Advice needed about clinical instructor

[RNbethy]

I'm having some trouble in a clinical course with one of my instructors... My confidence is somewhat low, but I feel like she hasn't given me a real chance to demonstrate what I am capable of.

For example, I was going to do an IV start on a patient. Before we went into the patient's room, I asked if I should explain what I was going to do beforehand.... She didn't think this was necessary, but then at the bedside she told me exactly what to do for every single step. I felt like I didn't get a chance to demonstrate what I actually knew about the skill. I also felt like having everything described in front of the patient may have been scary for this pt. I understand that some of this was necessary, but maybe not for every step. I should have been able to insert the IV bevel up with a 30-45 degree angle and then lower w/ flashback on my own without being told all of that right in front of the patient. I get flustered easily (which I realize is something I need to improve on), but this just made it worse... especially since she had a different way of doing things than I was taught. During the skill, I was able to insert the IV ok and advance the cathlon but ran into problems when she told me to hold on to the cathlon and "not to let go." I felt so frazzled about what I was doing... She started holding on to the cathlon, so I thought it would be okay to let go... anyhow, this didn't work out so well..... Afterwards, I expressed my disappointment about my performance to the instructor but I think this just reinforced my low level of confidence....

Another example: During an admission of a patient w/ a language barrier, I didn't feel like I had a chance to demonstrate what I actually knew about communication. As soon as we ran into trouble, the instructor told me exactly what to say next... She didn't pause and allow me to work through it. I could have worked through this on my own! She even told me when to thank another student for helping me out... I could have done this myself!

In the first half of the course, I barely saw my instructor because we were on another unit... (long story). Now she is telling me that she doesn't think I have the confidence to preceptor in the ICU... but I feel that her judgment is based on situations in which she didn't give me an opportunity to show what I know.

My confidence is low, but I will do whatever it takes to be successful. She tells me she "doesn't want me to fail" but I'm in my 4th year and have been very successful so far and earned this placement. I know I will have to deal with lots of scary equipment in the ICU and that this will take some getting used to. But I don't think the teacher is judging me based on a fair assessment of my capabilities....

What should I do? I am so frustrated and at a loss of what to do as I only have a few more clinical days left to change her mind.

[loriangel14, RN]

I don't see what your complaint is. She is an instructor.She has been instructing you. If I was doing something new I would be glad for someone more knowledgeable walking me through it.

[RNbethy]

Yes, I appreciate having someone with more knowledge help me out... but there is a balance.

My complaint is that I have not had an opportunity to demonstrate what I know in the course... In other courses, other instructors allowed me to show what I knew and I did well... My instructor doesn't think I'm capable of preceptoring in the ICU, but I don't feel her assessment of me is entirely fair.

[JZ_RN]

I think that your instructor is doing just fine. Be happy for practice and guidance. Remember when she is teling you what to do that you are working under HER license, she has to be sure you don't mess up.

[RNbethy]

Good Point.... but she could have discussed it with me outside the patient's room rather than act like it would be "so easy..." She also went too far with the admission... I could have problem solved around the language barrier.

[sharpeimom]

i would have been so happy and relieved if most of my instructors had instructed more instead of assuming

i already knew a skill. after all, your patient already knows that you're a student. students, by definition,

are there to learn.

[RNbethy]

Ok, you guys aren't getting this at all! I must be in a different program, but we are EVALUATED based on our PERFORMANCE. If the instructor does the PERFORMANCE, how can the student be evaluated fairly? Yes, I agree that it is nice to sit back and watch the more experienced in action, but there is a balance here... I've had lots of instructors who have struck this very well...

[BostonFNP, APRN]

Ok, you guys aren't getting this at all! I must be in a different program, but we are EVALUATED based on our PERFORMANCE. If the instructor does the PERFORMANCE, how can the student be evaluated fairly? Yes, I agree that it is nice to sit back and watch the more experienced in action, but there is a balance here... I've had lots of instructors who have struck this very well...

So are you looking for advice or for validation?

The advice would be to value the learning experience, having someone watch you do a procedure and give feedback is an important part of learning.

As for validation, you tell us you are a great student and are clinically competent, so you should be fine. Well unless you responded to your preceptors advice like the advice here.

[earthcrosser]

If its your first time doing something with her, it may be appropriate for her to talk you through things. This is not a fault of hers, just a different way of dong things. I sometimes talk people through things while they do things with me the first time - I've never seen them do that task (and if it is your first time doing it, you often can get flustered during the skill, even if you can verbalize the steps beforehand). You are not looking bad to the patient by having her talk you through it.Perhaps she really is getting a vibe from you of not having much confidence whatsoever while on the unit and is simply trying to help you as best she can? Maybe have a private discussion with her to see where she thinks you can improve and how to improve upon it. You may get more freedom when you are doing things to her satisfaction.How is she managing the other students?

[RNbethy]

Thanks for all the advice here. I will reflect some more on my own practice. I still don't know what to do in terms of my preceptor plans later this year... Do I switch to a less demanding unit based on this instructor's assessment or do I go where I really want?

[earthcrosser]

You may do well in the ICU, but you really need to reflect on why your instructor thinks your confidence is lacking and work with her to figure out ways to improve upon it. Having people walk you through stuff will occur in the ICU oftentimes - people are very, very sick and you cannot have someone simply try and figure things out (or get flustered during their first times doing techniques) - so you need to relax when your instructor is talking you through things so that you can still do well. It is a different technique than one you were used to, but it is for your benefit. You are still learning (and getting hands on time) and she is making sure you are practicing safely.

She is not saying you CAN'T do ICU (and be successful), simply that at this time, she is unsure that you would be successful at this time. You have room for improvement, but you need to come up with a game plan - and that means working with her to come up with those ways to improve on your practice as a nursing student.

[fctxs]

I don't see what you are complaining about either. My instructor walks us through step by step also. You have to remember you are practicing under her license. If something goes wrong the instructor can loose her nursing license and the school can loose their accreditation. I think you are being a little too hard on the instructor. She is only doing her job. It takes a special person to be a nurse and an even more special nurse to be an instructor. Learn from her and take in the information. I love my instructor and I have learned so much from her.