Clinical Instructor Sharing Information from My Journal

[sKris]

Long story short, we are required to keep journals about our clinical experiences which we hand in to our instructor. Last week I wrote about something I witnessed that I felt was unprofessional and unfair to the patient. The next clinical day my instructor comes up to me and says that the nurse manager would like to speak with me and another student (who also witnessed and wrote about the same incident). She had shared the account from our journals with the manager. I was a bit taken aback as I thought our journals were private. If my instructor thought it was something that should be addressed, I think she should have at least let me know first or encouraged me to speak to the nurse manager on my own. The nurse manager said she is going to address the situation with the staff member. As a student I feel like this could cause resentment towards students in the future. I don't want staff to think we are 'spying' on them and rating out there bad behavior. Luckily our time on this unit is almost over.

Just needed to vent a little.

[guest042302019, BSN, RN]

While you aren't a spy, you can keep people accountable for their actions (even as a student). Maybe a warning from your instructor so you weren't caught surprised, would've been nice. However, it must've been serious enough to mention to the nurse manager (a patient safety issue?). I doubt very much that names will be used when the manager talks to the nurse about his/her actions. You may be even be placed with a different nurse from now on. No harm done. And, you seemed to make the environment safer for the patient. :)

It may be better if your instructor speaks with the manager first. There is a lot of "stuff" that occurs in order for students to be on a particular unit. This may have been a sensitive matter that a more experienced nurse, the instructor, needed to broach. I wouldn't take it personal. Good luck.

[elkpark]

I agree that it would have been nice if the instructor had let you know up front that there were limits to your confidentiality in your student journal. However, if it was a serious enough safety/professionalism concern, that trumps "privacy" in your school paperwork, IMO.

It may also be the case that the nurse manager came to your instructor initially, rather than the other way around. I had an unusual experience the last time I taught a psych nursing clinical, a few years ago. I had students on a child psych inpatient unit, and the attending psychiatrist on the unit was someone I already knew professionally. The facility was a teaching hospital, so there were also medical students and residents on the unit. One day in post-conference, a couple of the nursing students were talking about how one of the medical students had been flirting with them openly (and pretty clumsily) on the unit, and had also displayed some behavior with the clients on the unit that seemed odd enough to them that they mentioned it in conference. We all agreed that that was pretty inappropriate and unprofessional of him, but the students weren't traumatized or anything :), they just laughed it off (and no client safety concerns were involved), and I wasn't going to say anything to anyone about it. However, a couple weeks later, the psychiatrist approached me and asked me directly if any of the nursing students had had any unusual or inappropriate experiences with that particular medical student. I mentioned hearing from the two students in post-conference, and she asked if they would be willing to speak with her directly about that (which they were, reluctantly, when I approached them about the situation). Turned out the psychiatrist, who was responsible for the med student(s), already had significant concerns about that particular student based on previous incidents, so she was actively looking for additional feedback about his behavior/performance.

This may have been the situation in which your instructor found her/himself, and the nurse in question may have already been under scrutiny. In my case, it turned out that that medical student had already been counseled multiple times about some inappropriate and unprofessional behaviors, and was on "probation" of sorts. The nursing students' account of their experience with him turned out to be "the final straw," and he was expelled from the medical school (in his fourth year, and the chance that he would be able to get into another medical school under those circumstances was basically zero; his medical career was over). The students felt horrible about that when they found out, but reassured them that it wasn't their responsibility, he had made his own choices and he was responsible for them.

[llg, PhD, RN]

I agree that the instructor should have talked with you first, if that was feasible. However, she may not have had that opportunity.

And I think you are right about it possibly causing tension between the students and the staff. If it only happens very ocassionally, then it probably won't become a big deal. But if the staff feels that students are critiquing their preformance and getting them in trouble for "every little thing," they will probably stop welcoming students to their unit. Tread carefully there for a while until you see which way the wind is blowing.

[nurseprnRN, BSN, RN]

Had I been that instructor I would almost certainly have shared serious safety or ethical concerns with the nurse manager (it's the instructor's job to maintain a collegial relationship with the nurse manager where students are placed), if they were brought to my attention by my students' journals.

I would have asked the students to speak to the NM at her request; this is another learning opportunity for students, to see how safety or ethical issues are handled in a work environment. Learning about what happens next is instructive, too; I would be pretty sure the NM would protect my students by emphasizing the ramifications of the issue with her staff regardless of how it came to her attention, which would mitigate blowback on the students from staff.

It would also be my responsibility to report this to my boss, the director of the nursing program, and to debrief the entire clinical group in clinical conference.

You are actually lucky to have had this experience. I tell students over and over that learning about nursing in clinical is far, far more than "getting to do ..." tasks. Learning how to work in the environment is huge. They never believe it, because they are so focused on the tasks, but now... you know.

[sKris]

I appreciate the feedback and I understand where my instructor was coming from. The incident did not involve patient safety, or any real ethical issues, and I know the manager did not come to her. It was more of a personality conflict/tension between staff members and some unprofessional behavior towards a patient (speaking rudely, etc). Honestly of all the things I talked about in my journals (some of which seemed much more concerning--this floor has some serious issues) I was surprised she decided to report this incident to the manager. My only real problem is that she didn't talk to me first. If she felt it needed to be addressed she should have let me know before going to the manager in my opinion. I had even discussed the incident privately the day it happened while we were still on the unit. If she thought it was serious she could have let me know then as well.

Luckily my time on the unit is basically over and my last day went really well and was filled with much more positive experiences. I also wanted to mention that I really do like my instructor. Besides this incident she has been wonderful, and although I'm a bit frustrated, I don't hold it against her. :)

[vintagemother, BSN, CNA, LVN, RN]

I think it would have been more ideal if your instructor told your class, from the outset, that information in the journals can be shared with whomever she deems appropriate.

However, I also know that ANYTHING you put in writing can be shared with ANYONE. Writing us kind of like taking nudy pics, you never know where the pics will show up so its best not to take them unless you are alright with them being shared.

I do, however, understand your being unhappy about the teachers actions, especially since she didn't ask your permission, she simply told you.

[Jory, MSN, APRN, CNM]

You are viewing this the wrong way.

Nothing you write for school and turned in should be viewed as private anyway....remember that.

As a student, you are not yet experienced enough to know that what you saw needed to be brought to the attention of management and addressed with the nurse. I can almost guarantee that the staff member will never know which student the information came from...so please don't worry about that.

No disclosure was necessary and what the instructor did was not even close to being inappropriate. You are assuming that everything you folks wrote in your journals was discussed with everyone...your instructor would be doing you AND the patient a grave disservice if she ignored what you wrote. What would you have done if you were the instructor? Ignore the comment and let the patient suffer or address it with management?

This is a lesson for you as a future patient advocate...are you going to turn your back on a patient if you see a co-worker being unprofessional and compromising care just so you can get along with your co-workers?

If so, reconsider the profession of nursing. The patient comes first...not the nurse.

[Jory, MSN, APRN, CNM]

I appreciate the feedback and I understand where my instructor was coming from. The incident did not involve patient safety, or any real ethical issues, and I know the manager did not come to her. It was more of a personality conflict/tension between staff members and some unprofessional behavior towards a patient (speaking rudely, etc).

Speaking rudely to a patient is unethical behavior and it is a REAL ethical issue. The patient is there to receive quality care, not to be the subject of verbal abuse by the people getting paid to take care of them because some nurse obviously hates her job.