Clinical Instructor

[Guest1204365]

I just need some advice regarding my daughter, who is currently in nursing school.  She was at her clinical rotation when she received a finger stick injury.  Her nurse had her wash her hands and then it was reported to the charge on the floor.  My daughter then messaged her instructor to let her know about the incident.  When the instructor got to the floor she became extremely upset and started slamming things down yelling at my daughter stating she should've contacted her immediately.  She was extremely rude, so much so, the charge and her nurse stated she was behaving very unprofessionally.  My daughter was so upset she went to the bathroom and just cried as she was utterly humiliated in front of so many individuals.

At post conference, all the students were talking about their day, when her instructor suddenly turned to my daughter and told all her fellow students that she had received a finger stick injury.  The instructor then got up and said conference was over and excused the class.  Once again, she felt utterly humiliated.  I am so angry I don't know what to do.  My daughter said she would email her instructor tomorrow to talk to her about what happened.

What I would like to know is if this instructor violated HIPAA by telling the class what happened and the various labs she had drawn.  I also think the dean should be made aware of the instructors unprofessional behavior as this makes her teaching institution look really bad.  I am trying to stay out of this and allow my daughter to handle it, I'm just looking for a little guidance.

P.S. The nurse who was working with my daughter gave her her phone number just in case she needed someone to collaborate her story.

[Hoosier_RN, MSN]

Dili said:

No one said you were being mean, unkind and cut-throat were the words used. 

Thanks for the input. 

If you, or you daughter in the general sense, think that anyone one here is mean, unkind, or cutthroat regarding how we gave general answers to her situation, she needs to re-evaluate her entry into nursing. Patients and families, along with doctors, coworkers, managers, and administrators are going to be a lot more blunt over time. It's life, not everyone is going to sugar coat things or put it in a pretty box with a bow. Especially people in crisis situations, or with life stressors that are present in the healthcare arena

[Tweety, BSN, RN]

I wonder why so many advised you to stay out of it when clearly you said you would let your daughter handle it.

Butting heads with an instructor usually isn't a good idea even if justified.  Administration will most likely support their instructor, not the student.  The instructor probably was upset because of the work it involved for her/himself and dismissed the class to get that done.  They have to file a report, action plan, etc.  It wasn't handled correctly for sure.  She should have been supportive and I don't think it's the whole class's business.  But you can't fault the students for talking about a needle stick. It would be a big deal.

I hope it's a learning experience for her, as to how to avoid a needle stick.

I also find some people to exaggerate.  I've heard one student say "did you see the way that nurse yelled at me".  No that nurse didn't "yell" she just told you what you did was wrong.  

[Nurse Alexa, MSN, RN]

Dili said:

Nurse Alexa, MSN, RN

I could maybe understand the need to tell everyone in her group if it was a teaching experience, but it wasn't.  The professor simply blurted it out and excused the class. No follow up, no educational teaching and no room for questions. 

I hope that everything works out for your daughter and this clinical interaction did not have debilitating effects for her. This a difficult experience to go through at the whims of others, which definitely should have been treated differently by the professor.

While we are nurses and should know what is ethically right, we are also all people. I would hope and think that this clinical instructor did not intend for this incident to be malicious. I would explain to your daughter that sometimes we cannot control how others act with sensitive information (even when they are in a role of authority).

I believe you guys did the right thing and used the chain of command to escalate your discomfort with the situation, to prevent this from happening to others. I could picture your daughter being not only embarrassed but intruded on and you're right - it's no one else's business.

[hppygr8ful, ASN, RN, EMT-I]

I am absolutely certain that the clinical instructor's unprofessional behavior didn't help but could it also be true that your daughter could have been feeling some remorse, regret, humiliation over the fact that she had a needle stick. Don't get me wrong, these things happen and once dealth with should be water under the bridge. I remember with crystal clarity the first time I had a needle stick! I kept telling myself how STUPID, STUPID, STUPID I was.  I felt bad enough to have made the mistake let alone have a clinical instructor harp on it.

The thing I always wonder is "Why slink off the bathroom to cry?" While we are all human, nurses need to be made if sterner stuff. Imagine if she had in the presence of her peers said. " You know you're right! It was a dumb mistake and one I'm not likely to make again so can we please move on with today's itinerary."

My point being that right or wrong a nurse will face many situations , rude co-workers,  unforgiving supervisors, angry patients and their families and let's not forget the doctors."  Facing these people head on robs them of their thunder. 

I remember one doctor who was quite inappropriately dressing me down and saying "Excuse me Doctor I think the conversation had better move to HR so all parties can have their say!" That doctor later became one of my fiercest allys.  

I know your daughter will benefit from learning to fight these battles so that she can effectively advocate for her patient when the Dr. Is clearly in the wrong.

Hppy

 

[londonflo]

Dili said:

She was at her clinical rotation when she received a finger stick injury.  Her nurse had her wash her hands and then it was reported to the charge on the floor.  My daughter then messaged her instructor to let her know about the incident.

Where was the instructor???  Washing the hands is always the first step. But you need the instructor on the floor with the student. BTW many programs require the students have private health insurance to provide $$ security. 

Frankly I am going to emphasize that a nursing student should go to a program where an instructor is ALWAYS present on the floor, supervising all skills. 

[Hoosier_RN, MSN]

londonflo said:

Where was the instructor???  Washing the hands is always the first step. But you need the instructor on the floor with the student. BTW many programs require the students have private health insurance to provide $$ security. 

Frankly I am going to emphasize that a nursing student should go to a program where an instructor is ALWAYS present on the floor, supervising all skills. 

The instructor may have been on the floor, in another room, with another student. 1 instructor can't be with all of the students 100% of the time. But after washing hands, the student should have notified her professor. The school may have a different protocol than the hospital. This may have been covered at 1 time or another, prompting this professor's response. None of us were there, so hard telling, too many variables unknown

[Tweety, BSN, RN]

Hoosier_RN said:

The instructor may have been on the floor, in another room, with another student. 1 instructor can't be with all of the students 100% of the time. But after washing hands, the student should have notified her professor. The school may have a different protocol than the hospital. This may have been covered at 1 time or another, prompting this professor's response. None of us were there, so hard telling, too many variables unknown

Agree.

The student did message the instructor whom obviously wasn't there.   So first she told who was there, and it sounds like a floor nurse was present.  The floor nurse would naturally tell the charge nurse to get the incident reported via the hospital chain and the other chain is the instructor.  I think all things were done according to proper protocol.

The issue is the instructor behavior and like you say we are only hearing one side of the story as told to the mother who wasn't there.  We don't know the instructor's perspective.  It does sounds like perhaps the instructor could have behaved differently.

Here, I don't know about where this student is, it's very common for students to work with floor RNs without the instructor present.  The idea of "Frankly I am going to emphasize that a nursing student should go to a program where an instructor is ALWAYS present on the floor, supervising all skills. " might be a good idea but is an outdated one.  Often instructors have students on different floors or units paired up with floor RNs.  

[Hoosier_RN, MSN]

Tweety said:

The idea of "Frankly I am going to emphasize that a nursing student should go to a program where an instructor is ALWAYS present on the floor, supervising all skills. " might be a good idea but is an outdated one.  Often instructors have students on different floors or units paired up with floor RNs.  

Yes, when many clinical instructors have anywhere from 10 to 20 students (I've heard of even more, but it's rare), some may be on the med surg unit, 1 or 2 at surgery, 1 or 2 in the critical care units and ER, 1 at the inpatient (acute) dialysis unit, almost all paired with other nurses. So hard to keep up. It's one of the reasons why I got out of nursing education 

[londonflo]

Tweety said:

The idea of "Frankly I am going to emphasize that a nursing student should go to a program where an instructor is ALWAYS present on the floor, supervising all skills. " might be a good idea but is an outdated one.  Often instructors have students on different floors or units paired up with floor RNs.  

But then we read on this forum that the students are a burden on floor nurses who already have a plateful. Forgive me if I missed it on your mini-bio but I don't see that you have a College Clinical Instructor role so you are making an assumption that having an instructor on the floor associated with the clinical group is outdated. For an entry level nursing program, a faculty is usually responsible for skill activities. The rise of the "capstone" courses have allowed the entry level programs to abdicate this important responsibility.

For the 2 hospitals I have taught at: students are not allowed to perform skills with out the instructor present. Your mileage may vary. 

Hoosier_RN said:

when many clinical instructors have anywhere from 10 to 20 students (I've heard of even more, but it's rare),

Each state has established the number of students a faculty is directly responsible for in clinical rotations. I have never read of a state Nurse Practice act to allow more than 10 students in direct supervision. Where have you seen more than 10 students (especially your quote of 20 plus more). Are you attributing students in observational experiences in the 10 +? These students are also included in the faculty student headcount established by the state. 

[Wlaurie, RN]

Ugh....nursing instructors. I had a terrible one that was way worse than this and had her for 2 rotations. Wasn't part of the school, an adjunct cause they couldn't get enough instructors. Just a few highlights if I may. First day of rotation, calls us in and threatens to flunk all of us for the lousy job we had done. Then found out this was only our second rotation and did a 180 and said oh then you did great. So many examples I could give and the tears that were shed by all. Last rotation, she has her favorites and not favorites. Tells us we'll know where we fall. I was in the not favorites group and she refused to spend ANY time with me and several others. Wouldn't even assign us to a nurse. I had to ask a nurse if she would let me shadow her. I just put my head down and got thru it but it was gut wrenching not knowing where or when she would explode on one of us.

[Rnis, BSN, DNP, APRN, NP]

It's always hard to hear our child being in a way that feels unfair. when emotions are high, it's hard to know the exact situation that occurred hearing it as 3rd or 4th parties but kudos to your daughter for personally taking her concerns to the actual instructor.  That shows professionalism and confidence that will take her far.  you should be proud! hoping all goes well with source testing. 

[Tweety, BSN, RN]

londonflo said:

But then we read on this forum that the students are a burden on floor nurses who already have a plateful. Forgive me if I missed it on your mini-bio but I don't see that you have a College Clinical Instructor role so you are making an assumption that having an instructor on the floor associated with the clinical group is outdated. For an entry level nursing program, a faculty is usually responsible for skill activities. The rise of the "capstone" courses have allowed the entry level programs to abdicate this important responsibility.

For the 2 hospitals I have taught at: students are not allowed to perform skills with out the instructor present. Your mileage may vary. 

Why the snark?  

But no I don't have any clinical instructor experience but I know what I see on the floors.  None of the four schools that have clinical in my hospital have the instructors on the floor following each student for every task.   Most of the time the instructor is close by and can be called to observe a student do something they haven't done before so they can be checked off, but if they've done it before they can do it with a nurse.

So yes, I find your suggestion " that a nursing student should go to a program where an instructor is ALWAYS present on the floor, supervising all skills. " to be outdated.  At best it's privilege, as students around here that would follow your advice would have to move.

When I have 6 patients on the floor and student comes along to be with me it is a burden, but I don't complain, it's my duty and I'm happy to do it.