Failing student in clinical

[organichombre, ADN, BSN, MSN, LPN, RN]

Yesterday I had to fail my very first student in clinical An ADN student who was an LPN but had never worked as a nurse. A single mother in her 40's whose mother and father both in their 80's had moved in with her so she could complete nursing school. I know right?! This student was a failure from the first day and it amazes me how she could have made it to the last med/surg clinical before their Capstone clinical! Her assessments were without detail, she could not or would not take off a binder to see what was underneath, she had no idea of how to begin a foley placement, she could not tell me at the end of the day how much drainage had came from the chest tube, the list goes on. We discussed all these areas ad nauseum and at midterm she was still lacking basic skills that should have been in place 2 clinicals back. So I failed her, developed a plan for her to be successful at finals, the powers that be brought in another instructor to evaluate her for 2 days, she then went to SIM lab and I had her for the final 2 days. She improved her documentation to where it should have been already, her care plans and concept maps were complete and informative but she still did things like, (and I swear, I am not making this up), when asked how much o2 was her patient on with a nasal cannula she responded, "50". 50 what I asked? She pointed to the suction flow meter and said 50! When hanging an IVPB I asked her what the rate would be for 100ml over 30 minutes and she said, ".3", "No, 30". As to her responses she is the only student I have ever met who thought they knew more than they really did. When we spoke yesterday the clinical coordinator was there with me for support of the both of us which was nice. When I ask the student to evaluate herself I get, "Well I'm great at a lot of things". So name one specific. "Well, I talk to the patients really well, I let them know that I am there for them and can get them whatever they need". But specifically how are you applying the nursing process to what you are doing? 'well I do not know for sure but I know that I am doing the things I'm supposed to be doing." From what I have seen once she realized that I had failed her at midterm, she felt that I was not going to allow her to pass the course. I was undoubtedly flabbergasted that she had indeed made it this far without being failed and she probably picked up on that but this student was given every opportunity to pass clinical but did not even realize that she was not failing. It had all boiled down to the fact that I was not going to pass her and I did not like her. She had met with the dean of the school, I suggested she meet with the student assistance person who helped develop a plan to study and prepare for clinical, and as I said she had another instructor for 2 days who evaluated and precepted her and in between she went to SIM lab which apparently did not work out as well. So I was at an utter loss when she continued to tell me the same thing over and over that she could not understand how I felt that she was unsafe and that all she needed was for someone to tell her what was wrong and then "I would never do that again"! I have never been confronted with someone who was in such denial. Not only for the fact that I had failed her but that so many other people had recognized the same things that I was seeing. I know this went long and it's one sided but believe me I feel much better knowing that she will not graduate...yet! And then that is a whole other story! Thank you for listening...

[SHGR, MSN, RN, CNS]

Wow, do you have clinical fail days? These are big safety issues. We are allowed to give students a clinical fail day for such things and two fail days=failure of the course. I am frankly just as surprised as you that she had not previously failed out of the program.

So frustrating.

[nursej22, MSN, RN]

I was recently involved with failing out a student; I was one of 2 observers giving her one more chance to demonstrate a vital skill.

Your description of her be so oblivious to her errors sounds so familiar. Her lack of insight and critical thinking was shocking.

Now she is grieving based on racial bias. SMH.

[jifferte, BSN, MSN, RN]

It is always difficult to fail a student, and it sounds like both you and the program took several opportunities to bring her up to snuff. When grievous clinical errors are made, or the student is failing theory, we put pen to paper in the form of conferences outlining the deficiencies and what tools the student can use to help learn from the situation so that it does not occur again. The student can appeal all they want but if the evidence is there in the form of a paper trail outlining patterns of deficiencies without improvement she most likely will not be successful.

[nursej22, MSN, RN]

I think that is pretty standard. Unfortunately, some students just don't appreciate the seriousness of conferences, until they dismissed from the program. And then the blame is not with them, it is the instructor or the text or the clinical setting.