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.

[TheCommuter, BSN, RN]

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.

I never said that the student was smarter than the instructor. You are putting words in my mouth. I said that no matter how bright a nursing student may be, the evaluation of an unscrupulous clinical instructor can lead to failure.

Perhaps the nursing instructor knows something about a particular situation that the student doesn't

Perhaps. However, my example in the article involved an instructor giving a tube feeding to a patient who was laying flat, which is blatantly unsafe due to the high risk for aspiration.

Since when is it old fashioned to respect authority?

It is old-fashioned to blindly respect authority. Only dictators and autocrats demand blind obedience and blind respect, and they generally do not want to be questioned regarding why they do the things they do. A democratic leader will earn respect and not demand that it be automatically conferred. A democratic leader will not mind being asked questions.

Higher education teaches people to respectfully question authority if something does not quite sound right. The least educated members of our populace obey without questioning and blindly respect authority figures, and as a result, get steamrolled in life.

[itsnowornever, BSN, RN]

Correcting anyone in public is bad form and should earn you some scorn. As an adult and person you should know better than to do that. Also, thinking this is the right thing to do, will gain you some well earned hatred once you become a team lead, charge nurse or manager.

Posting from my phone, ease forgive my fat thumbs! :)

[Feistn]

So what? Guess what, you're going to work for people in the field who don't like you, humiliate you in front of patients, never take your side, and are hypercritical of your work. And those people will be especially difficult when you are starting out and genuinely do NOT know everything. You don't like your clinical instructor critiquing you in front of others, yet you called out her skills in front of others. You have to give what you want to get. And if you recognize that a clinical instructor "has it out for you," did you throw up your hands, sit down and have a little girl fit about things not being "fair," or did you try to figure out what YOUR contribution to the situation was? Were you defensive every time she said something? Did you argue every little point? Did you at least TRY her suggestions? Did you badmouth her to other classmates and faculty, and have it reach that person? Instructors that you don't "gel" with are going to happen. It will also happen in the real world, and then you have to deal with that person a lot longer than 17 weeks. Think of it as practice for that reality.

[TheCommuter, BSN, RN]

So what? Guess what, you're going to work for people in the field who don't like you, humiliate you in front of patients, never take your side, and are hypercritical of your work. And those people will be especially difficult when you are starting out and genuinely do NOT know everything. You don't like your clinical instructor critiquing you in front of others, yet you called out her skills in front of others. You have to give what you want to get. And if you recognize that a clinical instructor "has it out for you," did you throw up your hands, sit down and have a little girl fit about things not being "fair," or did you try to figure out what YOUR contribution to the situation was? Were you defensive every time she said something? Did you argue every little point? Did you at least TRY her suggestions? Did you badmouth her to other classmates and faculty, and have it reach that person? Instructors that you don't "gel" with are going to happen. It will also happen in the real world, and then you have to deal with that person a lot longer than 17 weeks. Think of it as practice for that reality.

To whom are you responding?

I am the person who originally wrote the article, and the events described (such as calling out skills in front of others) were hypothetical scenarios that didn't happen to me. I'm describing stuff that has happened to other current and former students.

I'm way past nursing school and have been working in the 'real world' of nursing as a licensed nurse for 7 years, so I certainly know how the real world works. Many students are not knowledgeable about nursing school politics, which is why I wrote the article.

[melizerd, ASN, RN]

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.

Addressing the part where you said you would have to be late one day and miss one day: That's not nursing politics, that's attendance. We know going in that unless you or someone you love is dying (almost quite literally) there are no missed days, Period. We know the policy on attendance going in, it is spelled out.

[SoldierNurse22, BSN, RN]

Correcting anyone in public is bad form and should earn you some scorn. As an adult and person you should know better than to do that. Also, thinking this is the right thing to do, will gain you some well earned hatred once you become a team lead, charge nurse or manager.

Posting from my phone, ease forgive my fat thumbs! :)

That's a nice theoretical stance to hold, but reality isn't quite so simple.

For example, if you accidentally put the BP cuff on the patient incorrectly or you give them the wrong lunch hours for calling in their meal order, I'll correct you outside in private and let you fix it later.

However, if you fail to wash your hands between patients, program an infusion rate incorrectly or are about to do something that could cause harm to the patient, I will stop you on the spot.

I will show you how to do it correctly and then explain myself further outside if need be, but don't think for a second that correcting someone in public is always a bad thing.

[tobjur]

nice post. well this is a problem everywhere as i see it now. with due respect to all you nurses in big country's, who has the broadest aspect of nursing. i smiled a lot when i read this post and the thread that followed. i remembered a lot of incidents during my phase of life as a nursing student especially the times when we lucky tipped for a clinical procedure and how i always used to pick up the senior staffs.it always worried me sick to do my sign outs with the senior lots for the fear that they might find out the smallest of mistakes and send me out with a 'repeat' which was the worst nightmare during student life. all those memories flashed back...thank you..:):)

[elkpark]

However, if you fail to wash your hands between patients, program an infusion rate incorrectly or are about to do something that could cause harm to the patient, I will stop you on the spot.

I will show you how to do it correctly and then explain myself further outside if need be, but don't think for a second that correcting someone in public is always a bad thing.

Again, though, this is something that can (and should) be done without calling the attention of everyone within earshot to the fact that you're doing it.

[SoldierNurse22, BSN, RN]

Again, though, this is something that can (and should) be done without calling the attention of everyone within earshot to the fact that you're doing it.

I don't believe I ever indicated that I would try to draw the attention of "everyone within earshot". Not quite sure where you got that impression.

There is a difference between gentle correction designed to change a behavior/thought process and humiliation.

[elkpark]

I don't believe I ever indicated that I would try to draw the attention of "everyone within earshot". Not quite sure where you got that impression.

There is a difference between gentle correction designed to change a behavior/thought process and humiliation.

I agree with you, and wasn't suggesting that you implied that -- the OP's article described a student nurse criticizing/correcting the nursing instructor in front of the whole clinical group, in a public setting.

[SoldierNurse22, BSN, RN]

I agree with you, and wasn't suggesting that you implied that -- the OP's article described a student nurse criticizing/correcting the nursing instructor in front of the whole clinical group, in a public setting.

Ah, gotcha. Yes, I agree that is in very bad taste and doesn't accomplish much of anything but a headrush for the instructor.

[ThePrincessBride, MSN, RN, NP]

Very true article. My clinical instructor hated me (and I wasn't mouthy or disrespectful), talked about my performance to other students behind my back and was overall a complete *****. She failed me and made false accusations about my performance, but I have since had two awesome clinical instructors.