Grrrrrr...insulted by clinical instructor

[Jennerizer]

This is my first experience with a not so nice clinical instructor. She approached me towards the end of the day & started questioning why one of my pt's had a wash basin on his bedside table. I informed her that he told me he feels nauseous from time to time & wanted it within reach & that I had offered him an emesis basin, but he said it was too small. She looked at me like I was lying. She asked me why my second pt did not receive a bed bath. I told her I offered him one & that he was in so much pain (he had been shot between the eyes & had his left eye removed) that he didn't want anyone touching him. I offered him a washcloth for his face & he said his head was killing him & he didn't want one. Once again, she gave me a look like she didn't believe me. Then in front of everyone that was at the nursing station...she stated "You've done nothing today but stand around." I couldn't believe she said that because it wasn't true & I told her that was not true. She repeated it again, I denied it again. So she tells me to follow her & we take a few steps into the hallway & she again repeats that every time she's seen me, I was standing at the nurse's station. I tried to explain exactly what I had been doing all day & that if she had seen me at the nurse's station, it was because I was doing my documentation.

This was my first day with this instructor. She then turned it into a personal attack & had the nerve to say "I hear you are an intelligent person, but intelligent people don't always make good nurses. That sometimes people get into nursing for the wrong reasons & it's her job to weed those people out." I told her that I want to be a nurse, that I wasn't here for the wrong reasons. She just went on & on with the personal attacks. I simply replied (thanks to someone else posting on here about constructive criticism) that I appreciated her comments. She told me I need to improve & then told me that she wasn't saying these things to make me feel bad or to make me cry....she just wants me to improve. I didn't even feel the urge to cry because I was shocked at her commentary. She walked off & my classmates that had overheard everything said "If she talked to me that way, I'd be crying right now." I didn't mind that they overheard because they know she was out of line & they know that I do a good job. About an hour later before post-conference began, I did start to get teary eyed when they were talking about the things she had said to me. They told me not to let her see me cry & not to listen to what she says. I kept it together during post-conference so she wouldn't see that she had gotten to me, but later out in the parking lot with my friends, I did start to cry again. And I don't even know why...because I know she was way offbase & I don't even like her as a person, so why should her opinion make me feel that way?

I went home & spent most of the night crying on & off. I went from being hurt to being mad. Now I have recovered & am trying to figure out how to handle it. I am mostly worried that her opinion would be able to fail me in clinicals & therefore fail me from being able to move on in nursing. I have decided to go to my classroom instructor this week. She was my clinical instructor for the first 6 weeks & she is also the head of the department. I just want to make her aware of the situation & how unprofessional the conversation was & also find out what it is they want me to "improve" on, because I don't understand where they think I'm lacking.

This is the first time I've ever been personally insulted while in school. Any advice on how to shake it off or how to handle it the best way possible?

[meownsmile, BSN, RN]

I know there are a lot of less than adequate clinical instructors. And they usually cant/wont tell you what the real beef is. But a couple things that you can do that may help next time.

When your patient wanted the wash basin, because of nausea, did you follow up with the staff nurse assigned to find out about an antiemetic? Maybe it had been a while since he had something and had something else ordered he could have had to relieve his nausea.

The bath situation is understandable considering the injuries. Did you follow through with the staff about pain medication/how long it had been since it was given/ did he have something else available also/ did you follow up later after the pain medication was given and offer the bath again. If he still refused thats fine, but did you take time to sit and talk with your patient?

Maybe the instructor was looking for you to tell her how you followed up on the problems.

I know it was your first experience and it will be easier as you go. But remember, there could also other problems other than the immediate dx that may be hampering the patients recovery and willingness to participate in their recovery. Was the guy with the gunshot depressed, upset about family, his situation? Sometimes if those problems are aired, just to have someone to listen to you can help the patient think through their situation and may help clue staff in to how to better care for a patient. Dont forget the patients psycological care, its not all physical. Maybe he needed some counseling/clergy/support group referal?

Good luck,, im sure youll be a great nurse, keep going.

[Jennerizer, ASN, RN]

Y'all are helping me a lot...thanks so much!!!!!

Yes, I can see how she was pushing for me to go one step further (with the anti-emetics). It's hard to explain it the way she'd like with the way she was drilling me with questions, but I suppose it's one way to learn. I did offer anti-emetics in the morning & he refused. That was the only time during the 7-3 shift that he felt nauseous, but I followed his lead with wanting the wash basin to remain there. I felt that I had a good day because this gentleman started out so grumpy & rude, but after a couple of hours, I actually had him smiling & talking about his family. He was also had an order to drink Ensure 3x a day. I noticed there were 5 cans sitting on his bedside tray. I asked him why they were there. He said that he preferred them cold. I remembered from class my instructor saying that sometimes pts won't speak up about something they don't like, so they simply don't drink it. I told him I could put them in the refrigerator for him & he said that would be great. I also asked him if this was the flavor he liked, because again...they won't always speak up to tell you. He said no, he preferred chocolate. It's something simple, but if that's what it's going to take to get him to drink it, then I think the changes should be made. I also explained to him the importance of drinking what the Dr. ordered. When I came back after lunch, he had drank 1/2 a can & proudly admitted it to me.

As far as my gunshot victim. He did confide in me. He wanted to know if he could ask me a question. I said sure. He asked what would I think of a man wearing a patch over his eye. I was honest & told him I would wonder what happened to him, but it wouldn't make me think any less of him. He then proceeded to tell me that he feels his friends avoid making eye contact with him & how it hurts. I encouraged him to talk about it more & I told him that perhaps he should tell his friends how he feels & also encourage them to talk about how they feel. I also informed him that maybe his friends aren't even aware that they are looking away. That it could be a subconscious reaction. We talked a little more about it & he thanked me, told him I made him feel better & that I was making him smile. I felt great walking out of there not only because I made him feel a little better, but because he taught me a valuable lesson also. The afternoon before when I was researching his chart, I had thought about my reaction to the situation......how would I be able to handle dealing with someone that lost an eye. I've never had that type of experience before. It was an enlightening experience to not only think of my reaction, but to think of how the pt feels about having someone new in their life---if only for a day.

You are right though, he probably could have been better served by having some type of support group or clergy talking to him. He was also worried about not being able to afford the pain medicine. I informed the nurse of that, but did not know how I could make that situation any better.

I am beginning to see the entire situation in a different light & that is a good thing even if I had to deal with being insulted to get there. I realize that perhaps this is some type of training for when I one day run into a not so nice Dr. It caught me all by surprise though. I'm glad I had the weekend to think it through.

Thanks everyone for all of your words of advice, encouragement & mutual stories. It has helped tremendously. :)

[kimtab]

Be careful. Going up the chain of comand may be perceived (and not completely unjustifiably so) by your instructor as going behind her back. There was a similar situation at my school where this approach did NOT turn out well. I would suggest that you attempt to solve your problem with your instructor first. Bring a copy of the clinical objectives (probably found in your syllabus or student handbook) and limit the conversation to those and how she feels you could inprove on each. If she turns the conversation to personal remarks, ask her to relate those to the clinical objectives for you. If you attempt honest, open and appropriate communication with her and she still behaves inappropriately, then tell her that you would like the input of another instructor. Do not do this in front of other students, she will feel as if she is on the spot. You already have witnesses that she is not a professional communicator. You behave as the professional that you know that you are.

Nursing school is like Survivor sometimes. Here are my tips on how to play. Find out what she expects and beat her to it. If she doesn't want to see you at the Nurses sta. don't be seen there. Shadow another nurse when you aren't busy with your patient. Do your documentation elsewhere. Be proactive about telling her what is going on with your patient. Don't wait for her to ask- you go find her and give her a report. If your patient didn't want AM care tell her what else you did to meet his needs. If you have a question you are wondering about go look it up and report on it in Post conference so everyone else gets the benefit too. If you always go the extra step she will have to notice you for what you are, a great student nurse! I really would try this before going up the next rung. You may be able to turn your problem around yourself instead of risking turning a personality conflict into an all out war.

Good luck, I think you will be FINE.

[Carolanne]

Jennerizer, that connection you made with your patient is what matters the most. I know it's hard, but let that take priority over what's happening with your instructor. If you have a gift to make someone who has been in a horrific accident like that open up to you, maybe that's what your instructor sees and it's either making her a little envious, or she's trying in a twisted way to push you to be the very best nurse that you can. I know it's hard to see it that way, but there are instructors like that at my school too - they treat you like you're a total moron, but they're actually pushing you to your fullest potential. Just do your best when you're around her and don't ever, ever doubt yourself or your worthiness of being a nurse. Keep pluggin!!

[bigmona]

I am not in nursing school yet, but I just wanted to say reading your posts is very inspiring. I would hope if I were ever faced with your situation that I'd handle it with the same dignity you have. You're very level headed and open enough to try to see the situation from different perspectives, instead of feeling defensive or sorry for yourself about it. Good luck with everything.