How not to get ****** at clinical?

[noyesno, MSN, APRN, NP]

The following situation occurred in clinical last week during medication administration:

-I was giving medications with my instructor

-She wants me to scan patient, scan all the medications but wait until the end to click the confirm button (so she can look them over)

-After scanning each medication, I set aside the wrapper in case something went wrong with the computer and I needed to scan them again

-My instructor yelled at me for not immediately putting the wrappers in the garbage, so, I put all the wrappers in the garbage

-I explained to her that I was saving them in case I needed to scan them again but she told me to throw them away anyways

-I threw them away

-Meanwhile, a PA is removing my patient's hemovac and replacing his dressing with a new one

-She places the blood filled hemovac and the old dressing in the garbage on top of my wrappers

-The computer logs me out (because it was taking too long to confirm) and I have to re-scan the medications, you know, the ones that are in the garbage

-So, my instructor makes me dig through the bloody garbage (mind you this is a MRSA patient) to retrieve all the wrappers and I re-scan the medications

*The reason it was taking so long was because my patient felt like he was going to throw up and I wanted to give him some time to feel okay before asking him to swallow some pills (I got him an emesis basin and some ginger ale).

Situations like the above seem to happen a lot in clinical and I get ****** off. So far, I've been able to keep my frustration inside but I fear that I will loose it sometime soon and say something like the following, "I'm not too thrilled to be digging through the bloody garbage, especially since I had set aside all my wrappers in case this situation arose but you made me throw them away and now I am not happy." Obviously, this would just screw me over and biting the tongue is the best thing to do. However, this is very difficult.

So, anyone have any advice as to how to not get ****** off in situations like the above?

How do you keep your cool?

[Boog'sCRRN246, RN]

I don't know if it is possible to not get ****** off in a situation like that! Even if the bloody hemovac was not in the garbage, I'd have a problem with being made to dig through trash. Was there possible another way to re-scan the meds? Have you tried talking to your instructor (I know, I know, sometimes they aren't the most reasonable creatures)? If she is truly that unreasonable, maybe you should speak with another faculty member from your program. If you don't speak up for yourself in one way or another, you're just going to stay ****** and your clinical instructor is going to keep making students do ridiculous things.

[RyanT]

Something that has always worked for me is to pull my boss/instructor/whoever off to the side and respectfully give them your opinion. State your intentions, and state (respectfully) that things ended up not working out the way you wanted to. Let your instructor know your thinking process especially regarding the patient's nausea, etc. This will allow you to get your point across in a professional manner. Do it correctly and your instructor can only respect you more.

[noyesno, MSN, APRN, NP]

I don't know if it is possible to not get ****** off in a situation like that! Even if the bloody hemovac was not in the garbage I'd have a problem with being made to dig through trash. Was there possible another way to re-scan the meds? Have you tried talking to your instructor (I know, I know, sometimes they aren't the most reasonable creatures)? If she is truly that unreasonable, maybe you should speak with another faculty member from your program. If you don't speak up for yourself in one way or another, you're just going to stay ****** and your clinical instructor is going to keep making students do ridiculous things.[/quote']

There would be no way to re-scan them without the bar codes on the wrapper. You can enter in that the bar code was not working or that it was unavailable but it would look bad to do this for all my medications.

Last semester, I would speak up when I thought my clinical instructor was being unreasonable and this did not go over well. I do not want to do this again.

I'm looking for tips on how not to confront the instructors because being assertive has not boded well for me in the past. This is really sad, but I guess I'm at the point where I accept that the clinical instructors are going to be unreasonable and borderline abusive and I want to figure out how other students endure this unhealthiness. It is not in my nature to, "bend over and take it." How do others do it?

I want to add, I don't think clinical instructors are bad people. I believe they act this way because they are overwhelmed with the responsibility of ten students.

Also, I have had clinical instructors who have been reasonable to work with, just not recently.

Thanks for your reply Boog's, it made me happy to know that the situation would have ****** you off too! :)

[noyesno, MSN, APRN, NP]

Something that has always worked for me is to pull my boss/instructor/whoever off to the side and respectfully give them your opinion. State your intentions, and state (respectfully) that things ended up not working out the way you wanted to. Let your instructor know your thinking process especially regarding the patient's nausea, etc. This will allow you to get your point across in a professional manner. Do it correctly and your instructor can only respect you more.

RyanT,

Thanks for your reply. I totally agree that being assertive like you describe above is a great way to go. Unfortunately, last semester, I took the approach you described above and my clinical instructor did not want to hear what I had to say and it did more harm than good. So, I'm taking the "bend over and take it" approach this semester because it seems to be the approach instructors at my school prefer...

When I'm working, I will be able to stand up for myself and be assertive. In the meantime...

[nurse2033, MSN, RN]

Well you can't win them all. Sounds like you have a better plan than your instructor. She should have apologized. Some days you are the nail and others the hammer. Look at it this way, not only are you learning, but you're practicing your anger management too! I would write this up in detail, then give it to your school once you graduate. That way they can realize (if they don't already) that the clinical instructor is not very good. The instructor should let you find solutions to problems and test them to see if they work. This is how to teach critical thinking. Maybe this is why people complain new grads don't have good critical thinking skills. Her method takes too long and led to a time out. Did she explain why keeping the wrappers was a bad idea? Or was it just not her idea? I do that all the time in case a patient refuses a med or one drops on the floor or whatever. An empty wrapper is not any kind of hazard I can think of. Hang in there, jump through their hoops and learn the lessons you know you will need later. Dealing with clods in positions of power is just one of the facts of life. Best of luck!

[anonymousstudent]

She made you DIG THROUGH THE TRASH?

Yeah, I understand that people make mistakes, but what the hell was she even thinking? I wouldn't have done it. I understand chain of command. I understand submitting to authority. I understand, I promise. But there's a line. That was the line. NO! As nurses we are going to encounter situations where we have to say NO to a person of authority...to a doctor who gives a wrong dose, to a fellow nurse who is being unsafe, whatever. Start now.

I hope you never have to deal with it again.

[Tyler77]

Why was a bloody Hemovac being thrown into the regular garbage? Doesn't your hospital have medical waste receptacles?

Enough about "your thinking process" and "this is the I thought it should be"---THEY DON'T CARE. DON'T WASTE YOUR BREATH!!

I would go right to the nursing director and explain that Miss Attitude needs to bring it down a notch. If she under stress over watching over 10 students, then she's in thew wrong profession. If it continues, I'd go to the dean of students and file a grievance against this instructor. Now you've got your behind covered, and if she catches an attitude again, you have evidence to back it up.

I had an instructor that would TEXT behind the nurse's station and roll her eyes every time a student needed her help. After the semester ended, she was kindly told never to come back.

[noyesno, MSN, APRN, NP]

Well you can't win them all. Sounds like you have a better plan than your instructor. She should have apologized. Some days you are the nail and others the hammer. Look at it this way, not only are you learning, but you're practicing your anger management too! I would write this up in detail, then give it to your school once you graduate. That way they can realize (if they don't already) that the clinical instructor is not very good. The instructor should let you find solutions to problems and test them to see if they work. This is how to teach critical thinking. Maybe this is why people complain new grads don't have good critical thinking skills. Her method takes too long and led to a time out. Did she explain why keeping the wrappers was a bad idea? Or was it just not her idea? I do that all the time in case a patient refuses a med or one drops on the floor or whatever. An empty wrapper is not any kind of hazard I can think of. Hang in there, jump through their hoops and learn the lessons you know you will need later. Dealing with clods in positions of power is just one of the facts of life. Best of luck!

An apology would have been nice!

Practicing my anger management is a good way to look at this situation.

That sounds like a good plan, to write up what happened and submit it following graduation. I don't really feel comfortable starting a battle when the grading is so subjective and she could fail me so easily.

I agree with the clinical thinking. I think I am only going to request her presence when it's 100% necessary. I want to learn to think on my feet. She was hovering around my room a lot that day because my patient was very unstable (his BP dropped to 80/30) and the nurse was completely hands off.

I didn't understand why she said the wrappers were a bad idea. I think it had something to do with the importance of minimizing clutter. I normally hate clutter too but I know sometimes things happen with the computer and I wanted to save my booty if something went wrong.

Thanks so much for your very helpful advice! I feel empowered! :)

[RNCEN]

Why was a bloody Hemovac being thrown into the regular garbage? Doesn't your hospital have medical waste receptacles?

Ding ding ding....we have a winner! That was my first thought as I read the original post. I would challenge the instructor on asking you to root through contaminated waste, especially after you requested to keep the labels handy for a potential re-scan. Maybe the instructor should dig through the trash, since it was his/her idea to toss them.

[noyesno, MSN, APRN, NP]

She made you DIG THROUGH THE TRASH?

Yeah, I understand that people make mistakes, but what the hell was she even thinking? I wouldn't have done it. I understand chain of command. I understand submitting to authority. I understand, I promise. But there's a line. That was the line. NO! As nurses we are going to encounter situations where we have to say NO to a person of authority...to a doctor who gives a wrong dose, to a fellow nurse who is being unsafe, whatever. Start now.

I hope you never have to deal with it again.

Yes she did.

Last semester I was all Bob Marley, "get up, stand up: stand up for your rights!" and that did not work out the best for me because my instructor always won. About midway through the semester, I learned that it took less energy to submit than argue and this allow me to have more energy to be there for my patients.

I'm a huge advocate for being assertive but our grades are so subjective that instructors can easily fail you if you get on there bad side (and pointing out how they are wrong is an excellent way to do this). Another thing, I don't want to get on her bad side in case I need a letter of recommendation from her for jobs. So, yeah, I'm kind of at her mercy...

[noyesno, MSN, APRN, NP]

Why was a bloody Hemovac being thrown into the regular garbage? Doesn't your hospital have medical waste receptacles?

Enough about "your thinking process" and "this is the I thought it should be"---THEY DON'T CARE. DON'T WASTE YOUR BREATH!!

I would go right to the nursing director and explain that Miss Attitude needs to bring it down a notch. If she under stress over watching over 10 students, then she's in thew wrong profession. If it continues, I'd go to the dean of students and file a grievance against this instructor. Now you've got your behind covered, and if she catches an attitude again, you have evidence to back it up.

I had an instructor that would TEXT behind the nurse's station and roll her eyes every time a student needed her help. After the semester ended, she was kindly told never to come back.

I almost mentioned something about the hemovac being thrown in the regular garbage in my original post but I didn't want to get too long winded. As she dumped that thing in there on top of my wrappers, I was thinking the same thing, "how about a biohazard bag PA lady."

I totally agree, they do not care.

Going to the director really isn't an option because our class of 60 people already filed a petition against her to the Dean of Biological and Health Sciences and she pretty much hates us (an effort that I spearheaded). The Dean was supportive of our side, shows how much the dean really sucks too.

The texting, eye rolling instructor sounds horrible! She is definitely wasn't do her job; it's a good thing they let her go. You can't get paid for nothing IN THIS ECONOMY.

I should add, I actually like this instructor in class and she isn't all bad in clinical (she is really good with patients, something that I really value in an instructor). The situation I described above, really set me off because it reminds me of the horribleness that was last semester (my instructor was the devil last semester). I still don't agree with making me dig through the garbage though.

Well, I better go eat some ice cream now!

Thanks for your reply! :)