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.
Sbe is a nurse and one thing you will learn eventually is that nurses are use to taking charge and "just doing it". I'm a new grad and I'm already getting like this. I understand exactly where you are coming from when you say that you want her to ease up a little and let you take the wheel. Maybe you should sit her down and just tell her how uncomfortable it makes you and how you want to figure it out on your own. She may not even realize what she is doing. Nurses are just use to just getting it done and moving to the next thing. And as far as choosing a preceptor, choose where you want to go and what your interests are. You will learn more, and you will enjoy your experiene much more. Hope I helped.
Thanks Neena_RN for the advice to go where my interests are... The ICU is what interests me the most, so that is where I think I should go!
My instructor is really awesome. She let me do another IV start today, and it went really good! I actually learned quite a bit from her the first time and was able to apply my learning today, which felt so great!!! I also got to do some blood admin.....
At one point, the instructor said: "You will see a lot of this in ICU..." I don't know if that means she's reconsidering my preceptorship, and I was a little scared to ask... but I sure hope so!
I think this was the PUSH I needed to stop hanging my head and to find my confidence.
i'm glad things went so well today! i can't count the number of times i've heard my husband say
he'd love to help this or that student learn but he or she had already closed his/her ears because
he/she had already decided that he "wasn't being fair" or "he just won't give me a chance" or "he
must think i'm an idiot." self-defeating and it assumes far too much.
clinical instructors and professors are usually willing to help their students any way they can and that
includes helping their students gain confidence. i'm happy things are working out for you.
thanks for the support! yes, it's good to be open to feedback... even if it takes a bit of thought! if my mind is closed, i lose out - if my mind is open, there is so much to gain :)
I think I have a simliar problem, the CI is coaching me through things, and then threatens to fail me because she feels she is coaching me too much. However, my complaint is, if I've never done the particular skill, how is possible for me to go in like i've done it a million times already? Obviously she expected me to do that, otherwise she would not complain she had to coach me, she is always putting me down. i just feel like okay, if the technical part is such a big deal, and at rounds, i can't explain a patient condition, that not even the doctors haven't diagnosed medically, and then claim it's because i don't read the charting correctly, i'm obviously not to a nursing standard. Blame the CI for a career change, and a student loan to pay, and denying my chance to get a license, making the past 6 years of nursing education a waste of time then. If it's okay for CI's to pick on a last year student, to get her 'fail' quota, then maybe this is not a great field. congrats to those who survived. how was i supposed to build confidence while constantly being criticized for not doing things i've never done before like an expert?
I think I have a simliar problem, the CI is coaching me through things, and then threatens to fail me because she feels she is coaching me too much. However, my complaint is, if I've never done the particular skill, how is possible for me to go in like i've done it a million times already? Obviously she expected me to do that, otherwise she would not complain she had to coach me, she is always putting me down. i just feel like okay, if the technical part is such a big deal, and at rounds, i can't explain a patient condition, that not even the doctors haven't diagnosed medically, and then claim it's because i don't read the charting correctly, i'm obviously not to a nursing standard. Blame the CI for a career change, and a student loan to pay, and denying my chance to get a license, making the past 6 years of nursing education a waste of time then. If it's okay for CI's to pick on a last year student, to get her 'fail' quota, then maybe this is not a great field. congrats to those who survived. how was i supposed to build confidence while constantly being criticized for not doing things i've never done before like an expert?
Sorry you are having a struggle with your CI.
A few tips from an unbiased perspective:
1.) Some CIs are better than other and some
have teaching styles that work better for you than others, but do your best to adapt.
2.) I have never heard of any CI having a quota of number of students to fail.
3.) Practice skills outside of the patient room;
open skill lab times are great for this but students
rarely utilize them when needed. If you need coaching, get it before you head in to perform the task.
4.) You are not responsible for forming a medial dx. You are responsible for knowing the patients response to the disease process: vitals, I&Os,
prn med usage, concerns, etc. You should be able to verbalize this during rounds. It's good the medical teams include the RNs at your hospital. I know it's hard on the interwebs, but your post was full of double negatives that make it hard
to follow what you are saying, and this my be part of your report at rounds or end of shift. Take time to organize your report into SBAR and make sure it makes sense;'write it out if you have to.
Ok folks...I can see the OP's point and I'm surprised others cannot clearly see what the problem is with the clinical instructor.
The clinical instructor should make comments at the bedside MINIMAL as yes, this does increase anxiety for the patient.
The proper way with the IV situation is for the clinical instructor to say BEFORE entering the room..."Now, show me what supplies you'll need and verbally go through the steps.". When I have students with me I usually have a clean, retracted cannula so they know what to push to retract the needle, etc. I have them lay out the materials, go over how to cleanse the site, what to say to the patient, etc. That way, only minor corrections should be needed at the bedside.
I walk in with the student and say, "Mr. Smith, I have a student with me, would it be ok if she started your IV?" The only thing that I don't do is say it's a student's first time UNLESS THEY ASK.
When a student is engaged in conversation with a patient...I give them a couple of minutes to stumble through it...even if they tell them something wrong, give them a chance to correct themselves, before I say anything.
Constant interruptions distrupts a student's thought process.
If the instructor wants to micromanage the process, then he/she will probably see nothing but students at their worst.
I know what you mean...some people only know how to tell you what to do but a real teacher guides and watch you learn and problem solve on your own...i wouldn't want someone to tell me what to do everytime...if it keeps up by the time you are on your own you won't recall anything...
Neena_RN
4 Posts
Sbe is a nurse and one thing you will learn eventually is that nurses are use to taking charge and "just doing it". I'm a new grad and I'm already getting like this. I understand exactly where you are coming from when you say that you want her to ease up a little and let you take the wheel. Maybe you should sit her down and just tell her how uncomfortable it makes you and how you want to figure it out on your own. She may not even realize what she is doing. Nurses are just use to just getting it done and moving to the next thing. And as far as choosing a preceptor, choose where you want to go and what your interests are. You will learn more, and you will enjoy your experiene much more. Hope I helped.