Clinical Instructor

Nurses General Nursing

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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

I know how cut-throat nursing can be, but being mean and or cruel to new nurses and nursing students is definitely going to end up biting us in the behind.

Cruelness shouldn't be tolerated and its actually no longer being tolerated as nurses are leaving bedside in astronomical numbers.

We have to do better in the way we treat are new nurses and nursing students.  

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Hoosier_RN, MSN

I know how cut-throat nursing can be, but being mean and or cruel to new nurses and nursing students is definitely going to end up biting us in the behind.

Cruelness shouldn't be tolerated and its actually no longer being tolerated as nurses are leaving bedside in astronomical numbers.

We have to do better in the way we treat are new nurses and nursing students.  

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JKL33

My "tone"?  I simply asked for guidance, and informed you all what she did and how she handled it. I don't feel I gave off a "tone".  

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Specializes in Dialysis.
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. 

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. 

I've been a didactic (med surg I & II) as well as clinical instructor. I haven't done it for 5+ years, so I took it out of my bio, as I did ICU, med surg, LTC, HH, hospice, PDN, and corrections. I kept what was relevant for me. So yes, I do understand the whole headcount being established by state. It doesn't mean some less than scrupulous schools haven't bypassed that. A close friend taught clinicals at the former Brown Mackey where she was supposed to have 10 students, regularly had 25 due to no show other instructors. Others like MedTech pulled the same garbage. It's part of the reason why neither are in business anymore, at least in Indiana

FYI, I didn't make the original comment that a clinical instructor had to be present 100% of the time for students. Sorry, but you cannot be with each student 100% of the time, for my groups, they were assigned out to too many other areas.. As seniors, when they are with another registered nurse, they may perform various procedures (dressing changes, med pass, etc) with that nurse present. That's my mileage, at the 4 hospitals that I was at, per school policies as well

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Specializes in Dialysis.
Dili said:

Hoosier_RN, MSN

I know how cut-throat nursing can be, but being mean and or cruel to new nurses and nursing students is definitely going to end up biting us in the behind.

Cruelness shouldn't be tolerated and its actually no longer being tolerated as nurses are leaving bedside in astronomical numbers.

We have to do better in the way we treat are new nurses and nursing students.  

No one was cruel, cut throat, or even mean, as you stated. Many were direct. If that a problem, that's a reflection on you, not any of us. Again, your daughter will run into many patients who are distressed in her career, administrators who are cutting corners, managers who are carrying out whatever objectives. They aren't going to worry about anyone's feelings. If you're a nurse, you already know this. The NETY to me is way overplayed. When someone is truly being bullied, yes, it's a bad thing. But having to walk on egg shells around every coworker to spare their feelings constantly does no good either

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Specializes in oncology.
Tweety said:

Why the snark?  

But no I don't have any clinical instructor experience but I know what I see on the floors

Tweety said:

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,

Student contracts with the school/college delineate what  skills a student can do without a lab skill experience, check off or etc.. But I agree, these experiences come way before the student has actually done the experience within a controlled environment. These skills should be outlined by the instructor but I can feel your pain. 

I worked with first semester students (2 weeks into their first nursing course)  posted for staff the skills students will do:

  • vital signs
  •  physical assessment of their patient. This was made very clear to the student. and noted to staff (but who looks at those assignment sheets?)

A student would come to me saying " I told the RN I would do this dressing change." I said "You mean I will do the dressing change and you will help (the student had no medical or surgical asepsis education.)... I would show how to open dressings etc. but the student totally  missed the reason this was their first clinical experience versus the "clinical focus" on physical assessment ( including vital signs, pulse Ox etc). And I was there in front of them explaining would our goals were that day before we met the RNs.. 

Tweety said:

ut 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.

If your workplace has then many students, there must be an Nursing School Education coordinator..  Time to talk to them. There are being paid for this coordination. 

Tweety said:

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.

Tweety said:

but I know what I see on the floors.  

  • Where do you live...Do you have a community college? Communicate with them. There should be a contact person both at your institution and the school
  • We all hate outdated things --- I stopped wearing mini-skirts when I hit 40. But the problem of delivering an effective nursing education, is not outdated (unlike me). I don't need to tell you about the challenges you see with students, new graduates and even those new to the setting. 
  • You know more about what the RN needs to know, anticipate and evaluate on a shift. 
  • A good experience on your unit will go far to recruit that graduating student to your unit. And I can guarantee this is a fact.  And these new grads may (hopefully) recruit more students the next semester
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Specializes in Med-Surg, Trauma, Ortho, Neuro, Cardiac.
londonflo said:

Student contracts with the school/college delineate what  skills a student can do without a lab skill experience, check off or etc.. But I agree, these experiences come way before the student has actually done the experience within a controlled environment. These skills should be outlined by the instructor but I can feel your pain. 

I worked with first semester students (2 weeks into their first nursing course)  posted for staff the skills students will do:

  • vital signs
  •  physical assessment of their patient. This was made very clear to the student. and noted to staff (but who looks at those assignment sheets?)

A student would come to me saying " I told the RN I would do this dressing change." I said "You mean I will do the dressing change and you will help (the student had no medical or surgical asepsis education.)... I would show how to open dressings etc. but the student totally  missed the reason this was their first clinical experience versus the "clinical focus" on physical assessment ( including vital signs, pulse Ox etc). And I was there in front of them explaining would our goals were that day before we met the RNs.. 

If your work place has then many students, there must be an Nursing School Education coordinator..  Time to talk to them. There are being paid for this coordination. 

  • Where do you live...Do you have a community college? Communicate with them. There should be a contact person both at your institution and the school
  • We all hate outdated things --- I stopped wearing mini-skirts when I hit 40. But the problem of delivering an effective nursing education, is not outdated (unlike me). I don't need to tell you about the challenges you see with students, new graduates and even those new to the setting. 
  • You know more about what the RN needs to know, anticipate and evaluate on a shift. 
  • A good experience on your unit will go far to recruit that graduating student to your unit. And I can guarantee this is a fact.  And these new grads may (hopefully) recruit more students the next semester

Not my monkeys and not my circus but thanks for your input.

 As I said, not that your experience isn't the more superior of the two models, but I didn't come up with it and literally hundreds of students have gone through it over the years.  It's my job to mentor while they are there and give them a good experience, but I let it go at that.  The one advantage to them working in conjunction with a floor RN is that they get a taste of the real world.  

My guess is that it's the school's themselves that have come up with this model, not my facility as it's also done at other hospitals the schools go to.  Although certainly they come together and agree to implement it.  It's been many years now.

Allowing students is indeed mentioned as part of my facilities recruiting program.  

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Specializes in oncology.
Hoosier_RN said:

've been a didactic (med surg I & II) as well as clinical instructor. I haven't done it for 5+ years, so I took it out of my bio,

Hoosier I was not responding to you on this thread. I know you have many years of  providing nursing education. I am sorry I did not address my comment to whom it referred. 

Hoosier_RN said:

Sorry, but you cannot be with each student 100% of the time, for my groups, they were assigned out to too many other areas.. As seniors, when they are with another registered nurse, they may perform various procedures (dressing changes, med pass, etc) with that nurse present.

I tried to not  describe that these type of experiences were what are called "Capstone" courses. But it does distress me that these same "capstone" students are paying the same  credit hours for the responsibility, guidance and focus of a nursing  instructor as those in the first semester. 

Hoosier_RN said:

So yes, I do understand the whole headcount being established by state. It doesn't mean some less than scrupulous schools haven't bypassed that. A close friend taught clinicals at the former Brown Mackey where she was supposed to have 10 students, regularly had 25 due to no show other instructors. Others like MedTech pulled the same garbage. It's part of the reason why neither are in business anymore, at least in Indiana

I am so glad these programs are extinct. If they were  RN programs, the faculty member, no matter how many absences by other instructors, would be held liable for the law as specifies in the Nurse Practice Act .

  • when teaching , an RN instructor is still held liable for knowing the Nurse Practice Law. The Nurse Practice Act states the MOST number of students that the instructor can be responsible for. 
  • I have had adjunct instructors let students hang blood, (in my state you have to have an RN license to do this),
  •  Leave a patient in respiratory distress  without a call bell in reach (respiratory patient who panicked),  etc. I say this from the the one who had to remediate them. 
  • Frankly, as a course chair this all comes to me. 

The rise of MSN nursing education programs on line is my main bone of contention. If you are preparing for the role of nurse education,   unsure of what your student can do, do you put into writing on a "message board" for all to see on the course? How about we talk about in person, where we can learn at the moment, discover better ideas, new learning activities etc. 

And yes the Nurse Practice act is the law... what is specific (usually 10)  more than 10 (depending on the state) is violating the law and is fodder for your license and malpractice suits. 

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Specializes in oncology.
Tweety said:

Not my monkeys and not my circus

It might be your monkeys and circus, if a student is given an assignment and skill over the students educational level and the action has untoward effects,, harm comes to the patient.  Who is responsible? 

Why are students paying dearly for credit hours their last semester when staff are donating their time? 

You will not like my answer, but provide your charitable hours to someone who is not paying for them. (I am sure you are providing great educational experiences, I truly mean that)

The schools/colleges are taking great advantage of you and your colleagues. This is big mess that needs to be cleared up. How can a college evaluate the educational experiences across the board when one student has a great experience with you and one has the wicked witch of the west?

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Specializes in Med-Surg, Trauma, Ortho, Neuro, Cardiac.
londonflo said:

It might be your monkeys and circus, if a student is given an assignment and skill over the students educational level and the action has untoward effects,, harm comes to the patient.  Who is responsible? 

Why are students paying dearly for credit hours their last semester when staff are donating their time? 

Again, I can only speak to my experience.  

Students aren't given an assignment and are never unsupervised and know what they can and can not do.  They work with an RN with the RN's assignment.  

I've never heard of a student causing patient harm where I work, but I suppose the hospital and the school both are liable for those delivering care within the facility.  We're a teaching hospital with many disciplines so I'm sure they are covered somehow.  More often staff nurses make the errors and the hospital picks up the liability.

I have had nurses say "I'm not being paid to be their instructor" and so they can refuse a student.  I choose to participate.  It's my choice.  

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Specializes in oncology.
Tweety said:

've never heard of a student causing patient harm where I work, but I suppose the hospital and the school both are liable for those delivering care within the facility.

I have to note that I just edited my previous response to you but the content is the same.

From 40+ years, the blame for a injurious error can be distributed across the hospital, school, student and preceptor.  The preceptor  (putting themselves in the responsible position) 

In my previous entry, I noted that a graduating student left a SOB respiratory patient with out a call light. The patient panicked. Upon review of the situation the student was failed what would be her last semester (she did successfully complete the curriculum the next semester) and the staff nurse was disciplined. Unfortunately the student never realized the gravity of the situation, continuing to blame the staff nurse. The student was the LAST one out of the room. 

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Specializes in oncology.
Tweety said:

  More often staff nurses make the errors and the hospital picks up the liability.

You may want to review this statement.

Quote

On Friday March 25, 2022, former nurse RaDonda Vaught was found guilty of criminally negligent homicide and gross neglect of an impaired adult. These convictions came from Vaught's medication error that killed patient Charlene Murphey in 2017 at Vanderbilt University Medical Center.Jun 1,

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