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Palliative Care, DNP 12,381 Views

Joined Jun 28, '11 - from 'Virginia'. Palliative Care, DNP is a DNP, FNP. She has 'Since 2009' year(s) of experience and specializes in 'Family Nurse Practitioner'. Posts: 742 (55% Liked) Likes: 1,829

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  • Mar 24

    Quote from mw73
    It seems that the majority of the comments indicate that nursing is a highly stressful career. Are any of the posters that have commented about this NPs in private practice?
    I believe some of the prior posters are NPs and others are student NPs or RNs.

    I am a private practice NP. Nursing is a stressful career. Nursing at the APN level is perhaps less physically stressful and more mentally stressful. You are responsible for the life of 1500-3000+ people in a job where one miss or one mistake could significantly impact the quality or quantity of life in any one of those people. Additionally, there is a significant amount of administrative red tape which is also stressful. As is just dealing with people at times

  • Mar 24

    Quote from Sue Demonas
    The best foundation for a successful nurse practitioner career is to have strong bedside nursing experiences. Entry level nursing (ie bedside care) provides the foundational experiences and skills that are needed to build on for advanced nursing practice.
    Do you have a source on this that you can share with us?

  • Mar 24

    You are never going to find a work environment that doesn't have variables that get in the way of good nursing practice. Anywhere that you work, there will be a person or persons whose sole job it is to maximize bang for the buck. These people aren't nurses, and they care about saving money, period. That could mean scrimping on equipment, or supplies, or salaries, or training, or staffing - or any combination of these.

    As far as the NP goes, my sister (long-time veteran RN) just finished hers, and she can't find a job with it.

  • Mar 10

    As a student graduating in May, I think you should probably fail her. Not knowing how to do some things and being a bit unsure comes with the territory of being student (and apparently a new grad for at least 6 months from what I've been hearing). But refusing to actually do things and refusing to take the opportunity to learn while she still has so much support as a student is probably a bad sign. The fact that others have also picked up on her behavior validates your concerns.

  • Mar 10

    Quote from Avid reader
    Why do I need to be evaluated? I tried to give her the benefit of the doubt and be a good preceptor. I'm not her school. I'm not her program. I bent over backwards teaching her. I know I have to fail her but I know it's going to suck. Thanks making me feel even worse.

    DWelly, I'm not trying to make you feel bad, you're doing that for yourself. I'm not also trying to be harsh re your student but you simply have to pay more attention. We cannot afford to ever not be vigilant. You of all people should know this being in L&D. I find it impossible to understand that people can't understand that when our patients suffer from our mistakes, multiple entities are involved and not just physically but also psychologically and emotionally. You have to be prescient, vigilant, always!! We all make mistakes but if it involves myself, I can live with the consequences hopefully, but to through carelessness or inattentiveness cause harm, appears criminal. Your primary priority is to advocate for the patient and that means reasonable standards of care. And grow a set if you are to be effective at your job. The better the nurses you educate, the better they represent us effectively.
    I guess I don't understand what you are saying at all. No patients have been harmed. I have made sure of this. My student is just not performing and needs to be failed. I'm having a hard time with this because it is never easy telling someone that they are not able to do something that they have put so much time and money into (I'm not going to say effort because it does not appear she has put much effort into it). I'm not a heartless jerk who can just casually do that. I know that I need to fail this student because of the behavior I have witnessed. I was hurt by your originial comment which I interpretted that I somehow needed to be evaluated because I was a poor preceptor or teacher. I'm thoroughly confused by your more recent comment and how it applies to my student.

  • Mar 10

    Quote from lnvitale
    In my program people did not fail clinical unless they repeatedly did something very aggregious. Nothing like what you are describing here. No one failed their leadership/capstone clinical.

    Your expectations for what a student should be comfortable with in their last semester may not match those of the school. Schools have shifted focus in recent years and this shift is based on research.

    We ought not be having a discussion on whether or not you should fail her because that isn't your call to make.

    However, you definitely meed to have a talk with her instructor about your concerns.
    The school I'm working with it is my call to make as her instructor is not with her during this rotation. I am. I evaluate her and ultimately make the call as to whether she met the criteria to pass her clinical portion of her capstone. She can absolutely fail if she is refusing to perform the duties assigned to her. I honestly wouldn't fail her for anything else but there have bee 4-5 times that I literally have not been able to find her. If this were her job, I would classify that as patient abandonment. That's pretty serious stuff.

  • Mar 10

    Fail her. Lazy and going to hide did it for me. Why would I want to meet another of her kind at work?

  • Mar 10

    Quote from cleback
    That's too bad. It may be too late now, but were you very clear on your expectations for her? Did you talk with her how you felt they were not being met?

    I remember being a student... this post brought memories of a not so pleasant rotation. The whole experience was bad and my instructor wanted me to be more independent than I felt comfortable with, but in general, I had trouble figuring out the role of a student nurse... I remember my instructor pulled me into a room for giving blood with another nurse--just as a learning experience. My other assigned patient happened to need a glucometer check at the same time, so I asked the nursing assistant to do it for me because I wanted to see the blood being given. My instructor chewed me out, saying my primary responsibility was to the assigned patient and I should have left the transfusion to take care of the glucose check myself. I really didn't know that's what she expected of me as a SN. So yeah, she probably thought I was shirking on my responsibilities too.

    Failing someone is really big deal. If she really is slacking, then by all means, do so. That said, I would hate to have that happen to someone if the problem was communicating expectations. Maybe, since it's late in the game, talk with the clinical coordinator with your concerns?
    Expectations have been discussed multiple times with her. The biggest issue is that she just laughs it off when you call her out on disappearing. So I'm walking in to go push with the patient and I saw her in an empty room opening a can of bleach wipes (she later told me she was in the bathroom) but I didn't have time to call her because the patient was about the birth. Later when we had a chance to talk and I said "why did charge have to come find you when our patient was complete and pushing?" she laughs and says "oh I was in the bathroom and didn't know where you were. If I had known where you were I would have been there." I was in our room for almost an hour before she finally showed up.

  • Mar 10

    Fail her. Lazy and going to hide did it for me. Why would I want to meet another of her kind at work?

  • Mar 10

    Quote from Avid reader
    Fail her! People's lives are at risk and you would be doing her a favor anyway. It's a serious job with serious consequences. People like her throw others under the bus to cover for their own mistakes and I would blame you for any of hers. It's also part of your job re evaluation. This isn't about your feelings but future possible lives. You need to be evaluated as well it seems. After so many clues of her deficiencies, you still need reassurance. Fail her, then help her or find someone else to better remonstrate her failings and lack of alacrity.
    With all due respect, it's not that easy to decide to fail someone, even if all S&Sx point to the fact that they need to be failed. A failure could potentially end a nursing student's education, especially if she's failed before and/or her program is very strict about the number of times a student can fail. And, as you can very well read by the number of sob stories in the nursing student forums, being failed is quite a crushing blow to the student. Often, it is a very much needed blow. But that doesn't make it any less crushing.

    I'm not saying OP should pass a student that is not performing at passing standards. If the student is performing poorly, then the student should definitely fail. But IMO it's OK for the OP to feel what he/she is feeling. It doesn't necessarily mean OP is a poor preceptor.

    OP: You've already talked to her, you've talked to her facility...at this point, Alice has the next 3-4 shifts to prove she got the message. It's really on Alice, not YOU, to determine if Alice can pass. If at the end of the preceptorship, nothing has changed in Alice's attitude or performance, then she deserves to fail. You've done your job--now Alice needs to do hers.

    And should she manage to pull it together and improve enough to pass, you are in no way obligated to provide a positive reference (or even any reference) to employers about Alice's performance.

  • Mar 10

    Quote from LovingLife123
    She's a student, not a nurse in orientation yet. I could get your frustration if she were a new grad that was an employee, but she is a student, of course she's nervous and scared.

    I'm surprised she's allowed to do as much as you are saying she is. When I was in school, we did nothing with the nurses, only our instructors. And when I have a student, they do nothing with us.

    I just think that expecting her to be a full on trainee nurse at this point is a little much. If she ends up graduating and passing NCLEX, then finding a job, let it be up to her employer to handle laziness.

    I was scared to death of IVs as a student and I still stink at putting them in!!!

    Now, if she's late, not following you around, not doing what you ask, that's a reason to fail. But not nerves.
    But she's NOT doing what she's being asked. She's NOT following the OP around; rather, the charge nurse had to search for her on an occasion. Major no no.

    I'm a brand, spanking new nurse, graduated in December. IV's are still terrifying to me. But when my instructor/the nurse/my preceptor tells me to try it ... I tried/try it. Same with foleys, dressing changes, trach care, etc. When you're a nursing student, you grab on to those opportunities because that's what's expected -- as evidenced by this particular nursing students' faculty members' midterm statement.

    Acquiring nursing skills can be really scary -- this I can certainly agree on. Still doing it. But this student is wasting the OP's time and doesn't appear to be meeting her school's set standards for this particular semester. Sorry kid = fail. That's the consequence.

  • Mar 10

    You have tried with this girl. She needs to be failed. You have done nothing wrong except try to be a great mentor. Why did she even pick L/D?

  • Mar 10

    That student from hell will become the co-worker from hell. For the sake of future patients and the nurses who will be caring for them, let "Alice" pass or fail on her own merits. She shouldn't need all this hand holding so close to graduation; someone who is close to graduate usually jumps at the chance to have more experiences or skills under his/her belt.

  • Mar 10

    Fail her! People's lives are at risk and you would be doing her a favor anyway. It's a serious job with serious consequences. People like her throw others under the bus to cover for their own mistakes and I would blame you for any of hers. It's also part of your job re evaluation. This isn't about your feelings but future possible lives. You need to be evaluated as well it seems. After so many clues of her deficiencies, you still need reassurance. Fail her, then help her or find someone else to better remonstrate her failings and lack of alacrity.

  • Mar 10

    As a student currently in practicum, my advice is to fail her.

    Practicum, as you know, is the time for us to prove that we are committed to learning and perfecting the skills we've learned so we can take care of patients on our own.

    The fact that she hides, instead of embracing these opportunities is a huge red flag. I would feel terrible as a preceptor if I passed her only to find out later she harmed a patient.

    We always talk about safeguards in the healthcare system to stop errors from happening. You are one of those safeguards. The nursing faculty trusts your judgement and is relying on your ability to discern whether she is ready to continue on to become a nurse (if she can pass boards).

    I think she needs to fail this round, have a come to Jesus moment with the reality of patient care, and have her try it again next semester. We can't always hold people up, sometimes it's best to let them fall so they can see where they actually are.

    I adore my preceptor, and I value her opinion of me and my skills. Should my preceptor ever say to me that she felt I wasn't ready, I would do everything in my power to fix my issues, not hide.

    I wish you luck. It sounds as though you are a very caring person and don't want to fail her, but your job as her preceptor is to do what's best for her and making sure she's safe to practice is definitely what's right.


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