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.

[DeepFriedRN]

It kind of sounds like this student isn't really struggling, it sounds like she is just not trying. Either that or she just does NOT get any of it. Not sure which is scarier. I'm kind of at a loss as to what to advice we could give you, as it seems as though you have gone above and beyond to try and help this person function appropriately. I think you've done a great job, at this point it's up to the student to follow the plan of action appropriately or not. She's going to have to step up and do what she needs to do.

[lisamc1RN, LPN]

Wow! You are a very patient and kind nurse. Thank you for your teaching heart! I'm sorry that your student doesn't seem as motivated to learn as you are for her to do so. How disappointing and frustrating to put all that effort into someone who doesn't seem to appreciate the real opportunity she's getting. Please don't be too discouraged. If you continue to teach, I know there are plenty of students who want to learn and will be so thankful for a teacher like you.

[Orca, ADN, ASN, RN]

(duplicate post removed)

[Orca, ADN, ASN, RN]

My take on this, after reading everything you have said, is that this student is not cut out for nursing. She doesn't seem to retain anything she is told. Whether that is due to lack of effort or just an inability to understand, I cannot say. Either way, she is dangerous to her patients. That she once used med cards but doesn't see the need for them now points to effort, IMO. She could use a very simple tool to help her retain the information, but she chooses not to. When I was in RN school we were required to make a card for each medication that each one of our patients was taking. They were an invaluable learning tool. There is something about writing something down that makes it stick.

This student seems to have no appreciation for the magnitude of the problem of her not knowing anything about medication, or the potential consequences. God help her patient if a doctor prescribes the wrong med or an incorrect dosage. She would never catch the error. Her lack of knowledge might kill someone some day, and it won't matter how compassionate she is.

You are a rare individual. I commend you for your efforts to salvage this student. I'm afraid that, in this case, it is a lost cause. If so, it won't be your failing.

[netglow, ASN, RN]

Wow, you are so kind, and patient.

From my very first clinical day I was expected to go in cold without having any patient information to prepare ahead of time. This meant that I was to have "prepared" by having actively participated in and feverishly studied in all my supporting classes up to that point. This of course would not make me an expert walking in cold, but I would have basic knowledge to approach a patient off report and quick chart read. A quick look-up here and there. We all are expected to stand and deliver anything asked of us by our instructor, re: current patient condition (initial basic PA) hx, pathophys, meds admin and pharmo checked and ready to pass, Kardex etc. within 20-30 minutes of getting report. Not that we all did this stuff so smoothly, but this is how it's gonna be, and now I am glad for it. I had thought that this way of "throw 'em to the wolves" teaching was a$$ backwards, but now I think I have and will benefit from it.

But having said that, I'd love to have you as my preceptor!!! I just know you'd be there for me if I had a question. Problem that I do have now, is that I generally try not to ask any questions, that is frowned upon. I am trying to remind myself that when on orientation in my first RN job, not asking questions is gonna make me seem like a "know it all" -which, I am not... Word to the preceptors out there, many of us have been conditioned not to, so don't judge too fast!!!

[beachbutterfly]

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.

You mean that the hemoglobin dropped from 9.6 to 8.6 not 96 to 86? Or am I missing something here???

[madnurse2b]

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.

You are amazingly patient and kind....this is not a struggling student. This is a student that does not care about what is going on around her.

Even as a medical assistant I knew what meds I was giving and why, even in charting their current meds. Yes, I left a room and asked a doc about the Viagra that my female patient was taking daily! How was I to know that they prescribe it for pulmonary hypertension! LOL

You can only do so much. This is not someone who actually cares about patients because otherwise she would want to know that she is giving medications safely. Get through what you have to - or let the teacher pull her from the floor.

Thank you for taking this much time with a student. It gives those of us who are looking towards our preceptorship hope that we might get someone like you.

[MaraG.]

Wow! What a response. It is nice to see how supportive everyone is, thank you. I remember being a student and know that I would have liked the extra help and tips. But now I realize that it is all being wasted. Looking up the same med 3x in one shift and still needing to explain that yes you have to read the uses for the drug, you can't assume that biaxin is for liver failure.

I spoke with her teacher tonight and will speakwith her again tomorrow AM...ugh this AM. I will suggest that she not come back.

Beachbutterfly:

I live in Canada we use a different scale for all most all of our labs, makes it confussing. Here normal Hgb is 120-150. LOL!

[Orca, ADN, ASN, RN]

Your efforts are very commendable. You did everything you could to support this student. However, if she isn't going to put in any effort, it doesn't matter how much support she gets. Nursing is not a profession you can coast through with a minimum amount of effort. Best to weed her out now than to have her working with you later.

[MaraG.]

Well it is done, I spoke with her teacher this AM and let her know how the night went. Missed two meds for one pt and an IV med for another. DId not think a low grade temp was a concern and only told me about 2 hours before the end of the shift. Once she told me the pt temp had elevated to 38.5. Luckily blood cultures had already been drawn the day before.

So now, with only 5 shifts left of her preceptorship/program, it lies in the hands of her teachers. I am sure that will what is in the best interest of the public. Thanks to everyone for all of the supportive words and encouragement. :heartbeat

[OgopogoLPN, LPN, RN]

It was not so long ago (last summer in fact) that I was an LPN student on preceptorship (in LTC, but that's another story!!) and I could only dream that I could have had a preceptor like you!!!!!! You sound so knowledgeable and patient!!!

It sounds like this student is much better suited to care aid work rather than nursing. It's also amazing that she made it through that far without her instructors noticing her complete lack of knowledge and critical thinking skills!

Thank you for taking the tough road and being honest with her instructors. It must have been a tough step knowing how close she is to finishing, but she sure didn't sound safe to practice at all. I had 3-4 students in my class who were really poor academic students, but were compassionate. They really struggled during clinicals, but somehow managed to pass and are now licesened which still scares me!!

Anyways, kudos to you for all your amazing effort and patience. I hope you continue to preceptor students in the future. I would love to preceptor in a few years when I'm more experienced. :)