How to positively help a really bad student

[redtshirt]

Hi I am just wondering if you can suggest some ways that I can approach a student nurse. She is currently in her final year of her programme and has 8 months of placement with something like 5 different units/wards in it. The idea is that the students at this level are half a qualified nurse and should now be independent within their own scope of practice. However I am nearly 2 years qualified working in a teaching hospital and have been named her preceptor. I haven't dealt with a student that I have had so many negative things for her to work on in order for her to pass and I am clueless in knowing how I should approach this. I have worked with her for two shifts now and all she wants is to do medications and I feel her basic nursing skills are lacking so I dont want her going near the trolley. I love teaching and i am confident in my own ability as a nurse to do so but there is so much to do with staff shortages and budget cuts i feel i am not getting the time to help her out. I have set that we will have a talk this week but where do i start?

These are issues I have so far identified:

- Not assessing situations appropriately and thus not being able to carry on efficiently. E.G When we do the washes instead of getting all the supplies first she ends up running in and out to get stuff.

So I want to teach her about the basic steps of nursing assess, plan, intervene and evaluate.

- Not knowing what to do in an emergency. We had a head injury patient seizing on the floor and she just stood in the way of staff and docs going in and out of the room until she ran off.

Apart for Airway Breathing Circulation and other things you would do for the patient I dont know what to say to her about that.

- Priority of care. Instead of checking vital signs on the sickies first she was checking those who are very stable.

I think a lot of this is common sense or i thought it should be. How do you teach common sense?

-Talking to teams and doctors. Ringing an doctor five times over because she hadnt thought the whole thing through.

I will tell her to think of what she needs to discuss with the doctor before ringing and how to communicate effectively the patients needs and a timeframe in which they need them.

-Documentation is just a nightmare. I nearly cried when i read what was not written into the documentation. Post op patient no note on what operation they had done. No note on what anaesthetic they had. No note on meds given. No note of post op instructions.

I think this may become clearer to her when we get the foundations understood.

She is very stressed and her basic skills are lacking. She took swabs and didn't label them. Had no idea how to take a urine sample from someone with a catheter in. No idea of a nursing admission. I am afraid that I will come off as a bully for bringing up all of these issues all at once in our meeting but if I dont she will continue on being dangerous. I ask her through out the shift if she needs help and she will say no. I ask her if she has questions and she will say no but other staff have told me she was telling them about things she doesn't understand. I am approachable according to the other students.

I am just lost in this situation and want to help. I am very stressed out about staff shortages. And her lack of basic skills is very worrying. Thanks for your help its much appreciated

[Whispera, MSN, RN]

Since she's telling others she is having troubles, she recognizes it. How about you ask her each day (or week) to write down 3 things she wants to work on, along with her plan for doing it? You'll take the list at the beginning of the day (or week) and go over it, making suggestions. Tell her she must do this; it's not an option. Then you help her with whatever she chose, and discuss it a bit by the end of your time together that day (or week). This way she's assessing, planning, and evaluating herself, as well as having you do it. Having someone do things for herself as an active participant in the process is generally more effective than having her do what you tell her to do or having her listen to you share your wisdom without her input.

Does your school have a checklist of things the student should have accomplished by now? Or things they need to accomplish this semester? How about borrowing a checklist that the facility you're in with students uses during orientation of new staff members? That might be helpful.

Is she intimidated by you? I ask this since she tells others her problems but says she's fine when she talks to you. I think it's time for you to tell her you see she's having troubles, and that you want to help her work through them...and that she needs to tell you what she's thinking and feeling or you can't help her as effectively as you'd like.

[redtshirt]

Thanks for the advice whispera. I had a chat with her today and she was able to point out things that she felt she needed to work on and they were similar to what i felt she needed to work on. She seems to have settled in a bit better to the unit this week which helps a lot. And she told me she has been asking her tutors for a bit of extra help and direction. We came out with a better understanding of each other and i have a better idea as to what way she approaches things now too. Thanks!

[concernedMD]

Leaves one wondering about how sufficient skills lab experience was, for example. Is the school providing adequate instruction from the ground up? Some schools seem to cater to students who already have HC experience and tend to leave out those who haven't had such prior experience. Could this be part of the problem too?

[jmqphd]

I sort of assume that you and I are probably practicing nursing in different countries, your educational and licensure system is not one with which I'm familiar. Nevertheless, it's clear our thinking about nursing standards and the nursing process are universal.

I endorse what Whispera has said. I couldn't add anything to your concern for both the student and your patients. In the school (ADN program) in which I teach, I am the final hurtle before the students graduate. Our clinical course objectives are very much like you describe. I would typically have 15 weeks (one 12 hour shift per week) to evaluate how a student is progressing and if they are competent to function in a novice nurse's role. I have failed 5 students out of the last two classes (about 50 students). That is the bad news. The good news is they repeated our course, and every one of them passed and said that "everything clicked" on the second try. They have also passed their board exams.

I don't know how your educational system is structured. Sometimes failure is constructive and can be the best thing that can happen... as long as the student is given a second chance. Because our school allows a "do-over", I am more comfortable in making them try again. If failure at my hands was permanent, it would be much more difficult, but I would err on the side of patient welfare.

Oh, and P.S.: I wish there were more mentors like you.

[kkestral]

Hi, I am a UK early second year student,

I don't know if this will will help or if you think it is appropriate due to my level, but I thought it might be good to offer a students view of situations like you described that I have observed in practice. I have on many of my practices observed and hear about students that love to just do paperwork, meds and so called percieved nursey tasks on placement. It is a shame when someone has that view. Indeed how can you check skin integrity unless you are doing cares and washes?, how can you check for infection unless you are aware of the looseness, colour and smell of stools? and how can you be a great nurse without that patient connection that develops experience, empathy and communication skills?

I was very lucky with my placements I was placed with the HCAs for the first two weeks til I became used to the ward routines. This taught me invaluable skills about basic cares and team work and being in a observational place where my patients were. I learnt to realy observe their colour, behaviours, breathing and look for things out of the norm. Doing repeated observations taught me to look for the abnormal patterns and ask questions of all the staff around me. I got a kick out of successfully having the time to think about what I had read and learnt at university and have time to apply it and put it into action.

Working through my CAP document (check list of expected achievements) really help to guide me on what I needed to learn and ask my mentor for opportunities to learn. Every mentor I have had has verbally encouraged me and talked me through every hesitant moment I have had and told me when I have done a great job. You really look up to your mentor so when they say 'good job' and 'thank you' you skip home keen for the next day and more willing to ask about uncertainties.

Your student sounds scared, does her course not cover assessment? and I agree with some comments here that maybe failing her will not be a bad thing as the patients wellbeing, dignity and respect are at risk. Surely she should have picked up such basics by her third year? I don't want to sound mean but patient care comes first your student needs to take control of your learning and apply evidence based practice to patient care.

Kkestral xx

[classicdame, MSN, EdD]

I think she is not a nursing candidate. But you know best. You have done an assessment, now create a diagnosis (lack of critical thinking skills, etc) then create some interventions and, if she cannot handle them, alert the school. Please don't push her through as she may be taking care of your loved one some day. You can try focusing on one thing at a time, like admissions, and then give her SPECIFIC tasks to complete correctly, such as choosing right forms, documenting correctly, getting right equipment, etc. If she does not do them all, you have real data to give to the school. Good luck. Appreciate your time in trying to do the job right.

[Purple_Scrubs, BSN, RN]

Thanks for the advice whispera. I had a chat with her today and she was able to point out things that she felt she needed to work on and they were similar to what i felt she needed to work on. She seems to have settled in a bit better to the unit this week which helps a lot. And she told me she has been asking her tutors for a bit of extra help and direction. We came out with a better understanding of each other and i have a better idea as to what way she approaches things now too. Thanks!

I just want to say thank you for not writing this student off completely. She may just be extremely nervous and she actually knows more than what she is showing, or she may really just be that far behind. Either way, I think it is admirable that you are so willing to help her work on her skills. You seem like a great preceptor and she is lucky to have you to learn from!