Having an ethical dilema

Mr Ian · Feb 15, 2009

Where is the administration's responsibility if those people end up hurting patients?

While they're a student - clinical responsibility is the nurse preceptor/mentor.

When they graduate - it becomes the BoNs.

The administration is not liable for competence in the workplace - merely gaining evidence of it.

If the student is no good - it's up to the clinical mentors to say so and fail the student.

Jolie, BSN · 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.

This is an interesting insight, and probably plays out in many school and work settings. How sad.

truern · Feb 15, 2009

Personally I think it startes with a graduation ceremony for preschoolers and trophies for everybody on the teams no matter which team wins!!

meluhn · Feb 15, 2009

Yes, I agree. It undermines the ones who really do shine and leaves the others with nothing to strive for. It takes away their drive. Why should they excel if A. No ones going to recognize it or B. I'll be patronized with a "prize" even if I don't. I think we are seeing the signs of this mentality in the generation that is college/HS age now. Not that some aren't still very driven. I am just generalizing of course but it is more true today than it was in the 70s and 80s when I was growing up. You actually had to do something to be recognized for it.

llg, PhD, RN · Feb 15, 2009

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

Actually, in many communities, nursing school seats are not rare. It is just that everyone and their uncle is trying to get a nursing degree these days. Every school that wants to make a buck has opened a nuring program. Think about it, until very recently, you could only get an ADN or BSN at a 4-year college or community college. Now, they are being offered by vocational schools. We even have a local trade school offering a BSN!

In my region, the number of nursing students has doubled in the past 5 years. One school that did not exist 5 years ago (a vocational school) accepted 360 students into their new ADN program in 2008! Existing programs have increased their enrollments -- in spite of not always having the additional resources (like clinical sites) to deal with the increased needs. When they don't have qualified clinical faculty, the clinicals become more "observational" than "hands on." They do more "clinical" time in learning labs. Some graduate having had no actual clinical in a specialty area such as peds or OB. The do 2 or 3 days of observation in the hospital and then talk to some moms and kids in the community, a clinic, or in a school -- and that is their maternal-child course. Med/surg is a little better, but not anywhere near as rigorous as it is at "the good schools."

Not all of these additional students are ones who would have been accepted into a nursing program in the past -- if you know what I mean. Will the school flunk them out early in the program? ... or ... Or will they take their money for a few semesters before flunking them out near the end of the program?

I keep my eye on that sort of think ... and I often do not like what I see.

caliotter3 · Feb 15, 2009

I went to a "traditional", "good" BSN program and they usually waited until the final semester to fail out students. As a matter of fact that was their favorite time to fail students. I would have thought that poor performance would have been evident prior to the final semester, if in fact, poor performance was really the issue.

llg, PhD, RN · Feb 15, 2009

I went to a "traditional", "good" BSN program and they usually waited until the final semester to fail out students. As a matter of fact that was their favorite time to fail students. I would have thought that poor performance would have been evident prior to the final semester, if in fact, poor performance was really the issue.

It is often the case that a student does well in the early courses ... and that faculty will give a student a "C" and let them have another chance in the next course. Maybe a little more time ... maybe a little practice ... maybe another instructor ... etc. But in the final semester, the student has to "put it all together" and if they have any weak areas, those weak areas will become very apparent. That happens even in the best schools.

I'm not talking about that -- and neither is the OP. We are talking about schools who do not allow their instructors to fail students or dismiss them from the program even when it is clearly called for. They want to "keep their enrollments up" and collect a few semesters of tuition first. In some cases, faculty are told straight out that they can not fail students. When you talk with the faculty and hear their stories ... and when you look at their patterns of student admissions, progression, and graduation ... you see a pattern that is clearly different from that of a good school that is trying to treat the students ethically.

BigBadInstructor · Feb 17, 2009

Faculty keep hearing from administration that "this new generation of nursing students" is used to fast, easy access, throw away, and do over, instead of working for what is needed. Could be, but this does not excuse the lack of respect that is being shown to their instructors, guests, staff, and peers. My syllabus keeps getting longer, and I have added "show respect to instructors, guests, and peers" as an outcome, and have included on the clinical evaluation also. I think we all have to document any break in ethical behavior, either in class or in clinical, and keep a paper trail. And we have to show this documentation, every time, to administration. And then document their response. As long as faculty is supported, then students seem to follow what is asked and required. But without that support, they are thumbing their noses at us.

There is an excellent article by Susan Luparell concerning this matter. She has had many follow-ups, and if you ever get the chance to hear her speak, go. Her article is:

The Effects of Student Incivility on Nursing Faculty

Journal of Nursing Education Vol. 46 No. 1 January 2007

Susan Luparell, PhD, APRN, BC

iteachob, MSN, RN · Feb 17, 2009

Thank God I work where I do!

I'm a senior faculty member who can and does deliver failing grades. I do not fail students......they fail themselves. I'm just the messenger.

I am fortunate to have a division chair that will not put up with a student who has a truth or civility problem.

I have adjunct clinical faculty for my course, and they are absolutely supported in their decision for clinical failure. I also teach some clinical, in addition to didactic. Students who perform poorly in clinical can be removed from the program, even if classroom performance is satisfactory.

A school that passes poorly performing students will reap the results of their poor board scores. It's just a matter of time.

njc2410 · Dec 8, 2009

Hello, I'm a student at a technical school in NJ. I just finished my first quarter. I've witness the same kind of disrespect to instructors and have been so disgusted. I'm in a classroom full of great people. My entire class is averaging A's and B's. Our problem is another class. I've heard a student basically throw an instructor under a bus, stating that she does not review for exams. I had to laugh. I told him that as students it's our responsibility to prepare ourselves for exams, not the instructors. Her job is to teach us to the best of her availability. I've witnessed students on their cell phones texting during class. I've heard students literally yell at the instructor as if she was that person's child. In the same turn, I've witnessed students give the instructors the utmost respect.

I've been to college and have had professors, walk into class, run a few slides on the screen and give an exam the next week. I've been in classes where we were told "Follow the syllabus." Now I have had some inept instructors in college and I just have to make do with what I have and strive to pass the course as I always do.

I'm saying this to tell you to hang in there, there are a few of us students that really care about our education and are working very hard towards our goals. Just separate the wheat from the tares and move on. I promise you, you're probably one of the most memorable instructors there. I know I have a few that I will never forget... :up:

meluhn · Dec 8, 2009

Hello, I'm a student at a technical school in NJ. I just finished my first quarter. I've witness the same kind of disrespect to instructors and have been so disgusted. I'm in a classroom full of great people. My entire class is averaging A's and B's. Our problem is another class. I've heard a student basically throw an instructor under a bus, stating that she does not review for exams. I had to laugh. I told him that as students it's our responsibility to prepare ourselves for exams, not the instructors. Her job is to teach us to the best of her availability. I've witnessed students on their cell phones texting during class. I've heard students literally yell at the instructor as if she was that person's child. In the same turn, I've witnessed students give the instructors the utmost respect.
I've been to college and have had professors, walk into class, run a few slides on the screen and give an exam the next week. I've been in classes where we were told "Follow the syllabus." Now I have had some inept instructors in college and I just have to make do with what I have and strive to pass the course as I always do.
I'm saying this to tell you to hang in there, there are a few of us students that really care about our education and are working very hard towards our goals. Just separate the wheat from the tares and move on. I promise you, you're probably one of the most memorable instructors there. I know I have a few that I will never forget...

Thank you for the encouraging words but this post is old and it has been 9 months since I left teaching and returned to my job at the hospital. At least there I felt respected and appreciated. I just could not contain my disgust with the innept students and the money hungry administration any longer. My short excursion into the world of teaching was disappointing and frustrating. There were some things about it that I loved but I don't know if I will ever try it again. If I do maybe I will approach it a little differently. Instead of seeing everything that is wrong and how the admin is making a mockery of my profession by letting people who are barely literate enter the program, I will concentrate on the many good students like yourself, who are doing well and appreciate being challenged.

After I finished out the term, some of my top students came to me and said that they learned more in my classs than they had the whole year because I challenged them and really made them study harder than ever. This made me feel good but the same day I was called into the office to discuss why 4 students had failed my class. Well, lets see, 1 could not do an assessment or write a coherent sentence to save his life, the 2 others failed every single test I had given including the open book final and the 4th never showed up to class. Yet I was called in to explain myself in front of the students and the director of the program. I couldn't help but blow my top.

I have since reported this school to the board of nursing which subsequently did nothing at all, which increased my frustration. I have just had to either let it go and put it behind me or risk getting crazy and depressed over it. I chose the former. Good luck to you in your studies. Keep your integrity and high standards even though it seems like those other people don't and are getting away with it.

SheaTab · Dec 17, 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.

There is a much more significant problem than the "bottom-line." With all the lateral violence we presently have in our profession, we really can't afford to admit one more disrespectful nurse into practice! There is no room for disengagement and ugly attitudes in nursing school or in practice. I am of the mindset that if a student can't conduct themselves in a professional manner while in school, then they are almost definitely going to be a problem when they graduate. These same students will most likely have challenges with their colleagues and also with their patients. Like you, I wouldn't want such a student to represent our profession. Student apathy will likely manifest itself later as nursing apathy. YIKES! This reflects poorly on your educational institution and also on nursing as a whole. We have an ethical obligation to promote the professionalism in nursing practice and when we graduate students such as the one you described, we are failing that mission in a monumental way. Just my thoughts. I don't envy your position.

Good Luck,

Tabitha