How do you deal with a bad clinical instructor?

Okami_CCRN, BSN, RN · Sep 24, 2014

I recommend you voice your concerns to the instructor before following up the chain of command. You could ask to speak to them on a 1:1 basis and at this time say something to the effect of "I feel misdirected at times during clinical and was wondering if there is something specific I should be doing or modifying to meet my clinical goals."

My experience is that approaching a professor without being accusational (sp?) or intimidating often leads to positive results. Best of luck!

kalycat, BSN, RN · Sep 24, 2014

I can't offer too much advice, but since it is your first rotation, maybe use this time to really hone your assessment skills. You can learn a lot about a patient by just looking at them and talking to them. Additionally, you can run through tasks and processes in your head, so to speak. Try to observe other nurses and think about how you would organize your care for that specific patient and how you would plan your day, step by step.

A lot of first semester, sometimes, is getting comfortable talking to and examining patients. As far as skills go, try to pull any process/procedure sheets available from your school or clinical site, and have the steps in mind as your perform the task, like chem sticks, for example. You can run thru steps mentally for things like subq injections and the like, and then when you get a chance to observe or perform the skill, you're ready to go.

Having issues with an instructor can be hard. Try to take ownership for as much of your learning as you can - study ahead, talk to nurses, try to get involved. Think about the types of patients your unit treats, and request to care for patients with diagnoses that interest you.

Sometimes you can build a good clinical experience on your own, even if your instructor isn't the best. Sometimes no matter what you do, it's rocky. Sorry if this isn't super helpful, but sometimes you've just got to try for a margarita when life hands you lemons! Good luck and hang in there.

Ps: I second Okami's statement about approaching the Prof. I think that was great advice! Be non confrontational and ask if he could possibly clarify the specific goals and objectives for this rotation. Back off if he starts freaking out, and take it up the chain of command if necessary.

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Lori215, RN · Sep 24, 2014

I recommend you voice your concerns to the instructor before following up the chain of command. You could ask to speak to them on a 1:1 basis and at this time say something to the effect of "I feel misdirected at times during clinical and was wondering if there is something specific I should be doing or modifying to meet my clinical goals."
My experience is that approaching a professor without being accusational (sp?) or intimidating often leads to positive results. Best of luck!

We have post conference every day after clinical and I tried to mention (because I wasn't the only one with this concern) that I was having issues knowing what the goal of each clinical day is and he/she did attempt to clarify that. The instructor just has poor communication skills (often diverting on tangents where we have no idea what he's/she is talking about...) which makes it hard. I'm not sure it's something that can be changed about them, it's just their personality. (Sorry for the choppy writing, I'm trying to semi protect the identity of the instructor by not giving a gender.)

In any case, would it be inappropriate to request to not have this instructor for future semesters? I know that may come off as childish, but I'm just not going to learn anything under his/her direction, especially when clinicals get more complicated. I just hate to suffer in the program when I am doing my best to learn and have a good experience. Seems like a waste of my time and money.

Lori215, RN · Sep 24, 2014

I can't offer too much advice, but since it is your first rotation, maybe use this time to really hone your assessment skills. You can learn a lot about a patient by just looking at them and talking to them. Additionally, you can run through tasks and processes in your head, so to speak. Try to observe other nurses and think about how you would organize your care for that specific patient and how you would plan your day, step by step.
A lot of first semester, sometimes, is getting comfortable talking to and examining patients. As far as skills go, try to pull any process/procedure sheets available from your school or clinical site, and have the steps in mind as your perform the task, like chem sticks, for example. You can run thru steps mentally for things like subq injections and the like, and then when you get a chance to observe or perform the skill, you're ready to go.
Having issues with an instructor can be hard. Try to take ownership for as much of your learning as you can - study ahead, talk to nurses, try to get involved. Think about the types of patients your unit treats, and request to care for patients with diagnoses that interest you.
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This was very helpful, thank you. I guess I just wanted an idea of what is expected of me for my first clinical rotation. I'm not sure if I should be performing assessments or simply doing a general assessment on my patient. I would hate to invade their privacy for no reason (especially since my patient Monday was being discharged that day... How silly to give me that patient!)

nowim clean · Sep 24, 2014

Simply say one on one I am very sorry I am not trying to be difficult, but I am just not understanding what I am suppose to be doing. I want to learn I just don't understand, and if they explain something that you don't understand tell them if you do understand it tell it back to them then go do it.

nowim clean · Sep 24, 2014

Not silly to have a patient discharged. You have no clue how much you can learn at bedside while the RN does the dc. There is an IV to d/c , a foley if they had one, cardiac monitor taken off, d/c instructions, teaching about the disease. Always look at your assignment as a chance to learn, one day you will be the discharging RN if you never did it in clinical how are you going to know where to start?

Lori215, RN · Sep 24, 2014

Not silly to have a patient discharged. You have no clue how much you can learn at bedside while the RN does the dc. There is an IV to d/c , a foley if they had one, cardiac monitor taken off, d/c instructions, teaching about the disease. Always look at your assignment as a chance to learn, one day you will be the discharging RN if you never did it in clinical how are you going to know where to start?

We weren't there for the discharge (we leave the site at noon) and weren't allowed to follow the nurse (that starts next week). We were supposed to be "taking care" of the patient (practicing ADLs).... They were independent.

mrsboots87 · Sep 24, 2014

There may not be much direct goals you are given, but as much as you are fresh and new and needing some direction, you also need to take responsibility for your own learning. If your instructor doesnt tell you what to do, then go ask the aids or the nurse if they need any help. You should definitely be practicing head to toe assessments. So do your patient first. Then when you find yourself with nothing to do, ask some of the other residents if they dont mind you doing an assessment on them. Many of them dont mind because they are getting extra attention. Also, ask the nurse in the morning what type of things they will be doing. Like if they have any wound care, foley removals, IV d/cs or insertions, d/cs, anything really, and ask if it would be ok if your observe. By telling you to practice ADLs and vitals, that actually is a lot. Dont just do your patients vitals. Each facility has a list of whos vitals they need and when. The aids usually have it. Ask them if they need help with vitals and they will likely give you the list and you can go practice to your hearts content. You can also practice ADL's on any resident. When a call bell goes off answer it. Basically, if you dont get what you need from your instructor, take charge and DO. This will help you in block two when beside needing the instructor to watch you do skills the first time, they basically send you off with a nurse. There are a few goals for the day, but nothing that would direct my entire day. GL. And I wouldnt ask for a different instructor next semester. First, becuase you dont get a choice. You get what you get. Second, because there will be an end of semester survey on your instructors and that will be your time to sound off. For now, instead of waiting until end of shift conference, find your instructor during your shift and pull them aside. Tell them directly what you need and go from there.

Lori215, RN · Sep 24, 2014

There may not be much direct goals you are given, but as much as you are fresh and new and needing some direction, you also need to take responsibility for your own learning. If your instructor doesnt tell you what to do, then go ask the aids or the nurse if they need any help. You should definitely be practicing head to toe assessments. So do your patient first. Then when you find yourself with nothing to do, ask some of the other residents if they dont mind you doing an assessment on them. Many of them dont mind because they are getting extra attention. Also, ask the nurse in the morning what type of things they will be doing. Like if they have any wound care, foley removals, IV d/cs or insertions, d/cs, anything really, and ask if it would be ok if your observe. By telling you to practice ADLs and vitals, that actually is a lot. Dont just do your patients vitals. Each facility has a list of whos vitals they need and when. The aids usually have it. Ask them if they need help with vitals and they will likely give you the list and you can go practice to your hearts content. You can also practice ADL's on any resident. When a call bell goes off answer it. Basically, if you dont get what you need from your instructor, take charge and DO. This will help you in block two when beside needing the instructor to watch you do skills the first time, they basically send you off with a nurse. There are a few goals for the day, but nothing that would direct my entire day. GL. And I wouldnt ask for a different instructor next semester. First, becuase you dont get a choice. You get what you get. Second, because there will be an end of semester survey on your instructors and that will be your time to sound off. For now, instead of waiting until end of shift conference, find your instructor during your shift and pull them aside. Tell them directly what you need and go from there.

Its a very tough situation, because I was previously an aide so adls and vitals are second nature to me. But Monday I was given an independent patient, so that wasn't exactly what I was supposed to be doing with her, and I didn't feel a head to toe assessment was necessary on a patient being discharged. When I asked my instructor, they simply gave me another set of vitals to do instead of answering my question (that happens a lot, unanswered questions.) I helped one of the other girls with her patient, but we get such a late start (and leave so early) that there isn't a whole lot to do by the time we get to the patient. Bath is done, bed is changed, patient has eaten so we can't even do our own intake output, you know what I mean? It's just a lack of organization, I feel.

So now that we are a little farther with assessments I will work on that, I am just no understanding whether during my assessment I should be writing down my own findings or is there paperwork that accompanies it that I would be doing on the patient? I'm sorry, I'm just so lost and frustrated I don't even think to ask questions like that during clinical. And if I do, they usually get diverted to another topic.

As as for my instructor, the communication is not that easy. I wish I could explain how difficult it is to get a question answered by them, but it's just a communication barrier for whatever reason. I am not the only one in my group feeling this way luckily, so we do try to pair up.

Thanks for your response though. I will be doing my best to get more concrete answers (even if it takes a few tries, which it normal does from this person...)

Also to add, we are on a medsurg floor, so most of the patients aren't as needy as they would be in a LTC facility. There were also only 12 on the floor on Monday and several were being discharged. I know it sounds like I'm making up excuses, but I hope you can see where my frustration is coming from. I try my best to find stuff to do but I feel like there simply isn't enough.

SopranoKris, MSN, RN, NP · Sep 24, 2014

You didn't feel a head to toe assessment was necessary? You're there to learn, take the opportunity to do it and get more practice. At least you're fulfilling your requirements.

I understand your frustration. I had what you might call a "flaky" clinical instructor my first semester. We never had clear direction and she never answered our direct questions in post-conference. I finally decided to write her an email and say "I need clarification on the following, so I can ensure I'm meeting our clinical guideline standards..." and then enumerated everything. It was written in a way where there was no way she could interpret what I said as a complaint.

If, after trying to verbally communicate and sending an email, you're still getting no where, perhaps you can speak with your lead faculty? Especially if you're not the only one experiencing this.

BTW, our faculty listened to our feedback and it was a positive change :)

Lori215, RN · Sep 24, 2014

You didn't feel a head to toe assessment was necessary? You're there to learn, take the opportunity to do it and get more practice. At least you're fulfilling your requirements.
I understand your frustration. I had what you might call a "flaky" clinical instructor my first semester. We never had clear direction and she never answered our direct questions in post-conference. I finally decided to write her an email and say "I need clarification on the following, so I can ensure I'm meeting our clinical guideline standards..." and then enumerated everything. It was written in a way where there was no way she could interpret what I said as a complaint.
If, after trying to verbally communicate and sending an email, you're still getting no where, perhaps you can speak with your lead faculty? Especially if you're not the only one experiencing this.
BTW, our faculty listened to our feedback and it was a positive change :)

Believe me, I am there to learn! That is why I am so darn frustrated with this. In this situation, I didn't feel it was appropriate since the patient was being discharged (and was independent) and since I didn't know if this was appropriate I asked for clarification from my instructor which I did not get. If I question anything, I ask, since I know how sticky things can get with he said/she said. The instructor simply gave me something else to do and literally ignored my question.

And I have considered talking to my nursing mentor about it since she is also one of the head faculty and very understanding and trustworthy. I don't think she would think I was complaining (hopefully) if I told her I wasn't getting the answers I need when I ask questions and maybe she can make a recommendation. I will try that! Hopefully it will be a positive change for us, too!