How to fail clinical

[cnmbfa]

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.
  

I would add to this that a NO CALL/NO SHOW (unless you were in a serious accident) is an automatic failure.

Nursing faculty take seriously their responsibility to protect the public from anyone who does not live up to these standards, or who lack the thinking skills, judgment, and organizational skills needed to provide safe, effective care. There are times when we recognize that a student simply is not ready to move to the next clinical, where he or she will encounter sicker, more vulnerable patients; in that case, the student may benefit from repeating a clinical, and go on to be a stronger, better nurse as a result. It is not easy to fail students clinicallly; no one I know does it lightly or looks forward to doing it. But it does happen. That said, it generally can be avoided by coming very well prepared, following the rules, being on your best behavior, communicating well, and by seeking and being open to early feedback.

[AtivanIM]

A couple of questions before I can provide meaningful feedback:

1. Is this your personal guidelines for clinical, all faculty use it, or is it pulled directly from the student handbook?

2. What semester are your students?

3. What is the students patient load?

4. How much time are they allowed to view patient data before preforming care?

[Esme12, ASN, BSN, RN]

It is HIPAA not HIPPAA (wink) I think it is a good idea to have clear expectations of the students and make sure they KNOW what they are.

[classicdame, MSN, EdD]

as a hospital educator I would like to emphasize that the school's code of conduct probably includes adherence to the facility code of conduct. So if you smart off to the CNO (yep. Someone did that ONCE), then you will be banned from the facility and may not be able to complete your clinical rotation. Our contract is with the school, not the student. The majority of students here enhance our own practice because they want to learn and that causes our own staff to not get into a rut.

[VioletKaliLPN, LPN]

Those sound very reasonable, they were the exact expectations from my LPN program.

[DebblesRN, ASN, BSN, RN]

In my second year of Nursing school, we were required to park in a mulch lot at one of our clinical sites. It had rained all night. the mulch lot was a muddy slush lot. I had some mud on my shoes and on the cuff area of my pants near my ankles. I was nearly sent home about it. Yelled at and embarrassed in front of the entire class until several others pointed out we had parked in a muddy bog and their shoes looked as bad or worse than mine. There was no apology from the instructor, just an assurance that if it happened again I would be dismissed. I eventually had to make a visit to the dean to get her to stop, and I wasn't the only one who had to make that visit.

If you make your students park in a quagmire, expect dirty shoes.

I guess I am saying that it would have been nice if some of my instructors had used common sense when enforcing some of their "rules."

[redhead_NURSE98!, ADN, BSN]

Oh, well wouldn't it be lovely if those rules were enforced all of the time. It would have saved several of my classmates who were fair at test taking but we all knew would be horrible nurses from being terminated at their first jobs out of school.

If you were looking for feedback, it is spelled "breach" not "breech" when you are talking about a failure and not the butt of a baby.

[SwansonRN]

Thank god I'm no longer a student nurse.

[hopeful_27]

Another one to add:

Do not fall asleep while at clinical!

[dirtyhippiegirl, BSN, RN]

A girl in my clinical group got reamed by the assistant dean at a clinical site for having a bit of a white t-shirt that she was wearing under her scrubs showing. She had to go change. We were allowed to wear white long-sleeves under our scrubs but, apparently, not white short sleeve shirts.

Same assistant dean later talked about how her nun-nursing-instructors would measure skirt lengths and you'd be sent home for having a run in your stockings. So, I guess there's that.

[nurseprnRN, BSN, RN]

I am old enough to remember when the hospital school of nursing students in my town had to wear girdles. No jiggling, you know. This was also, of course, before pantyhose were invented. And they had to kneel on the floor and if their skirt hems didn't touch the floor, they were in big trouble.

Other than the misspellings, I am in complete agreement with this. This is exactly how it works in most schools; faculty do take it seriously. Students will ignore it at their peril. And we do know that some will ignore it, and then we'll have them whining here.

[SummitRN, BSN, RN]

Don't show up for your Mental Health rotation at the VA dressed like this:

You'll definitely fail clinical... unless you get choked out from behind first.

On a serious note, a nursing school dressed their students in all black scrubs, and groups of them walking together at the VA unwittingly triggered some PTSD reactions.