Nursing Student From Hell

[DWelly14]

So I need help. I've been a nurse for 6 years now. I have a BSN & an MSN and am also a CNM. I've worked 4 years in critical care and the past two years in labor and deliver at a large suburban hospital. I've precepted several students and have always had positive experiences with them. I was not planning on taking another student this semester as I finally am transitioning into full scope midwifery practice but the local nursing school was desperate so they talked me into taking one last student. So in January, this student, let's call her Alice, started with me. When Alice first started she seemed very unsure of herself. She's a student though so not unexpected, even though this is her last rotation before graduation. But I got my teach on. We discussed anatomy and physiology of pregnancy and labor, walked through procedures at least 10 times, I stayed after every single shift to work with her, and she always went home with printed out policies and articles to read up on so we could discuss on our next shift. I felt like I was seeing improvement but I was always right there with her helping with her during the first 6 weeks of her rotation. When we had her midterm evaluation with her faculty member, Alice was told she was to take the primary role and I was to back off. So that's what I've been doing. Unless safety is in jeopardy, I've kept my hands off. And Alice is crashing and burning. To the point where I'm not sure how she's made it this far in her program. She is lazy, refuses to do basic nursing tasks such as starting IVs, and will just go hide to get out of things. We admit a patient. I go in to the room with Alice, she just stands there. I say "Ok, go ahead and get started." She says (in front of the patient mind you) "well, I haven't done many IVs so why don't I watch you one more time?" I say " you only have 2 weeks left, you only have so many chances left ... " Patient chimes in "I want you to start my IV please DWelly14!" .... opportunity lost. Fast forward to when the patient is complete. Alice is nowhere to be found. I'm in pushing with her and the charge nurse has to find her. Several of my coworkers have commented on her behavior to me, I've confronted her on it and she always makes excuses, and I've now emailed her faculty.

My question to all of you is do you have any tips for what to do? I feel bad just recommending that she not pass but at this point she only has 3-4 shifts left with me and I'm getting really frustrated with her. I'm really not willing to take her for any longer than the originally assigned amount of time because of the behavior I've observed. I feel like she's skated by through her whole program somehow and now she's finally having to actually do it and she can't. Help!

[Ben_Dover]

If the claims are real and true about this student.

Guys and gals, failing will not do her any good. What I think she truly needs is a new brain!

Is this a bit harsh, no?

[NurseCard, ADN]

The only part of your post that I have just SOME issue with... before

you went into the room with Alice to admit that patient, did she know

what was expected of her? Did she know she would be doing the

entire admit? Starting the IV? Was she okay with it? Did you make

sure she would be comfortable?

I mean, I understand the whole gist of your post, but... shew I'm

with a couple of other posters... after 13 years, this girl still HATES

starting IV's on most patients, and if put on the spot about starting

one, there are times when I will STILL shrink like a violet.

Other than that, I get what you are saying, I do. I vote to let

her do the rest of her preceptorship, make her fully aware that

her passing grade is on the line, and see how she does. Maybe

she will redeem herself?

[saskrn]

Unlike some others have mentioned, my final rotation in school years ago was similar to what you described, just on a different unit. Towards the end I assumed my preceptor's entire patient load, I started many IV's, etc, and essentially functioned independently like I would be required to do at an actual job after graduation. My preceptor stood back and only assisted if needed, and we were largely expected to function with minimal assistance.

All of my rambling is just to say that your student is not functioning in the capacity required to pass. It's a difficult decision, but I get the impression that as her preceptor you already know this. It sounds like you've gone to great lengths to help her, so I hope you don't blame yourself.

It's not her future employer's responsibility to teach her basic nursing skills and motivation, and for this reason she should fail.

ETA: At this late stage, I doubt that there's anything that she can do to prove to you that she is a safe, prudent nurse, and to prove to you that she's mastered the required skills, has obtained the necessary knowledge base, or even has the needed motivation to care for patients who are relying on her.

[LovingLife123]

I'm a little surprised at all the fail her posts. She's a student. A student. I feel like some of you have way high expectations of students.

Have you asked why she is hiding? It could be she just doesn't feel comfortable. Also, since you decide whether she passes or fails, have you clearly laid out your expectations? Do you interact with her outside of the room? Try to bring down her nerve level a little?

I always try try to find out a little about my students and I tell them a little about me. I get our conversation going so they aren't a bundle of nerves. It helps us work together better and even though they really can't do anything, they help with turns and some oral care.

You have every right right to fail her, but realize you are failing her and she may or may not get a another chance and this will affect her life in a big way. It's very difficult to get into other programs and it may very well be the end of her career. I just don't feel a few hours a week as a student is indicative of how safe of a nurse they will be. I would most certainly not give a recommendation if she were to ask for it and I would discuss my concerns with her, but fail????

[pixierose, BSN, RN]

Reading through more of the posts ...

I still stand by my original statement: a failing grade.

Maybe because school is still so fresh in my mind, and the fear is still very real ... again, like I stated before, learning new skills can be intimating. Hiding sounded pretty good sometimes (esp. with trach care, my kryptonite). Being a new grad, on a new floor, it's still damn scary!

But ... YOU DO IT! This isn't a new nursing student. This is an almost new grad! Why are we giving this special snowflake so much leniency? I'm sorry if this sounds harsh; however, this student completely knows the responsibilities more often than not, they have been stated in the beginning of this semester (and semesters prior). Gone over during her midterm evaluation. OP herself seems pretty organized, giving her handouts/readings on policies/topics/etc to prepare for next time. Many students don't even get this of which the OP is providing (at least, I didn't).

It sounds like this student really lucked out in getting the OP. She's missing a great opportunity to learn. Confidence (or lack thereof) ... it doesn't matter. It's time to buck up.

This student is learning something alright; that she can disappear when the going gets "tough" and not face the penalty.

[SmilingBluEyes]

If she is hiding out as a student, what can we expect as a nurse? You can't just hide out when the going gets tough. That is my biggest concern here. That and if she IS lazy, that won't do either.

Maybe, you should let the above concerns guide you on what to do. I don't see a lot of redeeming value in this person as a nurse, if everything you say is accurate, OP.

Otherwise others have pretty much said it all; won't rehash or pile on.

[NICU Guy, BSN, RN]

I'm a little surprised at all the fail her posts. She's a student. A student. I feel like some of you have way high expectations of students.

She is a senior student that is a few months away from graduation. This is not her first clinical. She needs to be held to the standard of a new grad hire. The expectations of a senior Capstone student is to be engaged in the clinical, ask for oportunities to increase her knowledge, attempt all skills ask for by the preceptor, be at the hip of the preceptor at all times, and by the completion of the final clinical- be able to independently care for a patient.

Have you asked why she is hiding? It could be she just doesn't feel comfortable. Also, since you decide whether she passes or fails, have you clearly laid out your expectations? Do you interact with her outside of the room? Try to bring down her nerve level a little?

She is hiding because that is what she has always done in group clinicals. The problem is that this is a one-to-one clinical and it is difficult for it to go unnoticed. She stated that she clearly laid out her expectations. The student "claimed" to have went to the bathroom and couldn't find the preceptor- BS. If she had told the preceptor that she is going to the bathroom and came back promptly, it would not have been a problem. The problem is that she told no one where she was going and then claimed she couldn't find her, so she hid somewhere. It is hard to believe that if she asked any of the other nurses, they wouldn't have a clue where the OP was.

My assumption is that since she is student and not a nurse you feel there are no expectations and she can hide out instead of participating in the clinical. Even if there were no defined expectations, she is an adult and should take it upon herself to learn as much as possible.

[Lunah, MSN, RN]

OP, is there any way that her instructor from school can drop in for a visit during these last shifts?

I would alert your student that she is on thin ice and needs to shine.

"Failing to fail" is a real phenomenon in nursing schools across the country. No one enjoys failing students, it is difficult and everyone suffers in the process; but we have to ensure that patients are going to be safe and cared for, and there are a lot of red flags here (namely the hiding). Just because a student has made it to practicum/capstone or whatever the school calls it does not mean they were stellar in their other clinicals.

OP, I am sorry you signed up for what you thought would be a nice swan song. It's clear that this is distressing to you, I suspect because you already know what you need to do. But it's the student who passes or fails, we don't just inflict it on them. Good luck!!

[NICU Guy, BSN, RN]

OP, I'm not going to weigh in on whether or not the student should pass/fail her preceptorship; you are the only one that has spent enough time with her and has the full knowledge of the situation. I can appreciate that you are using us as a sounding board to work through the seriousness of the decision you're trying to make.

What I want to tell you is this: there are presently a couple of posters on your thread that have/will have you scratching your head wondering how they've read so much into the situation and have the opinions they do. I would suggest (if you have the time or inclination) that you read through some of those posters' previous posts as it may help give you some clarity of their thinking/online personalities. It may help you decide how much time you want to spend considering their opinions and advice.

Best wishes.

and this is why we have the "special" snowflakes.

[Rose_Queen, BSN, MSN, RN]

OP, is there any way that her instructor from school can drop in for a visit during these last shifts?

This was standard during my capstone- the instructor had to drop in at least 4 times. We were asked questions just like we would have been in a normal clinical with an instructor. Concerns were addressed.

[Rose_Queen, BSN, MSN, RN]

I'm a little surprised at all the fail her posts. She's a student. A student. I feel like some of you have way high expectations of students.

And I think you're not getting that this student is near graduation and should be held to high standards. A student doesn't stay a student forever; expectations become higher as more classes are completed. A student in the last semester with a one on one preceptorship should be nearing new grad expectations.

[AceOfHearts<3]

My first thought was fail- not because she is scared or hesitant to perform tasks, but because she is going AWOL. There is really no reason for her to not be soaking it all in.

I think a very blunt conversation needs to be had with a written contract that she signs stating the goals/objective of the next 4 clinical days. This will CYA and make it perfectly clear to the student what she needs to do in order to have a chance at passing.