New to teaching/vent

[UnionRN2]

I decided to dip my toe into teaching and see how I liked it and so I took a clinical teaching position. The students are in their last semester. The lead instructor was adament in her lecture to the students (and me) that she did not want the students bogged down with bathing and making beds, instead they needed more experience with passing meds, assessments, and charting. Since I do not work in the hospital in which I have students, I job shadowed for a few days with the floor nurses to learn the rountines, policies, procedures, routines, etc.

Then classes started:

Day 1: Posted student assignments and focus was passing meds, assessments, and charting. The day went well.

Day 2: Did the same. However, the day went horrible! Three things happened.

1. One nurse made allegations that a student was impaired because she asked questions about the MAR and use of equipment. An immediate investigation by the lead instructor and myself found no impairment; just a student who had never been in the facility and had normal questions. The RN went to the nurse manager who without investigation wanted the student removed from the floor. I explained what the lead instructor and I had found. The NM did not seem happy, and announced she had to go to a meeting and would talk to me later. (She never did.)

2. One nurse turned out to be the type that eats her young. After a huge and very loud argument with the ward clerk she turned rabid on the student. It was late in the afternoon so I stayed with the student, had her report off, and put her in the conference room with some pertinent articles with post tests. And we had a discussion about the types of personalities in nursing and lateral violence.

3. One CNA was angry that the student did not bathe the patients in her group. She made several nasty comments about the student "neglecting" the patients. The RN for that group said the CNA is extremely lazy and tries to get out of her work all the time and to ignore her. I made a point of sitting down with the patient and asking her how her day went. It turns out she had wonderful things to say about the student, but not so nice things about the CNA, including the CNA swearing and and slamming things around in her room. The RN reported several successful learning experiences and showered praise on the student's ability and suggested a bright future. Since the NM was unavailable, I approached the assistant NM and explained this situation. He had a smirk on his face the whole time and it was obvious he didn't care to hear what I was saying.

I have since found out that I am one of a long line of instructors on that floor because of the problems there. The NM prefers to blame problems on the students instead of recognized the staff contributions.

So now I am not looking forward to next week (or the rest of the semester). I know I will never put students with the two nurses again. I question the ability of the first nurse when she couldn't recognize normal student questions and jumped to an extreme conclusion. And I cannot have a nurse performing lateral violence on the students. However, I am not sure I can successfully avoid placing students in the CNA's group.

There appears to be dysfunctional nurses with a nurse manager who has no control over the staff. With limited places for student's to get experiences, I know I have to slap a smile on my face and play nice with these people so the facility is open to future students. It is frustrating to not be able to confront people in an attempt to alleviate the problems.

Any suggestions? Would you have handled things differently?

[madwife2002, BSN, RN]

How Horrible for you and the poor student. What is wrong with these people? I am getting more and more frustrated with the atitudes of so called 'professional' nurses.

I think you did everything within your power to make things better If you do dont have the support of the nurse manager It will make things difficult for you.

Why dont you ask for a meeting, introduce yourself and ask the manager for her input into what she expects from the students on her floor and ask her what her expectations are of her staff.

[carluvscats]

I cannot think of anything you could have done differently. It would be great if you could have confronted the CNA head on, but it doesn't seem like you have the authority to do so... as you said, you "have to play nice" in order for the facility to have good rapport with the college.

Seems like for the most part, your hands are tied. We can control only those things we can control! I would encourage you to continue to be a strong advocate to your students. Give them all the wisdom you know how to give; be quick to praise anything they are doing right. Never underestimate the power of an encouraging word! They could come out of this semester remembering the awesome clinical instructor who helped them get through the dysfunctional floor.

Best of luck to you!

[DogWmn]

I'm sorry your having a rough time of it, good clinical instructors are really needed and don't give up!

Did your lead instructor provide an outline of goals to the unit NM and staff prior to showing up on the floor? I think something in writing will help the unit staff understand and be aware of the goals set for the students.

I'd also recommend the first clinical day to be orientation to the unit and intro to staff so they are not getting to the floor blind as to where things are and what floor policies are.

I would meet with the unit NM to find out how you and your students can meet the goals set and ask how you can best communicate to the unit staff the goals for each clinical session before you hit the floor.

I've worked in several teaching hospitals and one always let us know ahead of time what the game plan would be for the day/week/month/term and it help us plan our day. The other hospital I worked at, we might find out in report if a gaggle of students would be swarming that day and sometimes not, nor did we know what they'd be up to that day. It made it hard to plan out our day not knowing if the student would be doing bathing, meds etc.

Students can be a help or a hindrance on the unit and sounds like the staff has found them a hindrance in the past, hopefully you can turn it around and good luck!

[netglow, ASN, RN]

Unfortunately I witnessed and heard telling of similar things when I was in school. Two incidents where RNs actually were stopped from sabotaging the students, and I mean serious situations stopped by our instructors. The students do talk and the hospital does get a bad reputation. Heck, I told everybody I cared for that Hospital X and Hospital Y were not options for them as patients. Students are warned away from those clinical sites as well by other students. If a clinical instructor hangs a student out to dry, well...

I had a run in with a CNA with a similar complaint... on a second day, I was frank with this CNA when she said something nasty in front of my patient, to the effect that I didn't do what "she expected of me" the day before (she, the RN, the NM had been briefed prior, and had a sheet of my day's focus). I hooked my arm around hers and pulled her into the hall wth me, looked her hard in the eye and said, "it's not gonna happen... got it?!" I am not the type to do this back and forth for very long. I won't play with you, I'd rather you just know.

[Up2nogood RN, RN]

I'm sorry this is happening to you and your students but what a great way to learn what their future work environments may be like! I would take advantage of these learning oppurtunities and share these concerns with your students too. I think so many instructors paint such a rosy picture for their students and they crumble when they are first out on their own in the real world of nursing.

[sarabear44]

Wow! I hope it is not like that for me when I start nursing school. But I hope I have an instructor like you who would sit down and talk to me after a bad experience. I am switching to nursing from several years as a high school teacher so I know a little how you feel.

No matter what your students end up doing, it's not going to be a walk in the park and every bad experience is an opportunity to learn how to work through future bad experiences. Keep your head up and remember your priority is your students. :)

[classicdame, MSN, EdD]

I used to work in a hospital with a unit like that. No amount of coaching or lecturing or anything seemed to make a dent. Finally the unit was closed, everyone was fired, and later the unit re-opened under different management. The lesson was made to the staff in other depts that this behavior is not to be tolerated. I would talk to the liaison person at the hospital who works with students or the CNO. And I would make a point to not arrange clinicals there again unless there is no where else to go. However, YOU did the right things. Your students are learning how NOT to act, if nothing else. I would have the students critique the staff in writing so you can give to the CNO or your Dean. Also, this is a good opportunity to discuss group dynamics and Change theories. In other words - if the student was in charge what would they do?

[JulieCVICURN, BSN, RN]

I would have taken the CNA aside and told her that the students are not there to do the CNA's work and will not be bathing the patients, and if she has a problem with that she can talk to her manager or talk to me, but she'd better steer clear of harassing the students.

[morte, LPN, LVN]

if i could find a halo, i would give it to you!

i am wondering if the nurse who claimed your student was impaired was the impaired one? or was passive aggressively getting out of a task she never wanted?

the CNA, at least one of the staff nurses knew the score there already!

[aerorunner80, ADN, BSN, MSN, APRN]

From a student's perspective....is it possible to pull the whole group aside and talk about how to deal with difficult people? Maybe let them vent if they need to.

We had a situation when I was in level 2 with an absolutely terrible nurse who treated us students like crap. It really helped those of us who worked with her to be able to vent and talk about what happened and what we could do to get through it.

Other than that, I would get out of there ASAP! Who knows if they are going to start blaming you for something that could cause you to lose your license. It's just not worth it. I"m really surprised that this school continues to go here.

Before I was in school, there was one hospital in town that was problematic so the school pulled out and now nobody in our school will do clinicals at this hospital. I believe we don't even have the option to do preceptorship there either.

[Virgo_RN, BSN, RN]

It sounds like you handled everything very well. It also sounds like the culture in this unit is deeply entrenched, and that you and your students are in for more of the same. I'm not sure what you can do about that other than go into survival mode and be mother hen to your students. Sounds like they need you! Good luck!