How not to get ****** at clinical?

[noyesno]

The following situation occurred in clinical last week during medication administration:

-I was giving medications with my instructor

-She wants me to scan patient, scan all the medications but wait until the end to click the confirm button (so she can look them over)

-After scanning each medication, I set aside the wrapper in case something went wrong with the computer and I needed to scan them again

-My instructor yelled at me for not immediately putting the wrappers in the garbage, so, I put all the wrappers in the garbage

-I explained to her that I was saving them in case I needed to scan them again but she told me to throw them away anyways

-I threw them away

-Meanwhile, a PA is removing my patient's hemovac and replacing his dressing with a new one

-She places the blood filled hemovac and the old dressing in the garbage on top of my wrappers

-The computer logs me out (because it was taking too long to confirm) and I have to re-scan the medications, you know, the ones that are in the garbage

-So, my instructor makes me dig through the bloody garbage (mind you this is a MRSA patient) to retrieve all the wrappers and I re-scan the medications

*The reason it was taking so long was because my patient felt like he was going to throw up and I wanted to give him some time to feel okay before asking him to swallow some pills (I got him an emesis basin and some ginger ale).

Situations like the above seem to happen a lot in clinical and I get ****** off. So far, I've been able to keep my frustration inside but I fear that I will loose it sometime soon and say something like the following, "I'm not too thrilled to be digging through the bloody garbage, especially since I had set aside all my wrappers in case this situation arose but you made me throw them away and now I am not happy." Obviously, this would just screw me over and biting the tongue is the best thing to do. However, this is very difficult.

So, anyone have any advice as to how to not get ****** off in situations like the above?

How do you keep your cool?

[noyesno, MSN, APRN, NP]

Ding ding ding....we have a winner! That was my first thought as I read the original post. I would challenge the instructor on asking you to root through contaminated waste, especially after you requested to keep the labels handy for a potential re-scan. Maybe the instructor should dig through the trash, since it was his/her idea to toss them.

This made me laugh! HAHAHAHA, "you dig!"

Check out my reply to Tyler77 por favor!

[singingtothewheat]

I have been a clinical instructor in the past so I will try to do this tactfully. Let's see if I can pull it off.

1. I think maybe your clinical instructor probably hadn't ever really worked with meditech or like systems. Anyone who has worked with meditech knows it's an extremely good idea to hold on to wrappers for just a few moments to be sure that everything scans as planned, because some times IT DOES NOT!

2. I hope that your clinical instructor tactfully said something like, "Let me get you a bio-hazard bag for that" or at the very very least took you to get a bio-hazard bag, into which the entire contents of the trash, bag and all, were placed. As a clinical instructor I would either tried to mention, away from others, to that P.A. that I was concerned about how a bloody hemovac was discarded in general trash, or.... I would have spoken directly with the director of the unit for follow up.

Throwing a bloody hemovac in generally trash is just not acceptable.

Leaving a bloody hemovac in general trash is also unacceptable.

Expecting you to dig through this trash, with or without gloves is beyond unacceptable and should be reported to your nursing dean of students but at the very least you had every right to refuse!

[nursel56]

You have wisely concluded that a ******* match with an instructor rarely works out to the advantage of the ****** off nursing student in the end. Causing a ruckus should be reserved to those things that can actually jeapordize your ability to finish your program and pack her off to a far away place in your mind. You'll probably get ****** off again by some other bonehead move someone does that is irritating but without lasting consequence to your life and limb. Practice relaxation techniques. Write letters ripping her a new one and then tear them up. Picture yourself smiling happily at your graduation despite the old ******. Stuff like that.

Having you dig through trash filled with bio-waste is disgusting and inexcusable, though. It comes pretty close to a deal-breaker. The PA should be reported to your Infection Control Officer.

[BeenThereDoneThat74, MSN, RN]

Okay, as an instructor, I'm going to do something I rarely do here. I am not going to defend the instructor in this case.

She ****** up. It happens. She's human. The problem is she didn't know how to fix the problem. So instead, she made you do something that compromised safety and infection control... something she never would have done herself!! I have never worked with this kind of system, so I cannot say waht i would have done (as the instructor). Can you 'waste' the meds and start over? There has to be a way to do that. Of course, that would mean she needs to involve others (the floor nurse, head nurse, pharmacy, etc). Then that would open a can of worms about the bloody hemovac (which was neither yours or her fault, so that would not be a big deal).

With hindsight always being 20/20, I would have refused to dig into the garbage. Let her figure out how to rectify the problem, That's what they pay her (us) to do.

And I just have to address this:

I totally agree, they do not care.

Please don't generalize. I could make plenty of generalizations about students (and you wouldn't like them ).

She may not care, but many of us do. As far as "what you're thinking", that's basically all I want to know for the 6 hours I am in clinical with them. I hate robotic students, I love 'thinkers'. They make much better nurses

[noyesno, MSN, APRN, NP]

I have been a clinical instructor in the past so I will try to do this tactfully. Let's see if I can pull it off.

1. I think maybe your clinical instructor probably hadn't ever really worked with meditech or like systems. Anyone who has worked with meditech knows it's an extremely good idea to hold on to wrappers for just a few moments to be sure that everything scans as planned, because some times IT DOES NOT!

2. I hope that your clinical instructor tactfully said something like, "Let me get you a bio-hazard bag for that" or at the very very least took you to get a bio-hazard bag, into which the entire contents of the trash, bag and all, were placed. As a clinical instructor I would either tried to mention, away from others, to that P.A. that I was concerned about how a bloody hemovac was discarded in general trash, or.... I would have spoken directly with the director of the unit for follow up.

Throwing a bloody hemovac in generally trash is just not acceptable.

Leaving a bloody hemovac in general trash is also unacceptable.

Expecting you to dig through this trash, with or without gloves is beyond unacceptable and should be reported to your nursing dean of students but at the very least you had every right to refuse!

She is very familiar with the computer system. She has been going to this clinical site for years and they have been using the computer system for quite some time.

She did not mention anything about the hemovac going into the garbage. Every one, but me, seemed unconcerned by it.

I agree that it is unacceptable to put a bloody hemovac in the regular garbage and I was shocked that she left it there. I hate that, as a student, I feel that I have to do whatever the instructor says. Its messed up that I didn't feel I had the right to question her order.

Thanks for your reply! :)

[noyesno, MSN, APRN, NP]

You have wisely concluded that a ******* match with an instructor rarely works out to the advantage of the ****** off nursing student in the end. Causing a ruckus should be reserved to those things that can actually jeapordize your ability to finish your program and pack her off to a far away place in your mind. You'll probably get ****** off again by some other bonehead move someone does that is irritating but without lasting consequence to your life and limb. Practice relaxation techniques. Write letters ripping her a new one and then tear them up. Picture yourself smiling happily at your graduation despite the old ******. Stuff like that.

Having you dig through trash filled with bio-waste is disgusting and inexcusable, though. It comes pretty close to a deal-breaker. The PA should be reported to your Infection Control Officer.

Great advice! Thank you!

I'll do some deep breathing. During my non-nursing undergrad I was a stress management peer educator. I'll start utilizing some of the techniques I taught.

I do a lot of journaling and I agree, writing down your thoughts and frustrations can be very therapeutic. I never tried the ripping up the writing though. I'm going to give it a go! :)

Digging was disgusting and I was shocked she told me to do it. If I was a staff member, I would have said something to the PA.

[RyanT]

RyanT,

Thanks for your reply. I totally agree that being assertive like you describe above is a great way to go. Unfortunately, last semester, I took the approach you described above and my clinical instructor did not want to hear what I had to say and it did more harm than good. So, I'm taking the "bend over and take it" approach this semester because it seems to be the approach instructors at my school prefer...

When I'm working, I will be able to stand up for myself and be assertive. In the meantime...

In that case, I say keep on doing (simultaneously) whatever you think is right, and whatever your instructor wants you to do. Keeping your instructor happy should be important, but your intuitions are potentially life-saving. I'm sure you can get through this.

[HeartsOpenWide, RN]

First I would have politely reminded her that I specifically wanted to not throw the medication wrapper away until after it as giving to avoid this situation, that since she/he is the one that insisted me throwing them away, she/he could be the one to dig through the trash.

Second I would go to the dean.

[noyesno, MSN, APRN, NP]

Okay, as an instructor, I'm going to do something I rarely do here. I am not going to defend the instructor in this case.

She ****** up. It happens. She's human. The problem is she didn't know how to fix the problem. So instead, she made you do something that compromised safety and infection control... something she never would have done herself!! I have never worked with this kind of system, so I cannot say waht i would have done (as the instructor). Can you 'waste' the meds and start over? There has to be a way to do that. Of course, that would mean she needs to involve others (the floor nurse, head nurse, pharmacy, etc). Then that would open a can of worms about the bloody hemovac (which was neither yours or her fault, so that would not be a big deal).

With hindsight always being 20/20, I would have refused to dig into the garbage. Let her figure out how to rectify the problem, That's what they pay her (us) to do.

And I just have to address this:

Please don't generalize. I could make plenty of generalizations about students (and you wouldn't like them ).

She may not care, but many of us do. As far as "what you're thinking", that's basically all I want to know for the 6 hours I am in clinical with them. I hate robotic students, I love 'thinkers'. They make much better nurses

I agree, she is human. I actually like this lady and have not written her off as a bad clinical instructor. I think she did not know what to do and chose the worst option as the solution.

I guess I should have refused. My issue is, I don't like making the patients uncomfortable and I feared that refusing would have made a big ruckus.

I'm sorry about the generalization (I hate generalizations!). Last semester, I had an instructor that could care 100% less about your thought process. You would tell her your reasoning for doing something and she would literally say she didn't want to hear it. I think I became pretty jagged about clinical instructors by the end of the semester. However, what I said was wrong because prior to that instructor I had a few great clinical instructors that did care. Thank you for reminding me of the good ones. :) Also, it sounds like you would be a great instructor to have in clinical. Your students are lucky!

[nursel56]

I do a lot of journaling and I agree, writing down your thoughts and frustrations can be very therapeutic. I never tried the ripping up the writing though. I'm going to give it a go! :)

The stuff I write when I'm can't actually tell someone off but really, really want to isn't the stuff you write in a pretty flower notebook next to an aroma-therapy candle. Plus I'd have a concern that it would somehow appear on Facebook. I find that typing furiously into a Word document and then deleting it works well. Reading them again after I'm cooled off is a cheap source of entertainment as well.:)

[Moogie]

I've been a clinical instructor too and had many frustrating moments with a computer system that would take two weeks to recognize me (but kick me off at the end of every semester) and a Pyxis that I swear was possessed by Satan himself. For the first two weeks of clinicals (which lasted for half the semester) I would not be able to access charts or the Pyxis so, like it or not, the students and I had to find a staff nurse who had to log in so I could read the students' charting or give meds.

Having said that, though, even though I was not familiar with the system and had never worked with a portable medication system that required nurses and students to scan patient and medication bar codes, I would not have gotten upset with a student who did not throw away the medication containers after setting up the drugs. Look, I am a klutz and I have dropped medications myself and don't even like to open the containers until I am at the bedside (and even then they can end up on the floor) so I would probably give kudos to the student who was being as cautious and prudent as the OP.

I also am old enough to remember a day when dirty hemovacs were tossed into the trash. But that back in the day when nurses didn't wear gloves routinely like they do now. We didn't even wear gloves to give enemas----I surely don't want to ever go back to that aspect of the "good old days". Thirty years ago, no, a hemovac in the trash would not have been a big deal. Today, especially with MRSA, it IS a big deal.

Still, I also would never tell a student to do something I would not do myself. If I expected a student to go through the trash for something, I'd be putting on a pair of gloves myself and digging through the trash right along with that student. I may have been flummoxed by a unwieldy computer system---I will cut anyone slack for having difficulty with user-unfriendly technology---but I am outraged by the thought of an instructor being lax about infection control. (Yeah, and texting behind the desk and the eye rolling when a student needs help----not cool.)

But again, please don't paint all instructors with the same broad brush. There are some who are incompetent, some who are downright nasty, some who are in over their heads and want to do a good job but don't have the support from their institutions to do a good job. The incompetent can learn, as can those who are trying but don't have enough support or orientation. (Trust me on this---I think many students would be appalled that their clinical instructors often receive minimal orientation to unfamiliar facilities. It's fine if the CI also works at the facility but downright frustrating for everyone if he/she is not familiar with the place.)

I have had my share of nasty instructors, so I understand the whole fear and intimidation thing. I have spoken up----and learned that I should have kept quiet---and I have practically given myself ulcers by keeping quiet when I should have said something. Frankly, no one likes to hear that students think he/she is a poor instructor---but I want students to be honest with me (kind, please, but honest) and if I'm doing something wrong, tell me to my face and not behind my back. I can't do a better job if I don't get feedback and ideas about what I am doing wrong.

There are many instructors who don't know how to teach and don't really care about students. There are some who get into teaching because they "hate" nursing. But not all of us are like that. Some of us really love nursing, are passionate about helping students learn, and want our students to strive for excellence. When I read posts about students getting emotionally beaten up by their instructors, I feel discouraged and wonder if I even want to continue with graduate education and trying to learn how to be a good instructor when there are so many bad instructors out there.

Can an instructor who is not perfect make a positive difference in students' lives? I have to say that while I have had some horrific instructors at all levels of education, from AD through grad school, I have also had instructors who have helped me to learn, to grow as a person and as a nurse, and who have inspired me. I try to keep the good ones in my heart and the bad ones in my head so I do not end up treating students the way I have been treated by them.

I'm sorry---I'm feeling sad and angry and frustrated over what happened to the OP. What can we, as nurse educators, do to turn clinical experiences around from demeaning to inspiring?

[Moogie]

The stuff I write when I'm can't actually tell someone off but really, really want to isn't the stuff you write in a pretty flower notebook next to an aroma-therapy candle. Plus I'd have a concern that it would somehow appear on Facebook. I find that typing furiously into a Word document and then deleting it works well. Reading them again after I'm cooled off is a cheap source of entertainment as well.:)

I'm always afraid that if I journal on Word that I'm going to accidentally send it in an email to the person who is causing me stress at that particular moment. I've heard too many horror stories about people who have written emails or sent texts to friends in which they're complaining about a boss and they accidentally send them to their evil bosses.

Personally, I like a little music therapy. Go for a drive in the country with the music cranked up. The louder and more obnoxious the music, the better. Rap, metal, classic rock---I even have a "bad mood" mix on my iPod---plug it into the car and let the negative energy out.

Mellencamp. Authority Song. Always works for me. But you know, he has a good point. "I fight authority, authority always wins." Often, yes. You have to choose your battles wisely because people who have power over you aren't always going to relinquish that authority---and when challenged they hold onto it like Linus' security blanket. But sometimes, even if you challenge authority and end up paying the price, at least you have your dignity.