Issues with nursing staff

Specialties Educators


I've been assigned to the same clinical unit for 5 years. I am currently in my 6-week summer rotation with the second year ADN students. In addition to my group, I covered my colleague's clinical group this week. I had a "talking to" by a nurse this morning about my colleague's students. Her complaint was that her patients were not bathed and the students don't give medications or "do anything for that matter." Our objectives for the course are to begin delegating and focus on the RN role, including a 3-patient assignment for the students. I assign half of the students to give medications each day. I explained this to her, but she did not want to hear it. The secretary also chimed in, asking why the students didn't need to learn how to give baths.

So I thought about this on my way home. 1) She had 3 patients with the students, 2) One patient was transferred at 8:30, 3) One independent patient was being discharged by 10:00, and 4) The nurse administered medications for a student by 7:45. I also recall walking past the desk and she stopped mid-sentence about "new nurses these days", which I feel was now directed at me and the students. Two nurses gave the students glowing reviews, so I don't think her comments are truly warranted. In fact, I had 5 students in one room helping with extensive wound care and a bath.

Today, now with my own clinical group, she told a student not to touch a dressing until the surgeon/PA came to look at the patient on POD1. It is CLEARLY communicated that the students report off at 12:30PM for the day. Well, the surgeon came around at 1:30, and the nurse came asking why the student didn't do the dressing change.

I should preface this by stating that she always has an issue with a student. There have been many instances where medications have been missed in her assignment, or as mentioned above, she has given medications for a student. I do provide a written list of the students' responsibilities attached to the assignment sheet on the board every day. I've spoken with the nurse manager in the past, and honestly, nothing has been done.

So my question is... How do you handle working with a staff nurse who has a difficult personality? How do you help them to understand the objectives? Most importantly, how do you protect yourself in terms of who's accountable for what?

It is easy for me to say that it's impossible to supervise medications with 10 students and 30 patients and babysit.

Specializes in critical care, med/surg.

You are obviously committed to your students...wonderful. Students learn baths in their first quarter and beyond that most do not need a refresher. Like I tell the staff and students, if there is a lot going on with the patient at the beside's the bath my students will assist with the bath because as we know, we nurses make some big messes when performing procedures skills, etc.And besides it's a great time to do the skin assessment, but we do not do all the baths!!There seems to always be that nurse whom takes it upon herself to be what he/she perceives to be as the voice of the unit.And they often have the support of the lazy pca or the nosey secretary. As a male I have watched this dynamic for years and find it tirelessly unprofessional, too passive aggressive and a hindrance to patient care.Frankly, I call people out when their behavior warrants review whether I see myself in the right or not. "What is it about my students or myself that you find not in the best interest of the floor"? "Do you not have enough help from your PCA's?" "My students are nursing students and must get as much experience with medications, protocols, computer charting, prioritization and DELEGATION as possible for transition to practice"? Do you have the support of the Education Dept.? If one to one dialogue does not touch this person's sensibilities then Education needs to know that there is a disruptive influence on the floor. Hospitals want students to be on the floor because this represents an early orientation period for the ones who may apply there in the future. Each semester is a learning opportunity with my students and how best to get them the best possible experience on the floor. The more constructive criticism the staff gives me the better for everyone, especially the patient.

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