Students who won't listen---what to do?

Specialties Educators

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I have a student in MedSurg II who wll not prioritize. She has it planned in her mind what's important, mostly issues like ROM, feet elevation, etc. and will not pay attention to the clinical situation. For instance, if the drip bag is empty, she will not notice the beeping or respond to my request to put that before worrying about encouraging the patient to eat more fiber. Her nursing diagnoses center around risk for skin breakdown and pain instead of airway and arrhythmias. When I try to talk to her she acts hurt, then angry, and today complained about my annoying her in front of her patient! I cannot seem to reach her and I'm afraid that she will wind up flunking clinical. Any ideas?

Specializes in OB, MS, Education, Hospice.
I have a student in MedSurg II who wll not prioritize. She has it planned in her mind what's important, mostly issues like ROM, feet elevation, etc. and will not pay attention to the clinical situation. For instance, if the drip bag is empty, she will not notice the beeping or respond to my request to put that before worrying about encouraging the patient to eat more fiber. Her nursing diagnoses center around risk for skin breakdown and pain instead of airway and arrhythmias. When I try to talk to her she acts hurt, then angry, and today complained about my annoying her in front of her patient! I cannot seem to reach her and I'm afraid that she will wind up flunking clinical. Any ideas?

I struggle with this myself--one thing I tried recently (in MedSurg I) is to require my students to prioritize their top 3 diagnoses--and then tell me how the patient's medications fit into the plan of care based upon those three diagnoses... if the meds don't fit--then there is an "elephant in the room" that the student is tiptoeing around... I do this with each student in post-clinical (with the expectation that they will begin to do this at the beginning of the clinical day). It is working quite well--and is strengthening their pharm knowledge, too.

Just my :twocents:

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Specializes in Education.

So she is in MedSurg II with her nursing education and she 'will not NOTICE the beeping'??? and wants to put eating FIBER before this???

Wow. I teach nursing assistants and medical assistants. I see a lot of advice on these boards that these professions are a waste of time and the students should just skip them and go straight to RN programs.

Well, my opinion is that not everyone is wired to be an RN and my guess is this gal may be wired for some thing like that. Some people just don't have the critical thinking skills or multitasking skills to work at an RN level. Seems like it would be better for her to find that out now than after she has a serious incident with a coded patient who received ROM instead of defibrillation.

One other thing-is this normal behavior for this student? Sometimes students (and anyone) go through a personal crisis and just can't think clearly and make logical judgements due to stress for a period of time, but once through the acute crisis, come back to normal.

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It's typical for those who are new to nursing to focus on tasks. They feel they have things they must get done, so they set about to get them done. That leaves little room in the brain for thinking about the other things that crop up unexpectedly. If you haven't read it already, I'd recommend Patricia Benner's From Novice to Expert. It's wonderful for explaining the limited thinking students (and new nurses, as well as those new in any profession) have.

Being in the concrete thinking stage doesn't make their caregiving safe, though. They're riding on your license and the patients need competent care! Our job as instructors is to gently force them to do what we see should be done, if they can't see it for themselves.

I agree. It is hard to see the big picture when you are focused on tasks. I think most new nurses are very task oriented for about the first year. Moving from new nurse to experienced nurse is a whole different way of thinking--a different mindset. She will see this thought process in action if she gets to do some critical care nursing or ICU experience. Maybe as clinical hours you could send her and a couple others to observe ICU nusing. Often times students are assigned patients that don't really have a lot going on out of fear that something might go awry if they had a more complex case. Give her a challenge! Show what happens when a patient codes, get the wheels turning in that direction. If you are worried that she might fail it is because you see a spark there.....or you wouldn't be so worried. Has she ever had a patient that an infection starting or a new arrythmia?

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Specializes in Med-Surg.

Totally agree with all of the suggestions to help this students, and wholly agree that flunking the student maybe the only viable solution. But a word of warning. Do document every conversation, every outcome, and everything that was attempted. This student may or may not grieve the outcome, and you need to be ready to show why this student was not successful in this clinical. Been there and done that, and don't wish to have to do it again. But would not hesitate if the situation arises again. Good luck.

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Specializes in Hospital Education Coordinator.

tell her to go to www.skillstat.com and try to save a virtual patient. Even if you do not know ACLS this site challenges you to prioritize.

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Since it sounds like you've already spoken to her privately, I would encourage you to recruit your program director/coordinator of your specific program/whomever is the administrative person above you (I hope you've already at least made your boss aware of your concerns about this student), and schedule a sit-down for both of you and this student to review the concerns about her clinical performance and what needs to change/improve in order for her to pass. There is strength in numbers :), it's good to have a witness, and it may finally impress the student that someone else is considering this a problem besides "just" you. I would suggest you have (or develop in the "come to Jesus" meeting) a written action plan for her (and you) so that everyone is clear on the expectations and how she's going to be evaluated. After that, she really doesn't have any excuses.

I've been in similar situations, and they are rough. Best wishes!!

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Specializes in Med/surg.

Has she been working as a CNA? If so, perhaps she is hesitant in leaving her comfort zone. Counsel her on the differences, ie., task oriented vs critical thinking, etc. If she cannot move on from that role, perhaps she is not ready to become a licensed nurse.

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Specializes in ortho, hospice volunteer, psych,.

no point in getting the pt to poop if they are in v-tach!

i helped a neighbor's daughter pull a paper together over spring break last month. this kid is caring, gentle, very bright and motivated... but one thing kept interfering with her clinical work, paper writing and critical thinking. her grandma, who died recently at age 99, died after a l-o-n-g battle with parkinson's disease.

every time she had a patient who might have been her grandma, she hit a roadblock. she just could not

stop imagining that every patient she had, was someone's relative and got bogged down thinking of heel

protectors, laxatives, elbow protectors, feeding, diets, moist soaks, pain meds, thinking bed bath rather than shower for an alert ambulatory pt.,

she had been sent home from clinicals one day because an iv ran dry and she never heard the beep beep

because she was doing vitals on her three patients. her ci heard it...

other than the attitude problem, sounds similar.

kathy

shar pei mom:paw::paw:

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