Course demographics:
- Who are your typical students? Students are in their third semester of the nursing program, but this class is part of the first set of actual “NURS” content specific courses that they take. Some students are directly out of high school; others have entered the program as transfer students or degree holders.
- Class size: Between 120-144 students each semester.
- Typical classroom:Large lecture hall. There is little flexibility in the space.
- Course Outline: Available here
Thoughts and Reflections
How would you describe your typical flipped classroom?
This course focuses on the role of a registered nurse as a professional. Only two exercises through the course of the semester utilize flipped methods. The first is a mock tribunal hearing. A Registered Nurse (RN) will undergo a tribunal hearing after an official complaint and investigation is made against them for violating their professional standards. In a hearing, evidence is presented to a panel of RNs that determine whether or not the individual practiced unprofessional behaviour and what action should be taken if they are found guilty of doing so. These actions can range from receiving a caution, to taking courses to improve their practice, or the loss of a license. Sandi uses a mock hearing to help her students understand the importance of good practice and to see the impact of what they are learning in the real world.
Prior to the flipped activity, Sandi divides her class in half. Each group comes for half of the 3-hour lecture period to participate in the mock hearing. The smaller groups means that students can participate more than they would if the whole class was present. Before coming to the mock hearing, students learn what they are doing, why they are doing it, and how to prepare. There are some short readings required. These include the code of conduct, standards of practice, and other documents from the College and Association of Registered Nurses of Alberta (CARNA). They also can read some examples of tribunal hearings and their outcomes in the provincial nursing magazine.
During the mock tribunal case, Sandi takes on the role of a registered nurse who has been called to a hearing tribunal due to a public comments she made about a patient’s tattoo that some have deemed inappropriate. She does not put a student in the role because it is high-pressure and she wants students to feel safe in their learning environment. A handful of students in each group volunteer for the role of lawyers and panel members. The rest of the students make up the audience. They follow the structure of a real CARNA tribunal hearing. Students ask questions and ultimately make the verdict themselves. They have to consider the evidence, determine what can be used, and what is hearsay. They always determine that the nurse is guilty, although how they got to the decision sometimes differs. They also have to determine an appropriate sanction, which varies depending on the student group. This is a challenging but exciting activity for students. This is the perhaps first time they have seen the implications of their professional code and standards as registered nurses in action.
Following the activity, there is a class discussion about the experience. Students share what they took away from the activity and what might have surprised them about the experience. They constantly say that they understand their practice better and understand the purpose and context of the professional regulations.
What was your motivation to get started with flipped learning? How did you start?
Sandi started using flipped activities in her classes more than six years ago and they improve each time she uses them. She wanted to create an opportunity for increased student engagement and to see the hypothetical in practice. She implemented it by organizing her course to fit a few flipped learning opportunities within the set of regular lectures and assessments.
The experience of the mock tribunal hearing helps make the professional standards more real, more impactful, and more memorable for nursing students. The overall goal for students coming out of the mock hearing is to think continually about their practice and their role as a nursing student, and later as a Registered Nurse. The flipped activity puts their learning into context.
What were excited about? What were you concerned about?
It is always exciting for Sandi to see how each group of students approaches the tribunal hearing. Students think outside of the box every year and ask creative questions. She is also encouraged by how student engagement changes after this flipped activity. Often, more students take the time to meet with Sandi and make a deeper connection after taking part in the flipped classroom. While not every student chooses to do this, it does seem to impact the overall student commitment and to their professional practice.
Sandi’s initial concern was that she would have to sacrifice content in order to fit a flipped learning opportunity into the classroom. The nursing program is preparing students to write their Registered Nurse certification exam, and therefore is highly regulated and evaluated by the professional board. There is a lot of required content for the course, and she had some concerns that the flipped activities would reduce the amount of lecture time she had. However, the learning that students take away from the flipped experience is incredibly valuable. She does not miss any course content by doing two flipped activities, but is hesitant to try adding more in case it does impact the content covered.
What was your biggest challenge and how did you address it?
The biggest challenge Sandi faces is the large class size. It is hard to get to know each individual student or create a strong support structure when some students do not engage. Sandi feels that even when the class is split in half, the groups are still too large, but due to time constraints, there is no way to make groups smaller. Sandi does her best with having the two groups and tries to give them as much time to discuss and engage with one another as possible. Over time, dealing with a large class has gotten easier.
What tips do you have for other instructors to engage students in flipped learning?
Sandi believes there is room for some flipped learning, even in courses that are required to cover a lot of content, such as NURS 285. It requires thoughtful design and proper implementation, but it is worthwhile to give students a chance to experience learning in a new way.
She also provides the students who volunteer for the panel with a small thank you gift. It is unexpected and well appreciated by students. Sandi believes it is important to recognize the extra efforts that students make in the flipped activity.
Sandi’s final piece of advice is to make note of how each group of students is different and that some activities will work better than others. Getting to know students a little bit before doing the flipped activities can help an instructor determine what strategies might help that specific group.
What was your biggest take-away from the experience?
Sandi is constantly reminded that her students are entering the course and their entire program with the intention of being good Registered Nurses. Having that mindset has helped guide her in her further work as an instructor. Sandi notes that the flipped exercise is not directly preparing students for the licensing exam, but it is preparing for students for nursing practice, which is even more important.
An activity like a mock tribunal hearing puts students outside of their comfort zone, but that really helps them see the professional standards beyond just a list of words. They have a real impact on real people. Students really make a connection with the content when they see it in practice. She also finds it a lot of fun to get to work with students in a different way than just lecturing. She says that while it may be scary for some students to be part of the panel, the majority seem to enjoy the overall experience. A good flipped learning activity can be fun for both students and instructors.
Assessment and Technology
The flipped learning aspect of the course has no real impact on the assessments used. Students do short, online quizzes based on readings and learning activities. They also synthesize their learning from all their courses in the semester in a final paper, where they discuss the impact their learning had on their practice as student nurses. Their engagement with the tribunal activity is informally assessed but not graded. Sandi gets to see many of their thoughts and learning in how they interact with their peers and through the types of conversations they have in and out of the classroom.
Sandi uses D2L to provide students with readings, resources, and assignments. Otherwise, there is no technology use in the flipped classroom since the emphasis is on conversations and interactions.
Based on an interview with Dr. Sandra Hirst, Faculty of Nursing
