Nursing instructors-explain why...

psu_213, BSN, RN · Feb 5, 2014

Is it really necessary to scold a student when the situation isn't that serious? Ie.) Not offering coffee (I didn't know what her drinking/diet restrictions were).
If you make a big scene in front of the pt, he/she will mostly likely feel worried and anxious.
When a pt is coding, why do you allow one student to watch while you prevent another student from doing so?

As for your first situation, I am not going to try to defend the instructor. There is never a reason for a nurse/instructor/etc. to reprimand a nurse/student/etc. in front of a pt.

Now for your second situation, there are several reasons why this might happen. First, there is only so much space in the room. Even in our big rooms in the ER we sometimes have to "kick out" people who are just there gawking and contributing nothing to the effort because there is just not enough room.

Also, there are other patients on the unit. The nurse who is assigned to the coding pt must be in there. Another nurse (or 2 or 3 depending on the situation) needs to be in the room to help; however, every nurse on the unit cannot be involved in the code. There are experienced nurses who still need to learn this, so it is a good lesson to learn as a student. I know it is disappointing not to see something "neat," but there is other stuff that needs to be happening in other rooms as this is going on. What if your patient in another room codes at the same time? You need to be aware of what is happening.

llg, PhD, RN · Feb 5, 2014

1. The coffee situation does sound a little petty

2. About observing a code: There could be lots of reasons why 1 student was encouraged to do so and another student was not.

A. People in a real code situation do not want a large audience. She might have been trying to limit the number of spectators

B. The learning needs of the students may differ (Not all students have the same immediate needs and/or the same level of readiness)

C. One student may have a patient assignment that she should not leave to watch a code ... and the other student may have had the time to step away from her assignment to watch

3. Slower students need to go more slowly ... They need to be given simpler tasks and be watched more closely to protect the patient before they can be trusted with more independence. We all need to prove ourselves capable of the basic tasks before

we can be entrusted with more independence and responsibility.

4. While the instructor is not totally responsible for the student's mistakes -- he/she IS responsible for the decisions he/she makes regarding how much freedom to give that student, what tasks the student is assigned to, etc. When a student makes a

mistake, it raises questions about the instructor's judgment in allowing the student to do that task without direct supervision. If an instructor makes a bad judgment about the student's ability to handle things, then yes, the instructor would be held

accountable for her judgment in making that decision -- but not necessarily for the student's choices.

For example, if a student were to willfully murder a patient when the instructor was not looking, the instructor would not be charged with murder unless the instructor had reason to know the student was going to do something like that. But if the instructor failed to properly supervise a student who had been assigned to do things beyond that student's abilities, then the instructor could be blamed for her poor judgment

regarding that student.

bsyrn, ASN, RN · Feb 5, 2014

Is it really necessary to scold a student when the situation isn't that serious? Ie.) Not offering coffee (I didn't know what her drinking/diet restrictions were).

If you make a big scene in front of the pt, he/she will mostly likely feel worried and anxious.

Your idea of serious and your instructor's idea of serious are probably two different things. I highly doubt any instructor would " make a big scene" in front of a patient for any reason, much less over not offering coffee.

When a pt is coding, why do you allow one student to watch while you prevent another student from doing so?

I would assume, there was not enough room for anyone else to watch. When a patient is coding, a lot of different things are going on and unfortunately, having students in the room is not a priority.

How can the slower student learn anything if you baby them and ride their a$$?

what is a "slower student?"

Is the instructor held responsible for the student's mistake, does the instructor lose their license

Instructors are there to make sure student's don't make mistakes. As for losing a license, I have never seen that happen over a student mistake.

deetrain · Feb 5, 2014

Slower student- struggling with the skills/studies

nurseprnRN, BSN, RN · Feb 5, 2014

So many questions, so little time. :)

Is it really necessary to scold a student when the situation isn't that serious? Ie.) Not offering coffee (I didn't know what her drinking/diet restrictions were).
If you make a big scene in front of the pt, he/she will mostly likely feel worried and anxious.

"Correction" isn't necessarily "scolding." I would be happy to correct a student in front of a patient to reassure the patient (who, unbeknownst to the student, I have previously determined to be anxious about having a student) that her care is being properly supervised. There may be something else going on and you don't know what it is. And why didn't you know your patient's drinking/diet restrictions? If not your patient, then what ... ?

When a pt is coding, why do you allow one student to watch while you prevent another student from doing so?

Often there are too many people in a code room, and perhaps that student needed the experience more than you did, again, for reasons that you don't know. Also, somebody has to be available to care for the other patients, and that's something you need to learn how to manage too.

How can the slower student learn anything if you baby them and ride their a$$?

Not sure who the "slower student" is or how s/he got labeled that way and by whom, but I can make a guess as to why a student might attract and retain an instructors attention more than another student. S/he is probably someone who the instructor can't trust to be left alone yet, for some reason.

Is the instructor held responsible for the student's mistake, does the instructor lose their license?

An instructor cannot lose more than one license, his/her own, so I don't know who the "they" is you're talking about. The student has no license.

IF an instructor directs and supervises a student in an action that is outside of the scope of practice of that student or that nurse AND harm results, then action may or may not be taken against the nurse's license, depending on many factors. Loss of license is reserved for very serious things, not just "mistakes" such as most students make from time to time.

A student does not practice "under" an instructor's license. A student practices under authority from the college, and has the responsibility not to exceed his/her scope of practice as a student. A student can lose his/her position in the college by making a serious enough mistake (the kind that makes you just slap your forehead and say, "What the fresh hell were you thinking?") or repeatedly makes lesser mistakes on things s/he should have mastered already, with no awareness of how that's a problem. But these things do not cause action on the instructor's license, no.

ICULINDA · Feb 9, 2014

I'm confused are you talking about nursing school or CNA school because some of your posts say your doing CNA and others talk about RN school?

deetrain · Feb 9, 2014

I withdrew from NS 4 years ago. Recently, I completed a CNA program and I'm preparing for the state exam; haven't set a date yet.

leekaye · Feb 10, 2014

"Correction" isn't necessarily "scolding." I would be happy to correct a student in front of a patient to reassure the patient (who, unbeknownst to the student, I have previously determined to be anxious about having a student) that her care is being properly supervised.

I think it's in the tone and the frequency. It's possible to correct the student and exude authority in a way that relaxes the patient and also possible to make the patient a nervous wreck that an "incompetent" student is practicing on them. Having worked in the corporate world for decades, there were plenty of bosses who subscribe to the X-theory of management (autocratic), and I see the same in instructors. It's about the patient first, not the instructor or the student.

My first clinical instructor was so abrasive and rude that I had 3 patients in one week tell me that they did not want her back in the room, one even pointing out that the instructor had just chastised me harshly for doing what she exactly what she told me to do the first time we were in her room.

If you're faced with such an instructor, nod and be professional. If you're really being unfairly criticized, it will reassure the patient that you are professional and mature. If you're in the wrong, it will reassure the patient that you are serious about patient safety. And try to think of it as practicing patience which you will need in your future career.

WoosahRN, MSN, RN · Feb 11, 2014

My first reaction was why you didn't know your patient's diet restrictions? That's important information. What if they had an allergy it a fluid restriction? That is kind if basic knowledge and if unsure you can look it up or ask the primary nurse. Is this something that has been missed before? That said, you remember it now and it will be something to help you be better in the future so if it was correction, it was to make you better. I can't speak to how it was done because we have one side of the story and we weren't there.

As to the other stuff, other people gave good advice and answers. If you are slower a code isn't the best situation to be thrown into and if you haven't seen one, that's an important part of learning....observation. I didn't realize CNA programs had students do clinicals in the hospital and participate in codes. When I did my CNA we practiced cares on dummies and then went to a LTC facility.

nurseprnRN, BSN, RN · Feb 12, 2014

If you are in a CNA program, that puts an entirely different spin on things. Still not "practicing under anyone's license" or perfecting nursing practice. But CNA student has no business observing in a code anyway; the CNA's only responsibility in a code would be as a runner to get something or deliver something. Otherwise the CNAs should be watching the rest of the floor while the licensed professionals are in the code.