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.

[Frostin, BSN, RN]

Sounds like you were spot on in your teaching methods OP. Just 2 things I want to bring up.

(1) nomenclature: while each facility, and unit , for that matter may have a standardized nomenclature for specific types of medical devices/procedures etc (I've heard nurses refer to any type of venous introduced sheath as a "cordis") your first scrape with this student exemplifies the need for nurses as a whole to utilize a standardized nomenclature in referring to treatments/devices. It can be confusing for even seasoned nurses in a new environment when things are called different names than one is used to. I'm assuming that the mediport you referred to was some sort of surgically implanted vascular access device for.. let's say long-term chemotherapeutic or antibiotic drug infusions? I firmly believe that if these things actually had a standardized vernacular to name them, that situations such as these would be few and far between and I think that we as nurses should come together and decide on a standard, simplified way to name and describe such devices and procedures to eliminate any confusion which might arise from students/ travel nurses (as a travel nurse lol)

(2) your only misstep, in my opinion, was not reporting directly to this obviously misinformed and obstinate student's instructor after the second incident mentioned. He clearly needs some type of remediation in both physiology and clinical practice which both fall on the shoulders of his didactic and clinical instructors. Had this been my student in the CVICU, he would have either been taken aside by the instructor, or I would have made certain that he cried himself to sleep after clinical that day. Kudos to you for putting up with such nonsense with such poise! Hopefully this student is either going through remedial instruction or discharged from his program. You should not have had to put up with that... just my 2 cents

[Med Surg RN, BSN, RN]

Scary this student wants to be an MD in re to pt safety. Also concerned how he will treat nurses in the future and possibly try to throw them under the bus.

[armygirlabn, ASN, BSN, CNA, LPN, RN]

With that kind of attitude he will make a great doctor!!

[elfself25]

I was blown away at the behavior and attitude of this student nurse. I would never want him for my nurse or for my doctor if he continues on his current path of arrogance. I think there is a high correlation between arrogance and stupidity! I am so proud of how you kept your professional cool. I always think it is best to take the high road and not base my behavior on someone else's bad behavior.

I became a nurse when I was 25, but I have always looked 5-10 years younger than my age. People would always tell me that they thought I was a candy stripper (old school teenage volunteers who wore red and white stripped uniforms). Unlike your rather dim student, I discovered that most people let go of the youth bias after having experienced my professional demeanor.

[HalfBoiled, BSN, RN]

Update: WOW! thank you so much for the feedback everyone! I am reassured my teaching is on track.

Per the student's instructor (whom I conversed with last shift),

The student served the military (unsure which branch) and became interested in medical field after his term.

He worked as an EMT with the intention of becoming an MD later the road.

His nursing school program accepted him first. If he enjoys nursing, he will probably stay in our field instead of medical school.

As for his behavior, his attitude was brought up with school faculty (his classmates also reported him) and was given a clinical warning.

The student's classmates were well aware of his behavior because he was difficult to work with in the classroom/projects.

They did not expect for him to treat an actual nurse the same way.

He was unprepared and was unwilling to listen to someone who has only 1 year or nursing experience and, of course, younger.

He technically did not break any rules nor patient harm. Thus, no serious disciplinary action was taken.

The instructor and the head of the department gave him a serious talk and promised it will not happen again.

His future clinical instructors were informed of what happened and will keep a close eye for the upcoming rotations.

He was a 2nd semester student in his mid-30s.

I stayed patient because I still remember how intimidating clinicals were in my first year of the program.

I am NOT in that mentality of "swallowing the young"

HOWEVER I have learned to immediately report any student actions that made me uncomfortable to their instructor.

[dec2007]

I have been an RN over 25 years, and work in a demanding and highly technical SICU. We have many younger nurses who are extremely qualified and talented clinicians. I find they are usually better preceptors than I am, because they are closer in age to the students, and can therefore relate and communicate better with younger people. I'm sorry this student didn't understand that you're age has nothing to do with your qualifications or critical thinking skills. You sound like an excellent instructor! Unfortunately, this student does not sound mature enough to be in a nursing position, and certainly should not be a candidate for any medical school at this point.

Personally, I feel blessed to work with such an intelligent and professional group of young people!

[dec2007]

(Quote) He was unprepared and was unwilling to listen to someone who has only 1 year or nursing experience and, of course, younger. (Unquote)

Gosh, after all these years I'm very happy tio learn from my younger co-workers! I ask their advice and sometimes they ask mine. Frequently, getting another person's perspective helps to handle a situation better. Our co-workers of all ages are a great resource.

[jaderook01, BSN, RN]

I've been older than all of my preceptors. I didn't care at all. They knew their stuff and were willing to share.

[AutumnApple]

I read this and didn't comment but, I'm going to say it:

I've worked at teaching hospitals a lot, so I understand your frustration. In the student's defense though, I have to say, I think it's the instructor you should be upset with. That's just me though.

I see it as, while the instructor had great hindsight about the student's behavior (hindsight is 20/20, but I'll give her that she apologized for the situation after the fact), that's not where their input was needed. Truth is, while on the unit for clinicals, students have to report everything to the instructor. So, the constant reporting to them was not an issue from my point of view.

So, we have a student who is questioning all your advice and guidance. They run to the instructor with far reaching attempts to discredit you. Why did the instructor not correct it while it was going on?

I say this was not an issue of Y-ports, pain management or potassium. It was a bad attempt at belittling you. The issue was this need to appear superior to you, not the details (some, rather obvious details at that) of the care. The instructor should have seen that after so many attempts were made to find fault with your viewpoints.

Just my two cents but it had nothing to do with your age. If the student hadn't been using your age as their rational for their behavior, it would have been that you took too long in report, or you were talking too fast, or you didn't dress professionally, or............or.............or. Point is, he just picked your age to critique because it was the most convenient stick to pick up and beat you with. If it weren't that, they'd have found something else to bad mouth.

That student is passive aggressive, as evidenced by the fact that they were gossiping after the fact in the parking lot instead of making their feelings known at the time. If your age bothered them so much, they should have dealt with it and gone to the instructor about it then. Don't be a coward and complain well after the fact. Since they didn't do that, I can only surmise that it didn't really bother them that much.

This student is going to continue to be passive aggressive like this until someone calls them out on the floor for it. The instructor should have assigned them an article to write about the difference between passive aggressive and assertive, with being allowed to attend clinicals on hold until said article is written to satisfaction. THEN I'd believe the instructor's apology.

[vanessaem, BSN, RN]

First off, the guy sounds like an idiot. My preceptor was ten years younger than me so I'm not sure what his issue was. Insecurity maybe?