A plea to all nurse mentors/instructors

Daytonite, BSN, RN · Jul 17, 2009

there is something to be learned from every clinical rotation. i was trying to find what positive things you learned from this experience and they just aren't there. i see some things that you missed. . .

if i am courteous, hard working, respectful and mindful of your feelings, isn't it just common decency that you return the sentiment?

yes, it is always good to be courteous and polite to others no matter how they treat you. you can only be responsible for your own behavior. you can

never

make anyone else behave the way

you

want them to behave in interpersonal relationships. thinking you can do so is immature.

i have seen elderly patients yelled at and physically dragged up the bed by one particularly bad tempered nurse who thinks nothing of yelling a long list of curse words across the bays and stands around snarling at people until her next coffee break.

and did you report this to your instructor? anyone? because this is abusive. what did she tell you to do about it? by not doing anything about it yourself you are just as guilty of the mistreatment as they are. perhaps, as a student, you didn't know what to do or how exactly to handle it, but you do have an instructor who is your immediate supervisor that you can go to for guidance and support when these kinds of situations happen. so, my question again is, did you report this to your instructor? or did you just look the other way when these things happened? your argument that "students deserve a little respect too" kind of waned when i read you observed this happening to patients in your presence and you listed no follow-up action on your part to it. not following-up to observations like that is

not in accordance

with being a good nurse and developing skills (patient advocate) you will soon need as a new

rn

. i am wondering what else you observed that went right over your head and that you might have missed the importance of.

the patients (who are all frequent flyers, because of the type of ward it is) also now act in a similar manner and think nothing of yelling/shouting/snapping and throwing things to get your attention. i can't really blame them when that is how they are treated by the staff.

and did you discuss this with your instructor? these are patient problems that can be addressed through care planning. while these staff nurses you were paired with may not have been coping with the situation in a stellar manner, what suggestions did your instructor and fellow students have about the situation when you brought them up in post conferences? i've been a nurse for many years. i learned a long time ago that when patients resort to yelling, shouting, snapping and throwing things to get attention it is because they are

being ignored and they need something

. fulfill their needs and the yelling, shouting, snapping and throwing of things usually stops.

some years ago i took report from a nurse about a little lady who she said was a pia (pain in the tush) because she was constantly complaining, particularly about pain and the way she was being treated. and, it was true. the minute i walked into her room she started up with the complaints. i pulled up a chair and listened to her. before she was done with her tirade she told me she had fallen from a gurney in x-ray 2 days ago and her side was hurting her. after physically assessing her i left her room and was on the phone to her doctor faster than you-know-what through a goose. chest x-rays were ordered and the woman had 2 fractured ribs courtesy of someone in the x-ray department that had carelessly left the side rails of her gurney down so she had fallen and then

not reported the fall to anyone

. to several negative not very caring nurses this lady was a pia; to me she was a patient who needed something and the only way she could think of to get it was to act out.

i feel demoralised, de-skilled and have lost all enthusiasm for the profession i had wanted to be a part of since i was a child.

i am having difficulty with your placing all the blame on this ward of nurses you were working with. where does your clinical instructor come into this at all? when did you tell your instructor about what was going on? what was your instructor's advice? surely, you didn't just go to this ward each day and never advise your instructor of what was going on!

benjamin franklin said it best. . .

well done is better than well said.

all i am finding from your post so far is that you are pretty good at saying, but not so good at doing.

actions always speak louder than words and i cannot be impressed by what you have written here.

people will judge you by your actions, not your intentions. you may have a heart of gold - but so does a hard-boiled egg.

Angie1011 · Jul 17, 2009

there is something to be learned from every clinical rotation. i was trying to find what positive things you learned from this experience and they just aren't there. i see some things that you missed. . .
if i am courteous, hard working, respectful and mindful of your feelings, isn't it just common decency that you return the sentiment?
yes, it is always good to be courteous and polite to others no matter how they treat you. you can only be responsible for your own behavior. you can
never
make anyone else behave the way
you
want them to behave in interpersonal relationships. thinking you can do so is immature.
i have seen elderly patients yelled at and physically dragged up the bed by one particularly bad tempered nurse who thinks nothing of yelling a long list of curse words across the bays and stands around snarling at people until her next coffee break.
and did you report this to your instructor? anyone? because this is abusive. what did she tell you to do about it? by not doing anything about it yourself you are just as guilty of the mistreatment as they are. perhaps, as a student, you didn't know what to do or how exactly to handle it, but you do have an instructor who is your immediate supervisor that you can go to for guidance and support when these kinds of situations happen. so, my question again is, did you report this to your instructor? or did you just look the other way when these things happened? your argument that "students deserve a little respect too" kind of waned when i read you observed this happening to patients in your presence and you listed no follow-up action on your part to it. not following-up to observations like that is
not in accordance
with being a good nurse and developing skills (patient advocate) you will soon need as a new
rn
. i am wondering what else you observed that went right over your head and that you might have missed the importance of.
the patients (who are all frequent flyers, because of the type of ward it is) also now act in a similar manner and think nothing of yelling/shouting/snapping and throwing things to get your attention. i can't really blame them when that is how they are treated by the staff.
and did you discuss this with your instructor? these are patient problems that can be addressed through care planning. while these staff nurses you were paired with may not have been coping with the situation in a stellar manner, what suggestions did your instructor and fellow students have about the situation when you brought them up in post conferences? i've been a nurse for many years. i learned a long time ago that when patients resort to yelling, shouting, snapping and throwing things to get attention it is because they are
being ignored and they need something
. fulfill their needs and the yelling, shouting, snapping and throwing of things usually stops.

some years ago i took report from a nurse about a little lady who she said was a pia (pain in the tush) because she was constantly complaining, particularly about pain and the way she was being treated. and, it was true. the minute i walked into her room she started up with the complaints. i pulled up a chair and listened to her. before she was done with her tirade she told me she had fallen from a gurney in x-ray 2 days ago and her side was hurting her. after physically assessing her i left her room and was on the phone to her doctor faster than you-know-what through a goose. chest x-rays were ordered and the woman had 2 fractured ribs courtesy of someone in the x-ray department that had carelessly left the side rails of her gurney down so she had fallen and then
not reported the fall to anyone
. to several negative not very caring nurses this lady was a pia; to me she was a patient who needed something and the only way she could think of to get it was to act out.
i feel demoralised, de-skilled and have lost all enthusiasm for the profession i had wanted to be a part of since i was a child.
i am having difficulty with your placing all the blame on this ward of nurses you were working with. where does your clinical instructor come into this at all? when did you tell your instructor about what was going on? what was your instructor's advice? surely, you didn't just go to this ward each day and never advise your instructor of what was going on!

benjamin franklin said it best. . .
well done is better than well said.
all i am finding from your post so far is that you are pretty good at saying, but not so good at doing.
actions always speak louder than words and i cannot be impressed by what you have written here.
people will judge you by your actions, not your intentions. you may have a heart of gold - but so does a hard-boiled egg.

first of all, my clinical instructor (what we call a 'named mentor' in the uk) is the ward supervisor and is well aware of what goes on on the ward. i am supposed to work shifts either under her direct supervision or under the supervision of my associate mentor who is actually on annual leave and i have never met. since my clinical instuctor works p/t hours, for the other days of the week i am not with her,i have been placed with random rns on the unit. my university/nursing school tutor does not visit the hospital and is there as merely an academic advisor.

and yes, i did report my concerns to my clinical instructor and her response was that i should just find someone else to 'observe'. that was just the snappish nurse's 'way with people.' she then continued on to tell me how she was undermined by her staff and that the changes she had tried to facilitate in regards to several aspects of patient care had been denied by those 'higher up.' she listened to my concerns over the treatment of some patients and gave a defeated shrug of her shoulders and said, 'i know, it's very difficult sometimes.'

believe me, i do not stay silent if i believe somebody is being mistreated or caused distress and as for the other things that might have gone over my whimsical little head - there is a long list of things i have seen ranging from violation of antt procedure to medication errors. when you are doing nothing but watching, you notice things. and all of these matters have been promptly discussed.

as for care plans, they are largely ignored and if i hadn't spoken out as i saw a nurse about to give a second dose of heparin to a patient without reading his notes (and not listening to his insistant assurances that he had been given the drug earlier on), he would have been overdosed. luckily, i had been there when another rn had given it to him earlier.

further more, i also spoke to my nursing school when said instructor wrote on my official placement papers (that we are obliged to complete for every rotation), that she felt that i would be unable to meet my learning objectives because they did not allow students to participate in direct patient care. the university is now investigating this ward area as it is a fruitless exercise for them to send students to an area where they are not permitted to do/learn anything. i don't decide on a whim what i would like to learn from a placement, i am told what i must learn on each placement from my nursing school. if i can't complete those objectives, i can't pass the placement.

frankly, i would be happy making beds and fetching drinks etc. for patients. i don't care what i'm doing, i just want to do something!!

and once again, yes. i did try to answer patient call-bells and even just sit and talk to them. however, since i am not permitted to have any direct patient care, clearly addressing their needs is difficult and i have to inform an rn so i can get some help for them. informing one of the rns that a patient has asked for something, has chest pain etc. usually gets me snapped at, sighed at or a combination of the two. i do it anyway, because as you say, a good nurse is also a patient advocate. i am not stupid enough to bother somebody who is busy or otherwise occupied with another patient. i shouldn't have to worry about the response i will get when i am merely trying to address a patient's concerns or needs.

there are 2 other students on my ward currently. one has asked to be transferred and the other is counting down the days until he leaves as he, like me, reported concerns in patient care and we are both now being treated as tattle-tale, pains in the asses.

as for believing that i can make people treat me as i want them to in regards to interpersonal relationships, uhm... yeah. i used to work in politics and that is one delusion i have never suffered from. i merely meant that respect should be a two-way street, which it is not. doesn't stop me viewing those who are disrespectful and rude as being wholly obnoxious, particularly in healthcare where you are talking to people who are sick and scared. if ever there was a time to summon up what little social graces you might have, dealing with the sick and dying is surely that time.

but you're absolutely right. i hadn't written what i have learnt from this experience. i have learnt two things. firstly, i have learnt how not to treat people , whether that be patients/colleagues/students or just people in general. and the second thing i will take from this placement, is that bad management, bad communication and bad care ethics lead to an unhappy workforce and unhappy patients.

Silverdragon102, BSN · Jul 17, 2009

Hi Angie

It is hard as a student in the UK and believe me I have seen some good students and some bad ones. All said aside I am glad that the university is looking into your complaints as it really is not beneficial to anyone to be on a ward that is not utilising itself properly and especially not helping students. I loved working with the students s did the ward I used to work on.

I think you have to remember this forum is more geared up to US students so if not in the US may help giving a bit more info on where you are as thoughts can be more geared up to that area. May want to consider posting here in the UK forum if want to get more of a UK response plus this is a student thread aimed for the UK students Nursing students in the UK

Angie1011 · Jul 17, 2009

Hi Angie
It is hard as a student in the UK and believe me I have seen some good students and some bad ones. All said aside I am glad that the university is looking into your complaints as it really is not beneficial to anyone to be on a ward that is not utilising itself properly and especially not helping students. I loved working with the students s did the ward I used to work on.
I think you have to remember this forum is more geared up to US students so if not in the US may help giving a bit more info on where you are as thoughts can be more geared up to that area. May want to consider posting here in the UK forum if want to get more of a UK response plus this is a student thread aimed for the UK students Nursing students in the UK

Thanks, Silverdragon.

Thanks for the advice. I'm always a bit torn as to where I belong here as I was raised in the US (American Mom, English Dad) but am now married to an English guy and am currently settled in the UK. I know things are done a little differently in each country, so I'll try to keep that in mind in the future. :nuke:

Cilantrophobe · Jul 17, 2009

I have to butt in here.

Daytonite, can a girl vent without having you analyze and question her every statement? I realize there are many people who complain about something while never doing anything about it but I think you may be a little quick to assume that we are all afraid to stand up for what is right. Angie certainly gave me no impression that she was cowardly enough to stand by and do nothing.

Silverdragon, I realize things may be different in the UK, but there is no reason why we cannot sympathize with these said complaints. Just because Daytonite lacks sympathy and assumes the student is a coward does not mean the rest of us can't relate.

Daytonite, BSN, RN · Jul 18, 2009

i get that things are different in each country. however, as rns we are not all that different in what we want to do for patients. rns in both the us and the uk are leaders when it comes to patient care. i can tell you that as a student nurse i worked a part time job as a nursing assistant in a nursing home and i saw some awful things done to patients by both the other nursing assistants and some of the charge nurses! i was horrified. i talked this over with my instructors at the nursing school. what they told me then was that i pretty much had no power or authority to do anything about it. all i could do is be responsible for myself and what i was doing and correct what i could. and, that was something that i always remembered. while i worked my tail off doing nursing care by the book i was aware that some of the other nursing assistants were snickering at me behind my back. sometimes they deliberately gave me harder patients to take care of. i looked at this as a challenge and an opportunity to learn. not only was i learning about managing the patient's care as well as how to do new and different things, but i was also learning about the depths of sneakiness and nastiness of some people. it comes in handy when i suspect there is unfairness going on between subordinate workers since i once worked in the trenches.

there are many times nurses are in a one-on-one situation with patients and it is only due to each nurse following his or her conscience that the patient is treated as they should be. it can be so easy to cut corners. and, more often than we would like to think some nurses do just that and ignore what they were taught in school. i was a supervisor and manager for several years and i saw the fallout from the nurses that don't do as they are supposed to and things go wrong. i can also tell you that when there is an entire group of people who are doing things incorrectly it is often because there is poor management and leadership that is allowing it to occur. that makes it even more complicated. what i was told was that when i became an rn i should work toward becoming the person in charge of these staffs of people so i could have some power and authority to affect and change the kind of behavior i saw.

but, i have to tell you that it is not an easy task to address people's behavior. my first nursing management job was over a hospital med/surg unit that had gone through a succession on managers and had a handful of older rns who it was general knowledge were bullies and ran that unit the way they saw fit. several newly hired rn graduates had quit because of their nasty behavior toward them and the director of nursing wanted them stopped. first of all, i couldn't be everywhere 24 hours a day to observe what people on the nursing staff were doing. secondly, getting people on the nursing staff to write up incidences of medication errors or falls involving patients is hard enough. it can be nearly impossible to get them to write up abuse or nastiness to co-workers or patients. can you see any of the nurses on the unit you are assigned to tattling on each other? probably doubtful. three, even when i did nail someone for "bad behavior" they frequently didn't take the talking that they got from me very seriously. they would argue that there was no rule that they could be fired for their behavior. i felt defeated after a while. i discussed this with the director of nursing and our plan was that if any rule was broken, such as a medication error was made or attendance policy was broken by these troublesome people, the book was thrown at them (the strongest disciplinary action was leveled against them). but, i have to point out that i had the support of my boss. without her support i would have been a lone wolf and probably would have eventually been ganged up on my these wrong-doers who saw me as "the enemy" there to upset their cozy world.

it is easier to supervise and discipline subordinate workers such as nursing assistants since as rns we have authority over them by virtue of our job description here in the u.s. i took a number of seminars on "how to deal with difficult people" which were immensely helpful. i also have 2 books which have great ideas in them for dealing with smart mouthed types that i have to supervise or discipline:

- managing difficult people: a survival guide for handling any employee by marilyn pincus

- working with difficult people by muriel solomon

it is also very helpful to take a course in assertiveness. my bsn degree required a communications class and assertiveness training was included in that class. here in the u.s. a bachelor's degree in nursing generally includes leadership training since bsns here are expected to be managers and supervisors of patient care.

the only other advice i can offer is to just keep putting one foot in front of the other until you finish school. one thing i have learned in my many years of working--and i have held many jobs in nursing--is that the people we work with are what make the job enjoyable almost as much as the actual work involved. there were only a handful of places that were sublime to work at and i stayed at them for years because they were so wonderful. (low staff turnover is an indication that the staff like working there.) if you find yourself in the midst of lousy co-workers then move on to another place to work if that is possible. do what you were taught in school and do not compromise your ethics.

hang in there.

Silverdragon102, BSN · Jul 18, 2009

Silverdragon, I realize things may be different in the UK, but there is no reason why we cannot sympathize with these said complaints.

I am not saying that we can't sympathise or offer advice but knowing where the person is doing their training can help with offering appropriate advice and even point them in a direction that may offer help. I am all for this being a more international area but things are done differently and knowing and understanding that helps in many ways especially when offering advice

Cilantrophobe · Jul 18, 2009

Totally understood Silverdragon.

I just don't like it when people come here to vent and others find a way to make the 'venter' the guilty one, or put all the blame or responsibility in their hands. Just because people don't provide every detail when venting, doesn't give us the right to assume that they didn't do anything about it. Many people unfortunately don't, but we are not all the same. We are all either nurses, nursing students, or soon to be, so it should be expected, and possibly assumed that we will take action, or have taken action.