Blog Viewer

Why establishing psychological safety is crucial while teaching in a post-pandemic health-care setting

How educators can help create a positive culture around continuous learning

By Jennifer Dale-Tam
March 18, 2024
A nurse may not seek out educational resources if they have participated in a learning environment that was not supportive. When you employ the strategies described in this article in clinical settings, however, nurses will feel comfortable engaging with you.

Creating safe spaces for nurses to learn is essential. Many of us have a fear of looking inept or incompetent to our peers if we do not know the answer to something. Yet nurses are expected to question themselves when they do not have the requisite knowledge, skill or judgment to perform a task while caring for a patient. This is where the role of the educator in the clinical environment, whether a clinical instructor, a preceptor or a nurse educator, can have a positive effect. I will use the term “educator” to refer to all of these roles.

The COVID-19 pandemic has resulted in an even greater need for educators to create safe spaces for nurses to learn, grow and reflect. The pandemic has had a negative effect on the mental health of many practising nurses. Newly graduated nurses have not had the same exposure to clinical environments as those trained pre-pandemic. For nurses who graduated during the pandemic, it is even more important that they identify their learning needs and seek out the appropriate resources. They need a supportive learning environment in which to do this.

In this article, I first provide a definition of “psychological safety,” which is followed by strategies to help create a safe space for nurses to learn and engage in.

Psychological safety is the ability to express one’s thoughts and feelings without fear of negative consequences to one’s self-image, status or career. This definition has been used on an evaluation form of nursing educational programs I lead that has been completed by over 840 nurses. Of the 840 nurses, only two individuals responded “No” to feeling safe to express their thoughts. Close to 100% of the nurses felt safe in their learning environment using some of the strategies described in this article, which I use and have shared with my peers.

Psychological safety is a tenet of simulation-based education, which is one methodology of many that is used to educate nurses. Many of the strategies used in simulation-based education are applicable to other techniques of clinical education, such as shadowing, demonstration and in-servicing (education that occurs in one’s workplace). In my experience as a simulation educator and nurse educator, the following strategies have been helpful in establishing a safe learning space for nurses and other health-care professionals.

#1 Prebriefing

A prebriefing is conducted before every simulation-based education session, but it could also be done for clinical education sessions. Stating how long the session will last, what the objective of the learning session is and that asking questions during the session is expected can all be covered in the prebriefing. As an educator, if you use questioning as a method of engagement and learning assessment, saying that you will be doing so is helpful. I follow up by stating that it’s okay to say “I don’t know” when answering the questions, but the next action would be to develop the knowledge or skill through finding the answer.

#2 Role modelling

Like the previous statements about questions, when a learner poses a question that I do not know the answer to, I state, “I do not know, but I will find out” or “Let’s find out together.” This shows that we do not have the answer to everything; we are human, and that’s okay. The next step is to find the answer. This strategy role-models appropriate professional behaviour along with building trust with our learners.

#3 Acknowledging and normalizing

Learners may express feelings of fear or anxiety during an education session or they may exhibit fearful or anxious behaviours. If we dismiss, ignore or minimize those feelings, we are not recognizing the whole being that is the nurse, the human in us. Fear and anxiety can inhibit learning. When the educator acknowledges fear and anxiety and normalizes them, learners are put at ease. My follow-up statement to acknowledging and normalizing a feeling is “As we work through this education session together, hopefully those feelings will improve.” 

#4 Realistic statements

Some of these statements may sound cliché, but I have found them to be helpful in my education sessions:

  • “As nurses, we are all accountable for the care that we provide; therefore, if you do not know how to do something, you need to find out by using the resources available to you.”
  • “We are all human, and as such, we do not have infinite cognitive capacity to remember everything we have learned. But we do need to recognize when we do not know something and seek out the resources to assist us in learning about it.”
  • “As your educator, I want you to seek me out, especially if you are a new nurse.”

A nurse may not seek out educational resources if they have participated in a learning environment that was not supportive, where not knowing something was frowned upon or where asking questions was a sign of failure. They may hide their lack of knowledge, which could result in unsafe patient care. When you employ the strategies described in this article in clinical settings, nurses will feel comfortable engaging with you.

Research has shown that knowledge and skills deteriorate after about three months when not in use regularly but can be quickly refreshed through additional shorter education sessions. These sessions can be as simple as the nurse looking for resources on their own, such as hospital policies or best practice guidelines, or connecting with the nurse educator of the practice environment. For example, I’ve been working with nurses on refreshing their clinical skills throughout my organization. At the beginning of each skills session on their clinical units, I use the prebriefing; throughout the session, I use role modelling, acknowledging and normalizing as strategies to create a safe space. Three months into the initiative, 270 nurses have attended the sessions and gave them 9.84 out of 10 stars based on their experience. The nurses engage with me because they feel safe asking questions and know that it’s okay not to know the answer.

The underlying theme of this article is that it’s nearly impossible for a nurse to know absolutely everything in their practice and that it’s okay not to know. But we must seek out the resources to develop the requisite knowledge, skills and judgment. Educators in the clinical environment play an essential role in establishing a culture of continuous learning and being accountable by establishing psychological safety in spaces to learn.

Jennifer Dale-Tam, RN, MSN, CNCC(C), CCSNE, CHSE, is a corporate nurse educator (simulation) at The Ottawa Hospital.