Confessions of a Clinical Instructor (Part II)

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    Unfortunately, most students and nurses have little idea what its actually like to be a CI or understand the unique position we occupy in the world of nursing education. This two-part article series is based on my experience as a novice CI and includes the harsh realities, valuable advice, and words of encouragement that I have collected from experienced educators. Part II examines the relationship with students and correcting some of the misconceptions that students have about CI.

    Confessions of a Clinical Instructor (Part II)

    Students can be both a blessing and a curse for any clinical instructor (CI). We relish the days when we see the light blub turn on when a student connects the pieces from what they learn in class and applies it to their practice. At the same time we struggle when students tell us that they think clinical is not important or that we do not try hard enough to make the clinical experience worth their time. I love being a CI and most days I would not change it for anything in the world but here are a few harsh realities I wish that I could share with students.

    What students think...
    In addition to working with your peers at the college/university and at the clinical site, another challenging aspect of being a CI is that students tend to make some assumptions about CI that are completely off base. Here are a few examples...

    I personally developed the assignments (care plans, concept maps, process recordings, public policy presentations, concept analyses, etc.) that students complete in the course.

    Most likely the CI did not come up with any of the assignments you have to do, and we probably hate grading them more than you actually hated writing them. If I never have to read another half-baked care plan about “disturbed energy fields” I would be thrilled beyond belief. But seriously, are your assignments completely pointless and a waste of your time? No, because they were made to develop your critical thinking skills and learn that nursing is more than just the completion of tasks. Are some of them redundant and unlike what you will see in clinical practice? Absolutely, but nursing school is not just about procedures or checking boxes on an electronic medical record (EMR). It is about becoming a functioning professional member of the healthcare team, and because you are responsible for people’s lives, it requires a solid theoretical and practical knowledge base. It is not just about knowing what you need to do, it is about knowing why you need to do it.

    I personally know the entire full-time nursing faculty at the school and remain close personal friends with them.

    This largely depends on the school, but in many cases, the CI are adjunct faculty and may have only met a few of the full-time faculty members briefly or only communicate with them via email. However, when you meet with students, they will drop names of other faculty and assume that you are close personal friends with every teacher they have ever had. I sometimes have to remind students that I may not even know who some of the other faculty are because it is a large department and I am only on campus on a limited basis.

    With that being said, many times we know who the best and worst faculty are of the department and probably agree with some of the assessments made by students. While I may know some of the “worst” teachers and agree that their methods are off base or otherwise not in touch with reality, that does not mean I will ever share this with students or verbalize criticism how another teacher runs a classroom. I have had times where students have approached me about serious problems with other teachers and it puts you in a tough spot. I will ask students to discuss their issue with the teacher first, and if they feel like the situation was not resolved, then they should discuss it with the department chair. Depending on the severity of the problem, I usually contact the department chair privately to let her know that it might be an issue that she will have to address.

    I am not a moron so please don’t treat me like one by lying to me.

    This is pretty straightforward so we do not need to spend much time on it. I have only been teaching for a short time and yet I have heard some stories from students that rival major works of fiction. I understand that being a student difficult and sometimes the work gets to be overwhelming and then you get behind or make a mistake. Just tell me the truth and I will help you but do not insult my intelligence by telling me that you (a) have a flat tire every week, (b) left your assignment in your dorm room... again, (c) were sick with a GI bug all weekend (while I just overheard you tell your classmate about how you spent the weekend drinking/partying), (d) replied to my e-mail but it must have got lost (although you were able to e-mail me earlier in the same day asking for a grade on an assignment).

    If you do not pass the class it is because the CI had some sort of vendetta against you or wanted you to fail.

    I can tell you that I want each of my students to pass the class and be successful. I have no personal vendettas against students and to be honest the process of failing you is much more difficult than giving you a passing grade. CI, for the most part, do not have some sort of hidden agenda to make students suffer or fail. We become teachers because we love to teach and genuinely want students to be successful and go on to become competent, professional nurses.

    I am kind and fair to my students, but I will not pass someone just to pass them, and if they are failing to meet the minimum standards (even after I have met with them and tried to help them) then I will be forced to issue a failing grade. Students do not realize that the process to fail a student is daunting because it impacts us emotionally and the paperwork required is usually extensive. Students rarely ask themselves why they have earned a failing grade and never consider that their behavior or competency is what has caused this to happen. I am never going to expect a student to thank me for failing them but I also ask that they consider the impact of their actions if they choose to accuse a faculty member of discrimination (e.g. gender, race, age, sexual orientation, etc.) in response to a failing grade. Once you have been accused of discrimination, it is a bell that cannot be un-rung and even if the accusations are unfounded it still has a lasting impression on a teacher’s career. I have a family too and I do not deserve to have my reputation and career tarnished because a student is not academically ready to handle the rigor of nursing school.

    I am not saying that there are not cases where teachers have discriminated against students but in most situations, the student has failed to meet minimum competency requirements and should not be allowed to pass the course. Thankfully failing is uncommon and most nursing students are driven to pass and can do well with a little bit of support.

    Because we are not in the formal classroom setting it means that we can keep it casual, fun and speak like close friends.

    I get along really well with most of my students, I live in the real world and understand that nursing is not what you read about in books or see on television. During downtime I can engage in small talk with students and sometimes discuss pop culture, but sometimes students forget that CI are not their friends, we are still their teachers. We can have frank discussions about nursing and the current state of healthcare but that does not give you permission to swear in front of me or tell me about how wasted you got over the weekend.

    How you behave only reflects on you and if the staff of the clinical site do something then its fine for you to do it too.

    Your behavior at the clinical site reflects on you as a student, but it also reflects on the school and me as your teacher. Many times CI are also employees of their clinical site, and when students display unprofessional behavior it makes the CI look bad and it jeopardizes the viability of the clinical site for future students. When students are well dressed, prepared, helpful and speak in a positive, practiced method it reflects well on all of us and can lead to future employment opportunities for themselves and other graduates of the school’s nursing program.

    There are a countless number of other thoughts that CI wish we could share with our students, but these are some of the big points. If you are a teacher or CI and have some other ideas you wish you could share with students feel free to post it here! I love hearing feedback, comments, and further questions as well.
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    8 Comments

  3. by   ProfRN4
    I could have written this myself (except my students did not forget things in their dorm, as I taught at a commuter school). Well done. Especially the part about the other faculty members. I was a full time instructor, so I did know most of my colleagues pretty well (too well). Many of them I did not like/agree with, so the students' perceptions of us all ganging up and plotting to fail them were completely unfounded (I didn't feel that way, but sadly some of my colleagues did).

    I'll add this: the idea that professors/instructors do not know anything, but the staff nurse assigned to your patient (with one or two years experience) knows everything. While I do understand that there are instructors out there who are not current in clinical practice, do not paint broad strokes about all of us.
  4. by   SHGR
    Great article! Thanks for writing these. I second everything, especially the part about really wanting students to succeed and being willing to support that. It's definitely true that having a student who is not successful is difficult emotionally.

    I hope students read your articles to get our perspective! Knowing why things are the way they are definitely helps in accepting them.

    About the disturbed energy fields thing though...NANDA retired this one, mercifully, in their last update due to lack of supporting evidence (yay!)
  5. by   AliNajaCat
    I still have little wisps of PTSD from the last student I had to fail, who I had counseled, given remedial work, given a written improvement plan, and on and on and on. She refused to do any of it. She had no idea what her meds were. She disappeared off the floor without notice. I duly turned in all the required paperwork documenting all of this as we went along...and in the end, facing all that, she told the head of the program that I was biased against her on ethnic grounds. The head was retiring at the end of the quarter, AND TOLD HER SHE COULD STAY.

    The there was another one who was a new hire in the ICU where I was the clin spec. She was fresh out of an accelerated MN program and had never worked in M/S, much less ICU. The head nurse gave me strict instructions to be sure she was going to be OK, because we were short-staffed. She couldn't take blood pressures; she always wore her stethoscope backwards and made up the numbers. She had no idea why we had a guy in failure on a medication that increased his BP at the same time as one that decreased it. I literally had no idea what to do c her. She left. But the head nurse was ********.
    Last edit by Silverdragon102 on Dec 24, '16 : Reason: changed to all **
  6. by   taivin
    Confessions of a student nurse about one of her CIs:

    My clinical instructors were professors that taught in the nursing program at my university, so we knew them very well. In my senior year I ran into a newly hired assistant professor that took an immediate dislike to me. I was a 4.0GPA and she did her best to fail me. I have no idea why.

    It turned out that when we did our night rotation (BSN program) for 3 nights a week for a quarter she berated and embarrassed me in front of the nurses at the hospital we were at. The whole thing backfired on her as the RNs saw her for what she was.

    The CI would just leave me at the nurses station, but the nurses would come and get me and I did things that no one else ever got a chance to do! God bless those nurses who took me under their wing.

    Sometimes the instructor would catch me with one of the nurses going from room to room and the nurse would tell her "I asked her to help me with something" and the reply would be something like good luck. I have no idea how she was grading me since she never let me take an assignment. At this point in school, we were suppose to be taking 3 to 4 rooms each; census permitting. How the heck was she grading me and I often wondered what she was putting in my file.

    That instructor didn't give two whips about what I did, but didn't know I was getting the all time rotation of any student in my class. I know I should have went to my counselor or something, but she was new and I was so tired of jumping through all the hoops. In the end it paid off though. This instructor gave me a c- which took my GPA down and I grad cum laude instead of mega cum laude, but that's ok too.

    There are horrible students as well as horrible CIs...
  7. by   cjcsoon2bnp
    Quote from ProfRN4
    I could have written this myself (except my students did not forget things in their dorm, as I taught at a commuter school). Well done. Especially the part about the other faculty members. I was a full time instructor, so I did know most of my colleagues pretty well (too well). Many of them I did not like/agree with, so the students' perceptions of us all ganging up and plotting to fail them were completely unfounded (I didn't feel that way, but sadly some of my colleagues did).

    I'll add this: the idea that professors/instructors do not know anything, but the staff nurse assigned to your patient (with one or two years experience) knows everything. While I do understand that there are instructors out there who are not current in clinical practice, do not paint broad strokes about all of us.
    You make an excellent point about the students believing that the nurses on the unit are "real nurses" and thus they know everything about nursing while the clinical instructors are "just teachers" who do not know as much about "real nursing".

    I understand that students need to have role models and see future versions of themselves in staff nurses that with whom they are working. My approach is never to criticize the nurses of a unit I am bringing students to or communicate in a way that makes me sound like I am better than them (because I'm not). However, when I see behavior that isn't professional or practices that are not things I would want students to repeat I will try to discuss it in post-conference by asking the students what their impression was of a situation or behavior and would they have reacted/behaved in a similar way and why. I also try to provide stories from my own nursing experiences that helps to show students that I am a nurse in practice and have just as much clinical relevance as the staff nurses that they see as role models. It's not a matter of competing with them, it's more a matter of helping students to expand their definition of nursing and understand that direct care is not the only form of nursing practice.

    !Chris
  8. by   cjcsoon2bnp
    Quote from SHGR
    Great article! Thanks for writing these. I second everything, especially the part about really wanting students to succeed and being willing to support that. It's definitely true that having a student who is not successful is difficult emotionally.

    I hope students read your articles to get our perspective! Knowing why things are the way they are definitely helps in accepting them.

    About the disturbed energy fields thing though...NANDA retired this one, mercifully, in their last update due to lack of supporting evidence (yay!)
    I was skimming through my last NANDA-I guide (2015 - 2017) and noticed that the "disturbed energy fields" was removed. I used it to make a point in this article because I think it was one of the most senseless nursing diagnoses I have ever read and when other professionals see nursing diagnoses like this it makes it hard for us to be taken seriously (but that is a whole other conversation).

    !Chris
  9. by   cjcsoon2bnp
    Quote from taivin
    Confessions of a student nurse about one of her CIs:

    My clinical instructors were professors that taught in the nursing program at my university, so we knew them very well. In my senior year I ran into a newly hired assistant professor that took an immediate dislike to me. I was a 4.0GPA and she did her best to fail me. I have no idea why.

    It turned out that when we did our night rotation (BSN program) for 3 nights a week for a quarter she berated and embarrassed me in front of the nurses at the hospital we were at. The whole thing backfired on her as the RNs saw her for what she was.

    The CI would just leave me at the nurses station, but the nurses would come and get me and I did things that no one else ever got a chance to do! God bless those nurses who took me under their wing.

    Sometimes the instructor would catch me with one of the nurses going from room to room and the nurse would tell her "I asked her to help me with something" and the reply would be something like good luck. I have no idea how she was grading me since she never let me take an assignment. At this point in school, we were suppose to be taking 3 to 4 rooms each; census permitting. How the heck was she grading me and I often wondered what she was putting in my file.

    That instructor didn't give two whips about what I did, but didn't know I was getting the all time rotation of any student in my class. I know I should have went to my counselor or something, but she was new and I was so tired of jumping through all the hoops. In the end it paid off though. This instructor gave me a c- which took my GPA down and I grad cum laude instead of mega cum laude, but that's ok too.

    There are horrible students as well as horrible CIs...
    I'm really sorry that you had to experience that but I am glad you were able to hang in there and finish strong.

    I hope that in your final evaluation of the course you wrote comments discussing her behaviors (specific details using objective language is helpful) because the department head will review the evaluation and if it is poor then they will usually discuss it with the CI (if it seems credible and doesn't say "THIS TEACHER SUCKED. SHE IS SO DUMB!" or something to that effect). I will agree with you that there are some unprofessional CI and professors out there and some people who are in teaching (and nursing) who have no business being here. Thankfully there are more good teachers than the bad ones and most of us go into this because we love being nurses and we love teaching. If a student really feels like a CI is biased against them I would start off by meeting with them and asking the CI if they have some feedback about the student's performance and how to improve the clinical experience. If such a meeting doesn't go well or the behavior continues without any changes then it is time to approach the department chair or the dean and discuss it further. It's not an easy thing for students but if you are being treated unfairly or are truly being discriminated against then action should be taken to correct it.

    Best of luck my friend!

    !Chris
  10. by   Nurse Beth
    Thanks for sharing. I really enjoyed this article and laughed out loud at the "flat tire every week"

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