Struggling in Clinical

LynnLRN · Apr 19, 2012

Develop better coping mechanisms. Not everyone is going to be nice. You will run into pressure like this on the job and you need to be able to control your anxiety.

Wrench Party · Apr 19, 2012

I just finished my second round of clinicals today (med surg and psych) and can say

that a clinical instructor can make or break your experience. I lucked out with mine,

but my classmates had to take their experience with their CI to the dean because

they a) weren't getting the experience they needed and b) the nurses had to keep

defending the students to the CI.

Try to talk to your adviser, older students, and other instructors for advice on the situation.

Patti_RN · Apr 19, 2012

I swear those instructors say, "I had to jump through hoops of fire 50 years ago when I was in nursing school and I hated every moment of it and every instructor who abused me, so now it's MY turn to be the abuser!!!" (Accompanied by sinister laughter.)

I really do think it's more of a tradition of abuse than the personalities of the clinincal instructor. It's as if these nursing instructors believe that they somehow benefitted by the stress of disrespectful treatment and they are going to make current students undergo the same torture to strengthen them.

With the emphasis on Evidence Based Practice in nursing and medicine, I'm surprised these instructors don't consult with their brethern in academia for Best Educational Practices. If they did, they would learn that an atmosphere of stress and fear is not condusive to learning. In fact, when under enormous pressure, most people panic and are unable to learn or even think clearly. A student's first (or even last) clinical experience is no time to force them to practice the stress of nursing. At their infancy in a career path, beginning students need to be nurtured and encouraged, not treated like enlistees in boot camp (who shouldn't be treated that way either!)

The best atmosphere for learning is where mutual respect and understanding are the key elements. Think back to your early years in school--the teachers who got the best results did not rule by fear and intimidation; they were kind yet firm; they placed the bar high but cheered the students' attempts to reach that bar. Teaching adults is no different. Results are best when teachers have these qualities.

The problem students have in these situations is they are the ones lacking the power. The teacher holds the trump card, the school administration has a hard time filling these clinical teaching jobs and will usually back the abusive instructor. And, most of those administrators were products of the same treatment when they were in nursing school, so may not be very sympathetic. Sadly, even though you are the client and customer as a student, you don't hold the same power a customer would in another marketplace. Complain to the school, and they'll tell probably tell you to take a hike... and if you stay, you'll be labeled as a complainer.

This is a time when your interpersonal skills are called upon. Be respectful to the abusive instructor. Try to be as prepared as you possibly can be (know the meds you'll be passing, know the medical condition of the patient(s) you're caring for, and be punctual and as efficient as you can (be prepared to pass the 10AM meds at 9:30AM, and have everything organized (keep alcohol wipes, syringes, dressings, tape, pens, drug book or iPad, etc, in your pockets. I actually wore white uniform cargo pants to clinicals so I could stash all the crap in various pockets!) Don't give the instructor cause to berate you or be condescending towards you. You are the victim, and I'm not blaming you for getting this treatment, I'm just trying to steer you from getting even more of it.

As virtually everyone else has said, try to let the remarks roll off. And, count the days until you'll finish with this instructor and hope next semester doesn't bring someone worse!

mikeicurn, ASN, RN · Apr 20, 2012

One of my nursing supervisors has been an instructor at the local college for decades. She has told us many stories about some of her students. Like the group who contacted the board of nursing to complain the instructors where making them study to much. The board contacted the school to tell them to keep up the good work.

In my experience many students are just too thin skinned. Everyone is not "yelling" at you. I see some of the younger nurses around me in tears from time to time because the doctor "yelled" at them. I have happened to be in the same room on some of these occasions and I barely saw the said "yeller" raise their voice and merely scolded them for doing something, and told them to not do it again. You will have families accuse you of dragging their dear old grandmother out of the bed by the hair, tripping grandpa and laughing at him while he laid in the floor, with holding pain meds just to see them suffer, etc... You will have doctors get very cross with you for waking them up in the middle of the night. They might even curse on occasion. So, you need to toughen up that skin now.

The original poster even said "She yells at you for minor things and today was my day to get reamed over many little mistakes." Minor things and little mistakes kill people in this profession. Maybe she is just trying to get that point across to you.

Patti_RN · Apr 20, 2012

@Mike, I agree with much of what you said. I have seen some thin-skinned people (nurses, students, techs, etc.) dissolve into tears over some pretty minor exchanges. I've also seen some brutal instructors make grown men (and women) tremble in fear. The behavior I assumed the OP spoke of is similar to the behavior I've seen myself: mean, condescending, demanding, and threatening treatment when there was no infraction that was deserving of even a strict voice. (Threatening, as in threatening to send the student off the floor, or kicked out of the program.) This treatment does nothing to instill confidence; and lack of confidence results in mistakes and second-guessing oneself.

Nursing is a job that requires an individual to make few mistakes--and the mistakes that are excusable are the most minor of errors. It's understandable that an instructor wants to teach students that mistakes can be deadly, but when they are so harsh that the student lives in fear of being kicked out of the program, that's just not reasonable.

Amd a word about leadership and communication: no one has the right to be disrespectful to another person. A message can be communicated just as effectively in private, with a respectful tone. It's not how loud you scream, it's the words you choose. Those words should be respectful, no matter what the offense.

mikeicurn, ASN, RN · Apr 20, 2012

Patti,

Well thought out and nicely put. I agree with you as well. You are right about leadership and communication. People should respect each other, but they don't. I think instilling in nursing students that they are going to be treated like that in the hospital environment is unrealistic. MD's and family are going to disrespectful to you. That's just the way it is. I agree it isn't right, but it is realistic. And I also agree with you that instructors should not brow beat and terrorize students, and it doesn't instill confidence but that instructor is standing between her and graduation. So, she will have to learn to deal with it for a short while, then move on. Is it a good instructor? Probably not, but she is her instructor, so she has to deal with her.

God Bless,

Mike

allnurses Guide · Apr 20, 2012

Perception is everything. You complain she is picking on you about many little things. If you can't get the little things right, I am not going to trust you with the big ones.

I had a student who complained I nitpicked about everything. Well, sorry, but patient safety comes first and if you can't figure out why I am upset you walked away from a person in a cast trying to balance on one foot, you will never get it. She complained about me in graphic and insulting language, but it didn't fly.

So all of you who are so quick to jump on the bandwagon of "that mean bully of a CI" bandwagon, stop and think about it for a moment. Are there bullies out there? yes. Far more often there are CIs who hold you to a high standard so you will be the best nurse we can teach you be. We aren't your soccer mom cheerleaders, we are setting a professional standard for you.

For what its worth, my other students praised our clinical time together, and rather than going to the director to complain about me, complained about the student and expressed disbelief about how long I had put up with this behavior. And I spent a lot of years being that soccer mom cheerleading my children. You aren't my kids, you are my students, and hopefully my future colleagues.

mindlor · Apr 20, 2012

Hey Jbudd!! Thanks for being a clinical instructor. I can only imagine what a difficult endeavor it must be.

What I was saying is that I EXPECT and WANT to bbe grilled, nitpicked, criticized, in short I want your experience!!

However, I am certain that the above can be done in a professional, respectful manner.....

I will readily admit that many many students are WAY too sensitive and need to grow up......

tamadrummer · Apr 20, 2012

I was written up in my first quarter of fundamentals. The instructor forbade us from pt interaction in the halls and my pt was never in her room one time during clinical. I was ordered to help other students and that is what I did. When my care plan only had medical record info in it I was given a low grade. When I asked why and was told because I didn't meet or treat my pt I sternly reminded the instructor that I was ordered to do that and in turn got written up. Thankfully the other clinical instructor heard her and went to the dean for me. I had zero experience prior to nursing school and was terrified. Don't sweat little things and when it comes to fundamentals just keep your nose down and keep charging forward. If you are not being given bad grades, let the CI do whatever she needs to to feel better about herself and give her a crappy eval at the end of the semester.

Nurse Meshu · Mar 21, 2014

For every nursing student just starting out in clinicals I would highly recommend you to keep a personal journal to document significant events; both positive and negative. If you are experiencing abuse (as oppose to personality conflicts) document in your journal times and dates and quote the comment. I am a second year nursing student and I am currently in my 3 clinical placement. So far my first 2 instructors were amazing and used guidance to help students through errors or when they were simply not sure. my current instructor uses intimidation, humiliation as abusive non-professional language. Rather than guiding a student through a process, she waits for the student to complete a task in error and yells at them in front of patients and other nurses. then goes back to the nursing station to loudly gossip about it to other nurses in the presence of the student.

Since we as students are expected to complete a number of reflective writings for clinicals I have chosen to use my experience and the experiences of the other students. I will use accurate quotes and include times and dates (no names). I will back up my work using journals, CNO standards and the human rights commission regarding workplace abuse and the poisoned environment. Once I finish my pieces I will then talk to the director about these behaviours and have my pieces on hand so that the issues will be taken seriously and let them know that these behaviours reflect badly on the school. (Public Relations is always a soft spot for any organization) I'm not simply whining over a tough placement.

Clinicals placement is for learning and students should feel the support of their instructor not condemnation. If your issue is simply that you don't like your instructor, evaluate the reasons why first. go over your notes and assess whether or not the instructors language and actions are non-professional or abusive of if the instructor is simply strict and stern yet supportive.