Save Time, Teach Better: Ideas for Just-in-Time Clinical Paperwork Review
I noticed this discussion in an online space recently, and I think that many educators feel a similar way—reviewing and giving thoughtful feedback on clinical paperwork is time-consuming! When I was a new instructor, I experimented with a 'just-in-time' review approach for students. This method involves providing feedback and making suggestions at the most opportune moment, such as during the clinical shift, rather than after the fact. It allows for immediate application of the feedback and maximizes the time at clinical to work with students on not just their paperwork but also their thought processes.
Below are some ideas to help educators shorten their review time, provide timely feedback, and suggest changes that can actually impact patient care.
Just-in-Time Clinical Paperwork Review
Nothing is more frustrating for a clinical nurse educator than spending hours reviewing and offering suggestions on clinical paperwork, only to have students not read it and have no opportunity to impact patient care. For many nursing instructors, clinical paperwork is essential but can be time-intensive. A just-in-time review approach allows for efficient, targeted reviews that support timely feedback, while encouraging students to engage meaningfully with patient information, leading to impactful learning. While there are many ideas for alternative clinical assignments or even the elimination of clinical paperwork, these can take years to implement and get buy-in from faculty. So, even if you do not have input on the type of clinical paperwork your students submit, you can implement these small changes and see a significant impact. There are three main benefits to using Just-In-Time Clinical Paperwork Review:
Let’s take a look at each of these:
Saving Time
By efficiently using pre- and post-conference periods, nurse educators can significantly shorten the time they spend reviewing clinical paperwork.
💉 Preconference
Start by moving clinical prep time to the morning of clinical. I think many educators are already doing this, but this is life-changing! In my clinical groups, students arrive 90 minutes before the start of their shift, and I gradually decrease the prep time as they gain confidence and skill in reviewing the medical record. Students should conduct a focused review of the EMR, but just like a nurse, they gain most of their insight and information from the report and assessment.
Next, establish a routine of a short pre-clinical review between you and each student to assess their clinical readiness, understanding of essential concepts, planned interventions, and anticipated complications. Educators can tailor their teaching in real-time by identifying knowledge gaps immediately before clinical. Encourage students to embrace the routine and be ready with this information.
Utilizing pre-conference sessions also sets the stage for the day by helping students synthesize patient information, ask clarifying questions, and pinpoint learning priorities. This proactive approach primes students for success and enables educators to maximize teaching moments in real time.
🩺 Post-Conference
Setting aside structured time in post-conference sessions to review paperwork reinforces learning objectives and provides an opportunity for immediate reflection. Consider peer or group reviews of clinical paperwork. Set a timer and give students 15 minutes to complete missing pieces of their paperwork (adding a timer really seems to improve focus).
Consider offering small rewards or setting up a points system for completing clinical paperwork on the first day. I find that students make better use of their “downtime” when they are motivated.
In a two-day clinical rotation, the second day generally went smoother. Students know their patients, have already prepared their medications, and understand the plan of care. This is the day to review paperwork. I often found small pockets of time, just 10-15 minutes, to sit with an individual student and review their paperwork. I only sometimes got to everyone, but completing 2 to 3 reviews by the end of the day considerably decreased the time I had to spend outside of clinical grading. This leads me to the second benefit …
Provide Timely Feedback
Feedback is most effective when it’s delivered promptly and constructively. Implementing a just-in-time review system allows nurse educators to provide feedback while students’ clinical experiences are still fresh. As stated above, when students get your excellent feedback the next week, they hardly remember their patient or the clinical situation.
Research supports that timely feedback boosts students' motivation and retention. When students receive feedback shortly after an experience, they are better able to integrate the learning into future clinical practice (Rowbotham & Owen, 2015). Burgess et al. (2020) emphasize that effective and immediate feedback is crucial for promoting self-reflection, motivating learners, and improving clinical performance. The research highlights that the structure and timing of feedback can significantly impact learning outcomes and drive meaningful improvements in student performance.
Here are a few ideas to help
One effective strategy is to establish a structured feedback schedule. Schedule: review clinical paperwork on a set day, such as Tuesday, and deliver feedback on Wednesday. This approach ensures students have time to reflect and make changes while their recent experiences remain vivid. It builds accountability and creates a rhythm on which students can depend, enhancing the impact of your feedback.
Take excellent notes—I found it much easier to write student reviews when I prioritized my own note-taking during the clinical day and structured it around the learning outcomes. I would take notes such as “understood how to draw up medication from vial” or “connected blood pressure and fluid volume status” and then connect them directly to the learning outcome. If students were not meeting expectations, this practice gave me specific examples of where they were not meeting the outcomes.
Set up an office—I would always find a spot, somewhat private, where I could work with students 1:1 during the clinical day. One unit had a “back” nurse’s station, sometimes an empty patient room, but it is great to have a small workspace set up to review documentation and clinical paperwork and provide immediate feedback to students.
Another useful tool is a feedback bank. My friend and fellow educator Natasha Nurse-Clarke has a full masterclass on how to utilize a feedback bank to provide timely feedback if you are taking your clinical paperwork home. Essentially, a feedback bank is a collection of pre-written feedback that you can use as a starting point for your comments. If your school uses an online platform like Canvas, this function is available in the grade book, making it even easier to provide timely and constructive feedback.
Improve Patient Care
Seeing their care plan come to life in real-time is a source of student pride! If they can see that their plan to ambulate improves a patient’s respiratory assessment or when they catch a complication they had prepared for, that is what clinical education is all about! A just-in-time review approach equips students with essential skills and allows them to see how their care plan can directly impact patient outcomes.
📩 Have you had this experience before? I would love to hear about it. Let me know at martha-at-breakoutRN.com.
Work with students to set a realistic goal on Day 1. Utilizing the pre-conference sessions, ask students to establish a clear, patient-centered focus for the clinical week, which helps them prioritize care interventions. This preparatory work, along with ongoing reflection and feedback, builds confidence and competence.
In Conclusion
If you are feeling overwhelmed by grading or are experiencing a time crunch related to clinical paperwork, these tips can help you save time, provide timely feedback, and improve patient care.
Looking for other time-saving tools for an active learning classroom?
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References:
Benner, P. (1984). From Novice to Expert: Excellence and Power in Clinical Nursing Practice. Menlo Park: Addison-Wesley.
Burgess, A., van Diggele, C., Roberts, C., & Mellis, C. (2020). Effective feedback in clinical education. BMC Medical Education, 20(Suppl 2), 460.
Rowbotham, M. & Owen, R.M. (2015). The effect of clinical nursing instructors on student self-efficacy. Nurse Education in Practice, 15(6), 561-566.
Tanner, C. A. (2006). Thinking like a nurse: A research-based model of clinical judgment in nursing. Journal of Nursing Education, 45(6), 204-211.