Nursing Student From Hell

[DWelly14]

So I need help. I've been a nurse for 6 years now. I have a BSN & an MSN and am also a CNM. I've worked 4 years in critical care and the past two years in labor and deliver at a large suburban hospital. I've precepted several students and have always had positive experiences with them. I was not planning on taking another student this semester as I finally am transitioning into full scope midwifery practice but the local nursing school was desperate so they talked me into taking one last student. So in January, this student, let's call her Alice, started with me. When Alice first started she seemed very unsure of herself. She's a student though so not unexpected, even though this is her last rotation before graduation. But I got my teach on. We discussed anatomy and physiology of pregnancy and labor, walked through procedures at least 10 times, I stayed after every single shift to work with her, and she always went home with printed out policies and articles to read up on so we could discuss on our next shift. I felt like I was seeing improvement but I was always right there with her helping with her during the first 6 weeks of her rotation. When we had her midterm evaluation with her faculty member, Alice was told she was to take the primary role and I was to back off. So that's what I've been doing. Unless safety is in jeopardy, I've kept my hands off. And Alice is crashing and burning. To the point where I'm not sure how she's made it this far in her program. She is lazy, refuses to do basic nursing tasks such as starting IVs, and will just go hide to get out of things. We admit a patient. I go in to the room with Alice, she just stands there. I say "Ok, go ahead and get started." She says (in front of the patient mind you) "well, I haven't done many IVs so why don't I watch you one more time?" I say " you only have 2 weeks left, you only have so many chances left ... " Patient chimes in "I want you to start my IV please DWelly14!" .... opportunity lost. Fast forward to when the patient is complete. Alice is nowhere to be found. I'm in pushing with her and the charge nurse has to find her. Several of my coworkers have commented on her behavior to me, I've confronted her on it and she always makes excuses, and I've now emailed her faculty.

My question to all of you is do you have any tips for what to do? I feel bad just recommending that she not pass but at this point she only has 3-4 shifts left with me and I'm getting really frustrated with her. I'm really not willing to take her for any longer than the originally assigned amount of time because of the behavior I've observed. I feel like she's skated by through her whole program somehow and now she's finally having to actually do it and she can't. Help!

[tyvin, BSN, RN]

Have you sat Alice down and told her exactly what you just told us? As for the IV if I were Alice I would have felt put on the spot. How about the patient? How do you discuss things like that in front of someone who is suppose to get an IV? I would have asked Alice outside the room if she could handle it and not put her on the spot in front of the patient. After decades in nursing, I still can't do an IV.

Your whole post reminds me of when I first started helping my boys with their homework. I had college level standards and it was impossible for them to meet them. I soon realized my mistake. They were 8th graders, not college graduates; just saying.

If you didn't sit Alice down from the start to let Alice know what her shortcomings were, what she was doing right/wrong, discussed them, plan of action, what was expected of her, etc..., establish a rapport (not just have her watch and send her home with paper), then you are the one who failed. What you're saying is you let her watch you for a long period of time and then suddenly let her take the reigns near the end because the school told you? Why wasn't any of Alice's failing behavior brought up to Alice's nursing advisors/professors/etc..at the mid term evaluation or prior, how about your DON, boss, etc... long before the midterm mark. And again; why wasn't it brought up to Alice to improve her performance?

Alice chose L/D for a reason. There is a type of clinical that the bachelor programs have as their last clinical in the senior year; it's suppose to be in management. I chose management in psych and learned so much. My preceptor didn't send me home with a bunch of papers every clinical. I was hands on with him from the start. My school allowed him to make whatever learning program he thought would benefit me the most. Or maybe Alice is in an ADN program. In my nursing program it had to be managerial for a quarter. We had already done the one quarter buddy with a nurse thing (no paperwork sent home by preceptor, just hands on camaraderie). Isn't AnP a prereq for nursing programs? Ten times; I would have been insulted at how stupid you thought I was. I'm sure your nonverbal communication wasn't well received because it tells the other person how you really feel whether you realize it or not.

In my last clinical in management after every clinical my preceptor and I would have a small meeting to discuss things. He made a point of how most the problems in all areas of nursing are d/t a lack of communication. You also need to remember that while this clinical is going on the student has their regular classes and the "Capstone" and it's presentation is due at the end of senior year (in BSN programs).

After all the precepting you've done, now you write in and invite permission to justify your explanation of what went on with Alice from Hell. Also, if you didn't have a good relationship with this student how could you let it go on? It sounds like you have a lot of resentment built up. Perhaps it's the student's fault or maybe you know you shouldn't have taken on that last preceptor request. Are you sure your post is not projection in it's purest form...

The title to your post tells me what you want to hear. When I hear "I've confronted her on it" ; that doesn't sound like teaching. You and your cohorts were talking about her as well. "Skated through"...you allowed her to breeze on through without one word of how you really felt? This should have been nipped in the bud from the start. It takes two to tango.

Let me be clear, Alice could have also spoke up and helped herself but as you say "they were desperate"... So, at the end of it all you finally email her faculty. Way too little to late. I know many people like you; you are the last one to look at yourself as the problem..after all the degrees after your name tell us what an expert nurse you are. You will probably be shocked when the school does an investigation and you will also be investigated.

To actually admit you don't know how she's made it this far is so disheartening on so many levels I can't believe you haven't read your own lines. Transitioning into full scope midwifery has got to have huge challenges for you; in your own words "as I finally am transitioning"...sounds like it was a long hard road. Than to also add a student to your already burdensome schedule was a disservice to the student..you should have paid more attention to yourself and your goals.

I am wondering why the post since you have already emailed her school. Will it make you feel vindicated when people scream "Off with her head?" Do not worry, you will get plenty of that.

I'm sorry, but IMO; it sounds like you bit off more then you could chew. I hope one day you will be able to look back on this and learn from it.

[SaltySarcasticSally, LPN, RN]

The fact that anyone is even questioning whether or not you should report this student and end her preceptorship early is just crazy to me.

I start my preceptorship at the end of the month in the ER. I am getting flash cards together now so I know my meds, labs, common things they see in the ER, asking friends who work in trauma to tell me what I need to be prepared, just in the hopes that my preceptor will even trust me a little. I want to learn every possible thing I can from her and am honored she is willing to give me her time when she is already so busy, free of charge since she doesn't make any extra money doing it. If she says hey do an IV, my butt is gonna be in there in a hot second and doing the best damn IV I can do. That's what a normal student should do, anything less they should be failed.

You have already gone above and beyond for this student, anyone less would have been over it after the first two shifts together. IMO you have been failed by her school because this not all likely that she only started acting like this now. Please, fail her, I am beyond tired of staff members who do not pull their weight, never see repercussions, and drag the whole team morale down. She is exactly what we need less of in nursing.

[cocoa_puff]

Have you sat Alice down and told her exactly what you just told us? As for the IV if I were Alice I would have felt put on the spot. How about the patient? How do you discuss things like that in front of someone who is suppose to get an IV? I would have asked Alice outside the room if she could handle it and not put her on the spot in front of the patient. After decades in nursing, I still can't do an IV.

Your whole post reminds me of when I first started helping my boys with their homework. I had college level standards and it was impossible for them to meet them. I soon realized my mistake. They were 8th graders, not college graduates; just saying.

If you didn't sit Alice down from the start to let Alice know what her shortcomings were, what she was doing right/wrong, discussed them, plan of action, what was expected of her, etc..., establish a rapport (not just have her watch and send her home with paper), then you are the one who failed. What you're saying is you let her watch you for a long period of time and then suddenly let her take the reigns near the end because the school told you? Why wasn't any of Alice's failing behavior brought up to Alice's nursing advisors/professors/etc..at the mid term evaluation or prior, how about your DON, boss, etc... long before the midterm mark. And again; why wasn't it brought up to Alice to improve her performance?

Alice chose L/D for a reason. There is a type of clinical that the bachelor programs have as their last clinical in the senior year; it's suppose to be in management. I chose management in psych and learned so much. My preceptor didn't send me home with a bunch of papers every clinical. I was hands on with him from the start. My school allowed him to make whatever learning program he thought would benefit me the most. Or maybe Alice is in an ADN program. In my nursing program it had to be managerial for a quarter. We had already done the one quarter buddy with a nurse thing (no paperwork sent home by preceptor, just hands on camaraderie). Isn't AnP a prereq for nursing programs? Ten times; I would have been insulted at how stupid you thought I was. I'm sure your nonverbal communication wasn't well received because it tells the other person how you really feel whether you realize it or not.

In my last clinical in management after every clinical my preceptor and I would have a small meeting to discuss things. He made a point of how most the problems in all areas of nursing are d/t a lack of communication. You also need to remember that while this clinical is going on the student has their regular classes and the "Capstone" and it's presentation is due at the end of senior year (in BSN programs).

After all the precepting you've done, now you write in and invite permission to justify your explanation of what went on with Alice from Hell. Also, if you didn't have a good relationship with this student how could you let it go on? It sounds like you have a lot of resentment built up. Perhaps it's the student's fault or maybe you know you shouldn't have taken on that last preceptor request. Are you sure your post is not projection in it's purest form...

The title to your post tells me what you want to hear. When I hear "I've confronted her on it" ; that doesn't sound like teaching. You and your cohorts were talking about her as well. "Skated through"...you allowed her to breeze on through without one word of how you really felt? This should have been nipped in the bud from the start. It takes two to tango.

Let me be clear, Alice could have also spoke up and helped herself but as you say "they were desperate"... So, at the end of it all you finally email her faculty. Way too little to late. I know many people like you; you are the last one to look at yourself as the problem..after all the degrees after your name tell us what an expert nurse you are. You will probably be shocked when the school does an investigation and you will also be investigated.

To actually admit you don't know how she's made it this far is so disheartening on so many levels I can't believe you haven't read your own lines. Transitioning into full scope midwifery has got to have huge challenges for you; in your own words "as I finally am transitioning"...sounds like it was a long hard road. Than to also add a student to your already burdensome schedule was a disservice to the student..you should have paid more attention to yourself and your goals.

I am wondering why the post since you have already emailed her school. Will it make you feel vindicated when people scream "Off with her head?" Do not worry, you will get plenty of that.

I'm sorry, but IMO; it sounds like you bit off more then you could chew. I hope one day you will be able to look back on this and learn from it.

Wow...just wow.

[vanilla bean]

OP, I'm not going to weigh in on whether or not the student should pass/fail her preceptorship; you are the only one that has spent enough time with her and has the full knowledge of the situation. I can appreciate that you are using us as a sounding board to work through the seriousness of the decision you're trying to make.

What I want to tell you is this: there are presently a couple of posters on your thread that have/will have you scratching your head wondering how they've read so much into the situation and have the opinions they do. I would suggest (if you have the time or inclination) that you read through some of those posters' previous posts as it may help give you some clarity of their thinking/online personalities. It may help you decide how much time you want to spend considering their opinions and advice.

Best wishes.

[delawaremalenurse]

Hopefully you've documented your discussions, concerns, and recommendations with this student in writing and given her an opportunity to concur/non-concur in writing as well as acknowledge the concerns with her signature. I agree this student sounds as if she needs to fail or be recycled due to performance issues despite your best efforts.

Be careful, however, that you don't get caught in a "I was never told" situation without proper documentation. Unfortunately, this is the "go to" answer for many failing students when they feel cornered and lack options. I've also found that school administration is very weak and unsupportive of faculty and/or adjuncts when there is no paper-trail of corrective measures taken, an established action plan to address concerns/weaknesses, etc.

[Purple_roses]

As a student graduating in May, I think you should probably fail her. Not knowing how to do some things and being a bit unsure comes with the territory of being student (and apparently a new grad for at least 6 months from what I've been hearing). But refusing to actually do things and refusing to take the opportunity to learn while she still has so much support as a student is probably a bad sign. The fact that others have also picked up on her behavior validates your concerns.

[NurseLife88, ADN, RN]

I would speak out to her before she finishes her rotation with you completely. Let her know that she only has so many shifts left and if she can not step up and show you what she can do now then you can't give a good recommendation for her to pass. The reason I say this is because in my second to last rotation I had a similar experience. I was terrified of failing, making a mistake, etc. So I tended to stand back in a sense. My preceptor pulled me aside and said although she didn't doubt my ability she wasn't seeing what she needed to see and I needed to step my game up so to speak. I was thankful she said something so I was able to conquer some fears and then dive in and do what needed done. It worked in my favor and the favor of all my future patients that she pulled me aside and said something before I completely doomed myself due to lack of confidence.

[TriciaJ, RN]

HIDING? No. Just no. Her eval should highlight her lack of accountability and unwillingness to enhance her skill set in a supported situation. Does she think you're going to her first job with her?

Even if you're the preceptor from hell, Alice still has to own her own performance. It sounds to me like you went above and beyond. Sometimes someone just isn't nurse material. Hiding and making excuses and blowing things off isn't nurse material. Sorry, despite all your best efforts, Alice has to go. You can't save people from themselves.

[Boomer MS, RN]

Have you sat Alice down and told her exactly what you just told us? As for the IV if I were Alice I would have felt put on the spot. How about the patient? How do you discuss things like that in front of someone who is suppose to get an IV? I would have asked Alice outside the room if she could handle it and not put her on the spot in front of the patient. After decades in nursing, I still can't do an IV.

Your whole post reminds me of when I first started helping my boys with their homework. I had college level standards and it was impossible for them to meet them. I soon realized my mistake. They were 8th graders, not college graduates; just saying.

If you didn't sit Alice down from the start to let Alice know what her shortcomings were, what she was doing right/wrong, discussed them, plan of action, what was expected of her, etc..., establish a rapport (not just have her watch and send her home with paper), then you are the one who failed. What you're saying is you let her watch you for a long period of time and then suddenly let her take the reigns near the end because the school told you? Why wasn't any of Alice's failing behavior brought up to Alice's nursing advisors/professors/etc..at the mid term evaluation or prior, how about your DON, boss, etc... long before the midterm mark. And again; why wasn't it brought up to Alice to improve her performance?

Alice chose L/D for a reason. There is a type of clinical that the bachelor programs have as their last clinical in the senior year; it's suppose to be in management. I chose management in psych and learned so much. My preceptor didn't send me home with a bunch of papers every clinical. I was hands on with him from the start. My school allowed him to make whatever learning program he thought would benefit me the most. Or maybe Alice is in an ADN program. In my nursing program it had to be managerial for a quarter. We had already done the one quarter buddy with a nurse thing (no paperwork sent home by preceptor, just hands on camaraderie). Isn't AnP a prereq for nursing programs? Ten times; I would have been insulted at how stupid you thought I was. I'm sure your nonverbal communication wasn't well received because it tells the other person how you really feel whether you realize it or not.

In my last clinical in management after every clinical my preceptor and I would have a small meeting to discuss things. He made a point of how most the problems in all areas of nursing are d/t a lack of communication. You also need to remember that while this clinical is going on the student has their regular classes and the "Capstone" and it's presentation is due at the end of senior year (in BSN programs).

After all the precepting you've done, now you write in and invite permission to justify your explanation of what went on with Alice from Hell. Also, if you didn't have a good relationship with this student how could you let it go on? It sounds like you have a lot of resentment built up. Perhaps it's the student's fault or maybe you know you shouldn't have taken on that last preceptor request. Are you sure your post is not projection in it's purest form...

The title to your post tells me what you want to hear. When I hear "I've confronted her on it" ; that doesn't sound like teaching. You and your cohorts were talking about her as well. "Skated through"...you allowed her to breeze on through without one word of how you really felt? This should have been nipped in the bud from the start. It takes two to tango.

Let me be clear, Alice could have also spoke up and helped herself but as you say "they were desperate"... So, at the end of it all you finally email her faculty. Way too little to late. I know many people like you; you are the last one to look at yourself as the problem..after all the degrees after your name tell us what an expert nurse you are. You will probably be shocked when the school does an investigation and you will also be investigated.

To actually admit you don't know how she's made it this far is so disheartening on so many levels I can't believe you haven't read your own lines. Transitioning into full scope midwifery has got to have huge challenges for you; in your own words "as I finally am transitioning"...sounds like it was a long hard road. Than to also add a student to your already burdensome schedule was a disservice to the student..you should have paid more attention to yourself and your goals.

I am wondering why the post since you have already emailed her school. Will it make you feel vindicated when people scream "Off with her head?" Do not worry, you will get plenty of that.

I'm sorry, but IMO; it sounds like you bit off more then you could chew. I hope one day you will be able to look back on this and learn from it.

Everyone is entitled to his/her opinion, but I am astounded by the above comments. No good deed goes unpunished.

[kalycat, BSN, RN]

Fail her. Lazy and going to hide did it for me. Why would I want to meet another of her kind at work?

Ditto. We have a new grad on my unit now who somehow made it through school and nclex.

She has disappeared (off the floor, not answering her phone) for over an hour and a half. She is dangerously over confident, leaves vasoactive drips to run dry and doesn't reasses or have a replacement in sight, and has a major attitude if given any feedback. I would be more understanding if she was at least coachable and didn't hide constantly... and at least made an attempt to not continually repeat mistakes.

Students or new grads who need confidence boosts or who are intimidated by certain skills are one thing - lazy individuals who shirk responsibilities and run from opportunities are entirely another. In my experience, it's pretty easy to tell the difference.

OP, it sounds like you've gone above and beyond. She is earning her outcome at this point. Whatever your decision, know that *you* didn't fail her. She failed herself.

ETA: wow, this thread positively exploded while I was typing. Apologies if I just retyped exactly what everyone else had already said.

[Libby1987]

I think you have 4 more shifts with her? If so, it's not time to fail her, not yet, and she has 4 shifts left to redeem herself. One thing I've learned in my position is that if I'm going to let them go, they need to see it coming.

I would tell her that I need to see her fully engaged and showing progress (measurable and appropriate for a student, which should be clarified with her instructor). And I would be crystal clear, she disappears one more time and she's out, I expect her to be either at my hip soaking it all in and ready to discuss or a foot in front of me showing initiative and jumping in.

I hope she has 4 shifts left because while it sounds like you're understandably exasperated with her there also seems to be something nagging at you. I wouldn't want to fail someone if I had any doubt of my missing the mark and letting something slide without them seeing it coming like a Mack truck.

Good luck, tough situation.

[HAMSAMICH]

From hell? It does sound like she lacks initiative and that can be frustrating. But to say she's from hell? How many patients did she kill? A bit harsh, no?