Losing a friend due to nursing school

[Ioreth, ADN, RN]

As I near the end of my first semester of the nursing program, I am coming to an uncomfortable realization that I am losing a friend. I'm posting here mostly to share my experience, and while I welcome feedback and advice, that isn't my primary intention. I applogize in advance for the length of this post.

I have known this person for almost two years, and we attended most of our nursing prerequisites together. We spent long hours with the science tutors and in the labs to practice and make sure we understood the class material. We also met regularly in study groups - at first with others and later one on one as the class sizes got smaller. Our grades were so similar, we started to sit at opposite sides of the room on test days so that we would not be accused of cheating. In the prerequisites, she always had grades just slightly higher than mine, which I found amusing rather than upsetting. After all, we both received straight As in our prerequisites.

Her personality at this time was very intense but kind and patient. We would often see things in different ways, so one of the ways we studied was to teach each other to cover the gaps in our understanding. In Anatomy, we would drill each other on bone features, muscles, etc. We both still studied extensively on our own.

Halfway through the prerequisites, she started to date a classmate that was also interested in nursing. She seemed happier and more relaxed, and her grades stayed high. Overall I think this relationship is good for her, and I was happy that she was happy.

Everything seemed to change when the nursing program began. My friend, her boyfriend, and I all entered in the same cohort and we were in the same skills lab together. The tests were not as straightforward as the prerequisites had been, and there simply was not enough time in the day to attend clinicals, lab, lecture, and read all of the relevant chapters in the textbook, much less go into depth on the topics. It became clear that our study methods had to change, and both of us resisted this strongly at first.

Lab skills were also stressful, and in our school, the skills are particularly high stakes. If a student misses certain steps of the skill then it is an automatic fail. The student is permitted to repeat the skill, but if they fail a second time, they are out of the program. I am not complaining about this policy, because these steps generally are related to patient safety.

At first, we practiced lab skills together each time, and she became more and more hostile during practice over the semester. Some of this can be attributed to one instructor would show us to do to the skill one way, then another would say that this method would be a fail and that the skill should be performed another way. Inconsistent instruction was frustrating, but I soon learned to roll with it. I adopted the point of view that it really doesn't matter how it is done as long as it was safe and still got the job done without missing steps that would be an automatic fail. If the instructor wanted me to do the skill in a sequined ballgown and tap shoes, then that's what I would do.

My friend did not like the inconsistent instruction or to be told that she had to change something in her methods. She would complain loudly and frequently about needing to change her technique for certain instructors. When we practiced together and if she missed a step, I would tell her immediately so that she doesn't practice it incorrectly. I also would sometimes, but not always, mention the instructor specific quirks such as "at this point, Ms. name would want us to do this". To be clear, I don't insist that my way is the only way to do something, but this feedback was only if the skill wouldn't pass checkoffs for some reason. During the skills practice, her voice consistently became more hostile and sharp. She once went off on me saying that "one of the things that my sister, who is a nurse, hates is when people interrupt her when she's giving patient care. Why are you being so rude to interrupt me when I'm doing skills?" This shocked me, because she gave feedback when I was practicing skills in a similar manner, with the difference that she insisted that there was only one correct way of doing the skill - her way.

After that, I stopped working with her in skills lab. I was very meek with other students at first until they directly asked me why I was not giving feedback. Then I returned to my usual way of speaking up when steps are missed, the technique being used would mess up the student later in the skill, or things that one instructor requires and the others may not. I eventually worked with every student in our class, and all of us worked well together. If someone didn't want me to give feedback until then end, they would say so. If they were doing things in a different order that was still safe and effective, and if I misunderstood this, they would state what they were doing differently. There was no drama, I gave as well as received great feedback, and we all improved.

By the end of the semester, I had passed each and every skill on the first try. I was horribly nervous each time, but I made it through. My friend failed her first try of most of the skills, but she passed the second try. Very quickly I learned not to ask how she had done after skills testing. I remained supportive of her and positive in our interactions.

Lecture followed a similar pattern. I adapted my study style to reading summaries of the book rather than the whole chapter and relying more on the notes I took in class. Most of my time studying was spent doing practice questions provided by the instructor, the textbook, and various review books. She was inflexible in changing her study style and often lost valuable time trying to read each chapter multiple times. She had never taken notes in class and resisted relying more on lecture material than the textbook. When I tried to do practice questions with her she said that it was more stressful to do questions when she didn't know the material inside and out before starting the practice questions. Over time, I gradually shifted to studying with another study group while she studied alone. I always invited her to study with the group, but she always said that she needed to read and work through it on her own before working with a group. The problem was there wasn't enough time to do this, and the next exam would come before she could finish reading.

For the first time in all of our classes together, her grades slipped below mine. My grades stayed at a low A while hers fell to a low B and now may be a high C after finals. I only shared my grade with her after the first exam, but as her grades continued to drop, I began to keep my grades to myself and only sharing when she asked directly. Even then I would answer vaguely. I generally do keep my grades to myself, but in the past I had always shared mine with her since our performance was always so similar.

One of the most difficult things to witness is her change in personality. She used to be more easy going when it came to academics, and I understand that this is new and stressful to her. However she is putting a significant amount of energy into complaining about the instructors, tests, policies, and fellow classmates. Her attitude towards me has remained hostile and cold. Sometimes when I come to her about something that is bothering me, whether it is school related or not, she often talks over me and goes back to her complaining. I don't want to feel this way, but when I speak to her, her words seem to poison how I see those aspects of our program.

I don't know what to do about this change beyond what I am doing, which is letting this friendship cool and die. I do have other friends I can study with in nursing school, but I do also mourn this friendship. I am concerned for her and I worry for her success later in the program as the difficulty continues to increase. I'm also uncomfortable with the realization that I am happier without her, and when I've not spoken to her I'm more flexible and adaptable. Mostly I'm just sad that I am losing a friend and I don't know how to help her or if I can help her.

[Nurse SMS, MSN, RN]

I am sorry this is happening to you. It is not uncommon. Not everyone who comes into our lives are meant to stay.

Keeping doing well and continue to be positive and open. You don't have to seek her out, but recognize what is happening with her has very little to do with you, though you are getting some of the fallout.

Hang in there and good luck.

[blackboxwarning]

If it's really worth it to you to salvage this friendship, try doing some non-nursing things together. Have a weekly/monthly dinner check-in and no discussion of school.

The next time she snaps at you, you need to stand up for yourself. Calmly and firmly tell her she is out of line. Remind her that you are both working toward a goal. It's not a competition--you're on the same team.

This does not excuse her behavior, but what you're seeing is her cracking under pressure. Do you think she is mentally sound? Is she taking care of herself otherwise? One of my classmates had a literal nervous breakdown last semester, and I think we all ignored the signs.

[Ioreth, ADN, RN]

I completely neglected to respond here, but now I can provide an update.

Thank you so much, not.done.yet and blackboxwarning. I value your wisdom and suggestions. Over the break, we got together spoke a while about what had happened. She appologized for her behavior and attributed it to the extreme stress of this program. We may not be able to study together again or work together on skills, but we're both making an effort to stay in touch and spend time together during breaks. We're not ever going to be best friends, and I don't think that is what either of us wants. However our friendship is changing during nursing school, and often change and growth is awkward and painful.