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CURRENT POSITION: Clinical Nurse Specialist


CURRENT AFFILIATION(S): Hospital of the University of Pennsylvania, Philadelphia


AREA(S) OF SPECIALIZATION: Cardiology, critical care, progressive care, evidence-based practice translation


PROFESSIONAL EDUCATION: PhD, Temple University, Philadelphia, Pennsylvania; MSN, University of Pennsylvania, Philadelphia; BSN, Widener University, Chester, Pennsylvania


CERTIFICATIONS: CCRN (AACN), CCNS (Adult Critical Care-AACN), ACNS-BC (Adult Heath Nursing-ANCC)


Dr Linda M. Hoke was awarded the 2010 CNS Preceptor of the Year Award this past March in Portland, Oregon, at the 2010 National Association of Clinical Nurse Specialists National Conference, titled: CNS as Internal Consultant: Influencing Local to Global Systems. Dr Hoke is regarded by students as a superb clinical nurse specialist (CNS), leader, and mentor. She challenges students to sharpen their critical-thinking skills and empowers them to seek opportunities for personal and professional growth.


You are obviously highly respected as a role model for CNS students, what do you feel are the most important skills or competencies to mentor for such students?

Each student is different, and each student has different goals and objectives. To facilitate their learning, I found open communication and feedback are important skills to mentor CNS students. Communication is essential to a good relationship and promotes learning. Communication conveys complex ideas, theories, or strategies into something that makes sense. It responds to the needs and questions of the student. I always try to set aside time during the day, usually first thing in the morning and at the end of the day, to sit down and talk with them and see how things are going. I like to start the day knowing what their goals are for the day and explain what they may expect from me and my schedule. I like to conclude the day with how things went and what they learned. We usually discuss plans for the next clinical day and their progress on their project and how I can help them.


Feedback from preceptors is critically important, especially with adult students. Oral and written feedback provides advice to students on their behavior, action, and performance. It reinforces what has been done correctly, reviews what needs to be improved, and corrects mistakes. Feedback is less judgmental than evaluation and can be given informally throughout the student's experience. My students send me their journals or logs as they turn them into their instructor. I enjoy reading about their day from their perspective. I provide written feedback in their journal and return my comments to them. This could be asking them a question for them to further think the idea through, clarify what they wrote, or give them suggestions. Reading their journal helps me understand what they are thinking and how I can help them to look at it from a different angle or explore other options.


One of your personal skills mentioned by your nominees was challenging students to sharpen their critical thinking. What do you think are the best precepting methods to do this? What other most frequently used preceptor strategies do you use?

Adult learners are often experiential learners who prefer to take an active part in the learning process rather than being passive recipients of information. I challenge my student to sharpen their critical-thinking skills by setting goals, asking questions, and exploring issues in-depth to make good decisions. During their clinical rotation, I provide an optimal climate for active learning to form a trusting relationship. This involves introducing them to the staff, having mutual respect, and providing a motivating environment for them to learn and ask questions.


Each student needs to feels comfortable and confident in the environment so he/she is able to interact with the staff and ask questions. I start the first day with a tour of the unit, introducing them to the entire staff as we go through the unit. Every CNS student sends me a short biography of themselves and what they want to learn. I forward this e-mail to the staff. They learn about the CNS student who will be on the unit and how the CNS student can help them.


I create an informal environment in which my students can feel encouraged to discuss their needs and circumstances openly and in confidence so I can provide constructive feedback. A trusting relationship establishes ground rules and builds respect and confidence. This begins with open communication and building trust through discussion of sensitive information. I am very open with my student about what is going on in the unit and any issues that come up. I explain how and why the situation was handled a certain way. I include the CNS students in all situations if possible so they can see first hand how it was handled and the importance of the CNS role. Afterward, I ask them for feedback or suggestions on what they would do differently and why. I routinely provide learning tips to make them successful, by explaining what I am doing and why.


I motivate my students by being upbeat and positive and telling them why I like my position as a CNS and how the CNS can positively influence patient outcomes. I provide examples of why they need to embrace new opportunities and to be involved in professional activities. I share with them my personal experiences and insights. I tell them to strive for excellence and to keep plugging away and be persistent in pursuing goals despite obstacles and setbacks. I give them examples of how they can learn from their mistakes and still come out on top. I advise the student CNS on professional growth and encourage publication and presentations.


In your years of experience, is there one particular aspect of CNS practice that you think students struggle with the most and why? What successful learning activities do you use to help them in this area?

Students are often passive receptors of information. Through technology, the amount of information available today is massive. Clinical nurse specialist students need to think creatively to stimulate curiosity and promote divergence. One main role of the CNS is to develop innovative ways of providing care that are cost-effective and result in positive patient outcomes. Clinical nurse specialists need to be creative in how to get the message out as a teacher, leader, and change agent. While being creative, they need to navigate the political arena by developing formal and informal networks to message their ideas so they can implement their projects. They may get turned down in one direction but can try a different approach. I challenge their traditional thinking and push them to come up with creative thoughts and ideas from their perspectives and experiences. Clinical nurse specialists need to use creativity to explore new ways of looking at issues and help staff find creative solutions to problems. I challenge my student to think out of the box and create something new or original. I do not prescribe to them how to do their project. They need innovative novel ideas with new approaches and information.


What helped you the most in preparing for the role of a CNS?

I have been a CNS for a long time, and the role has evolved over the years. I think it is important to find a mentor or someone you can bounce ideas off and will keep you moving forward. It is so easy to stay stuck in the same routine, but we need to be innovative thinkers, moving ideas and projects forward. When I wanted to start to do research, I sought out my mentor Barbara H Munro, PhD, RN, FAAN. She walked me through the steps and helped me to successfully complete my first of many research projects. Her mentorship and support moved me in the direction to pursue a PhD. It is important to find someone who is supportive and positive, but willing to give you constructive feedback, someone you can ask for advice and share challenging situations.


What do you find you learn from the experience of precepting CNS students?

Precepting CNS students help me to expand my vision and open me up to new ideas. I learn from my students. Reading their journals, I see nursing from a different point of view. Things that are routine to me may be a big deal to them. They will sit in a meeting and read expressions or messages from leaders through different eyes. It is always an eye-opening experience, and I value their opinion. I enjoy talking with them about their courses and what they are learning. They tell me how the CNS role fits into their ideal role or job. I learn the direction nursing is taking and the CNS role as it evolves.


What has it meant to you to receive this award both personally and professionally?

After the shock is the honor of nationally representing all CNSs. I felt especially proud that my student took the time from her busy schedule to submit the application. Knowing that I positively influence and promote the CNS role brings me full circle in my career.


I am proud to be a CNS and role model to my students.