The Wicked Politics of Clinical Practicum in Nursing School - page 7

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... Read More

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    I like to view my patient as a whole person, not just a patient with medical problems.

    I don't know how theraputic it would be for me to enter a room, introduce myself, sit down and say ''so how does it make you feel to have a bilateral mastectomy?"
    And then silence.......

    Then i'll tell them ''ill just stay here for a while"
    More silence...........
    "It seems to me like you're a little apprehensive right now, tell me more about that..."

    GET OUT!!!!!!!!!!!!

    What really gets me is the ''its my way or it's wrong"
    Just like the type A vs type B personality nurses, or the quiet nurse, etc.

    I've been working in a hospital for over 2 years, have had people tell me they're scared to die alone, they feel ashamed, etc.

    There's more than one way to skin a cat, I think my instructor jumped to a conclusion too quickly

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    I failed my clinical for LVN and was dropped from school.7 months into the nursing programe. I tackled my clinical teacher for always calling me YOU - I am 57 and she didn't like me. She got me so rattled I made mistakes in clinical one week and was out of the course and at my age - don't feel up to starting all over again
    milfordmom likes this.
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    Quote from GrnTea
    I don't see anyone here posting from the instructor perspective. I have been a student, too, and remember it vividly, good instructors and not so good ones (my psych instructor had a breakdown halfway through the semester and had to leave... oy). And I have also been a staff nurse, a manager, and an instructor, which students have not. No matter what you think you know about the performance issues of other students, all you know is what the student tells you, loudly and aggrievedly.

    Your student friend is not likely to tell you that the reason she was put on probation by the department, not just by me alone, due to poor clinical performance was because her care plans were late, incredibly poor, completely illegible, and/or missing the required elements of assessment and planning.

    Or that her "med cards" had nothing more than the name of the drug on it, and she wasn't able to tell me why her patient was getting any of them, and couldn't figure out the dose.

    Or that because she was an LPN and knew how to make an occupied bed with both eyes closed, she thought that meant she knew everything there was to patient care.

    Or that, having being incompetent in all these IN ONE WEEK, after missing one or two of them in the previous three weeks, she was put on an improvement plan and committed to making up the missing work, knowing her meds, and knowing her patient's diagnosis next week....and did none of it. Showed up at clinical without having done any of it at all.

    So yes, when you walked past me at the med cart with her and heard me tell her that it was inexcusable that she had not done what she had agreed to do, in writing, in front of me and the program coordinator, then you might not really know what was going on and think I was a terrible person. But when you heard her tell it later, I was the world's biggest soandso because I got mad at her just because she didn't know one medication. And I was mean to her because my best friend was the coordinator (um, not so much), or because we were of different ethnic groups (oh, puhleeze). And the program was prejudiced against her because she came from (some other region of the country). Or some other BS.

    Just sayin'. Sometimes they really are terrible students and they really do deserve to get put on probation and they really do flunk out.

    Would you want us to do otherwise? Is your mother in that bed? Believe me, no matter what it looks like to you or what anecdotal things you hear, people do not go into teaching nursing (which pays a lot less than being a working nurse on a floor) to make life miserable for students. We do it because we care deeply about our profession and want to see how many, if any, of our students will have that spark and catch our passion for it.

    We are also evaluated by our managers, and if we have a larger than average number of failing students we have to account for that. Yes, we discuss students among ourselves, just as you discuss instructors. We work hard to read and critique care plans, journals, papers; we take continuing ed ourselves to help us be better teachers. As I said, we've been students, we know how it is. It's probably not reasonable for you to think about what it's like to be instructors and deal with the groups we see. But it wouldn't hurt to think, just for a moment, that you don't really know much about what you're talking about so cavalierly.
    All of this! I have been told that I am evil for failing a student who twice tried to perform skills outside the scope of practice despite warnings. A student tried to poison her entire class against me by claiming I am a racist and targeted her (she was caught stealing and dismissed). The vast majority of students are great, but just as there are terrible instructors, there are also terrible, incompetent students. Never once have I heard the dangerous student admit that failure was his/her fault. It is ALWAYS the instructor's fault. I make about half of what I could in full-time practice because I am dedicated to the future of nursing. I can say that I've never seen a student failed out of clinicals that I would want caring for me or my family.

    There are scary, incompetent, and hateful people who are instructors, students, and members of every profession/group under the experience is that this is a small percentage and not the norm.
    ProfRN4 and elkpark like this.
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    Clinical portion was difficult for me. Typically there were 6 to 8 of us students per clinical. I was quiet in school. Most of the students in my small program were part of a clique. It should be noted that most were hispanic. I'm white but I speak Spanish well. I can't count how many times I heard "this white girl this" "this white girl that." That did not help me want to make friends. (Oh the surprised looks on their faces when they saw I understood them when they spoke spanish) I was about a decade older, so they were young. Most very gossipy. I despise gossip. I remember watching students laughing and talking to each other, to then see one of them walk away, and the remaining girls laugh behind her back. Bottom line, I stayed out of it. I remained cordial, smiled at my class mates, laughed when appropriate, Participated in group conversations. But, staying out of gossip made me an out cast.

    During clinical the other students cliqued up while I focused on the work. I still made sure I worked as part of a team. We didn't have to like each other, but I respected them on the job and offered and accepted assistance when needed.

    I recall during one of my clinical reviews, my instructor saying that I did not act as part of the group. I wanted to say, "your point?" But, she herself being young and gossipy even with the students, apparently judged me by this. Not by my clinical skills, judgement, paper assignments, presentations...I don't believe she even noticed how frequently I offered my assistance to both classmates and staff; she had already made her mind up about me. I wasn't trying to be buddy buddy, and that really affected how 2 of my instructors viewed me.

    It wasn't til a year after I graduated that I met up with an old clinical instructor who then admitted to me that when I came to her clinical rotation the other instructors "warned" her about me. She told me that all during clinical, she could not see what those instructors meant AT ALL. This instructor gave me an incredible letter of recommendation and allowed me to take her NRP class for free.

    ***SOME**** instructors have preconceived notions about students, and it meant the world to me that my OB clinical instructor said to me in reference to those other instructors, "screw 'em."
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    Quote from SleeepyRN
    I recall during one of my clinical reviews, my instructor saying that I did not act as part of the group. I wanted to say, "your point?"
    Something similar happened during my time attending an LVN program back in '04/'05. My clinical instructor would ask, "Why don't you eat lunch with the other girls?" and "Why don't you talk to the other girls more?"

    I didn't tell her that the other 'girls' were too giggly, gossipy and immature for my tastes. I didn't mention that the 'girls' spread horrible rumors and talked behind peoples' backs.

    It's a sad day when one is expected to conform to the lowest common denominator.
    SleeepyRN likes this.
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    I am a good student who has definitely had clinical issues--not with my practice, mostly with grossly unprofessional instructors. One I have now is retired from the hospital where we are doing rotations and she spends the vast majority of her day gossiping with her coworkers. One can never really tell what will push you to her bad side, so I even when she tries to provoke me, and she tries hard, I don't take the bait. As a result, I'm getting a subpar clinical experience where I can't ask questions. It's just a huge waste of my time--I end up asking nurses where I volunteer to help fill in those clinical gaps but they can only do so much.
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    At my school there is rubric that is supposed to be followed for clinicals, but its use seems to be optional, as every clinical instructor I've had goes about giving assignments or judging what constitutes passing in a different way, sometimes disregarding the rubric all together. We don't get a grade besides pass or fail for clinical and it's rare that someone fails. Theory exams are where the actual letter grade comes from. Having said that, I've had some good clinical instructors and some really horrible ones. Currently, I am dealing with an instructor who is great at organization and seems to know her stuff, but she is extremely moody and tends to demoralize students. I've personally found that in clinicals, the best way to go forward is to smile and keep my mouth shut. I've seen some things in clinical that actually enrage me and/or seriously make me hope to never be in that particular hospital as a patient or a nurse. But I've learned the best thing to do is to keep my mouth shut and smile. I've also learned by observation that by pointing anything out or trying to do things the way we were taught to do them, you will be targeted. It's sad actually that this will be one of the biggest things I learned in clinical rotations.
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    Quote from runsalot
    Best lesson for nursing students. Be quiet. And smile. A lesson I learned again this week.
    I am a second degree student who in their previous career was always encouraged to have healthy conversations with my bosses. Not so in ns. Smile and take it. I may have a tattoo put on my body to remind my self.
    My daughter is an RN, and now many years later, I am following in her footsteps with a second career goal of becoming and RN in my mid 50s. Her best advice to me was to watch and listen, smile and be quiet, never let them know you know how to do something, just step up and do it! Best advice ever!!
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    I completely agree with this article. I had a similar experience in nursing school, and I have seen first hand how a personality conflict "real or imagined" in the instructor's mind can cause unfair treatment. I had always done just fine in clinicals but 3rd semester that all changed. I had an instructor who decided to hang me out to dry whenever she got the opportunity, bully and berate me in front of my other classmates. I was completely floored by her behavior. Every friday after clinicals I would hold it together and then cry all the way home. The other students used to ask me why she had it out for me and why she was being so rude to me all the time and I could honestly say "I DON'T KNOW." Long story short, this instructor yelled and screamed at me in the med room when nobody else was around. I had enough and told my contact person in the nursing program who was a very fair and kind-hearted instructor. She intervened in my behalf and even went to the dean. I was able to prove the abusive behavior because the clinical instructor had gone so far as to write nasty comments on my care plan that were really unnecessary but I'm glad she did because it was her eventual undoing. Anyhow, they didn't confront her until my clinicals were over, because I was afraid of retaliation on her part. But I had given them a heads up in case she tried to fail me. On the last day of clinicals she actually tried to do just that. She confronted me and said that my skills were not where they need to be, and on and on. I told her "How can you rate my skills when you have refused to help me all semester and are never around to observe what I am doing?" She agreed in a sarcastic manner and on my review wrote "I can't rate this student's skills because she did not come to me for help." She finally admitted to me that she had an issue with me because I was filling out my clinical evaluations wrong all semester. She claimed she tried to correct me and that I just continued to do them wrong. I remember her telling me they weren't right but she did not explain exactly what was wrong, and I thought I had corrected the problem. So instead of her sitting down with me and pointing out what I was doing wrong and making sure I understood, she just assumed that I was purposely ignoring her correction and turning them in the way I wanted to do them. She said it irritated her so much that she didn't want to deal with me anymore. I thought she sounded absolutely insane saying that especially after she had just denied having any issue with me and saying it was all in MY mind. So yes, sometimes you can get an instructor who isn't fair and they can make your clinical life miserable and fail you too. Side note, I started clinicals 4th semester in the ICU, and was told by my preceptor that I had very good skills, and was a fast learner and smart too. I graduated in December and have been working in the ICU ever since. How did I go from being incompetent 3rd semester to a shining star 4th semester and getting offered a job in a high acuity setting?? I think it speaks for itself.
    pjgal2000 likes this.
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    I have to agree with this completely. I am about to graduate in a few days (thank God) and was fortunate enough not to have any major problems, but that was definitely not true for everyone! After first semester our instructors did not stay on site with us and provided no feed back at all throughout the semester. We received one mid semester eval and one at the end to result in a P or an F. I came from a professional background in operations and am used to interacting tactfully with superiors as another competent adult. NS was a major wake up call for me in that a few instructors very much treated us like children and tolerated no input of any kind. With our grading structure they could easily fail someone in clinical with little to no reason and pass someone else with identical discrepancies.
    coolbreezegurl likes this.

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