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]

londonflo said:

The rise of MSN nursing education programs on line is my main bone of contention

100% this! And why I partially believe nursing is in the shape that it's in

[Tweety, BSN, RN]

londonflo said:

You may want to review this statement.

Thanks.  I did say "more often" than students, as I understand there are no absolutes.  The Vanderbilt case was an outlier and really not an every day experience.  But certainly not unheard of and we should always be diligent.

[Tweety, BSN, RN]

londonflo said:

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. 

Fair enough, I'm sure there are countless stories like this one.   I certainly understand that as a preceptor I do need to keep a watchful eye out.  Just because in my 30 years of precepting I've never heard of a patient injury or potential injury caused by a student,  certainly doesn't mean I think it's unheard of.  

The only death I've heard of an RN being involved in where I work is when a patient chocked to death in a wheelchair in restraints.  It was a sentinel event and RN on duty retired.   I know these things happen.  I do presume that a thorough investigation of any injury of all parties involved would be done...and action and blame thrown around.  

At the end of the day I've been lucky, and I am always on my guard for errors or potential errors, and I have lost sleep when patients crash "what did I do or could have done??". 

[klone, MSN, 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. 

When I went to school, the bold was true for the first time a student does a skill. After that, they are supervised by the nurse they work with/shadow. 

If a nursing instructor was meant to be with every student 100% of the time, we wouldn't need nurses to precept students, would we? Seriously, saying that the instructor should be with every student 100% of the time is completely unrealistic. That's why they have skills check-offs. To show the instructor that the student can safely perform a skill. Then they're allowed to do it without the instructor present.

[JKL33]

Dili said:

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".  

That is literally not true.

In any case, it is over and your daughter has handled it to her satisfaction. I hope the rest of her semester goes well for her.

[mmc51264, BSN, MSN, RN]

Hoosier_RN said:

Realistically, the school/hospital/professor cannot discuss with you, as it is a privacy issue from that standpoint. 

My child signed a FERPA form. I can speak to his professors if I need to (he is a T1 diabetic and on the spectrum)

[Hoosier_RN, MSN]

mmc51264 said:

My child signed a FERPA form. I can speak to his professors if I need to (he is a T1 diabetic and on the spectrum)

And that's a totally different thing. I'm talking about parents who have no standing. Before I left nursing education, you can't begin to imagine the calls and emails from "Susie's mom", "Mary's dad", etc,  wondering why their child, age 18+, got such and such grade for the class or on individual papers, tests, or clinicals. With said parents, I could only offer that I could not give information about adult age children without express written consent on file. Of course, "Susie" and "Mary" usually had lousy attendance and gave 0 effort when they did attend. I was often met with "I pay her/his tuition!", to which I still had to inform that I could not break privacy laws. I would then refer them to our campus ombudsman/business office who could direct them appropriately. And, on the flip side, "Susie" and "Mary" almost never wanted to give consent, because mom/dad would have an MI after learning the truth

[londonflo]

klone said:

When I went to school, the bold was true for the first time a student does a skill. After that, they are supervised by the nurse they work with/shadow. 

This depends on the hospital, where the student has their clinical practicum. Our hospitals require the instructor be present and they control our clinical placements. We are guests in their institutions and therefore have to follow their rules or we will not be able to use their facility. And schools are standing in line to get placement there. We can easily lose our slots.

klone said:

That's why they have skills check-offs. To show the instructor that the student can safely perform a skill. Then they're allowed to do it without the instructor present.

Our skills check off is in a controlled environment, set up on campus with the ideal situation (mannequins, materials readily available etc) that designed to measure the skill under the best circumstances possible. Ours are high stakes testing which after the student fails twice after much remediation they fail the course. Performing a skill in the hospital possibly requires some adjustments to meet the needs of the patient. Yes, the hospital presents some additional challenges.

klone said:

If a nursing instructor was meant to be with every student 100% of the time, we wouldn't need nurses to precept students, would we?

Then why have nursing educators/instructors at all? Go to an apprenticeship method. Why does my state nurse practice act require a MSN to teach nursing? Why have any standards.

[Tweety, BSN, RN]

londonflo said:

Then why have nursing educators/instructors at all? Go to an apprenticeship method. Why does my state nurse practice act require a MSN to teach nursing? Why have any standards.

Nursing is a bit more complex than that.  You need classroom instruction and you need hands on instruction as well.  I suppose where the issue is who does the hands on instruction.  Even 30 years ago when I was in school we still have a preceptor those final hours where we worked one on one with a preceptor RN with no instructor in sight.  That was a very valuable experience to me.

That's all I'll say.  We're not helping the original poster anyway.  

[londonflo]

Tweety said:

Even 30 years ago when I was in school we still have a preceptor those final hours where we worked one on one with a preceptor RN with no instructor in sight.  That was a very valuable experience to me.

Yes, I remember my last days as a student doing public health. I remember being thrilled I could answer the client's questions without needed input from an instructor.. Thank you for bringing back those memories, It is truly a unique time when classroom, skills lab, and clinical come together! 

[londonflo]

mmc51264 said:

My child signed a FERPA form. I can speak to his professors if I need to (he is a T1 diabetic and on the spectrum)

I can understand your concern. A support system of a concerned parent past the age of 18 is so important. (I have been there with a daughter who failed a "Jazz course' and concealed from me.)  But when I learned eventually from her I said " They didn't expect you to compose it or perform it".  We discussed it and found out her distractions...sometimes you need to talk to a parent.

MMC OP

I think if you had a parent who was also a nurse, you would relish their wisdom and use it to clarify what has happened. So glad you are in there "your knowledge and experience mean more for role and professional development than one instructor". 

Hoosier_RN said:

I was often met with "I pay her/his tuition!", to which I still had to inform that I could not break privacy laws. I would then refer them to our campus ombudsman/business office who could direct them appropriately.

Hoosier.. I too get these calls..but most often on Christmas break (after first semester). We just gotta live with them and live with the privacy laws. 

[Guest1204365]

JKL33

Sorry you feel that way.