Nurturing Confidence In Nursing Students

Nursing school can be one of the most daunting times in the life of a student. Nursing school can wreak havoc with a student's confidence. As an educator, the spirit with which you lead can help your students develop a growing confidence in their ability to succeed as future professionals. While nursing school will never be easy, educators should be a partner in a student's journey to success, not a barrier to success. Nurses Announcements Archive Article

  • Specializes in ER, ICU, Education.
Nurturing Confidence In Nursing Students

As I work on my latest research, one common theme is evident in nursing students. Many lack confidence. Among several areas of research interest, I am most passionate about several issues: nursing students and bullying, predictors of nursing student success, and the relationship between a student's expressed level of confidence and their ability to persevere in nursing school. As a child, I saw a comic strip called Pogo, and the most famous comic strip they released said "We have met the enemy and he is us." I did not understand what this meant when I was young. I believe that I am beginning to understand now.

As a nurse educator, my role is multi-faceted. I believe it is both my duty and privilege to serve as an example of professionalism and life-long learning, to teach students both the information and the skills that they need to succeed, and to help them develop professional habits and coping skills to deal with the reality of nursing. When I first began researching students' experiences with bullying, I noted that students often referred to feeling worthless and unsure in their abilities as a nursing student. These feelings appeared to be especially common in first-semester students. Students reported wishing that they could hide at clinicals, feeling unsure in their skills, and experiencing pressure and feeling like a failure when their skills are not perfect and their knowledge is not complete.

One of the most difficult aspects of nursing education is releasing control, allowing your student a measure of free reign to learn and to succeed, while ensuring patient safety and excellent care. The first time that I saw a student start a foley catheter, it was all that I could do not to grab it and do it myself! This was not due poor technique on the part of the student, but simply to my inability to relinquish control! It took me time (and learning to put my hands behind my back) to watch my students and to demonstrate trust, while still offering support and guidance.

When nursing students encounter dark humor in the clinical setting for the first time, it can be shocking. Hearing a nurse joke about death can lead to the view that the nurse is cruel or callous. I believe there is a similar phenomenon in education. Someone from outside our practice setting is less likely to understand our particular challenges. It is difficult when you put everything you have into nurturing students, only to have the only thing that is mentioned on your evaluation be the thing that you did "wrong" in the eyes of the student. It is frustrating when you try to create fair rules, only to have a manipulative student flout them. When you catch a student cheating, it can destroy your trust. However, as educators, we have a duty to manage our own stress, and not to take this out on the students. That majority of the students are excellent and hard-working. We also have a responsibility to demonstrate open dialogue with students and to "think out loud" as we educate them and perform skills.

For example, one of the things I have noticed with beginning students is the confusion they face when learning a new skill. For example, when starting and securing an IV, the student may see several methods of securing the IV catheter, and be unsure which is "right." They fear failing a skills check off when they see several methods and each instructor insists that their way is best. I believe we owe it to the students to convey which aspects of the skill are essential, such as preparing the site, vein and IV catheter selection, and how we dress the site so that we can view it. However, we should also convey why some areas of a given skill are a matter of personal preference. We should also back up our practice with current evidence. I remember my time as a student, watching a "real nurse" perform a skill, and just knowing that there was no possibility that I could ever replicate that skill, and yet in time I learned to do so.

What your nurse educators often fail to convey is that we've all been there. We've all been the student who felt like an idiot at clinical despite adequate preparation. We've been the student who wanted to hide from the instructor because we were afraid of not knowing. Many of us have been near graduation, terrified that at any moment someone would discover that we are not competent and refuse to allow us to graduate. I spent the first year in the ICU in mortal fear that I would make a mistake, that I would kill someone, that someone would find out that I was really just an imposter, not worthy of caring for patients. As the year went on and I learned to love the ICU and grown in confidence, I could recognize that same look in the faces of most students and new graduates.

The response to a student or new graduate who lacks confidence can vary from bullying the weak to nurturing them. It has taken me years to find the right balance of high expectations, but delivered with compassion and with an understanding that students often lack confidence. I have had so many students tell me in the course of my research that they felt belittled, demeaned, and constantly in fear of failure or reprimand as students. Are nurse educators the enemy? We can be, if we are not transparent. I believe it is a good thing to be transparent, to be human. I tell my students that I know how they feel. I have felt like an idiot on every "first day" I've ever had, from kindergarten to my doctoral education, and at every new job I've ever held. The key is to know what you do know, what you still don't know, and try your best to learn. Have faith in yourself and your ability to learn in time. You will never know it all!

As an educator, we can avoid being the enemy. Never back down on your standards or expectations, but explain to your students why you hold them. I hold high expectations of students because I know in time that they will be capable of meeting them. I want them to be the best. I want to see them move from a point of fear and uncertainty to a point of confidence and security. I see glimpses of this while they are in school. I see their potential begin to come to fruition when they return to visit and tell me of their latest accomplishments in their career. Tell your students early and often that the lack of confidence that they feel is normal, but that it is not a permanent condition! Encourage them to reach their highest potential. I do believe that as educators we can have a great influence on whether our students are confident and whether they love to learn or if learning is something that is motivated only by fear of failure.

Nurse! 15 year(s) of experience in ER, ICU, Education

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Specializes in Pediatric Hematology/Oncology.

And what of the students who, in spite of being in the most incredibly nurturing environment, still continue to lack confidence and tear themselves down constantly?

At my program we have a student mentorship program where the incoming cohort gets paired with a mentor from cohorts ahead. My mentor was great and continues to be awesome though she has graduated already. I was inspired to do this for someone else and I signed up for the program. Oh my goodness....my experience has me seriously considering mentoring again. My "mentee" was the epitome of everything you described above. And yet, no one is bullying her but herself! The educators at my program are beyond amazing, accommodating, understanding, encouraging, nurturing, etc., etc. and there is no excuse for this olympic-level lack of confidence. Come to find out, it's fairly symptomatic of this student's cohort.

Do you think that the highly intense competition to get into impacted programs is leading students to be mistrustful of each other and continue to be competitive? Her number one complaint about her progress/lack of progress is that she feels she doesn't know as much as everyone else and can't understand why she isn't at what she perceives to be the same level. I find this a problem in a lot of the fundamentals cohorts, including my own to a limited extent. It seems to take them a while to shake off the hypercompetitive spirit and learn to work as a team. The instructors can only be so nurturing if the students are all so intent on being scared together and the stronger ones insist on stoking this fire.

isonacloud

5 Posts

I definitely agree with this, I'm in my first semester, and have about 3 weeks left, but my whole class is extremely competitive. After exams there's always a group of people comparing answers. Once we get our grades back, my classmates always compare grades... It can get really discouraging because everyone has the mentality that A's are the best and if you have straight A's you're better than everyone else or smarter than everyone else. Even though so many more experienced people, like our faculty and other more experienced nurses have told me and us that getting A's doesn't always determine a good nurse. That fact still doesn't seem to sink in and the competitive spirit is still strong within many of the students in my program. I don't think being competitive is bad, it obviously helps us strive for success, but it can also be really discouraging for the people who feel like no matter how hard they try they can't get A's. However, those people may be far more caring, empathetic and are more equipped as people to become good nurses. I and a few other people have really tried to foster a more team-focused spirit by trying to be as helpful to other classmates whenever they ask questions or need help, which I think has definitely helped our class bond. But there is still that spirit of arrogance/competition around a lot of the students who are getting straight A's... I just wish more people would realize that we're all in this together. I'm a grateful though that my class isn't as bad as the semester ahead of us, apparently they were like 10 times more aggressive and competitive.

Specializes in Pediatric Hematology/Oncology.
I don't think being competitive is bad, it obviously helps us strive for success, but it can also be really discouraging for the people who feel like no matter how hard they try they can't get A's. However, those people may be far more caring, empathetic and are more equipped as people to become good nurses. I and a few other people have really tried to foster a more team-focused spirit by trying to be as helpful to other classmates whenever they ask questions or need help, which I think has definitely helped our class bond. But there is still that spirit of arrogance/competition around a lot of the students who are getting straight A's... I just wish more people would realize that we're all in this together. I'm a grateful though that my class isn't as bad as the semester ahead of us, apparently they were like 10 times more aggressive and competitive.

You are absolutely right that the ones who are trying the hardest in spite of not getting the As may very likely turn out to be the best, most competent caregivers. We have this same mentality with some people in the class but their compassion and skills are kinda whack. It was pretty bad at the start and I still don't get people posting their final grades on Facebook (I guess I'm just old) but it seems to have kinda cooled off somewhat. The people that don't flaunt their grades and offer help are the best example for this, especially when the more arrogant ones are getting knocked on their butt by their instructors (which is funny but I laugh inside only). That's great that you're making an effort to help remedy the problem in your cohort -- that mentality definitely doesn't uplift the nursing profession and is essentially the opposite of what it means to be in service to others as a nurse. You can't give of yourself when it's all about you, you know?

AOx1

961 Posts

Specializes in ER, ICU, Education.
And what of the students who, in spite of being in the most incredibly nurturing environment, still continue to lack confidence and tear themselves down constantly?

At my program we have a student mentorship program where the incoming cohort gets paired with a mentor from cohorts ahead. My mentor was great and continues to be awesome though she has graduated already. I was inspired to do this for someone else and I signed up for the program. Oh my goodness....my experience has me seriously considering mentoring again. My "mentee" was the epitome of everything you described above. And yet, no one is bullying her but herself! The educators at my program are beyond amazing, accommodating, understanding, encouraging, nurturing, etc., etc. and there is no excuse for this olympic-level lack of confidence. Come to find out, it's fairly symptomatic of this student's cohort.

Do you think that the highly intense competition to get into impacted programs is leading students to be mistrustful of each other and continue to be competitive? Her number one complaint about her progress/lack of progress is that she feels she doesn't know as much as everyone else and can't understand why she isn't at what she perceives to be the same level. I find this a problem in a lot of the fundamentals cohorts, including my own to a limited extent. It seems to take them a while to shake off the hypercompetitive spirit and learn to work as a team. The instructors can only be so nurturing if the students are all so intent on being scared together and the stronger ones insist on stoking this fire.

Educators should also play a role in encouraging teamwork. I believe extreme competitiveness arises from several areas. If you are confident and know your true abilities or lack thereof, you don't need to always show off. If you are acing your exams and understand the material, there is no need to make others feel "less."

In reality, safe practice is high stakes. What should not be high stakes is every single thing in nursing school. Yes, poor grades can bar the way to graduating, but if every single skill, quiz, exam, paper, etc is high stakes, we never allow students to SAFELY fail. Yes, students will fail. So do nurses. After all these years, I still have the days when I don't spend time listening to someone who is lonely because I'm running a code. I still question if I did all I could have done. If the school creates a high-strung environment in which any faltering leads to failure of the course, is it any wonder that the environment is cut-throat?

And as for those who still lack confidence, you do what you can. You assess the reasons behind it, continue to work with them, and refer them as needed. A nurse educator is not going to cure all issues all students are having, just as a nurse won't and can't make all patients well and whole. This is about creating the best environment possible, and partnering with students as adults to help them reach their full potential, whatever that may be.

AOx1

961 Posts

Specializes in ER, ICU, Education.
And what of the students who, in spite of being in the most incredibly nurturing environment, still continue to lack confidence and tear themselves down constantly?

At my program we have a student mentorship program where the incoming cohort gets paired with a mentor from cohorts ahead. My mentor was great and continues to be awesome though she has graduated already. I was inspired to do this for someone else and I signed up for the program. Oh my goodness....my experience has me seriously considering mentoring again. My "mentee" was the epitome of everything you described above. And yet, no one is bullying her but herself! The educators at my program are beyond amazing, accommodating, understanding, encouraging, nurturing, etc., etc. and there is no excuse for this olympic-level lack of confidence. Come to find out, it's fairly symptomatic of this student's cohort.

Do you think that the highly intense competition to get into impacted programs is leading students to be mistrustful of each other and continue to be competitive? Her number one complaint about her progress/lack of progress is that she feels she doesn't know as much as everyone else and can't understand why she isn't at what she perceives to be the same level. I find this a problem in a lot of the fundamentals cohorts, including my own to a limited extent. It seems to take them a while to shake off the hypercompetitive spirit and learn to work as a team. The instructors can only be so nurturing if the students are all so intent on being scared together and the stronger ones insist on stoking this fire.

Educators should also play a role in encouraging teamwork. In the real world, that is what helps you survive the bad days. I believe extreme competitiveness arises from several areas. If you are confident and know your true abilities or lack thereof, you don't need to always show off. If you are acing your exams and understand the material, there is no need to make others feel "less."

In reality, safe practice is high stakes. What should not be high stakes is every single thing in nursing school. Yes, poor grades can bar the way to graduating, but if every single skill, quiz, exam, paper, etc is high stakes, we never allow students to SAFELY fail. Yes, students will fail. So do nurses. After all these years, I still have the days when I don't spend time listening to someone who is lonely because I'm running a code. I still question if I did all I could have done. If the school creates a high-strung environment in which any faltering leads to failure of the course, is it any wonder that the environment is cut-throat?

And as for those who still lack confidence, you do what you can. You assess the reasons behind it, continue to work with them, and refer them as needed. A nurse educator is not going to cure all issues all students are having, just as a nurse won't and can't make all patients well and whole. This is about creating the best environment possible, and partnering with students as adults to help them reach their full potential, whatever that may be. Your mentee might benefit from being asked for a concrete plan.

Example:

Mentee: I just can't do this! It's too hard everyone knows so much more than me.

Mentor: I understand that it can feel that way. What is your plan to help yourself? Will you spend more time in the skills lab? Will you get an internship this summer?

Honestly, just like patients, students must choose to improve and learn, just as educators must be willing to create a climate that allows for learning to be appealing.

Specializes in Pediatric Hematology/Oncology.
In reality, safe practice is high stakes. What should not be high stakes is every single thing in nursing school. Yes, poor grades can bar the way to graduating, but if every single skill, quiz, exam, paper, etc is high stakes, we never allow students to SAFELY fail.

I guess my puzzlement with this is that I come from a program that has been definitely high on the ability to safely fail. The pre-clinical drug calculation exams aside, there really has been no reason for anyone in my cohort to feel as if anything they are graded on is high stakes. And still this mentality persists. I guess we don't really know how easy we have it. I'm getting that feeling after seeing a lot of the student posts on here and feeling very blessed to have had the phenomenal instructors I have had so far and will have again in advanced quarters. :) It's nice to see that there are instructors, like you, who are consciously changing the education in a manner that is more for encouraging growth and less about terrorizing students (although a little fear never hurt anyone).

AOx1

961 Posts

Specializes in ER, ICU, Education.

Oops, sorry, new tablet and accidentally posted midway!

AOx1

961 Posts

Specializes in ER, ICU, Education.
I guess my puzzlement with this is that I come from a program that has been definitely high on the ability to safely fail. The pre-clinical drug calculation exams aside, there really has been no reason for anyone in my cohort to feel as if anything they are graded on is high stakes. And still this mentality persists. I guess we don't really know how easy we have it. I'm getting that feeling after seeing a lot of the student posts on here and feeling very blessed to have had the phenomenal instructors I have had so far and will have again in advanced quarters. :) It's nice to see that there are instructors, like you, who are consciously changing the education in a manner that is more for encouraging growth and less about terrorizing students (although a little fear never hurt anyone).

I do know that every class has its own personality. Has anyone in authority ever talked to the class about this, especially early in the program?

Specializes in Pediatric Hematology/Oncology.

And as for those who still lack confidence, you do what you can. You assess the reasons behind it, continue to work with them, and refer them as needed. A nurse educator is not going to cure all issues all students are having, just as a nurse won't and can't make all patients well and whole. This is about creating the best environment possible, and partnering with students as adults to help them reach their full potential, whatever that may be. Your mentee might benefit from being asked for a concrete plan.

Example:

Mentee: I just can't do this! It's too hard everyone knows so much more than me.

Mentor: I understand that it can feel that way. What is your plan to help yourself? Will you spend more time in the skills lab? Will you get an internship this summer?

Honestly, just like patients, students must choose to improve and learn, just as educators must be willing to create a climate that allows for learning to be appealing.

She is not my mentee anymore but still checks in with me from time to time about how awful things continue to be. I have continued to encourage her ask her what her plan of action is to deal with these fears and it seems she is more interested in hiding behind her inability (like it was a disability) to face her fear and do something real to empower herself. I know that if she doesn't get it together she eventually will be faced with tougher instructors who will be mandating a plan of action to remedy these issues before she gets dropped from the program. The above example is nearly word-for-word of some of these overwrought conversations we have had and it generally ends with her repeating how afraid she is (among some other very disconcerting, self-disparaging comments) and how she won't make it. It's been a joy. :no:

Specializes in Pediatric Hematology/Oncology.
I do know that every class has its own personality. Has anyone in authority ever talked to the class about this, especially early in the program?

I think anyone who has been too much with the arrogance has had their moment with an instructor who broke it down for them in a way that may have driven the point home.

However, our last quarter my clinical instructor was also our pharm instructor and ALSO our theory instructor and ALSO the program coordinator (and had to cover occasionally for clinical instructors who for whatever reason weren't able to do their clinical days). It was a fun time for her. Clearly this schedule is an abnormal workload for a single instructor and, though everyone in my clinical group was in awe of her composure and insight and understanding with us (among so many other things that were amazing -- I felt SOOOOOOOOOOOOOOO spoiled being under her instruction for a whole quarter), the entirety of the situation had some serious drawbacks and the remainder of my cohort who wasn't familiar with or didn't care about the extremeness of the situation judged her unfairly and developed a pretty bad attitude towards her. In reality, it is the fault of program admin for asking her to take on such a workload -- we are in the process of hiring new faculty so this should never happen again. However, the ramifications have extended into some pretty arrogant attitudes towards instructors and, with time, I know that they will get some sort of an "adjustment" especially since she is now our patho instructor for this quarter. Time will fix it -- I hope. It can kind of be a drag being around so many complainers.

AOx1

961 Posts

Specializes in ER, ICU, Education.

It does sound very frustrating. I hope this doesn't discourage you from being a mentor in the future! One of the most difficult things, whether you're a nurse, educator, mentor, preceptor, etc is seeing someone stuck in a negative mindset. It can be situational or due to underlying issues like anxiety or depression. Just try not to take it personally. It can be hard to deal with.