES The students cited discontent and frustration with some of
the teachers, their teaching styles, and their organization: "The
teacher was not very involved"; " ... not much teaching or
direction regarding the use of the [manikin] program." Other
negative comments were directed at the staff who participated in the
project: "The nurses were there because they were told to be there.
Nurses were negative at the end of the project as well. Nurses did not
have information ... they were burdened with the thought of
A common thread noted was the need for clear instructions and
explanations about the project/strategy as well as disclosure of faculty
expectations. "The whole thing could have been more prepared and
had a better presentation"; "No specifics were provided for
the group. Felt lost at times"; "I felt there was little
guidance, poor preparation, and felt that as a result my time would have
been better spent in the critical environment with actual patients and
nursing staff willing to teach."
Project Limitations Certain factors contributed to limitations in
the rigor of this project. The group discussions were designed to allow
for interaction among participants, but the data sources varied; they
included a videocassette, a portion of a CD, and brief written
responses. In contrast, the data were detailed and sufficiently rich to
uncover emerging themes and trends in student responses. The themes were
quite pervasive. Important quotations were derived to substantiate the
Implications for Nursing Education Emerging themes obtained from
the data were strategies, context, resources, and roles. Nursing
students characterized innovative teaching/learning environments and
strategies as those that excite, refresh, and open their eyes. The
environment prepares students for practice, offers wide boundaries to
explore, and allows alternative perspectives, empowering the student to
be in charge of time and pace. Resources help students review for exams,
provide notes prior to or after the lecture, and support interactive
learning or learning via the Internet. Students desire an active role,
some humor to hold their interest, good preceptors and staff, hands-on
practice, teachers who share their experiences and help make
connections, faculty who are open and accept student guidance, and
stated parameters that allow independence. Some students were noted to
embrace the challenge associated with something new and experimental.
While students praised the flexibility, interactive work, and the
challenges and independence inherent in innovative teaching strategies,
some students were disappointed at the lack of help with exams, the time
schedule, equipment problems, and unclear directions and expectations.
It may be that the best way to implement innovation is to take into
consideration that students experience positive and negative attributes
of innovation in the context of each program's unique culture,
values, resources, behaviors, and beliefs. What works for one program
may not work for others. Resistance to change, time constraints,
personal learning styles, and life events must be considered. The
experiences of these students provide perceptions of the positive and
negative attributes of innovation. It is hoped that they will offer
valuable insight for the development and implementation of innovative
teaching strategies for nursing students.
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This article was submitted by the NLN Task Group on Innovation in
Nursing Education. Lois H. Neuman, PhD, RN, is faculty at Montgomery
College, Rockville, Maryland. Karen T. Pardue, MSN, RN, CNE, ANEE is
interim director and associate professor, Department of Nursing and
Health Service Management, University of New England, Portland, Maine.
Janet L. Grady, DrPH, RN, ANEF, is director and associate professor,
Nursing Program, University of Pittsburgh at Johnstown, Pennsylvania.
Mary Tod Gray, PhD, RN, is an associate professor, East Stroudsburg
University Department of Nursing, East Stroudsburg, Pennsylvania. Bonnie
Hobbins, MS, RN, is testing manager, Elsevier Review and Testing,
Houston, Texas. Jan Edelstein, EdD, RN-CS, is a professor, Marian
University School of Nursing, Fond du Lac, Wisconsin. Judith W. Herrman,
PhD, RN, is assistant director, University of Delaware School of
Nursing, Newark. The authors are grateful to the NLN Special Grant
Research Program; Mount Aloysius College RN-BSN Program; Kim Carman,
MSN, RN, CRNP, Angela Vauler EdD, and Corinna Dotter, ND, RN, MSN, East
Stroudsburg University; the Pocono Medical Center, East Stroudsburg;
Dolores Yundt, MSN, RN, Theresa Croushore, MSN, RN, Alexander Press,
BSN, RN, Marian College MSN Program; Gina Dennik-Champion, Executive
Director, Wisconsin Nurses Association; and P. Lea Monahan, PhD, RN,
CNE, Western Illinois University. Write to Lois. Neuman@Montgomery
College.edu or firstname.lastname@example.org for more information.