how to help a struggling student?

[MaraG.]

I have an LPN student who is on precpetorship right now. She is at the half way point in her time on the acute care ward I work on. Her mid term eval is coming up this week and I have concerns. I have already sent an email to her teacher about the concerns but want to see if anyone else has any good ideas on how I can help her prepare for licensing exam and new career

She is compassionate with the patients and very helpful. However, I am mainly concerned about her level of knowledge with medications. She looks some of the meds up but is unable to connect them to the reason the patient is on the med. (Septra DS - her reason the pt has new hemmroids/prolapsed rectum. She did not connect it to the pt's UTI) A different pt had leg pain d/t an extensive DVT. I asked her what medication would she would chose Gravol or Diluadid as these were the only two prns ordered. She replied- "Gravol is for nausea, so dilaudid." When I asked why dilaudid- "Its an anti-coagulant, it will help reduce the size of the DVT and lessen the pain it is causing."

Noticing a knowledge gap, I offered to sit down with her and review the medications of a pt she has had for 7 shifts. She could not tell me what any of the medications were. Even with reviewing the meds together she had a difficult time understanding why the patient was on any of the medications. Such as, Lasix. We reviewed the uses of Lasix, she felt HTN was the best choice. I asked her about the pt's edematous legs and CHF, she replied "Cardiac Heart Failure?" I explained what CHF was and she had no insight about this disease (I think I have heard of that) and why lasix would be given. She gave another pt morphine without checking he ID band.

She is very green to acute care and I have concerns about her ability to problem solve. She was unsure if she had to do vitals sign on a night shift. I told her yes indeed you do along with all of your assessments. At the end of our HS round I asked and she had not done any assessments. Again, I explained to her that you need a baseline and esp if a patient has been c/o abd pain during the day......a short time later that pt rang having abd pain and nausea.

She shows potential. She takes feedback and applies it. I can see a difference from shift to shift with time management. But I am concerned that she does not have the knowledge to complete the program.

Her midterm eval is this week and I plan to discuss this with her before her teacher arrives. Also I will reduce her assignment and give her time to look up all of the medications her pt's are on. Then review them with her, and unless she has a good understanding for those medications, she can not give any of them out. It feels mean, but I am not sure what else to do. I want to ensure that the safety of the pt's is first.

[Chapis]

you sound nice, and indeed you want to help this girl out as much as you can. many people wouldn't go that far! she is lucky to have you! i think you've done all you can, sitting with her and helping her think about why this medication is for this. . ., she needs to pull her weight. if i didn't know a type of medicine, i would go home find out what is for and i would apply that knowledge at clinicals.

[Virgo_RN, BSN, RN]

How much pathophys and pharmacology does the LPN program cover? That's what I'd be wondering.

[April13RN]

I agree with Chapis, thank you for being so nice. I was not so lucky to have a preceptor like that. I can give some insight from a student perspective.

I had many clinical rotations but none of them really encouraged me to apply critical thinking, it was mostly just learning how to perform tasks and procedures. When it came to my semester long internship at a major Boston hospital I felt clueless and overwhelmed when my preceptor expected me to already function as a seasoned RN. I was eager to learn but every time I had a question she looked at me with a blank stare and either said go look it up or you should know that already, even if I had just spent an hour trying to find the answer online or in my books. This made me feel intimidated and uneasy about asking my preceptor anything.

What would have been most helpful for me was if my preceptor took a few minutes to conference with me about important medications and rationales for treatments. Internship was a big transition period for me to start going from student to nurse and even if something may seem simple a quick explanation may be remembered for years.

Good luck! Thank you for being a preceptor!

[MaraG.]

Chapis - thanks for your reply. I hope that she takes advantage of the time i plan to give her to look up all of her meds.

Virgo- There is a lot covered over 3 semesters. They touch on some things and go in depth with other things. CHF is covered in great detail. Left sided heart failure vs right sided heart failure. You are expected to know enough A&P to be able to admin medications safely.

Erin- I too remember what my preceptorship was like. It was a challenge d/t the transition you speak of. I do ask my student to look things up, but we do it together. We ask each other questions and try to apply the knowledge right away. The LPN preceptorship in our province is so short, only 165 hours. There is an expectation on the student that they will transition from student to entry level LPN during that time.

[20mom10]

My school requires "med sheets" to be completed for each new med we are dispensing. My clinical instructors also review each med, its purpose, s/e, expected dose, etc. before each administration. You could try using a modified med sheet for your student, sometimes writing the info makes it stick better.

[AllSmiles225]

As an LPN and an RN student I can tell you that pathophysiology & pharmacology are NOT covered nearly as in depth in LPN school as they are in RN school. That being said--there is absolutely no reason why a future LPN should be completely clueless about CHF or what Lasix is for. In my pharmacology class we covered each class of medications just brushing over the bigger ones in particular. When I was in clinical if I didn't know a drug specifically I would be able to figure out its use based on classification. I probably wouldn't be able to tell you in the same exact words as an RN would tell you when I was in school--but I could give laymans terms AND THAT SHOULD BE EXPECTED! Not only does she have to administer the medications safely but patient teaching is a HUGE part of nursing care. When a patient asks.. "oh what's that for?" are you going to look at them blankly and say.. "you know..I don't know.." because I really don't think that is going to fly.

Now I can tell you that transitioning from student LPN to LPN made a huge difference in the matter of understanding medications effects but thats only because I am actually able to watch them work! Certain things do come with time..but what you are describing to me seems unsafe & unacceptable.

I hope that you do express your concerns to the teacher & to the student as you would be doing a huge diservice to not only her, but her future patients if you did not.

I'm sure that you know what your doing--always remember that students are thankful to have preceptors like you and when you sleep at night remember that you did everything you could to help a struggling student. You sound awesome and I can only hope to come across someone like you!

[MaraG.]

Thanks for the replies all. I hope that I can help her along and get her ready for the working world. It's hard because the course is so short and in 3 weeks she will be done and writing her exam.

[nerdtonurse?, BSN, RN]

What helped me was I made baseball cards, sorta. Front would say something like "CHF: Congestive Heart Failure" followed by S/S, Causes, and finally Treatments. On the back, most common meds associated with CHF. And keep in mind, what I found was that while one hospital may address a BNP of 3300 with a natrecor drip, another may just use Lasix and look at you like you're crazy if you mention natrecor.

I'm an LPN, in the middle of my ADN program, and they took out pharmacology to give us a class in nutrition (grrrrrrr). I'd much rather have had microbiology, pathophysiology and a good pharmacology class.

[nerdtonurse?, BSN, RN]

Oh, and BTW, before I forget....

Thanks for being a teacher.

[MaraG.]

I wanted to thank everyone for their replies. On our next shift I spoke with the student about my concerns. I told her that her practices were unsafe and that I had a lot of concerns with her basic nursing knowledge. I took the entire assignment and she spent 3 hours looking meds and diagnosis. When I asked her about timolol gtts. She replied it is for BP, but when I asked what condition it was treating, she could not tell me. She had stopped reading when she got to PO and not read on to eye gtts.

Later that day we met with her teacher. Her teacher had not gotten the email I sent and was shocked to hear the news. Her teacher was ready to pull her off the floor, but I urged the teacher to give her a chance to prove herself. The student was strongly spoken to about the risks she is taking and told that she is at risk for failing. The teacher asked her if while in school she had to make med cards and notes for each pt. She said yes, but did not think it was needed now.

So the teacher said she would return the next day with a contract that would detail strict requirements for the student to live up to. The teacher stressed the need for her to study medications and know why she was giving it. Do the 8 rights and 3 checks.

Wanting to boost her moral I offered for her to give one of my pt's newly order medications. I answered her bells and tended to her pt 's while she researched Humira.:typing I printed off info for her to take home about Crohn's, confident she saw the writing on the wall. So the next day, I asked if she read the info on Crohn's and reviewed the medication. No she had not! She had family over and did not get to it.

Later that same pt lab work came back and her Hgb had dropped from 96 to 83. I showed her the labs and asked what she should be assessing. She replied "I don't know" I asked what hgb is "It has to do with your blood" I pressed further "It has to do with your sugars" I asked her to sit down and look up hgb. When I came back, she was reading about what causes hgb to drop. "Great! What is the first thing you should assess?" She read the list "Severe blood loss, bone marrow ....., malnutrition." She felt malnutrition was most important. During her first week we talked about GI bleeds and blood loss in great detail, she researched it and I gave her handouts. we work on a GI floor!

Her teacher came later that day with the contract. I told her teacher about the day the lack of research, the hgb and other issues through out the day. The teacher was blown away when the student told her she did not do any research to prepare her for her day.

The contract says that the student has to have 60% of the workload tonight, med cards, research about the conditions of her pt and assessments that she will do, all written out and ready for me and the teacher to see. I suggested she sit down for a while to write out medications and conditions so that she could prepare. She did not, I suggested that she spend time with the chart of one of our new pt's and she did not. Instead she stood by the nursing station listening to some of the nurses talking.

[CrystalClear75, BSN, RN]

It seems like this student isn't very motivated despite your conisistency in trying to help her out. It's kind of obvious that she has no determination in passing,seems that way to me anyways.

I wouldn't try helping her out as much or going that extra step as you have been, now it's all on her, she knows what she has to do.