Nursing Student From Hell

[DWelly14]

So I need help. I've been a nurse for 6 years now. I have a BSN & an MSN and am also a CNM. I've worked 4 years in critical care and the past two years in labor and deliver at a large suburban hospital. I've precepted several students and have always had positive experiences with them. I was not planning on taking another student this semester as I finally am transitioning into full scope midwifery practice but the local nursing school was desperate so they talked me into taking one last student. So in January, this student, let's call her Alice, started with me. When Alice first started she seemed very unsure of herself. She's a student though so not unexpected, even though this is her last rotation before graduation. But I got my teach on. We discussed anatomy and physiology of pregnancy and labor, walked through procedures at least 10 times, I stayed after every single shift to work with her, and she always went home with printed out policies and articles to read up on so we could discuss on our next shift. I felt like I was seeing improvement but I was always right there with her helping with her during the first 6 weeks of her rotation. When we had her midterm evaluation with her faculty member, Alice was told she was to take the primary role and I was to back off. So that's what I've been doing. Unless safety is in jeopardy, I've kept my hands off. And Alice is crashing and burning. To the point where I'm not sure how she's made it this far in her program. She is lazy, refuses to do basic nursing tasks such as starting IVs, and will just go hide to get out of things. We admit a patient. I go in to the room with Alice, she just stands there. I say "Ok, go ahead and get started." She says (in front of the patient mind you) "well, I haven't done many IVs so why don't I watch you one more time?" I say " you only have 2 weeks left, you only have so many chances left ... " Patient chimes in "I want you to start my IV please DWelly14!" .... opportunity lost. Fast forward to when the patient is complete. Alice is nowhere to be found. I'm in pushing with her and the charge nurse has to find her. Several of my coworkers have commented on her behavior to me, I've confronted her on it and she always makes excuses, and I've now emailed her faculty.

My question to all of you is do you have any tips for what to do? I feel bad just recommending that she not pass but at this point she only has 3-4 shifts left with me and I'm getting really frustrated with her. I'm really not willing to take her for any longer than the originally assigned amount of time because of the behavior I've observed. I feel like she's skated by through her whole program somehow and now she's finally having to actually do it and she can't. Help!

[Scottishtape]

As a student currently in practicum, my advice is to fail her.

Practicum, as you know, is the time for us to prove that we are committed to learning and perfecting the skills we've learned so we can take care of patients on our own.

The fact that she hides, instead of embracing these opportunities is a huge red flag. I would feel terrible as a preceptor if I passed her only to find out later she harmed a patient.

We always talk about safeguards in the healthcare system to stop errors from happening. You are one of those safeguards. The nursing faculty trusts your judgement and is relying on your ability to discern whether she is ready to continue on to become a nurse (if she can pass boards).

I think she needs to fail this round, have a come to Jesus moment with the reality of patient care, and have her try it again next semester. We can't always hold people up, sometimes it's best to let them fall so they can see where they actually are.

I adore my preceptor, and I value her opinion of me and my skills. Should my preceptor ever say to me that she felt I wasn't ready, I would do everything in my power to fix my issues, not hide.

I wish you luck. It sounds as though you are a very caring person and don't want to fail her, but your job as her preceptor is to do what's best for her and making sure she's safe to practice is definitely what's right.

[LovingLife123]

She's a student, not a nurse in orientation yet. I could get your frustration if she were a new grad that was an employee, but she is a student, of course she's nervous and scared.

I'm surprised she's allowed to do as much as you are saying she is. When I was in school, we did nothing with the nurses, only our instructors. And when I have a student, they do nothing with us.

I just think that expecting her to be a full on trainee nurse at this point is a little much. If she ends up graduating and passing NCLEX, then finding a job, let it be up to her employer to handle laziness.

I was scared to death of IVs as a student and I still stink at putting them in!!!

Now, if she's late, not following you around, not doing what you ask, that's a reason to fail. But not nerves.

[Avid reader]

Fail her! People's lives are at risk and you would be doing her a favor anyway. It's a serious job with serious consequences. People like her throw others under the bus to cover for their own mistakes and I would blame you for any of hers. It's also part of your job re evaluation. This isn't about your feelings but future possible lives. You need to be evaluated as well it seems. After so many clues of her deficiencies, you still need reassurance. Fail her, then help her or find someone else to better remonstrate her failings and lack of alacrity.

[OCNRN63, RN]

That student from hell will become the co-worker from hell. For the sake of future patients and the nurses who will be caring for them, let "Alice" pass or fail on her own merits. She shouldn't need all this hand holding so close to graduation; someone who is close to graduate usually jumps at the chance to have more experiences or skills under his/her belt.

[DWelly14]

Fail her! People's lives are at risk and you would be doing her a favor anyway. It's a serious job with serious consequences. People like her throw others under the bus to cover for their own mistakes and I would blame you for any of hers. It's also part of your job re evaluation. This isn't about your feelings but future possible lives. You need to be evaluated as well it seems. After so many clues of her deficiencies, you still need reassurance. Fail her, then help her or find someone else to better remonstrate her failings and lack of alacrity.

Why do I need to be evaluated? I tried to give her the benefit of the doubt and be a good preceptor. I'm not her school. I'm not her program. I bent over backwards teaching her. I know I have to fail her but I know it's going to suck. Thanks making me feel even worse.

[Rose_Queen, BSN, MSN, RN]

She's a student, not a nurse in orientation yet. I could get your frustration if she were a new grad that was an employee, but she is a student, of course she's nervous and scared.

She's a student in her last semester who is getting one to one time with a nurse, not trying to compete with other students for an instructor's time.

I'm surprised she's allowed to do as much as you are saying she is. When I was in school, we did nothing with the nurses, only our instructors. And when I have a student, they do nothing with us.

This is clearly a program that offers a capstone/preceptorship/whatever other term of the day is used. This student is getting intense one on one time with a nurse in a certain specialty with the expectation that the student will be acting independently with the supervision of the nurse who agreed to be a preceptor.

I just think that expecting her to be a full on trainee nurse at this point is a little much. If she ends up graduating and passing NCLEX, then finding a job, let it be up to her employer to handle laziness.

Nursing clinicals and especially capstone/preceptorship should be considered as an extended job interview. An impression will be made on staff, who will have opportunity to provide input if/when the student applies for a job in that unit.

I was scared to death of IVs as a student and I still stink at putting them in!!!

There's a difference between being nervous and avoidance. This student is clearly avoiding instead of trying to learn.

Now, if she's late, not following you around, not doing what you ask, that's a reason to fail. But not nerves.

There are many reasons a student can and should fail; not demonstrating expected actions during a clinical is one of them.

[Meriwhen, ASN, BSN, MSN, RN]

...never mind, I just reread the post I was referring to. Carry on.

[NicuGal, MSN, RN]

You have tried with this girl. She needs to be failed. You have done nothing wrong except try to be a great mentor. Why did she even pick L/D?

[pixierose, BSN, RN]

She's a student, not a nurse in orientation yet. I could get your frustration if she were a new grad that was an employee, but she is a student, of course she's nervous and scared.

I'm surprised she's allowed to do as much as you are saying she is. When I was in school, we did nothing with the nurses, only our instructors. And when I have a student, they do nothing with us.

I just think that expecting her to be a full on trainee nurse at this point is a little much. If she ends up graduating and passing NCLEX, then finding a job, let it be up to her employer to handle laziness.

I was scared to death of IVs as a student and I still stink at putting them in!!!

Now, if she's late, not following you around, not doing what you ask, that's a reason to fail. But not nerves.

But she's NOT doing what she's being asked. She's NOT following the OP around; rather, the charge nurse had to search for her on an occasion. Major no no.

I'm a brand, spanking new nurse, graduated in December. IV's are still terrifying to me. But when my instructor/the nurse/my preceptor tells me to try it ... I tried/try it. Same with foleys, dressing changes, trach care, etc. When you're a nursing student, you grab on to those opportunities because that's what's expected -- as evidenced by this particular nursing students' faculty members' midterm statement.

Acquiring nursing skills can be really scary -- this I can certainly agree on. Still doing it. But this student is wasting the OP's time and doesn't appear to be meeting her school's set standards for this particular semester. Sorry kid = fail. That's the consequence.

[Meriwhen, ASN, BSN, MSN, RN]

Fail her! People's lives are at risk and you would be doing her a favor anyway. It's a serious job with serious consequences. People like her throw others under the bus to cover for their own mistakes and I would blame you for any of hers. It's also part of your job re evaluation. This isn't about your feelings but future possible lives. You need to be evaluated as well it seems. After so many clues of her deficiencies, you still need reassurance. Fail her, then help her or find someone else to better remonstrate her failings and lack of alacrity.

With all due respect, it's not that easy to decide to fail someone, even if all S&Sx point to the fact that they need to be failed. A failure could potentially end a nursing student's education, especially if she's failed before and/or her program is very strict about the number of times a student can fail. And, as you can very well read by the number of sob stories in the nursing student forums, being failed is quite a crushing blow to the student. Often, it is a very much needed blow. But that doesn't make it any less crushing.

I'm not saying OP should pass a student that is not performing at passing standards. If the student is performing poorly, then the student should definitely fail. But IMO it's OK for the OP to feel what he/she is feeling. It doesn't necessarily mean OP is a poor preceptor.

OP: You've already talked to her, you've talked to her facility...at this point, Alice has the next 3-4 shifts to prove she got the message. It's really on Alice, not YOU, to determine if Alice can pass. If at the end of the preceptorship, nothing has changed in Alice's attitude or performance, then she deserves to fail. You've done your job--now Alice needs to do hers.

And should she manage to pull it together and improve enough to pass, you are in no way obligated to provide a positive reference (or even any reference) to employers about Alice's performance.

[cleback]

That's too bad. It may be too late now, but were you very clear on your expectations for her? Did you talk with her how you felt they were not being met?

I remember being a student... this post brought memories of a not so pleasant rotation. The whole experience was bad and my instructor wanted me to be more independent than I felt comfortable with, but in general, I had trouble figuring out the role of a student nurse... I remember my instructor pulled me into a room for giving blood with another nurse--just as a learning experience. My other assigned patient happened to need a glucometer check at the same time, so I asked the nursing assistant to do it for me because I wanted to see the blood being given. My instructor chewed me out, saying my primary responsibility was to the assigned patient and I should have left the transfusion to take care of the glucose check myself. I really didn't know that's what she expected of me as a SN. So yeah, she probably thought I was shirking on my responsibilities too.

Failing someone is really big deal. If she really is slacking, then by all means, do so. That said, I would hate to have that happen to someone if the problem was communicating expectations. Maybe, since it's late in the game, talk with the clinical coordinator with your concerns?