How to fail clinical - page 3
This is from a document I post for my students at the start of clinical. Doing any of these things will probably result in failing clinically. Remember, we faculty have wide leeway in making a... Read More
Oct 5, '12I should clarify that for some of these (being unprepared, inability to answer straight forward questions about patho, drugs, etc. or failure to follow up when specifically directed to do so), I am quite tolerant of it happening once or maybe even twice. I know that everyone has a bad day now & then. It becomes a probklem when it happens repeatedly. This document is intended to send a clear message about my expectations, so that students cannot use "I didn't know that being unprepared could lead me to fail clinical."
After being clearly told that a rumpled (actually, beyond looking like it had been slept in) uniform was not OK, doing it a second time is not good. Neither is coming smelling so awful that I could detect BO within three feet, as could the staff and patients. Yes, I will fail you if you do this; when I let it slide, the person went on to get even worse in the next clinical.
Students will fail after just one incident of falsifying data (has happened), or of clearly rude, disrespectful, or disruptive behavior.
I have also had students come to clinical clearly hung over. When I was in school, one of my peers came in drunk! She tried to hide from the instructor. I waited a bit, went to a phone, and called the instructor to tell her where to find her. She was sent to the lab for a BAC level, and was later dismissed from the program.
I have directly told students to go in and recheck the vital signs, I&O, or pain level and then found out in post conference they simply did not do it. Another one was directed to go the NICU, get certain information about preterm infants, and come back and go over it with the high risk pregnant Mom. This was the second time this person did not do something she was directed to do. Result was a clinical failure. After an appeal to me by another faculty member, I agreed to go back (on my own time) with her for two hours, so she could do the teaching she skipped. I also told her that she had to impress me with her knowledge of the client's condition. When we went back, she did an impressive job. She later thanked me for getting her attention, and went on to do well. I recently ran into her at a conference--she is now a nurse educatior.
FYI: So far, all but one of the ~8 students I have nfailed (or threatened to fail) have thanked me for doing so. The one who did not was the someone who made up references and plagiarized on several papers.Last edit by cnmbfa on Oct 5, '12 : Reason: spelling errors, left out one sentence
Oct 5, '12Quote from ColleenRN2BWow.Clinical shoes should NEVER be worn outside of the clinical area!!! NO WAY do I want to take that stuff home to my family!
Not that it matters, or should even be an issue, I take my shoes off at the door when I get home. I have separate shoes for work than I do for other activities.
I guess you shouldn't assume things about people you don't know.
Oct 5, '12Quote from ColleenRN2BIf you were to read her post, the hospital parking lot was muddy. She should be barefoot until she gets inside the hospital?Clinical shoes should NEVER be worn outside of the clinical area!!! NO WAY do I want to take that stuff home to my family!
Oct 5, '12Often times instructors and staff nurses forget that students are people. Not some lowlife to be looked down upon or treated like something rented. Students will get frustrated easily due to the stress of being in school. I have noticed often instructors act like their class is the only class you are taking. Sometimes we get conflicting information due to our books not having the same information. If the information conflicts those questions should not be on tests. If an instructor or staff member gets smart with me I give it back in kind. Maybe because I am an older student (nontraditional), or maybe because I am a male and don't go to the bathroom and cry if someone is rude. I have noticed over the years that those that go on a power trip when they are "in charge" of someone are those that have no backbone when dealing with their spouse or peers.
Guidelines should be in place and clear cut. CI's should be required to follow the same guidelines as the students. Not be a "do as we say, not as we do" situation.
A pet peeve of mine is do not show me how it is done in the "real world" unless that is how I will be tested on it. I tend to remember more what I see and do rather than what I read.
Oct 5, '12My program has pretty much the same rules... Only after 3.5 semesters, I have discovered (through the actions of my classmates, not my own) they pretty much don't enforce them. at all.
Oct 5, '12I'm really hoping that my current CI has the balls to fail a classmate.
I doubt it will happen, but I *really* hope it does. This person is NOT safe and has never BEEN safe from day one. The thought of her being able to administer IV medications on her own in a little over seven months scares me poopless.
Thank you to all the CIs out there who take the time to impart their wisdom onto us.
Oct 5, '12A clinical failure and dismissal from the program will result if you miss 2 clinical days for ANYTHING. However, it depended on who you are. One student missed 3 days because she "forgot' about her clinical days with no make up days left in the semester....and she graduated.
Plus the student who did not use the 5 rights before giving medications twice and gave the wrong meds on both occasion in front of the instructor and he just said "We'll just monitor the pt and keep this between us." I assumed he was more concerned about protecting himself.
Life goes on...
Oct 5, '12Quote from cnmbfaWhen I was a student, the same reasons were cause for failing clinical. You would also fail without question for missing clinical time. Any missed hours had to be made up before semester's end. The hours are mandated by The College of Nursing (BON equivalent). Some people failed clinical through no fault of their own, if illness resulted in absences. Hours are non-negotiable.This is from a document I post for my students at the start of clinical. Doing any of these things will probably result in failing clinically. Remember, we faculty have wide leeway in making a call on this. It often boils down to not letting you move on if you are unprepared, unprofessional, unsafe, unskilled, are unable to critically think, or communicate poorly with others or fail to take responsibility for your actions.The following infractions may result in a clinical failure:
- Tardiness or absenteeism (See course syllabus).
- Recurrent or flagrant dress code violations
- Rude, disrespectful, undermining or uncivil behavior toward a patient, family member, staff member, peer, or faculty; OR repeated actions that create unnecessary conflict and turmoil for others.
- Serious complaints from the agency nursing staff concerning the student's behavior
- Being unprepared to provide safe patient care to patients, OR inability to answer common questions or explain the client's pathophysiology or medications, treatments, procedures and/or nursing interventions.
- Inability to create or communicate a reasonable plan of care, or inability to through and evaluate the client outcomes
- Serious lack of organization that leads to late treatments or medications, or that forces others to assist a student so that care can be completed on time.
- Failure to follow up on an action after being specifically directed to do so. For example, failing to recheck I&O or vital signs or a client's response to a med after being directly told to do so by the instructor or a staff nurse.
- Repeated failure to convey important changes in the client's status promptly to the staff nurse of the instructor.
- Breech in confidentiality or HIPAA violations
- Administering medication without the instructor or without having attained prior approval to administer a medication with a licensed RN
- Misleading or misstating facts or events, or fabricating client assessment data
- Repeated submission of late or unsatisfactory work (even if ungraded); failure to redo and resubmit written material as requested by faculty.
- Delay in responding to or noncompliance with a faculty directive to undergo remediation to address a skill or knowledge gap.
- Actions or inactions deemed unsafe by the faculty.This goes beyond serious medication errors; it includes actions or inaction that puts clients at risk for avoidable complications or potential harm.
- Violations of the Code of Conduct found in the School of Nursing Student Handbook. Failure to achieve master the skills or knowledge needed to provide safe care to patients, including physical assessment skills; or failure to meet any of the other course objectives.
Oct 5, '12In my next life (if there is such a thing), I want to be a better typist and a much better proofreader. nfailed = failed; probklem=problem
Oct 5, '12The problem we instructors face is that what you see (real world) is NOT what NCLEX may want. A perfect example of this is bathing newborns. Book and NCLEX expect us to clean the head first, and to use a washcloth to clean the NB's scalp. Real nurses clean the scalp last, and carry the baby under their arm like a football to the sink and wash the hair under running water. If I don't point this out, the student may get it wrong on NCLEX.
I will not leave out or drop items if there if a student is able to find more than one answer. Here is why: practice may have changed. For example, we rarely see trach ties anymore, and are instead using foam straps or other ways of securing the trach, but books don't reflect that. Another problem is that answers may differ between more up-to-date sources or ones supported with better evidence vs. those that are not. Last year, I had a student who never bought the required nutirtion book. Instead she used the ATI book. It included some incorrect information, did not reflect the latest nutrtion research, or did not refelect the newest (2010) Dietary Guidelines for Americans. So, even though she could show me a supposedly "correct" answer, I wouldn't accept it.
I have also encountered legalistic students who are angling for points, who will find a source that lists the key symptoms of __________ condition or the major interventions for _________ in a different order than our text. They try to use the fact that their source listed such & such first to mean that the answer they selected was right, even though I clearly said in lecture that the nurse should do ___________ first, or that the most significant sign of ________ is _________. Some seem to be trying to pressure me into giving them points, and just refuse to see that while they may be able to make a technical point here & there, they are missing the key issue.
I had one student who was quite smart, and who graduated with honors. I predicted that despite his AB grades, he would fail NCLEX, because he insisted on arguing over several questions on every single exam. He was so insistent that he succeeded some of the time in wearing me down and to giving him the points. I later heard that he did the exact same thing to every instructor he encountered, and that he was not at all open to hearing why his choice was NOT the best answer.
Sure enough, he failed. I wonder how he coped when there was no one he could argue with to try to get enough points to pass NCLEX.
As a result of my experiences with him, I no longer give in to those tactics. I tell the studetns that they are more than welcome to write up a rationale for why their answer is superior, and to take it to our program director to appeal. No one has done this so far.
In addition, many students are very black & white thinkers, especially at first, and I know it drives them crazy that there is more than one right answer; they don't "get" that one answer really is superior to the others. However, welcome to the world of nursing, where there are many shades of gray. We are testing less for your ability to memorize facts than for your ability to USE information to solve clinical problems, set priorities, recognize a change in the client's status, etc. It is all part of developing good clinical judgment. Staying stuck in balck & white world impairs the development of those skills.