How to help a nursing student not doing well

APBT mom, LPN, RN · Feb 8, 2008

Since you just gave the areas of where she needs improvements I'll try to give some general examples.

Time management- What areas does she need improvement? Is it over all or when something unexpected happens. Maybe at the beginning of the shift make a "to do list"/ "schedule" of everything that needs to be done. If she works with the same patients as the day before say at 0700- checks charts for any new orders, prints/copies an updated MAR's for each patient and highlights the meds she is to give, checks blood work for any abnormals to report, pull meds if due for any patient

0730- visits each patient to see if there's any changes/needs anything/check if supplies are in the rooms for procedures (dressing change, tube feeding,...) then write a "shopping list" for what she needs when she returns, turn pts if needed, help with morning routine

0800- gets supplies and starts assessments, and whatever procedures/meds are due.

0900- chart if unable to do it after each person, recheck charts for new orders, give meds, prep pts for procedures that they will have to go off the floor for

1000- visit each patient again to see if they need anything, make another "shopping list" if not in room

1100- give meds if needed/procedures due

repeat (times not real just an example) and try to give some wiggle room between things that need to be done. Maybe a 30 min window in case Ms. Jones wants to talk, or Mr. Smith needs help going to the BR.

Skills- Does she have lists/check off sheet on how to do these skills? If not have her bring one (most fundamental books have them written step by step, she can copy the pages/ instructors might have given her the steps in lab). Have her write on each one the supplies she will need unless indicated differently in the order. Then before she goes in to do the procedure have her do a run through in the hall/at the nurses station before she goes in and actually does it. It's what we do at clinicals and it helps us realize if we've missed any steps. Have her bring extra of things tha can get contaminated (sterile gloves, a couple of IV's, two foley kits,...) so she doesn't get the OH NO look and have to run out of the room to get what she needs.

Clinical judgement- Does she not look for what's important or doesn't see the whole picture? If she sees the same patients each day perhaps quiz her about the patients problem to see what she understands about it then go over the disease/disorders process with her on the things that she doesn't know before going into the room and interacting with the patient so SHE can see what she knows and help build her confidence. Maybe advise her on getting a small med/surg book from B&N or Borders that she can carry so when she has some down time (may be rare) or needs a little more insight she can look it up herself without having to feel like she has no idea what's going on. Mosby's makes a good one called Medical Surgical Nursing (green cover). Same with a drug guide if she's having troubles with that so she doesn't always have to run to you for an answer.

I think that her main problem is not messing up in front of you but in front of the patient which makes her doubt things to much. Our instructor asks us questions before we do anything and lets us do a quick run through before we do procedures and it does help build confidence when you get things right. If you have that "gut" feeling though that she could be a risk to patients I would tell her clinical instructor.

I wish more nurses were like you in regards with being so receptive of students and wanting to help them accomplish things. So thanks for being so kind, a good teacher, and willing to search for ways to help this student when most would just go to the clinical instructor and tell them that she's not performing like he should and they don't want to deal with it. So thank you times infinity.

Daytonite, BSN, RN · Feb 8, 2008

Over my career I have seen, I think, 2 who fit this category. There was nothing we could do to salvage them. All you can do is keep encouraging them to think before they do something and watch them like a hawk so they don't accidentally kill someone. I wouldn't worry too much about time management as that is something that takes time to develop. Skills also have to be learned over time and unless they are doing things in a really bizarre and stupid way newbies sometimes just need time to get over their fear and anxiety with doing procedures. But, clinical judgment involves nursing knowledge and if that isn't there, then she hasn't been learning her lessons--and that I would be the most critical of. In the end, if they don't pass muster, you can't pass them. These are often students that kindly instructors worked with and just passed through their programs. In the 2 cases I remember, they were both new grads and, thankfully, the state board did it for us--they both failed the NCLEX and were automatic job terminations. But, we were on pins and needles with them.