This article is a collection of ideas and research for nurse educators related to structuring and organizing groups in a nursing flipped classroom.

While using a variety of techniques in an active learning classroom is essential, group work is a cornerstone activity.

Beginning to develop a nursing flipped classroom? Group work will certainly be a key component and when used under the guidance of a skilled instructor, it can create engagement, interaction, and learning like no other activity can.  

That’s not to say it is without pitfalls.  It can take a sour turn with poor planning and vague directions.  These guidelines will help you optimize your small group activities and keep students moving towards those learning targets.

It all starts with preparation

Preparing for a group activity is essential.  Group work is most effective when students have had long periods of individual, self-managed learning time, which correlates with the idea of an active learning classroom.  The first step is moving some lecture time out of class for independent review and utilizing small groups when everyone is together during class time.

Size of the Group

Decide on the size of your group based on the task they will complete. Pairs, according to seating, are useful for occasional, short problem-solving activities.   A group of 3 is optimal for math or problem solving, while 4-5 is best for tasks with multiple answers, brainstorming, or problem-solving.  Groups of up to 7 can function effectively.  

Long Term vs Short Term Assignments

Long-term group assignments for major projects or ongoing tasks can refine cooperative skills. One study found that permanent groups produced better work and developed stronger interpersonal skills. Short-term assignments that change every few weeks allow students to get acquainted with more classmates.

Teacher-Created vs Student-Created Groups

According to an informal Facebook poll we did a few weeks ago, most educators create groups themselves rather than allowing students to choose.  Teacher-created group formation is supported by research. The educator can choose group members according to skill level, for example, in a clinical setting or randomly in a large theory class. When students formed their own groups, they sorted largely by demographic information and did not form diverse groups.  

How to Prepare for Group Work in a Nursing Flipped Classroom

Group Rules

Having group work guidelines for nursing students gives the educator the confidence that your students are participating and interacting in a way that leads to meaningful learning.

  • Give the group a specific, structured task to complete.  A written or visual product is great to show at the end.
  • Enforce time limits.  Even for short tasks, set a timer for a few minutes.  For longer activities, give a warning for 10 or 2-minutes remaining.  Time limits help keep teams on task.
  • Assign individual roles. If nothing else, at least assign a leader.  This person will speak and share the answers.  I choose a leader randomly each week with a specific question – “Who has traveled the farthest?” or “Who has a birthday closest to January 1?”  This helps build camaraderie and helps students get to know a little about each other.  Other roles could include note-taker, timekeeper, math whiz, or researcher.
  • Set some basic etiquette rules.  Only one student talking at a time.  Bring the classroom to silence by raising hand and asking them to stop talking and raise their hand when they see you do this.

During Group Discussion

Be available for questions—no sitting up at the front podium going through email.  Get in the trenches.  Walk around and ask them to explain their thinking.  Have the group leader practice what they will share with the larger group.  

Group work guidelines for nursing students include an educator who is involved.

I believe this is an essential step in creating a connection with your students.  It moves you as the educator from an unapproachable podium speaker to a relatable human there to help them learn and develop.  It creates an environment where students are open with their questions and feel safe sharing their ideas.

Add a Conclusion

Wrap up by asking for progress reports or shareouts.  Have them take a group exit ticket or complete a short quiz.  This will ensure that they had a genuine learning experience and can share what they learned.

Types of Group Work

Research supports that courses that are structured with collaborative learning and group work have improved retention and persistence rates. There are actually many varieties of ways that students can work in groups.  It does not always have to be a “share with your neighbor” scenario.

Cooperative Learning

Cooperative learning is what you typically think of regarding group work: everyone on the team, working on the same problem, completing the task together.  It is a classic teamwork scenario where students must communicate effectively and use the “soft skills” to succeed.  Some students may not come to your class with these skills and be uncomfortable with this type of learning.  Another important aspect is everyone has to agree.  Throughout the problem-solving process, they will come to points where there may be disagreements.  If the majority overrules, the whole group may go down the wrong path.

Collaborative Learning

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This one takes the highest spot in Bloom’s taxonomy – create!  Students actually create a product.  It could be a patient teaching handout, a care plan poster, or a crowd-sourced study guide.  But the idea is to move control of the activity from the instructor to the student groups.

Peer Teaching

In this type of group work, students become the teachers.  I actually love using this type of activity.  In learning to interpret arterial blood gases, I have student groups learn different techniques through recorded lectures and online research.  In class, we teach the other groups the technique they have mastered.  By clearly teaching others, students can clearly demonstrate that they understand the content.  On the flip side, this is an activity that the instructor must be monitor closely.  You would not want a student teaching incorrect information or a wrong idea.

Drawbacks of Group Work

As with any teaching technique, there are disadvantages for group work.  By being aware of the potential downside, you can be proactive to give students the best group experience possible.

  • Inactivity by some members – there is a term for this called social loafing. It is the tendency for a student to exert less effort on a project when working with a group than if they worked independently.  Some students will inevitably coast and allow others to carry the bulk of the group’s assigned task in a larger group.
    • Ways to combat social loafing: smaller group size and peer evaluations.
  • Even if everyone participates, there will inevitably be an uneven distribution of the work.  
  • Students can easily be distracted by social conversation.
  • Grading groups leads to unfair assessment for some.
  • Opportunity cost – lost time to direct instruction or other teaching methods.

Final Take-Away: Group Work Guidelines for Nurse Educators

Group work can be an amazing tool for educators in a nursing flipped classroom. With some preparation, thoughtful setup, and consistent structure, it can lead to engaged learners who demonstrate clinical judgment. Following these group work guidelines for nursing students will ensure that you are successful as you move to a flipped classroom.

Group work can offer opportunities for collaboration and community building in classrooms


Aggarwal, P., & O’Brien, C. L. (2008). Social loafing on group projects: Structural antecedents and effect on student satisfaction. Journal of Marketing Education, 30(3), 255–264.

Harding, L. M. (2018). Students of a feather “flocked” together: A group assignment method for reducing free-riding and improving group and individual learning outcomes. Journal of Management Education, 40(2), 117–127.

Howell Major, C. (2016). Understanding different types of group learning.  The Teaching Professor. Published Dec 1, 2016.

Nilson, L.B. (2010). Teaching at it’s best: A research-based resource for college instructors.  Jossey-Bass.

Zeff, L. E., Highby, M. A., & Bossman, L. J., Jr. (2006). Permanent or temporary classroom groups: A field study. Journal of Management Education,30(4), 528–541.

Did you know we have a community?

Head over to the ACTIVE LEARNING STRATEGIES FOR NURSE EDUCATORS Facebook group for more ideas and inspiration!

Martha Johnson is the charge nurse over at BreakoutRN

Martha Johnson MSN, RN, CEN

Charge nurse over at BreakoutRN with a focus on helping other nursing educators transition from lecture to active learning.  She believes it does not have to be hard or overwhelming, just take it one activity at a time 💜

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