Why are clinical instructors so cold

Kelly_the_Great · Dec 10, 2005

Tulip,

Sounds like you are a lot more involved in the clinical process than my instructors have been. They don't pick out our patients or review their records the night before. Rather we are assigned a preceptor for the length of that course's clinical rotation (unless they quit, like mine have done - you know nurses & turnover... :rolleyes: ) and usually the preceptor decides which patient/patients we should take on. Mine usually just asked me which ones I wanted.

BCzito,

Let me give you some advice, it's worked for me thus far. Prepare in your mind, a verbal report of your patient, while you are caring for them throughout the day. Start out as soon as you receive the pt., dx., age, support system, was this an acute dx. or an exacerbation of an existing condition, also as you mentioned the labs, meds, recent dx. studies, x-rays, etc. Then while you're actually performing the care think of the reasons why. Tulip provided some really great examples above.

Reheorifice this report in your mind. Talk to your preceptor (if she has time) about your patient, many enjoy teaching as well. Then when your instructor comes to the floor and asks, how's your day and what patients you have. Just begin your report.

This will help you in a lot of ways. Number one, in your particular situation, the instructor is so busy listening to your report she's not busy asking questions you don't know the answers to...lol. They don't have all day just to spend with one student, they'll need to be movin' on rather quickly. Number two, this will help you learn, it'll help you better format your care plans & if you have any concept mapping to do as well. Number three, this is a skill you need to learn anyway, you need to learn how to give a good report to your fellow nurses @ shift change (when you become a nurse) and you'll need to know how to give the docs a good report. Believe me, docs are not gonna pry (sp???) it out of you the way instructors do and if we don't tell 'em, usually they don't care, that is until th' sh*t hits th' fan, then guess who'll get all th' blame.

Hope this works for ya! In the meantime, hang in there...

BCzito · Dec 10, 2005

Tulip,
Sounds like you are a lot more involved in the clinical process than my instructors have been. They don't pick out our patients or review their records the night before. Rather we are assigned a preceptor for the length of that course's clinical rotation (unless they quit, like mine have done - you know nurses & turnover... ) and usually the preceptor decides which patient/patients we should take on. Mine usually just asked me which ones I wanted.
BCzito,
Let me give you some advice, it's worked for me thus far. Prepare in your mind, a verbal report of your patient, while you are caring for them throughout the day. Start out as soon as you receive the pt., dx., age, support system, was this an acute dx. or an exacerbation of an existing condition, also as you mentioned the labs, meds, recent dx. studies, x-rays, etc. Then while you're actually performing the care think of the reasons why. Tulip provided some really great examples above.
Reheorifice this report in your mind. Talk to your preceptor (if she has time) about your patient, many enjoy teaching as well. Then when your instructor comes to the floor and asks, how's your day and what patients you have. Just begin your report.
This will help you in a lot of ways. Number one, in your particular situation, the instructor is so busy listening to your report she's not busy asking questions you don't know the answers to...lol. They don't have all day just to spend with one student, they'll need to be movin' on rather quickly. Number two, this will help you learn, it'll help you better format your care plans & if you have any concept mapping to do as well. Number three, this is a skill you need to learn anyway, you need to learn how to give a good report to your fellow nurses @ shift change (when you become a nurse) and you'll need to know how to give the docs a good report. Believe me, docs are not gonna pry (sp???) it out of you the way instructors do and if we don't tell 'em, usually they don't care, that is until th' sh*t hits th' fan, then guess who'll get all th' blame.
Hope this works for ya! In the meantime, hang in there...

sounds like good advice. I just wish I wasn't such a sensitive person because I know all the students in my group are working their bums off trying to learn to be great nurses , and all they want to do is to do a good job, they aren't trying to scrape by on work or the likes, they just want to take care of their pts really well and learn. Its just hard. I have a degree in neurosciece and it was just a very different learning enviroment. Sometimes I think to myself, I wish she was trying to learn the brain surgery's I did in my research experiments (on rats) and see if she could learn that in 8 days. I bet not. and personally I think nursing has a lot more components to it, so its just beyond me. I feel like they don't want you to succeed. And don't get me wrong I definately learned allot from my cold clinical instructor, I just wish I could have passed over the lesson about how most people in this world don't really give a **** about you , how you feel or anything... I guess I am just a really sensitive person. I was given some good advice here, and from a classmate, basically people suck and just ignore them. I was always really into our post conferences and learned allot from what people presented and was really interested, but I feel like instead of being seen as an eagar student I was looked upon as an annoyance to her. so basically now my plan is to only speak when spoken too, and never say a word ever. Its the only way I feel comfortable at this point. so I guess thats the plan.

Paleobug · Dec 10, 2005

I look at most clinical instructors as cranky bosses not nurturing, mentoring instructors. I don't really learn much from hard nosed instructors that try to be intimidating. I try to learn from nurses who like students. These nurses have usually graduated in recent years so they're not burned out and negative yet.

BCzito · Dec 10, 2005

I look at most clinical instructors as cranky bosses not nurturing, mentoring instructors. I don't really learn much from hard nosed instructors that try to be intimidating. I try to learn from nurses who like students. These nurses have usually graduated in recent years so they're not burned out and negative yet.

I very much agree with this statement, I only wish they would have called her my "clinical supervisor" or "clinical boss" instead of instructor which lead me to believe she was there to "instruct" me. Now I know you should treat them like a boss that you hide your weaknesses from. In addition I totally agree about flocking to the floor nurses who are truly great nurses and willing to help. There were a few of these on the floor that I worked on and I learned more from them than any book or "instructor". Actually it was kind of funny one very experienced cardiac nurse on the floor who I was shadowing confided in me that she "hated" my clinical instructor. I was pretty surprised since we had just been looking up CRE levels of new labs. She just saw her and was like "argh, I hate your clinical instructor, she always gets in the way even when there aren't students around. One day when I had a pt faint she was getting all excited and making it a very roudy environment instead of letting me do my job, I was calm because I've dealt with pts like her a million times and I know how to do my job, and she just would not get out of the way, and it was MY patient." so it was slightly validating, although I just listened and did not add to the conversation, mainly because at that pt I didn't realize how cold she really was yet and because I always try to give people the benefit of the doubt. What was most surprising was the nurse that said this was very proffessional and reserved... I guess now I know

1Tulip · Dec 10, 2005

Just wanted to say that I do understand how much is going on for my instructor, however, she would often criticize me to things beyond my control, such as brushing a mans teeth who had encephalopathy and did not communicate, and everytime you would get near his mouth he would clamp it shut. I tried to pull his chin down (pretty firmly), but I think there comes a point where that pt is trying to assert what little autonomy he had left and I didn't want to hurt him. When I voiced that I felt like I'd hurt him she says "its a sponge!" really annoyed. I wasn't talking about the brushing I was talking about breaking this poor mans jaw off.
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Let me tell you how to do this. Because mouth care is reeeeeaaaly important. (Know how crappy your mouth is in the morning? Know how many drugs have anticholinergic (side) effects and dry the mucous membranes? And imagine how bad it gets in that guy's mouth because he can't just sip some water when he wants to.)
Anyhow, this is a common problem. And your instructor is a dope because she didn't know this trick. Plus she thinks that those little spongey things do any good. (They are next to worthless.)
Here's what you do. Get stuff together: Water, mouth wash, maybe tooth paste, and a tooth brush. (Sometimes I use dilute hydrogen peroxide, but ask before you use it.) Get a suction catheter hooked to suction. And get a whole big stack of tongue blades. Put some chux down across the pt's chest.
Take two tongue blades one on tope of the other. Gently pull the pt's lips open, and find a spot of maloclusion where the teeth don't set right on top of each other. This is usually in the front. And everyone has some small gap if you look for it. You may need a penlight, but it's not too hard to find. You can also do this with an edentulous patient, you just have to be a bit more careful.
Insert the two tongue blades between the teeth. You may have to use the lower teeth as a fulcrum to open the mouth enough to insert the two tongue blades. Then take one or two more tongue blades and insert them between the first two. Then two more. Then two more, then two more. Now you have the mouth open. Move the stack of tongue blades a bit back between the molars. (Gets them out of the way.) Then go to work with a toothbrush dipped in water and/or mouthwash or a little of both. When the mouth starts to get full of liquid or saliva, use the suction catheter. Be quick, but take enough time to do it thoroughly. Make sure to give the buccal membranes a good washing. Secretions can grow so thick on the inside of the mouth that they form a film that looks like skin. Hopefully you'll never see that, but make sure you are looking at healthy mucous membranes and gently (soft bristles) massage those as well as get the teeth clean. Also the tongue.
Voila! Clean mouth. Patients should have good mouth care at least every four hours in my opinion. They are always having some "micro-aspiration" and if the mouth is a cess-pool, you can imagine what's going to get into the upper airways.
Finally: Try to get your satisfaction from what YOU do, not from what others think about you. If you are making progress in your studies that should be what matters. If your patient is a little bit better off after you've spent the morning with them... that's what counts.

hope3456, ASN, RN · Dec 10, 2005

I am encouraged to know I was not the only one who had problems with clinical instructors! It sounds like it is a common problem.

However, my Medsurg II instructor was really out to get me. That was over a year ago so I am beginning to laugh at the situation. (It's kindve long and maybe boring, but it is nice to get it off my chest)!

It started the 2nd day of clinicals when I needed to give a IV push of zophran. I calculated the dose (2ml), and then went to get my instructor to help me draw it up into a syringe and administer it. Now, I don't have problems drawing up IV meds out of vials anymore, but excuse me, that was like the 2nd time I had done it, so I was having minor trouble - esp since zophran is kindve thick.

She kept telling me what I was doing wrong, not holding the vial straight, ect and then when I got to the 1ml mark I kept drawing more med.....dose was 2ml right? She practically yelled at me..."what are you doing? That is enough. put the excess back into the vial." I admit,that made me mad (mostly at myself) b/c I thought I had calculated the dose wrong and I thought to myself "I am just about a RN and I can't even figure a simple dosage calc?" I got kindve shaky and nervous at that point also, it didn't help w/ this instructor standing right over me. In retrospect, I probably could have drawn up the medication fine if I was left to do it myself.

Okay, so finally I am ready to go give the med. I know I must have looked really nervous but partly it was b/c I knew it was the wrong dose and I am thinking to myself...."what should I do?" I didn't want to cross the instructor (I heard you should never do that) but I didn't want to give the wrong dose. Finally I looked at the MAR, recalculated and told her the dose was 2ml, not 1ml. She looks at it and was like "okay,(very snotty) draw up the rest." I put the needle back in the vial and yes I am upset and shaking - not a good combination for having to hold that little vial....and she just became even more impatient and critical as I was drawing up the 2nd ml...

So anyway, this clinical is graded on a pass/fail basis -there are some VERY subjective criteria which they deem you Satisfactory or Insatisfactory - and the instructors writes an eval on you midway through and at the end. My midway eval was very negative and MEAN. However, I could tell that it was also very vague and subjective... she really didn't really have a specific complaint on me. Just saying I couldn't communicate, ect. She didn't really say anything to me about it, so I just decided, "if she is going to fail me, let her. I am doing the best I can." I also kindve figured it was a personality difference. I also knew that if you were in danger of being failed they had to give you a verbal warning, which she didn't.

Through the second week, which was on a Telemetry floor, she continually tried to stump me and embarrass me in front of my coassigned nurse. Now, I worked as a CNA on a tele floor so ..ha ha. I have to say I knew my $##$# pretty well and she had a hard time.

Okay, so for my final eval, she pulls me aside and tells me she is concerned about my anxiety problem.... and then relates back to the 2nd day w/ the zophran push! She lectures me about how lousy I did and also gives me this speal about how I have problems following directions...all related to drawing up 2ml of zophran! This is all in a very condescending tone of voice. And yes, at the time I did have somewhat of an anxiety problem, but what nursing student doesn't? And then I understood then what the problem was, I hurt her pride...or something of the sort and she had to cover herself over her mistake of calculating the wrong dosage.

I know I am not a perfect person and am open to criticism to repair my faults. But if I really had a problem with all this, why didn't she bring this up with me at the midway eval or sooner? I regret I didn't stand up to her more and present my side....I even think now that i should have gone to the lead clinical instructor and asked for another placement. Oh well. live and learn. And yes, sometimes i do have a problem with assertiveness.

They say that nurses need thick skin. I have to say, she definately made my skin thicker!!

ortess1971 · Dec 10, 2005

I have found that the instructors/nurses that are nasty to students are usually the ones who are insecure in their own abilities and are threatened by students who they think "know it all". I work in the same hospital where I am doing my Maternity rotation and I actually dread running into someone I know while my teachers are there. The instructors also give anyone who has prior healthcare experience a hard time. My instructor asked me where I wanted to work after graduation and when I replied that I am going to be an OR nurse, she replied that she thinks the OR is a "boring" place to work?!??? Whatever.... One of my coworkers is doing a project on "lateral violence"- which is basically nurses eating their young and being nasty to each other. There are always seminars about it around here. As soon as I graduate, I'm going to send a letter to my school, enclose a brochure from one of these conferences and say that seminars on lateral violence should be required for nursing instructors:chuckle

Paleobug · Dec 10, 2005

Yes, clinical instructors can be drama queens. A lab instructor told us one time that another purpose for clinical rotations is so that the students will get used to different bosses/supervisors management styles through clinical instructors, like it is in the real world. I'm just finishing third semester, and that is so true.

BCzito · Dec 10, 2005

All this advice has really been helpful (especially about the mouth care! that is a really great technique!) I doubt my clinical instructor would have liked it, I'm sure she'd find something wrong with it, because she hated me. Someone mentioned having a problem with anxiety, and I definately do. I can't help it. I can do things when she isn't around but I freeze in terror when she is because the moment she is around she criticizes everything I do. I would love to hear more tips about how to get difficult tasks done like that tricky mouth care situation. Also my next group of clinicals are OB and PEDs and community health and psych (the only one I really want to work on!) does anyone have any advice on specific things I should look up to prepare for these, what types of differences are there with flushing or general protocals. (we haven't studied either in class yet cause I am in the masters entry.). Are there any difficult situations that people have come up with unique ways to deal with them or to get things done. Its so helpful to learn from you guys. really I can't explain it enough.!

Whispera, MSN, RN · Dec 12, 2005

I'm a nursing clinical instructor and don't believe I'm cold toward my students. Hmmm... Also, I've had plenty of clinical instructors who were extremely warm and caring. Maybe you've just gotten a bad batch?

1Tulip · Dec 12, 2005

I'm a nursing clinical instructor and don't believe I'm cold toward my students. Hmmm... Also, I've had plenty of clinical instructors who were extremely warm and caring. Maybe you've just gotten a bad batch?

I don't think I'm "cold", but no one would call me warm and nuturing either. (I have my two kids who get that from me... I figure any student who needs me to be their emotional pillow has problems that clinical instruction can't cure.)

BUT... having said that, students deserve to be treated with dignity. And, they deserve to be treated fairly. I particularly hate that vague stuff. I myself was told I was "unprofessional" at least once in nursing school. And my psych instructors criticized me for having anxiety problems. Well duh! I'd been attacked (no harm done) by a loon on a locked ward. Go figure!

I don't think students need sweetness and light from their instructor. But they need to see enthusiasm for the practice of nursing, they need to be encouraged when they do stuff right. They need to be told they did something wrong, but they can get it right next time.

I don't think students need a "mom" on the unit. And they don't need a drill instructor either. I think they need a coach.

BCzito · Dec 12, 2005

I don't think I'm "cold", but no one would call me warm and nuturing either. (I have my two kids who get that from me... I figure any student who needs me to be their emotional pillow has problems that clinical instruction can't cure.)
BUT... having said that, students deserve to be treated with dignity. And, they deserve to be treated fairly. I particularly hate that vague stuff. I myself was told I was "unprofessional" at least once in nursing school. And my psych instructors criticized me for having anxiety problems. Well duh! I'd been attacked (no harm done) by a loon on a locked ward. Go figure!
I don't think students need sweetness and light from their instructor. But they need to see enthusiasm for the practice of nursing, they need to be encouraged when they do stuff right. They need to be told they did something wrong, but they can get it right next time.
I don't think students need a "mom" on the unit. And they don't need a drill instructor either. I think they need a coach.

I couldn't agree more especially abou the part that if they do something wrong they should be told something to the efffect of you'll get it next time. and mine never never told us when we did something well, she was enthusiastic though. I'll give her that. Anyway.. off to studying thanks for your input, its given me some hope for my next clinicals.