Teaching the Art of Nursing

Heidi Hahn-Schroeder is the clinical placement director for the combined BS/MS Entry-To-Practice (ETP) Program at Columbia Nursing where she oversees students’ clinical placements at hospitals, community health settings, and clinics. This month, she moves into the role previously held by Ellen (Sunni) Levine ’96, for the last decade.

Hahn-Schroeder began her career as a nurse providing care for patients recovering from strokes, as well as head and spinal cord injuries. She subsequently worked as a nurse on the inpatient pediatric units as well as the pediatric and adult emergency departments at NewYork-Presbyterian Hospital. She joined Columbia Nursing in 2005 as an instructor in clinical nursing in pediatrics at NewYork-Presbyterian Morgan Stanley Children’s Hospital (CHONY).

Q  What do students learn in their rotations that would be impossible to glean from a text book or lecture?

They learn the art of nursing— how to apply the human component to classroom lessons. When I was a clinical instructor, my Columbia Nursing students cared for a 16-year old in the final stages of AIDS. She had contracted the disease congenitally from her mother, who hid her daughter’s HIV positive status from her and told her she had cystic fibrosis until the daughter googled the names of her meds and found out she had AIDS. Our students were caring for this girl in the final stages of her life. They held her hand when she was crying out in pain. They helped her prepare for the prom that the hospital hosted. They allowed her to have moments that any healthy 16 year old girl would experience, in addition to assisting with her treatments and other medical management. Our nursing students became an integral member of this patient’s health care team. The caring component of nursing, the art of nursing, is essential and can’t be taught in the classroom.

They also learn how to work with other members of the health care team: doctors, social workers, other nurses and nurse managers. We teach them to be confident in their ability to approach these other providers both in real life clinical settings, and in role playing exercises and post-conferences after their rounds.

Q: What challenges do students face in their clinical rotations and how does your office support them?

For some of our students, this is their first time working in a health care setting. Everything is new to them—from getting used to the smells of a hospital, to learning how to safely open a dialogue with their patient. Developing relationships with the rest of the health care team can also be overwhelming. Many students come to me after dealing with a patient’s death for the first time, which is always challenging. I let them express what they are feeling and refer them to other services if they need it. I try to let them explore their own feelings in a safe space, and not interrupt them with my own perception of the event.

Q: Nursing students need to put their feelings and biases aside when they are caring for patients. Why is being impartial so critical as a nurse?

I often tell my students that when I worked as a pediatric nurse, I often cared for children whose parents abused drugs and were neglectful of them, and yet were still involved in their care at some points. I had to hold back my judgment to avoid doing anything that could have a negative impact on the patient. As a nurse, the safety of your patient is the most important thing. A big component of Columbia Nursing's clinical rotations are the conferences we hold after rounds, where students can discuss their feelings and work to understand them, and support their patients. I always tell them to be honest with themselves about what they can handle and remain impartial. You have to continuously evaluate yourself as nurse.

Q: How has precepting nursing students changed over the last decade?

It's striking how much the acuity of patients has risen while their length of stay in the hospital has declined in the last decade. Our students treat sicker patients and deal with more life and death scenarios on general hospital floors outside of ICUs. Our students need to make quicker decisions with bigger consequences.

Q: Why did you decide to become a nurse?

To be able to make a difference in a person's life during a time of illness or when they are dying is a privilege I have had for 25 years. I knew I wanted to be a nurse before I entered high school. The compassion involved in caring for a patient is what drew me to the profession. It was not until I entered the LPN program at the age of 16 that I realized how awesome the profession truly is. What makes each day challenging and interesting is the ability to think critically, continually assess patients, manage their plan of care, and at the same time advocate for them. The ability to perform all of these skills in varied settings such as a hospital, outpatient clinic, or a school, made nursing even more appealing to me. Add to this, teaching your patients and colleagues on a daily basis, and I knew nursing was the choice for me.