Preceptorship: My Nursing Student Didn't Take Me Seriously Because of My Age

[HalfBoiled]

I graduated and became a licensed RN at the age of 21. I started working a med/surg floor just a few months later. I'll post detail of my student pathway in the comments.

After I just reached my one year mark working in my unit, I was given a student to assist caring for a patient with a small bowel obstruction.

The issues with my student follows (no particular order)...

1) Pt had a mediport and MD allowed to access because of multiple electrolyte infusions. I informed student what I was going to do. He thought a mediport was a brand name needle for a peripheral IV and wanted to insert himself for more practice. I explained the difference between a central and peripheral IV, but he insisted to insert. I asked the instructor if it was in his scope of practice and, of course, it wasn't

2) I inserted an NGT for my patient. I called for xray to verify placement prior to leaving for lunch. I returned, did rounds for my other 4 patients and came back to my students and patient. During this time, my break relief informed that the student walked the patient around the hallway. When they returned, the NGT was out and I ask why I wasn't informed immediately. His response was, "She sneezed it out. You weren't here. I told my instructor. I figured she would have told you."

3) My patient was pain management around the clock and my student attempted to advocate for pain medications. I praised for his assessment. I asked him to take vital signs and report the respiratory rate and O2 sat. IT WAS 9 and 87% I rechecked and it was still 9. I questioned the student what was a common clinical side effect of opioids. He confidentially said "Addiction." I corrected that it was not pertinent to the current situation and I explained respiratory depression. He was adamant that addiction was correct and went to his instructor to validate. I was right.

4) I tried to explain that an IVF Normal Saline bolus and IVPB of anything does not infuse simultaneously and we would require a second IV pump. He still didn't understand and asked for clarification with his instructor. The instructor said verbatim of what I said including the use of a y-port.

5) Student saw my patient's K+ 3.3 and immediately gave orange juice. I explained it wouldn't bring up the K level compared to IVF and I asked if he was mixing it up with blood glucose levels. He didn't understand went straight to his instructor before I could explain.

6) The clinical instructor wanted the student to practice hanging IVPBs. I informed the student that we will be hanging K+ replacements. We met in the patient's room and I sat the supplies down on the clean bedside table. Before I could verify/scan patient identity, my student started opening IV tubes from the packages and was about to pike the potassium back and I firmly told him to stop. He dropped everything and said "fine." I explained, that I need to perform the 5 rights (there are probably more) of medication administration. We completed the task and he stormed off.

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The instructor found out that the student (while walking to his car) openly admitted to his classmates he couldn't take someone who was younger than him seriously. He got wind of my age from his classmates. Per the instructor, this student had a health care work history (non-nursing) and the program was just a filler until he can apply to medical school.

In the end, no patient harm was done. I understand what it was like to be a nursing student and I stayed patient. I always educate and make sure my students are always safe in any patient interaction. I took theses small circumstances as teaching points for any nursing student having a rotation for my unit.

[JackDawson23]

Do you guys live in Mayberry? Everyone knows everybody's business :) But seriously, how did you know he was just doing the nursing program to get into medical school? And why did his instructor allow all those things in the first place? So many questions...but you did good nonetheless.

[TriciaJ, RN]

Toadette said:

Wow. That's insane to me. My clinical instructors were always on the floor with us and we did not do anything without checking with the instructor first. Our clinical instructors checked our med pass, supervised the administration of meds, supervised dressing changes, and other skills as we learned them. The nurses on the floor loved having students because we decreased their workload. The floor nurses were available for questions but absolutely were not responsible for our education.

I keep reading stories like this and I'm coming to appreciate my nursing program more and more as time go by. How do nursing programs guarantee any sort of quality without supervising nursing students?

They don't guarantee any quality. I overheard one nursing instructor tell a student "In this program you set your own learning goals." ***** And no student ever decreased my work load.

[HalfBoiled, BSN, RN]

Thank you for the kinds responses everyone!

Everyone in my unit knew about my age. It is just floor gossip. I didn't really mind at first.

JackDawson23 said:

Do you guys live in Mayberry? Everyone knows everybody's business ? But seriously, how did you know he was just doing the nursing program to get into medical school?

No we don't. I'll just say my location is in a more populated area.

The instructor told me about the student when she returned this semester.

My best guess is that the student got accepted to a nursing program first and he is stockpiling hospital hours to apply for medical school.

I am unsure about the process and requirements in applying.

I was a bit triggered by what the student said to his classmates; which led to this post.

JackDawson23 said:

And why did his instructor allow all those things in the first place? So many questions...but you did good nonetheless.

The instructor had about 8 other students to oversee.

She couldn't be holding the student's hand all day. lol

[JKL33]

HalfBoiled said:

The instructor had about 8 other students to oversee.

She couldn't be holding the student's hand all day. lol

They used to manage just fine with groups of 8-10. First of all, you were sent to the library if you couldn't recite everything important about all of your patient's medications when the instructor met you in the morning and also reasonably present your plan of care, and if someone was sent to the library it was considered a clinical absence. The instructors then made note of potential learning experiences going on with the patients and made their way around to be with each student. When it wasn't your turn you were providing personal care, trying to engage in therapeutic communications with your patient, reviewing labs, accompanying patients to tests/procedures, etc., etc. When other opportunities presented themselves, the instructors found a way to be present so that the student could participate. We were never assigned to staff members but knew that we were expected to seek to 1) help them if the opportunity arose 2) try to engage respectfully in order to learn from them.

I have a feeling this guy would've been sent to the library to research all of these things he supposedly had questions about. His antics definitely wouldn't have been entertained in my program.

[RoyalTeaRN]

Your attitude, demeanor and ability to keep the patient's safety from being compromised in these situations were exceptional. Also, better late than never? Glad you received a formal apology.

[gpsrn, MSN, RN]

Thank you for helping the student. You did superb in providing him with learning opportunities and experience. Please continue.

[Thanksforthedonuts, BSN, RN]

I totally agree with you! When I was in school (graduated this past May) our clinical instructors were always with us OR made sure to do a check up on us and inform us if they were going to be occupied with another student for any extended period of time (typically when assisting procedures etc). We also always had their cell number on us at all times and we provided our nurses with a list that provided our instructors cel number, a list of what skills we can do and a list of skills we MUST NEVER DO (typically per hospital policy for students).

I went through an awesome nursing program. Reading comments on here just solidified what a blessed program I went through! So thankful!

[NICUMurse87, BSN, RN]

If this student is ever my physician, just pull the plug, because I am already dead.

[RNBSNPITA]

Was he a brand new student? First semester?

[brillohead, ADN, RN]

I'm gonna guess, from his superiority complex, that he's interested in being a surgeon!

I graduated nursing school at 44yo -- virtually everyone who precepted me was younger than I was. Age is just a number....

[3ringnursing, BSN]

My friend, you truly are a saint. You performed beautifully in the face of adversity, and kept your cool while being on the receiving end of extreme disrespect and poor behavior. Kudos to you and your professionalism.

This is such an old person thing to say (because let's face it - I am old! ) but while I was a nursing student that crappola would never fly, and any of my instructors would have come down hard on me and my fellow classmates. We'd have a foot up our orifice, and a most sincere apology written by the end of the day in hand. We would have been lucky to pass the clinical rotation behaving like that for even one day, let alone an entire semester. Dear Lord in heaven ...

I experienced something similar, but it was a new grad nurse whom didn't want to shadow me because I was a decade younger, and only a year out of school myself. I was also 6 months in recovery at the time, and he felt superior. The bottom line was I had a lot more to offer than he originally thought, and he learned in spite of his initial judgement of me. It's funny how the universe works - 8 years later we both ended up working in the same ICU at another hospital, and he himself had ended up in recovery within a year. He apologized for his previous poor behavior having seen the error of his ways and gained some humility, maturity and insight. We became good friends, and 23 years later still exchange Christmas cards (but at the time I wanted to twist his 'lil bobblehead right off his neck - hey, I'm only human).

I find so many areas you discussed both alarming and concerning (not to mention offensive) but the things that stand out the most is his lack of maturity, his impatience, and his need to be right no matter what. Not good qualities for any professional. At the very least failing the rotation with a mandatory do-over seems in order, as allowing someone to practice with that type of conduct seems wrong, and if nothing else unsafe to the Nth degree. A personality reconfiguration in my opinion is the duty of the clinical instructor and nursing program for obvious reasons. Passing him with the demeanor you described seems to me to be validating it, and saying it's okay. It's not.

However, the primary concern that screams DANGER WILL ROBINSON (look up the term online if you are unfamiliar with it) is the fact he plans to become a physician. I've known many a condescending MD in my career, and if his plans come to become a doctor come to fruitation he will continue his tyrant reign of Napoleonism on many an innocent nurse for years to come unless a long over due attitude adjustment intervention is held on his behalf.

His guy is dangerous in his current state of mind of mistaken superior self beliefs - I pray a change occurs soon. It's not hopeless, but he needs much work first.

[al3x117, RN, EMT-B]

You sound like a badass nurse! You literally did a great job of keeping your patient and even the student safe! Personally I think this student needs to start reading the material.