The Wicked Politics of Clinical Practicum in Nursing School

[TheCommuter]

Nursing school is not always fair. And, in my honest opinion, the most unfair aspect of the nursing school experience is the clinical practicum portion, also known as 'clinical rotations.' Here is why.

The grades that students earn in the classroom-based theoretical nursing courses are, in most cases, usually objective. Even though the professor who teaches the advanced medical/surgical nursing course might hold personal grudges against a couple of students, the multiple choice exams and quizzes help to even the playing field by giving all pupils a fair chance to demonstrate their knowledge base.

A few exceptions exist, such as the occasional poorly written test question, and the subjectively-graded essay or paper. However, students who are personally disliked by their classroom professor, classmates who are outspoken or opinionated, and those who have been labeled as difficult 'trouble makers' by certain faculty members can still pass (and even do well) in the theory portion of their nursing courses through strong performance on objectively graded tests if they study, use all the resources at their disposal, and fully comprehend the material.

On the other hand, the grades students receive in the clinical practicum portion of their nursing school educations are purely subjective and based almost solely on the opinion of the clinical instructor. This is certainly not a problem if the clinical instructor is fair, balanced, rational, has realistic expectations of pupils, and capable of modulating his or her emotions while evaluating students' performance. It also helps greatly if the clinical instructor possesses a true fondness for transmitting nuggets of knowledge and wisdom to the next generation of nurses.

Let's return to the subjective evaluation of the clinical portion of nursing education. This is not problematic if the instructor is fair and impartial. However, the end result could be a disaster if an outspoken or mouthy student is being taught by a clinical instructor who has old-fashioned values and expects students to obey, conform, comply, respect authority, and avoid painting her in an unfavorable brush in front of others. No matter how intelligent or skilled the student might be, he will almost certainly fail clinical practicum if he rubs his instructor the wrong way.

Many clinical instructors currently work in inpatient settings such as hospitals where they practice procedural skills regularly; teaching students is a second job for these instructors. However, other clinical instructors exist in academia who have not regularly performed patient care in many years. You may notice some of these instructors performing skills in an outdated manner, or quite possibly, they might do something incorrectly.

The outspoken student who announces in front of other students and nurses in the clinical setting that "Mrs. Smith gave a bolus tube feeding while the patient was laying flat in bed" will become a target, even if he is right and the instructor was wrong. This is the same instructor who will be checking students off on skills. This is the same instructor who evaluates students' performance and determines who passes or fails the clinical practicum.

If the instructor is the old-fashioned type who does not like it when students correct her in public, do you think she's going to penalize the mouthy student? If she disapproves of students who question authority, do you think she might give the student who openly questions her a hard time? Keep in mind that if she refuses to check you off on a skill, it is her word against yours. If she insists you failed your most recent clinical rotation due to substandard performance, be cognizant that the director of the nursing program might side with her.

I've revealed the nastier side of the politics that permeate clinical rotations in nursing school. My advice is to pick your battles wisely and tread very carefully. Think before you speak, especially when addressing instructors who make grading decisions that impact your future. The grades you receive in clinical practicum are purely subjective, so do not end up on a faculty member's bad side due to your strong personality and outspokenness. Be aware that no matter how bright you are, the evaluation of one dishonest clinical instructor who dislikes you can set your career back.

Learn to walk the political tightrope. After all, what you know is often as important as who you know in this day and age. Keep that bull's eye off your back.

[multi10]

Best 7 songs ever: Wonderful, Don't Get Me Wrong, Whiter Shade Of Pale, Fortress Around Your Heart, Sweet Child O' Mine, First Day, Graceland.

[TheCommuter, BSN, RN]

My nursing school had clinical rubrics, so I respectfully disagree with the purely subjective part. Forgetting to wash your hands or not have the proper supplies resulted in an automatic "F" for the day, and this was made known prior to attending clinical. However, I'm sure sadly that this probably occurs in other schools.

Even with clinical grading rubrics, an unscrupulous clinical instructor could accuse a student of being unprepared, and therefore, grant a failing grade for that particular clinical day. It is often the instructor's word against the students.

[blackvans1234]

Nursing, learn when to step up; learn when to shut up.

[SleeepyRN]

Even with clinical grading rubrics, an unscrupulous clinical instructor could accuse a student of being unprepared, and therefore, grant a failing grade for that particular clinical day. It is often the instructor's word against the students.

So true, and I experienced it. I had an instructor that treated me terribly. Other students saw it and would occasionally comment on it to me, but I wouldn't ask them to go on the record for me for a formal complaint because I'm sure they would say no due to fear of retribution. The clinical component of nursing school has left me somewhat traumatized to the point of anxiety over working. I need therapy to help me move on from what I went through. One thing that happened was I was put on probation because a nurse (a new grad herself) told my instructor that another student and I did something that I DID NOT do. The other student, however, did do it, and admitted it. I know the nurse wasn't lying, she I'm sure just was mistaken. First, the way I was put on probation....my right to having the dean of nursing present (according to our handbook) was not followed. It was the administrative assistant and my instructor present. I've already discussed our mutual dislike for each other (the assistant). The admin assist was incredibly rude to me, standing, her hands on her hips and pointing her finger. My instructor pulled out the paper for me to sign. I said to my instructor, tears in my eyes "I've always been honest and fessed up when Ive made a mistake." Then I gave her an example of when I had done that with her. I said I wasn't going to sign the paper. The dean of nursing just happened, by coincidence to walk in the office at that moment. So she did not get to witness the threatening, bullying manner in which the way the admin assist had treated me. I then told them if it comes down to me signing that paper that says I did this (it was not just a paper for me to sign acknowledging that I was on probation) then I am quitting the program and transferring schools to do LPN to RN. I was adamant. The dean was professional about it. She asked if I would be willing to sign the paper if I got to write on it that I disagreed with the accusations but would be willing to do the 1 basic lab day that went along with the probation. I agreed, signed the paper, was on probation and did the lab day. To top it off, this all occurred immediately before an exam (and they knew I had an exam and thought it was an appropriate time to call me in the office and put me on probation.) I cried throughout the entire exam and couldn't concentrate well. Oh, and furthermore, my instructor for the class I had just taken the exam in, THEN told me to come in her office after class. I did and she told me she was writing me up for being late to class the week before without advance notice. I told her that I DID give her notice and reminded her when I did so. She said I was right, then ripped up the paper and threw it away. What a day that was. Unfortunately it wasn't my only emotionally turmoiled day due to instructors. It is said that if everything is "always someone else's fault", then it is probably you. However, I worked at a hospital as a patient care tech for 3 years and was well valued by all my nurse managers. I never had a problem. Nor did I ever have authority issues when I attended NIU or high school or middle school. I swear to this day, the issues I had in nursing school stemmed from 3 unprofessional faculty members. How am I allowing 3 people from a year ago have such a negative impact on my life today?

[Violach]

Thanks for the advice. I am a "follow the rules, do what I'm told, and fly under the radar" kind of student. :)

[melizerd, ASN, RN]

We also have clinical rubrics. Almost all allotted points are part of various specific skills (with their own rubrics), math quizzes, and care plan maps (which also have rubrics for specifics).

The only time I've heard of a person failing clinical is because they did not meet the math requirement of 80% on math tests which is required even if all other requirements are met.

It was done that way to avoid the issues you've talked about between instructor and student.

[SleeepyRN]

Like the Commuter stated, things can and do still happen with rubrics in place. In my case, I was placed on probation for something I didn't do. If you got 2 probations, you were dismissed from the program. I was late to class one day because I was in the process of an orientation to go from patient care tech to ED tech and I had to be at work that day as part of orientation (my hopes were to work my way up the ladder from sitter to PCT to ED tech to ED nurse). After I was put on probation, there was 1 day of class I would have to miss completely for part of this orientation. If something were to happen and I was late or had to miss 1 more day of class after that, I would be put on my 2nd probation which would result in me being dismissed from the program. So I gave up being an ED tech deciding not to risk being late or missing a class. Can you tell I'm bitter? My point is things happen beyond our control, and even if we are hard working, follow the rules type of people, life can be unfair. Instructors have our futures in their hands. I decided not to fight back because by that time, I had such a fear of being kicked out. I had just one more semester to go. Sigh...if that were only the end of my nursing school troubles.

[rumwynnieRN]

I love this article. I'm fortunate enough to not have had these instructors in nursing school (or maybe I was just never on their bad side), but some of my classmates had instructors who would for no other reason than to "toughen them up" would make them cry at clinical, in front of staff. Yes, you need a thick skin for nursing in general, but I think that's going a bit far (I'm sure others have had worse). Other instructors, I heard, when giving their student evaluations, would accuse them of incompetence for things that were otherwise understandable ("Wow, you couldn't even get that IV stick right?" or "If I'm talking to you, you listen to me, I don't care who else is around, it could be the patient, and it doesn't matter."), and then without missing a beat say, "Stop crying. You look pathetic."

Regardless of the field, there are some people who shouldn't be teaching students at all.

[blackvans1234]

I have a classmate who thinks our clinical instructor hates her. I personally think this girl has extra thin skin (last semester her clinical instructor said that she might be better off doing physical therapy or something! )

[lolaviex]

I feel bad for students who have instructors that may be doing a procedure the wrong way... It's hard to bring something like that up to the instructor without feeling like you're going over the line. Luckily, most of our clinical instructors seem very knowledgable and I haven't encountered a problem like that yet.

If I see an instructor or RN doing something I'm not sure of I simply ask them if they can explain the rationale behind it to me. You can tell a lot from their response. The knowledgeable, experienced instructor will be able to explain the rationale, often times opening your eyes to a new way of doing a skill or giving you some great insight into a different way of thinking about something. If they're just plain old doing it wrong they usually mumble something and brush you off.

Admittedly, if you already know it's wrong but you ask them to explain the rationale, that's a bit passive aggressive. But sometimes what can you do? I was put in a bad spot with my clinical instructor and assigned RN a few weeks ago. I was supposed to do the assessment and chart on my patient, but the RN skipped ahead of me and finished the charting without ever doing an assessment. Later, my instructor asked why I hadn't charted when I was supposed to. Um... because the RN falsified the documents before I had a chance to put the real findings? I don't know. I didn't say that, but I wanted to.

Clinical can be hard enough whether you get along with your instructor or not. There are so many issues that you have to navigate through. If you're the loud mouth student who speaks up all the time and says the wrong thing at the wrong time you're going to have problems that follow you long after nursing school is over.

[rumwynnieRN]

Clinical can be hard enough whether you get along with your instructor or not. There are so many issues that you have to navigate through. If you're the loud mouth student who speaks up all the time and says the wrong thing at the wrong time you're going to have problems that follow you long after nursing school is over.

You know what they'll say to that though. "But you NEED to speak up when something is wrong." Great for patient advocacy, not so great for your co-workers though. It almost makes the previous point useless if no one wants to work with you.

[Laurie52]

Nursing school is not always fair. And, in my honest opinion, the most unfair aspect of the nursing school experience is the clinical practicum portion, also known as ‘clinical rotations.’ Here is why.

The grades that students earn in the classroom-based theoretical nursing courses are, in most cases, usually objective. Even though the professor who teaches the advanced medical/surgical nursing course might hold personal grudges against a couple of students, the multiple choice exams and quizzes help to even the playing field by giving all pupils a fair chance to demonstrate their knowledge base.

A few exceptions exist, such as the occasional poorly written test question, and the subjectively-graded essay or paper. However, students who are personally disliked by their classroom professor, classmates who are outspoken or opinionated, and those who have been labeled as difficult ‘trouble makers’ by certain faculty members can still pass (and even do well) in the theory portion of their nursing courses through strong performance on objectively graded tests if they study, use all the resources at their disposal, and fully comprehend the material.

On the other hand, the grades students receive in the clinical practicum portion of their nursing school educations are purely subjective and based almost solely on the opinion of the clinical instructor. This is certainly not a problem if the clinical instructor is fair, balanced, rational, has realistic expectations of pupils, and capable of modulating his or her emotions while evaluating students’ performance. It also helps greatly if the clinical instructor possesses a true fondness for transmitting nuggets of knowledge and wisdom to the next generation of nurses.

Let’s return to the subjective evaluation of the clinical portion of nursing education. This is not problematic if the instructor is fair and impartial. However, the end result could be a disaster if an outspoken or mouthy student is being taught by a clinical instructor who has old-fashioned values and expects students to obey, conform, comply, respect authority, and avoid painting her in an unfavorable brush in front of others. No matter how intelligent or skilled the student might be, he will almost certainly fail clinical practicum if he rubs his instructor the wrong way.

Many clinical instructors currently work in inpatient settings such as hospitals where they practice procedural skills regularly; teaching students is a second job for these instructors. However, other clinical instructors exist in academia who have not regularly performed patient care in many years. You may notice some of these instructors performing skills in an outdated manner, or quite possibly, they might do something incorrectly.

The outspoken student who announces in front of other students and nurses in the clinical setting that “Mrs. Smith gave a bolus tube feeding while the patient was laying flat in bed” will become a target, even if he is right and the instructor was wrong. This is the same instructor who will be checking students off on skills. This is the same instructor who evaluates students’ performance and determines who passes or fails the clinical practicum.

If the instructor is the old-fashioned type who does not like it when students correct her in public, do you think she’s going to penalize the mouthy student? If she disapproves of students who question authority, do you think she might give the student who openly questions her a hard time? Keep in mind that if she refuses to check you off on a skill, it is her word against yours. If she insists you failed your most recent clinical rotation due to substandard performance, be cognizant that the director of the nursing program might side with her.

I’ve revealed the nastier side of the politics that permeate clinical rotations in nursing school. My advice is to pick your battles wisely and tread very carefully. Think before you speak, especially when addressing instructors who make grading decisions that impact your future. The grades you receive in clinical practicum are purely subjective, so do not end up on a faculty member’s bad side due to your strong personality and outspokenness. Be aware that no matter how bright you are, the evaluation of one dishonest clinical instructor who dislikes you can set your career back.

Learn to walk the political tightrope. After all, what you know is often as important as who you know in this day and age. Keep that bull’s eye off your back.

Why is it that when an experienced nurse tells her orientee in front of someone that they did something incorrectly they are rude and/or bullying but when an inexperienced nursing student publicly corrects an instructor is just smarter than the instructor. Perhaps the nursing instructor knows something about a particular situation that the student doesn't

Since when is it old fashioned to respect authority?