Having an ethical dilema

Jolie, BSN · Feb 14, 2009

Boy, do I understand your dilemma! And I find it admirable that you want to undertake to improve the state of your nursing education program. But I have one question: Do you actually have the authority to do so? Can you fail a student without the approval of your superiors? If not, will they back up your assessment that a student's performance is unacceptable?

If you don't have the authority to make this decision or the backing of those who do, then you may as well accept that the program is as it is. Or you will drive yourself nuts trying to change something that you don't have the power to change. Been there, done that, resigned.

Best to you!

caliotter3 · Feb 14, 2009

You need to make the choice between doing what you want to do and what your supervisors will allow you to do and still keep your job. I doubt that you will gain support in your efforts. If the problem bothers you that much then you most likely should pursue a position in a school with higher standards to begin with. The other alternative, "developing" these non-performers, is probably more than you can accomplish single-handedly, not that you shouldn't make the effort.

Mr Ian · Feb 14, 2009

The 2004 Duffy report (UK) spoke of "failing to fail" and how incompetent nurse students are being processed through regardless.

Some of it is to do with poor mentoring on the ward (incl. poor support for mentors from the faculty staff) but in a large way it's also as you say -the student calibre.

Universities are funded by bums on seats and it's more important to finance the course than to appropriately fill it.

llg, PhD, RN · Feb 14, 2009

I know lots of people in that same situation as I live in a region with 3 different schools who do the same thing. Their faculty members feel the same way -- but they need the jobs right now. I may be in a similar situation soon myself. I wish I had an easy answer for you. Good luck.

In my (expert) opinion, the lowering of standards within some of the schools is one of the reasons we have so many nurses struggling so much in their first year of practice.

meluhn · Feb 14, 2009

I will soon find out if I have the power to make change. I had a situation just this past week where a student yelled at me in front of staff and patients at a clinical facility. I told her to leave and called the director of the program. I told him the situation and he said that she would "most likely" be dismissed from the program. I have had problems with this student in the past but this is the first time I am documenting any of it. I know from what other instructors have told me that administration just gives the student a slap on the wrist and sends them right back. Unbeknownst to anyone else, I took matters into my own hands. I explained the situation to the DON of the facility and asked her to request that the student not be allowed back. Having to deal with low-life cnas and nurses all the time, she understood completely. She wrote a letter to the director and requested that the student not be allowed back. I can hardly wait to get back after this long weekend and see what the outcome will be. By going directly to the DON I bypassed the administration and got their attention. Now they understand that allowing low-lifes into the program threatens their precious bottom line. If we don't have clinical sites willing to work with us, we don't have a program. The nursing program is the biggest money maker at the school and they don't want to loose it. I plan on getting an audience with the powers that be to explain to them that by being more selective and having higher standards to begin with we can avoid many of the problems that threaten the existence of the program. I am a brand new teacher and I don't know how I will be received but I have nothing to lose.

Mr Ian · Feb 15, 2009

Good luck to you meluhn - make sure you build some suitable networks amongst the powers-that-be.

I've recently moved into a managerial position and my first job was to make me seem irreplaceable (which no one is - but I'm doing all the "right things" for the people that count first).

llg:

In my (expert) opinion, the lowering of standards within some of the schools is one of the reasons we have so many nurses struggling so much in their first year of practice.

And that's only half the problem I believe.

Half of all students and new grads are attending the wards unprepared because of this shift in student nurse character. The nurses mentoring and precepting them are dealing with unknown quantities; spending far too much time wet-nursing whilst also catching the backlog of care.

HCAs run havoc about them and medics despair over them.

Other than that - it's great.

Whispera, MSN, RN · Feb 15, 2009

I'm having trouble reconciling schools' willingness to keep twitty and incompetent students in their programs when I hear pre-nursing students scared to death they won't get into nursing programs because there are so many potential students. What's up with that? Are they afraid to confront the students?

As an instructor and nurse, I am not going to let a student ride on my license who isn't doing his or her best work (of at least adequate quality). I would not put up with disrespect either--meluhn, you did the absolute right thing! Such behavior on the part of a student can undermine a whole class, and lower the respect a whole unit has for the students and their instructor.

caliotter3 · Feb 15, 2009

I will soon find out if I have the power to make change. I had a situation just this past week where a student yelled at me in front of staff and patients at a clinical facility. I told her to leave and called the director of the program. I told him the situation and he said that she would "most likely" be dismissed from the program. I have had problems with this student in the past but this is the first time I am documenting any of it. I know from what other instructors have told me that administration just gives the student a slap on the wrist and sends them right back. Unbeknownst to anyone else, I took matters into my own hands. I explained the situation to the DON of the facility and asked her to request that the student not be allowed back. Having to deal with low-life cnas and nurses all the time, she understood completely. She wrote a letter to the director and requested that the student not be allowed back. I can hardly wait to get back after this long weekend and see what the outcome will be. By going directly to the DON I bypassed the administration and got their attention. Now they understand that allowing low-lifes into the program threatens their precious bottom line. If we don't have clinical sites willing to work with us, we don't have a program. The nursing program is the biggest money maker at the school and they don't want to loose it. I plan on getting an audience with the powers that be to explain to them that by being more selective and having higher standards to begin with we can avoid many of the problems that threaten the existence of the program. I am a brand new teacher and I don't know how I will be received but I have nothing to lose.

Getting the clinical site to help you with this problem student was an excellent move on your part. And you are quite right. No clinical sites, no program. Good luck.

meluhn · Feb 15, 2009

Mr Ian,

You are right about the student nurse character. These students today have been brought up in a generation where everyone was a "winner" just for trying. They don't understand the concept of being criticized and then evaluating themselves to see how they can do better. It can never be them that is wrong, It is always someone else's fault or the instructor is a biotch or she has it out for them. It can't possibly be that they are doing something wrong. It is these same students that can't be bothered taking notes in class, they just highlite their textbooks and god forbid you don't go in order, they get all freaked out. Some people are just not willing to push themselves. I am speaking of a percentage of my students of course, not all. I have some fabulous students that I hope will continue on for their RN because I know they will be exellent.

pricklypear · Feb 15, 2009

Wow. Good luck to all of you instructors out there struggling with this kind of situation. I didn't even know this kind of thing was going on! I never encountered behavior like that when I was in college, and I can't even imagine anyone I went to school with acting in that manner. Our instructors were like Gods to us!

How unbelievably sad that you have to not only put up with abuse and incompetence, but not be supported when you feel a student is not competent to continue in the program. Where is the administration's responsibility if those people end up hurting patients?

Please keep up your good work. Our profession needs more caring, compassionate and ethical instructors like you.:bowingpur

SuesquatchRN, BSN, RN · Feb 15, 2009

I don't understand why, with nursing school seats so rare, the caliber of student being admitted is so low.