Hi guys! I'm on my 2nd year, 3rd semester of nursing school for the OB/Psych rotations. I got a failing score for my OB clinical grade yesterday and I'm very worried I'll fail clinicals. I feel like my clinical instructor is watching me like a hawk compared to my other classmates and since I'm not as outgoing as my other classmates I feel like she's targeting me that I'm not doing my job as a student nurse. I feel like she was not as understanding as my clinical instructor that I had during the first 2 weeks of this semester (she was supposedly to be our clinical instructor but had to focus on grading our theory/lecture grades since she's the only one this year teaching) and I feel like my new clinical instructor is purposely giving me nurses that aren't friendly or helpful towards students.
Anyways, here's my situation: I had a pregnancy induced hypertensive patient that was in labor and when the patient was able to deliver, my nurse asked if I wanted to give the meds to the baby. I asked if she wanted me to give the meds with her or my instructor and she said "Whatever you want, I'm kind of busy with charting." My nurse wasn't very helpful and only wanted me to do things if my instructor was with me. From the beginning, she wasn't willing to teach me what was going on with my patient. I told her that I'll get my instructor after I was finished assessing the mom's fundus and baby's vitals since I was supposed to assess the fundus q15 mins and baby's vitals q30 mins.
When I was done, I went to my instructor if she can give the baby's meds with me and she said that the nurse has to get the medications first. So I went back to tell my nurse if she got the medications out already and she said that they were sitting on the table. I went back out to get my Basic Needs packet to look up what each med was given for the baby but before I could do anything to look it up, my clinical instructor asked me if I was ready and I said let me look up the meds really quick to make sure I know what i'm giving. She said that I'm supposed to know all of my basic meds before coming to clinicals and that I should've looked them up earlier/before going to clinical.
I had another clinical instructor this semester that taught during the first 2 weeks of clinicals before my current clinical instructor took over and I remember her saying that "If you don't know a med. then that's where you look it up on your Basic Needs packet. I don't want you to give any meds w/o knowing what they're for."
When she quizzed me on each med I was able to list almost all what the purpose was for and route except for erythromycin. I told her that it was an antibiotic prophylaxis placed on the baby's eyes to prevent them from getting an STD. She marked me down because I didn't specifically say which STD-it was gonorrhea and chlamydia.
She also marked me down for not knowing what methergine was for. My patient had a complicated labor and wasn't progressing with the delivery because the baby was facing the wrong way so the Dr. had to come in and help reposition the baby. My instructor said to just observe how the doctor was helping the patient deliver the baby. I didn't give methergine but she asked me what's the purpose of it during post conference/lunch and why didn't the patient receive methergine-it's for the uterus to stop hemorrhaging/because the patient was hypertensive. She said, "don't you remember the doctor talking about it during the delivery?" I was only observing the delivery like she told me to-it was my first vaginal delivery so it was interesting, and I don't remember the Dr. talking about methergine when I was there so I just took a wild guess and said because it might affect the fetus.
She also marked me down for not giving an accurate and cohesive report on my patient to her and my classmates during post conference-she just told me this time that she wants me to start from the beginning so I'm guessing I'll use SBAR next week when I'm at post conference but she only told me about this now; what about the previous 2 weeks that I had her?
So during the post conference when it was my turn to speak about my patient, I started with the main problems of my patient-how she was having severe SEs of diarrhea from the meds she was given (she was given hemabate + cytotec) and had 2nd degree lacerations. I said everything about my patient (i.e. what's her diagnosis, G/P/A/L, when she ruptured, what was her cervical dilation when I came in this morning and when did she receive an epidural, when did she start laboring and when she delivered the baby) except for why the patient came in the hospital.
I forgot because I was going to write it down on my careplans before leaving the hospital/didn't know she would grade me so harshly during post conference for that one problem-it was a very busy day, there was so much to assess and chart (I had a difficult patient-even my instructor agreed), and I'm still slow and trying to get used to charting on the computers so I guessed that she came in for labor when my instructor corrected me and said she came in to r/o labor. She marked me down for using wrong terminology, I said the patient came in for pre-eclampsia and she said it was hypertensive induced pregnancy but I asked her if they were similar since she gave me a sheet at the beginning on how to take care of mom's with preeclampsia/other hypertensive disorders of pregnancy.
Since my patient had hypertensive induced pregnancy, I had to do DTRs and clonus. She marked me down for not knowing how to do DTRs and clonus. I told her that I only remember being introduced to that for a brief moment during orientation but we didn't practice that during the skills lab in orientation (we only practiced the main things like: putting on tocomonitors and US on pregnant mom's tummys, reading strips, listening to FHTs, lung sounds, APGARs/Ballards, holding/changing baby, IVs, and foley/IV catheters).
I was practicing all of that during my free time in the skills lab and I told her that I'm doing my best and I'm usually the only one that frequents the skills lab. She also marked me down how I assessed for edema on my patient-she said I'm supposed to press down on the long bone for 5 secs but I squeezed both sides of the calves for a few secs. I told her couldn't you do either one and she said no.
Based on all of this, she gave me a 1/5 for preparation, 1/5 for medication, 0/5 for communication, 1/5 for assessments, and 2/5 for maternal-child care (b/c "I was unable to provide care processes w/o moderate supervision and prompting" and "unable to look beyond tasks at bigger picture for patient,"-idk what she means by that but all I know she was watching me the whole day.
I did struggle a little bit putting on the ID bands on baby and getting the baby's temperature once or twice on the first attempt but that's b/c it was just delivered or either crying and that was it; and that she had to orient me on what I should be assessing for my patient who had pregnancy induced hypertension.
She didn't give me time to read the sheet she gave me that morning-after she gave me the sheet, I went into the room to see if the nurses were giving report since it was 7 minutes within the start of clinicals but instead the anesthesiologist was giving the epidural to the patient w/ the help of the night nurse so I observed while waiting for the day nurse to come in to get report; after the epidural was given the day nurse walked in and I was helping both nurses fix the IV lines/epidural lines on the medication monitor since they were tangled up, when we finished my clinical instructor came in and I was still reading/taking in the information on the sheet she gave me-it was a lot of information + my nurse was cold/wasn't helpful/didn't orient me to the client either-I felt like I was alone this time.
For example, I asked my nurse if it was okay if I can chart the assessments for her since I know she's busy but she said "Idk, doing the assessments are my responsibility-I told her that I did some of the assessments and charted them for her with my instructor earlier and she said as long as you only do it with your instructor. This is my 5th week and this was the first time my nurse didn't want to do anything with me-all of my nurses I had previously this semester including the 2 other nurses before her that were strict wanted me to do assessments for them but they had to be there just in case the student was doing it right since we don't have licenses.
I just wanted to do something with that nurse that day since they're responsible for grading us and I even offered to do/chart VS for her but she said they're automatically recorded on the chart from the monitors by pressing "t" for time except for temperatures and respirations; Idk maybe the nurse thought I would slow her down since I'm a just student).
So what do you guys think? Shouldn't clinical instructors be understanding, encouraging, and create an environment conducive to learning for students? I feel like she's watching me carefully and grading me harshly. Should I tell the head of the nursing department about my concerns? I didn't harm the patient or baby and I maintained aseptic technique during the foley insertion/cleaned and changed the patient's chucks since she had constant diarrhea due to the SE of her medications (the hemabate and cytotec)/I emptied out her dirty linen and trash bags when full.
I did everything that I could-it's not like I sat in the nurses' station all day finishing up my care plans
.. Any advice?
Thank you so much! It's 2 clinical warnings until a failure and I have a B. Should I ask my faculty advisor if I can switch clinical instructors?
Last edit by lilfayfay on Oct 11
Yeah girl you just have a tough instructor. It's hard to really judge because everyone's clinicals are different and our expectations maybe different. The only thing I would have done differently is look up the medications prior to getting my intstructor, but other than that I don't really see any glaring issues.
Secondly, this isn't your fault but having the staff nurse grade you seems very unnecessary and like it's just more paper work for them to fill out. Your instructor is supposed to be the one with you and teaching you not the staff nurse. This may be why you perceived the staff nurse to have been distant.
For documentation we absolutely cannot document on the computer without our instructor first verifying and confirming the information. Literally our instructor said if anyone of you save the information before I see it I will fail you on the spot. This is legal documentation and if I was the staff nurse I wouldn't want a student documenting without their instructor, and I would always do my own assessment and document. After all it is their patient ultimately.
Keep your head up girl and try to make the most out of a crappy situation.
Last edit by DesertRosee on Oct 12
: Reason: Spelling error