Intimidation Tactics as Teaching Tools?

mariedoreen · Jan 15, 2005

And yes you bet that was easily tons of reading, easily that many chapters per week we had a number of textbooks to pull from for every single disease process...pharmacotherapeutics, nutrition and diet therapy, Brunner's Med/Surg, Lippincott's Med/Surg, and so on and so forth.....yes ma'am. It was brutal.
I'm not talking about temper fits and humiliation but nursing requires so much dedication and sacrifice that the student (and the medical/nursing community, not to mention the patients) is done no favors by being coddled and spoon-fed - the student has to show drive, initiative, and resourcefulness - and a certain strength of character that will not be shown nor come through if the student isn't challenged to become that - if they fail, then another field is perhaps better suited for them.

Then I simply have to ask how long these chapters were. Because I'm sitting here looking at Kozier's Fundamentals of Nursing in which there are 50 chapters consisting of 1400 pages. That's a lot to read (and internalize and be expected to spit back out verbatim for the rest of your life... as you're indicating you had to do) in a week... and then you followed that with another 40-60 chapters the next week and the next and the next? You had then... about 60+ of these books over the course of your ADN education? (You see they teach us how to dissect statistical information now and determine if what we're reading is really valid or just a load of hooey).

But really back to the original topic. The OP is not complaining about hard work, is not complaining about meeting the bar that has been set, is not requesting to be coddled and spoon-fed, is not complaining about anything at all except for the fact that she and her classmates are being treated with intimidation and humiliation during their learning process. A lot of us put up with instructors like this, understanding that once we graduate we'll be back in the real world, working with caring, respectful human beings who don't consider themselves vastly superior to us and treat us like we're stupid. I can see we may be wrong about that tho...

IMustBeCrazy · Jan 15, 2005

Mariedoreen,

It's exactly that kind of 'herd mentality' and not having the discernment/critical thinking to challenge the practice (re. humiliation is ok because 'that's the way it's always been) that causes situations like super unsafe patient ratios....'because that's the way it's always been'...

The indoctrination starts out early, doesn't it?

IMBC

babs_rn · Jan 15, 2005

Mariedoreen,
It's exactly that kind of 'herd mentality' and not having the discernment/critical thinking to challenge the practice (re. humiliation is ok because 'that's the way it's always been) that causes situations like super unsafe patient ratios....'because that's the way it's always been'...
The indoctrination starts out early, doesn't it?
IMBC

We don't have the whole story on that matter - I never said that temper tantrums are okay, and i never said humiliation is okay. But what people may find to be "intimidating" is something that is entirely subjective. I've seen students and new grads complain about things that are entirely appropriate, quick interventions before they do kill a patient - interventions that may not be all "nice and sweet and soft" and are instead rapid and stern and direct - but that's what's needed. Society is removing the concepts of personal responsibility and putting everything squarely on the shoulders of the caregiver - the teacher is responsible for the student's learning and the nurse is responsible for the patient's compliance, etc... it's just WRONG and that DOES coddle the individual, who then is lost when faced with the reality of a tough world - A nursing education IS intimidating to someone who doesn't know what to expect in it. It IS difficult. It SHOULD be. We cannot afford to turn out everyone who thinks they want to be a nurse into the world to take care of us and our families when they are not cut out for it, not dedicated to it, do not take it seriously, are only in it for the paycheck, etc etc etc. I have seen way too many of them who literally apparently only view what they are being taught as just something they have to do to get a decent-paying job. We cannot afford to have that working alongside us and we SURE can't afford to have that taking care of us. All I can say is that the nursing schools in this area have gotten VERY lax and it is showing up in the quality of new grads who are turning up - and these nurses are still passing boards and they are making very grave errors. Nursing education is not there to change the system - it is there to prepare the student for the system that is and then once they have enough experience perhaps they can have a hand in finding solutions to the bigger problems. But I know that I would want MY nurse to be dedicated enough to have had to have worked for it and not used to skating through. Nursing students today (again, in MY geographical area) are being supported to the point that they are horribly under-prepared for the reality of the working world. Sure it's nice to have all those warm fuzzies but they're literally killing patients. They're missing important points. We can't afford that. You have to have a thick skin to be a nurse. You have to be able to take the abuse from your patients. You just have to. It's part of it. Yes standards should be VERY high. Our lives and our care depends on it. I'm not the only one. Even just last night at work all my coworkers were complaining about the quality of the new grads, how they just seem to be in it for the paycheck. We can't have that. I can keep saying that till I'm blue in the face. Lots of nursing traditions have gone by the wayside, and some of them needed to go. But the tradition of care of the whole being and of the high STANDARD of care and the dedication and the personal character --- cannot. And sometimes it takes a little wake-up call to shake up a person enough to make them see the seriousness of the matter. That's not just in nursing, that's in anything you do - well, anything that matters, anyhow. As a society we have this trend toward trying to make everything in the world soft and pleasant and so we wind up with a bunch of spoiled brats who can't handle the real world when they're suddenly faced with it. We are in this for a larger purpose and I, for one, am not going to let that larger purpose go by the wayside.

IMustBeCrazy · Jan 16, 2005

Of course there is a difference between constructive criticism and interaction meant to blatantly humiliate!

For example:

1) A student is told to immediately stop an IV drip because MedTele is pickingup arrythmias (potential side effect of said med, and this person should have been able to see it themselves, but the instructor intervened and asserted authority in the situation.) Later, in a private room, the instructor is discussing the lack of said intervention to this student. If the student feels 'hurt' by this interaction, too d*** bad!

2) Same situation, but the instructor yells how 'stupid' this student is and says 'we'll talk later' for all to hear.

Quite simply there IS a right and wrong way to handle this type of thing. I don't expect someone to handhold me. If I deserve a butt-chewing, I'll take it, PRIVATELY. I won't, however, allow myself to be publically chastised. World of difference. Nursing hasn't carved out some magical niche where this type of bully behavior should be tolerated.

IMustBeCrazy · Jan 16, 2005

I should add...

This being spoken as one who has the experience of having been in employee management for over a decade.

The most amazing part? I never had problems with those I was assigned to manage. In fact, we had an increase in productivity. Imagine that!

lil' girl, LPN · Jan 16, 2005

And hasn't research shown that people don't learn a Da** thing if they are yelled at? People do however learn if someone takes the time to explain it to them in a calm voice. I think the main problem is that we are working on their license and they are scared we are going to do something that will hurt them. Oh well shouldn't they have thought of that BEFORE deciding to teach????

dustydog · Jan 16, 2005

Well said imusbecrazy. Right on the mark.

Catys_With_Me · Jan 16, 2005

Mariedoreen,
It's exactly that kind of 'herd mentality' and not having the discernment/critical thinking to challenge the practice (re. humiliation is ok because 'that's the way it's always been) that causes situations like super unsafe patient ratios....'because that's the way it's always been'...
The indoctrination starts out early, doesn't it?
IMBC

I'm not sure if you're coming down on her or not, but if you are I'm not sure that's fair. Students don't put up with this because "that's the way it's always been" they put up with it because they feel that they're in a pretty powerless and precarious position. If you think about it half of your grade is pretty subjective, if they want you gone they might not have a hard time of getting you gone. At least, that's the fear a lot of us have.

IMustBeCrazy · Jan 16, 2005

I was agreeing with Marie :)

ER1010 · Jan 16, 2005

BabsRN,

Are you a nursing instructor? If you are can you please let all the potential nursing students where you teach so we can RUN LIKE HELK in the other direction???

LOL, I don't mean to be rude, but you are awfully harsh. Nursing students, for the most part, want to work hard, learn their stuff, so they can be good competant nurses, and not kill people.

Nursing is not the military, nor should it be. Do you subscribe to the theory that beating your kids makes them stronger too?

Letting us all know how much you suffered just makes you seem bitter. Telling us how bad you had it is intended to do what exactly????

We also know you didn't read as much as you stated, as it is completely impossible. I just took it as an exaggeration anyway.

Honestly, you should really take a look at your pessismism concerning nursing students. I am sure you just want to turn out good nurses, but when you look at the students, do you think you letting a little of your anger out on them? There are many ways to teach, and some methods are healthier than others. Just because you aren't a "hardass" doesn't mean you aren't getting nursing, and all of its seriousness, across to your students. Nice students taught by nice instuctors make nice nurses!

To the OP: Sorry to hijack this thread! I just had to get that out!!!

babs_rn · Jan 16, 2005

BabsRN,
Are you a nursing instructor? If you are can you please let all the potential nursing students where you teach so we can RUN LIKE HELK in the other direction???
LOL, I don't mean to be rude, but you are awfully harsh. Nursing students, for the most part, want to work hard, learn their stuff, so they can be good competant nurses, and not kill people.
Nursing is not the military, nor should it be. Do you subscribe to the theory that beating your kids makes them stronger too?
Letting us all know how much you suffered just makes you seem bitter. Telling us how bad you had it is intended to do what exactly????
We also know you didn't read as much as you stated, as it is completely impossible. I just took it as an exaggeration anyway.
Honestly, you should really take a look at your pessismism concerning nursing students. I am sure you just want to turn out good nurses, but when you look at the students, do you think you letting a little of your anger out on them? There are many ways to teach, and some methods are healthier than others. Just because you aren't a "hardass" doesn't mean you aren't getting nursing, and all of its seriousness, across to your students. Nice students taught by nice instuctors make nice nurses!
To the OP: Sorry to hijack this thread! I just had to get that out!!!

I don't want a "nice" nurse. I want a strong, compassionate, intelligent nurse who knows what the hell she's doing and who knows what her limitations are. As an ED NM (over me) put it, "Sweet and dumb is dangerous."

Okay...look. I'm not harsh at all (and no I'm not a nursing instructor) ...but my fellow nurses and I are sick to death of nurses coming into the field who should never have graduated. Nurses who don't expel the air in a syringe before going to a patient's bloodline (I personally snatched one out of a new nurse's hand as she put it into a dialysis patient's bloodline with 1cc of benadryl and 2ccs of AIR in it) - nurses who don't know the difference between SL and SQ. Nurses who take heparin drips off pumps to hang by gravity for transport to a hospital 80 miles away. Nurses who give Sufentyl instead of Fentanyl because it "sounds like the same thing" and then go on break and wonder why their patient is CODING when they return. Nurses who draw up Fluvirin for PPD. Nurses who don't think to look up medicines they don't know before giving them. (17 yrs and I STILL never give a med I'm not familiar with until I look it up) Nurses who can't seem to understand the IMPORTANCE of paying attention to what they are doing. Nurses who don't recognize chest pain ("like bricks on my chest") in a CARDIAC PATIENT as something to be concerned about. No exaggeration. These are things they should have learned in school. And I'm sure these things were taught but somehow the IMPORTANCE of it got missed, as if it were all just lip-service. All this I have seen happen within the past year and it just amazes me that these nurses were even allowed to graduate without mastering certain basic concepts such as the five rights of medication administration. They apparently memorized things but they haven't learned (the definition of learning being a change in behavior as the result of new information and knowledge) them. Believe it or not I am very easy-going and I don't expect someone to learn something overnight but I DO expect them to have some basic SENSE and to REALLY try, and I'm not seeing that. Again I am referring to my geographical area here, which is a rural poverty-stricken area and many see nursing as nothing more than a quick way to a better paycheck - I just don't think those people should graduate unless they make some basic changes along the way. Nursing is still a "calling". I take each one on a case-by-case basis but unfortunately I only see maybe one or two out of a class who really take it seriously and really do try. Meanwhile I see many trying to play politics and butter up the nursing supervisors. It amazes me. I see nursing students on hospital clinicals who might change a bed and might give a med or two but that's all they do here. There is no sense of responsibility for the care of the patient instilled in these people. They go socialize and take frequent breaks and try to leave a couple of hours early if they can get away with it. THAT is what I am seeing HERE and it's NOT working. And they still graduate and somehow manage to pass boards and then it's like everything they "learned" is gone. As if, as I mentioned before, they just thought it was some information they were supposed to have to pass a test so they can get a job and nothing more, like none of it's really important. And no, nursing isn't the military but it does still require a certain amount of character and integrity and sacrifice and accountability and for those who may not have that going in, one of two things has to happen - either it develops (which does take a wake-up call to do, like it or not the fact remains that adversity is what builds character) or it doesn't and if it doesn't then that person does NOT NEED TO BE A NURSE. I do not want that person responsible for MY care. I absolutely DO believe in weeding out the ones who can't hang, who don't take it seriously, in making them pay attention to what they're doing. Unless I missed something somewhere, you can't afford too many mistakes in nursing. The average lay person may be used to getting along with an error here and there in other jobs with no really heavy consequences but that's not always the case in nursing...people get hurt, people die, people sue, there's just NOT a lot of room for error in patient care and if you think there is, then I don't want you taking care of me either. I am a very vocal patient advocate and an old-school nurse and I make no apologies for it. I support my nurses and I support new grads but I will also say that if you pose a risk to my patients, I don't care who you are, I will be on you like white on rice. My patients trust me and my coworkers actually enjoy working with me because they trust me too. I'm laid back about a lot of things but quality of care is NOT one of them. I'm not bitter but I am frustrated with this kind of attitude coming into our workplace because it is for the rest of us to pick up after them and clean up their messes and WE are responsible for that. Yes I'd much rather work short than supervise a nurse whose care I can't trust. I would much rather answer what someone may consider to be a "stupid" question than to have that person go and make a terrible mistake. It frightens me when I work with a nurse who doesn't realize that the question should be asked (as happened with the chest pain situation - she went on as if the patient hadn't complained, I just happened to walk up and find out about it, she then told me that she just didn't realize it was important). THAT is what is wearing me out. I don't have a problem with nursing students - I have a problem with nursing SCHOOLS not getting things through to them. They've taken that soft, "nice" approach around here and this is where it has gotten us. Plus the nurses graduating from them are totally unprepared for the rigors of the actual world of nursing. At least we were prepared. Only difference when I graduated was that we had no more homework, no more tests, no more huge care plans, and we got paid instead of paying. So the transition was much easier for us than it obviously is for the new grads these days (who seem to do nothing but complain).

Yes, we had that much reading to do. Granted, many chapters were repeated in future lessons as concepts became cumulatively more complicated. But there's absolutely no exaggeration. It was very thorough. Each one covered chapters from two med/surg books, the nutrition book, the pharmacotherapeutics book, plus others that I honestly can't remember now but we bought many books at the very beginning that went with us all the way through as all total concepts of care were covered - not nutrition here, drugs there, but the entire disease process, the body's responses, compensation by other systems, diagnosis, treatment, complications, therapies of all kinds, prevention, what to expect, assessment, patient education, documentation, nursing diagnoses to go along with, nursing interventions and nursing care involving every possible drug and treatment and what they would do, (and nursing dx to go along with those too) etc etc etc - for EACH section and each major illness and then how that would tie in together with and be complicated by other co-existing disease processes. It was a damned good education. Our instructors/professors took a personal vested interest in the quality of nurses they turned out. My eyes stayed crossed. Books went with me everywhere, never did I have a waking moment (except in clinical) that I didn't have an open book in front of me. Probably read each chapter and each segment of each chapter 6-7 times between studying for tests and searching for the documentation for the planned interventions on the care plans. I read so much I frequently got to where I couldn't absorb another word. And I've have to re-read what I had just read because it I had totally missed the whole thing. If it hadn't been 17-19 yrs ago I'd have been happy to share the syllabus...but I had a big bonfire and burned it all after the pinning ceremony :coollook: Even so I'm not trying to complain about how nursing school was (though one thing I learned there was - FORGET medical school!) - The starch and the whites and all that was just part of the times (though I still shudder to see nursing students with bright fake nails and tons of jewelry fixed up like they're going out the club but for their scrubs). We had an absolutely beautiful traditional capping ceremony and it was a rite of passage for us. Same for the pinning ceremony. And there was a great deal of satisfaction for me when the very instructor who gave me the hardest time, who pushed me so hard and in so doing, taught me that I could either lay down and die or stand up and be strong and finish on time despite the difficulties and the hardship - and in that, that I really did have the strength in me to fight back and win by shaping up and not giving up and by graduating without having to come back and repeat the same classes same time next year, was the one who put that pin on my starched white uniform and smiled at me with pride. She pushed, and I didn't fall down and die. I despised her, until one day after it was over when I realized what she was doing. She was pushing me so I would be not only a strong nurse, but a stronger person ( I was the baby of the class, greener than grass and had never encountered that kind of hard work and those kinds of expectations before, and I passed the NCLEX-RN at the tender age of 20 - and was charge nurse of a 35-bed tele floor within 6 months - there was a shortage then, too). It takes that kind of gumption to do what we do for the long hours that we do it and to give up what we give up and to still find fulfillment and rewards in it. Nursing school is more than about learning how to perform tasks and give meds and do procedures and do paperwork. It is about learning how to BE a nurse. BIG difference. On so many other threads in this board we mourn the passing of the patient advocacy, of the mission of nursing, of providing care to the whole person (mind, body, and spirit), of the community-centered care model and we express so much frustration at the large corporate "bottom-line"-centered model of healthcare that predominates these days, and all the consequences that we suffer because of it. We still want to stand up and be counted as Nurses, and for the world to recognize that we are still something special and cannot be and should not be dispensable. If we want to continue to be able to do that, then we have to send out competent, skilled, sensible, reasonable, intelligent, caring, thinking people into the profession - and the schools around here aren't doing that. And the patients are suffering, and so are the rest of us. And if nursing students can learn to "fake their way through" as one previous poster suggested, then we're ALL in trouble. The only thing that offended me was that concept right there. If it's even POSSIBLE to fake one's way through nursing school, then the schools have to back up and look at things and are just going to have to make it tougher, not easier. If nursing school is soft and easy, there's no respect earned by obtaining that position - nor is it deserved. Back in my day the community looked at you and respected you because you "made" a nurse. You made it. It was a big deal. It was hard, hard work and required a great deal of sacrifice and we were respected and trusted for having done it. And if we have nurses working alongside us and caring for us who have faked their way through, then God help us all. There goes the whole profession and everything we have worked so hard for, and there goes the care and safety of our patients, who already get lost in a system that considers them merely sources of revenue.

mariedoreen · Jan 16, 2005

Sigh. Actually I think it's Babs that has hijacked this thread. When the gal said she had learned to fake her way through she didn't mean she was faking the material or the skills, she meant she was faking the confidence because some of the instructors like to chew us up and spit us out and will take every opportunity they can to do it. One of ours will ask you a question, you'll answer it and he'll give you the most disgusted look and say, "What?! You're gonna do that?! And you're sure about that..." as though you're about to kill your patient and are the stupidist person in the world (and he's not particular about who's around when he's doing this). You immediately begin to doubt yourself (because as students we have not yet graduated to being the god that Babs is) and your face gets flushed and your hands start to shake just to discover that you were right after all and he was messing with you (of course when he tells you you're right it's in a much lower tone of voice than when he's telling the world you're an idiot). So now because of this stupid game he's playing, we're all becoming these students who insist we're right whenever we're questioned. Tell me that's a healthy situation.

All we're saying here Babs, is that we resent being treated in a condescending, intimidating, humiliating, degradading way!!!!!!! You are taking your own personal situation and transferring it to this OP. She did not come on here and say, "Oh poor me, I'm so tired of reading all these chapters and doing my care plan all night and writing papers and researching disease processes for seminar presentation and learning skills for Lab and having to get up early for that darn clinical... Why can't nursing school be the easy life?" What she said is, "Anybody have any idea why we are being treated as though we're the scum of the earth?"

But then again, maybe you haven't hijacked this thread, because after reading your replies I'm getting a pretty good idea of why we are being treated this way.