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.
Specializes in Med/surg, Telemetry/PCU, Bone & Joint.
You mention that you don't want to fail, but you never actually stated if you are in fact failing. If you are in fact failing, the only thing you can do is go above her head and dispute your case. If I were in my last year and felt I was being given an unfair situation, I would certainly fight. If you aren't failing, then I wouldn't worry about it.
I came to the conclusion during my nursing classes that some instructors love to try and break a student...for whatever reason. Keep in mind, they are trying to prepare you not only with the necessary skills, but also for the "real" world. And after working as an RN for two years now, I can attest that it is in fact a very harsh world for RN's. If you think your instructor is harsh, wait until you have to give report to a more experienced RN with a God complex. Talk about making you feel like a complete looser! Thank the Lord they are few and far between, but non the less, prepare yourself!
here's the thing...no instructor is going to make a determination of preceptor placement based on these two events (i.e. IV placement and an isolated communication event)
what does make sense is that your instructor has made a determination based on a period of assessment and has determined that you are currently lacking or need development in areas that he/she feels are necessary for successful completion of ICU preceptorship
there is more to this than what the OP is revealing
For more than 50% of this course, the instructor has not been present. I saw her for maybe 3 minutes a day for the first few weeks....(i.e. she was not even on the unit). In the last week, she has seen me provide IV meds to 3 patients + perform an IV start and admission. When giving IV meds, I was so focussed on the task at hand that I wasn't very good at providing therapeutic communication... I know that I need to improve at multi-tasking... but when I am doing new things, I find this super challenging... especially since I don't want to mess things up.
I just don't understand how she can make an assessment based on so little.
You mention that you don't want to fail, but you never actually stated if you are in fact failing. If you are in fact failing, the only thing you can do is go above her head and dispute your case. If I were in my last year and felt I was being given an unfair situation, I would certainly fight. If you aren't failing, then I wouldn't worry about it.
I came to the conclusion during my nursing classes that some instructors love to try and break a student...for whatever reason. Keep in mind, they are trying to prepare you not only with the necessary skills, but also for the "real" world. And after working as an RN for two years now, I can attest that it is in fact a very harsh world for RN's. If you think your instructor is harsh, wait until you have to give report to a more experienced RN with a God complex. Talk about making you feel like a complete looser! Thank the Lord they are few and far between, but non the less, prepare yourself!
I'm not failing - my GPA is near the very top of the class, which is why I got an ICU preceptorship position in the first place. I'll just try to learn from this experience and grow from it!! Thanks
" since you have not yet passed the nclex and don't possess a nursing license of your own, you are doing every single thing in that clinical under her license."
common fallacy. students are not "practicing under (the instructor's) license." they are expected to practice to their own scope of practice, which is, what they've already learned in school, and not to exceed it without someone watching/assisting who has the scope of practice that can do it. schools are held accountable to see that the students behave under those constraints.
"i think i'm learning that i shouldn't let others know that i have self doubt. it's ok to ask questions when i'm unsure... but i should never show a lack of confidence in myself. "
this may actually be a very functional way to proceed. how would you like to be lying in the bed and sense that your nurse is full of self-doubt about what she's doing? your instructor has the background to put herself in the patient's place as well as in her instructor place, and is trying to improve your essence of being a nurse, for lack of a better way to put it.
do your rants and self-doubts here, where no one can actually see you and no one will be marking you or paying you. get it off your chest...but never let 'em see you sweat.
ps. i never said anything about your not being appropriate for an icu rotation. i said i could understand, perhaps, why the instructor might be seeing something you don't.
My 2 cents, fwiw: I think you should go to your instructor and talk about this. Calmly, non-aggressively, non-defensively. If it were me, I'd say something like this, "I feel disappointed and a little frustrated about a couple interactions and I'm hoping we can talk about it. I know there's an important lesson for me to learn here, and I'd like to improve." Then explain that during the interview, you wished you had a little more space/time to work it out before she intervened. Then ask why she did intervene when she did and listen to her answer. This reminds me a lot of teaching my daughter to drive. It's hard to be the coach. I want to give her space to figure out how to steer and brake, but not so much space that she drives off the road or rear-ends someone. When I was coaching her driving, I tended to jump in maybe a bit too soon, but she was new and unpredictable. MY comfort zone was that she started braking early because I wasn't confident that she would stop if she didn't. Does that make any sense? The sense I get from you is that you feel like your instructor is stepping in just a bit too quickly. Maybe if you can talk (not argue or defend but talk) to your preceptor and communicate what your feelings/needs are and listen to what her feelings/needs are, you can find some middle ground to make your learning relationship more effective. This will only work if you aren't defensive and really listen. I've found that when I've been able to do this, it's helped a lot. Good luck!
" since you have not yet passed the nclex and don't possess a nursing license of your own, you are doing every single thing in that clinical under her license."
common fallacy. students are not "practicing under (the instructor's) license." they are expected to practice to their own scope of practice, which is, what they've already learned in school, and not to exceed it without someone watching/assisting who has the scope of practice that can do it. schools are held accountable to see that the students behave under those constraints.
"i think i'm learning that i shouldn't let others know that i have self doubt. it's ok to ask questions when i'm unsure... but i should never show a lack of confidence in myself. "
this may actually be a very functional way to proceed. how would you like to be lying in the bed and sense that your nurse is full of self-doubt about what she's doing? your instructor has the background to put herself in the patient's place as well as in her instructor place, and is trying to improve your essence of being a nurse, for lack of a better way to put it.
do your rants and self-doubts here, where no one can actually see you and no one will be marking you or paying you. get it off your chest...but never let 'em see you sweat.
ps. i never said anything about your not being appropriate for an icu rotation. i said i could understand, perhaps, why the instructor might be seeing something you don't.
great post. i keep reading these posts about "practicing under someone's license." i am aware of no state in which a student nurse practices on someone else's license. clinical instructors, faculty and preceptors are required to have assessed a student's abilities and supervise them appropriately. however, student mistakes (as long as they are appropriately supervised) aren't "on" a clinical instructor's license. can you imaine? no one would ever be a clinical instructor if they were at risk to lose their license over students who are just learning. my understanding is that states have exeptions to the requirement for a license for students in clinical settings. you are required to stay within your scope of practice which means not performing skills for which you haven't been educated/trained.
op, i think you need to work on your confidence. it is important for your patients that you don't display a lack of confidence, even if you feel one.
I learned 30 or less... and then my instructor instructed me to insert at 45. This threw me off, and I started to doubt myself. Yes I would have liked a chance to discuss it before going in the room.
I didn't say she was "judging" me. I would have liked a chance to intellectualize the skill with her beforehand. Whoa-now got it right - I needed a few minutes to explain to her what I was going to do so that we would be on the same page.....
But I don't think the teacher is judging me based on a fair assessment of my capabilities....
I pulled that from your first post. Sorry, from what you said I did read that you felt she was judging you....
My apologies, I am one who made a comment about practicing under the umbrella of an instructors license. This is what is drilled into us as nursing students--that if WE mess up, it comes back on the instructor as it is under her license that we are allowed to perform skills in a clinical setting. I'd be willing to wager that my school would not be alone in perpetuating that myth.....
But I don't think the teacher is judging me based on a fair assessment of my capabilities....
I pulled that from your first post. Sorry, from what you said I did read that you felt she was judging you....
Colleen RN2B: Sorry, I guess I did use the word judge. However, "judging" has a negative connotation - what I meant to say is: I don't think the teacher is EVALUATING me based on a fair assessment of my capabilities...
Thanks for everybody's insight on here - it has been tremendously helpful!
My apologies, I am one who made a comment about practicing under the umbrella of an instructors license. This is what is drilled into us as nursing students--that if WE mess up, it comes back on the instructor as it is under her license that we are allowed to perform skills in a clinical setting. I'd be willing to wager that my school would not be alone in perpetuating that myth.....
Yes.. I've heard the "myth" perpetuated by others at my school as well :)
Honestly, snide remarks are totally not necessary. I've been in your shoes before. When it comes to clinical instructors, you're basically at their mercy. Some people are just pig headed as well. I've been in a situation where I was prideful, and really shouldn't have been. My clinical instructor called me out on it. I've been in a situation where I know I was giving 110% and my clinical instructor didn't think I was "made" for nursing. I've learned from both situations. Do you ever feel flustered while under pressure, especially from your instructor? I know that this is one of my weaknesses which I need to work on. ICU is a very demanding place. Strict and cautious practice needs to be in place.
I'd be curious to know how she is with the other students as well ...
i think your instructor is doing just fine. maybe it is just the way she handles students like us. my advice, just do what she says, obey her, for you will learn more. you can also confront her about the incident. i know she will listen to you. :)
whd13b
55 Posts
You mention that you don't want to fail, but you never actually stated if you are in fact failing. If you are in fact failing, the only thing you can do is go above her head and dispute your case. If I were in my last year and felt I was being given an unfair situation, I would certainly fight. If you aren't failing, then I wouldn't worry about it.
I came to the conclusion during my nursing classes that some instructors love to try and break a student...for whatever reason. Keep in mind, they are trying to prepare you not only with the necessary skills, but also for the "real" world. And after working as an RN for two years now, I can attest that it is in fact a very harsh world for RN's. If you think your instructor is harsh, wait until you have to give report to a more experienced RN with a God complex. Talk about making you feel like a complete looser! Thank the Lord they are few and far between, but non the less, prepare yourself!