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!
Lastly, Alice is going to graduate, if not now, very soon. She will learn how to treat her co-workers by how she was treated as a student.
I could be wrong but it seems from this comment that you think Alice is being mis-treated. Can you tell us how you came to this conclusion? Myself I don't see evidence of that from what the OP posted. I think Alice is either unstable or rude for laughing about her clinical insufficiency when confronted. I would probably overlook the IV thing but not everything else, especially her attitude.
That's how I feel and I learned it the hard way. If it was so easy to get rid of a student, the nursing shortage would be tremendous. As professionals, it is important that we gather all the information before we pass judgement. Also, everyone has different standards for what is acceptable behavior and performance. I truly think that Alice is not just being lazy and something else is going on.
The one thing I have to say is, I think this is Alice's capstone/practicum or whatever they call it nowadays, so she is able to do more than assessments and viatals. I really don't think that she should be with a CNM. She should be with a bedside nurse, so that she can learn that role. Her current situation is probably way above her head and not appropriate for a student. Med students are not dismissed as easily as I've seen recommended here, so we may need to settle down a bit.
Lastly, Alice is going to graduate, if not now, very soon. She will learn how to treat her co-workers by how she was treated as a student.
I'm pretty sure the OP is a new grad CNM who is still working in a bedside role in L&D, and it is in this capacity that she is precepting the student. I could be wrong, but this was my take on the info provided by the OP.
There is absolutely no excuse for a student to be caught hiding, multiple times, and then lying about what she was doing. I don't care if it's because she's scared, or wants to hide the fact that she doesn't know what she's doing, there are way too many people waiting to get into nursing school who would jump at the chance to be in her shoes and excel, for this person to be given more chances. Maybe she will graduate some day, but if I were her preceptor and I experienced this behavior from her, she would not be graduating with my help.
I could be wrong but it seems from this comment that you think Alice is being mis-treated. Can you tell us how you came to this conclusion? Myself I don't see evidence of that from what the OP posted. I think Alice is either unstable or rude for laughing about her clinical insufficiency when confronted. I would probably overlook the IV thing but not everything else, especially her attitude.
No where did I say the student is being mistreated. In fact, I think the preceptor has gone beyond the call of duty. What I am saying is that this student may have a problem that has not been disclosed and we do not have the right to give advice such as "fail her" without more information. This clinical rotation by itself, is not going to make or break her as nurse. She clearly won't start in L&D. She may be overwhelmed and may be precepted at a higher level than what her class calls for. No matter what, I think a conversation between the preceptor, the teacher and the student is the best way to address concerns. The student's behavior is to be looked at as an aberration. The preceptor is moving on, but has many opportunities to precept students who are at a higher level, which is sorely needed.
I'm pretty sure the OP is a new grad CNM who is still working in a bedside role in L&D, and it is in this capacity that she is precepting the student. I could be wrong, but this was my take on the info provided by the OP.
There is absolutely no excuse for a student to be caught hiding, multiple times, and then lying about what she was doing. I don't care if it's because she's scared, or wants to hide the fact that she doesn't know what she's doing, there are way too many people waiting to get into nursing school who would jump at the chance to be in her shoes and excel, for this person to be given more chances. Maybe she will graduate some day, but if I were her preceptor and I experienced this behavior from her, she would not be graduating with my help.
I think you are right about the OP working as an L&D nurse, but do you not think that she may be having higher expectations than what is needed, because of her additional training. This final term is only to give you more in-depth exposure and training in an area you like. It is not for you to become proficient. That is impossible. Everyone of us has different personalities and comfort levels and learn differently. We don't know what's going on with that student. Some people are skittish as students, but when they get on the floor they are outstanding. Some are slow starters, but when they become comfortable, they are excellent nurses. If she passed her other clinical rotations, she should be ok. Her teacher would know of any discrepancies in performance. If this is a pattern, then failing the clinical would not be a surprise, but if it's not, I doubt this term would keep her from graduating. At this point, I think the OP has enough input to make a decision on how to proceed. Hoping for the best outcome.
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
IF she is a nursing "student" who has not graduated yet - she has been told, and ALL the hospital staff were told up front that she can not legally do anything outside the scope of what her school allows her. PERIOD. In this case - if this IS the case - you are not her "preceptor" - A preceptor is a nurse who is shadowing a new nurse who has been HIRED. If she is a STUDENT, there with other STUDENTS with a school group - you are nothing to her - she is only there to shadow you (legally) and nothing more.
My school allowed us to get vital signs, do head to toe assessments - and that was it. Otherwise we had to have our SCHOOL instructor present to perform any procedures - drawing blood, removing an IV/starting an IV, catheters, flushes, dressing changes, etc. Our school instructor was usually ON THE FLOOR somewhere, and the student is responsible to her schools' instructor - no one else.
However, if this is someone your company has HIRED and asked you to be her preceptor - that's another story.
Also, I would not assume this person is just being lazy etc. Its an awful lot of work to get through nursing school to the point of being in a hospital for any reason just to go off and throw it away. I don't think she would have passed enough of her classes to get this far if that was the case - SOMETHING ELSE IS GOING ON. We do NOT have all the facts here.
Too many are just "fire her" -without even hearing the other side, or even questioning it.
The OP was told that Alice would be doing full patient care with the OP just there as backup. Alice was in that meeting as well. She is aware of the expectations of her. She "laughed it off" when she was told that disappearing is not an option. She's aware of the expectations, she chose to laugh it off. The OP has discussed this with her instructor. Given all of this, is it irresponsible NOT to fail her. Alice is presumably an adult. If there are extenuating circumstances, she should have brought them to her instructor early on. However, I cannot think of any circumstances which would make it OK to disappear on the OP (and then lie about where she was) and then be disrespectful when called on it.
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
No, probably not, but that's what some people do when they can't cope. We don't this young lady's background or thoughts. I've had students stare at patients with the look of terror in their eyes.
She won't do anyone any good if she cannot cope. I don't need to know her background or her thoughts. She isn't meeting expectations and was rude and dismissive when called on it. Time for coddling is over; she's about to graduate. Or not.
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
But Ruby, we don't know if that was part of her program. If it is not allowed, she could be failed for doing what she's not permitted to do. Many programs do not allow this. No hospital I've worked in allowed students to start IVs. Not excusing the other behaviors. We don't know if she is immature, anxious, lazy or entitled. We just don't know and an investigation and conversation with her and the school personnel together would be appropriate. I've experienced the same scenario and I misjudged the student due to lack of information. I was hours away from failing her (although she would have still graduated).
If her program didn't allow her to start IVs, that's what she should have told the OP, not that she was nervous about it and wanted to watch "one more time."
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
I would sure like to hear the perspective of a full time nursing professor (not a CI who doesn't teach) or a program director. Another point of view may be helpful in clarifying this scenario. What are expectations of all involved and how you (kindly and professionally) handle this type of situation. Anyone out there? Or do you have any professor friends you can query?
I teach CNAs -- classroom and clinical. You kindly and professionally meet with the student the first time this comes up to find out what is going on with them. I had one student who was unwilling to even try to start an IV. We tried to find out why, and she couldn't give us a reason. She just didn't want to. I offered to work with her in the skills lab after class. She wouldn't. I had one of my colleagues talk to her. Same result. She didn't make it through the program. Failing her was one of the more difficult things I've done in that program -- I really liked her. But she wouldn't do the work; wouldn't even try. Starting IVs was an expectation of the program. Failing her was the right thing to do, but it wasn't easy.
I'd sit her down and have a bit of a heart to heart with her. Say you don't want to fail her, but will if you don't see significant improvement and immediately. Perhaps make a list of things she needs to do and not do (to make sure you are absolutely clear). Make it concrete and measurable, ya know, like a care plan, lol! Are you absolutely certain it's laziness and not say, anxiety and low self esteem or something about the dynamic between you guys? Anything other than lazy? Either way, if you are super clear with her and have those objectives, she either meets them or she doesn't. But, having been a recent student and probably misunderstood myself, at least give her the benefit of being absolutely clear and concrete and allowing her to decide her fate these last few days.
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
You apparently did not do what is commonly known as a "capstone" or "practicum". This is a period of time when a senior nursing student is assigned one on one with a nurse at a clinical site. The student follows the nurse's schedule and the expectation is the student transitions from observation to total care by the time the capstone is done. I precepted (and yes this is the correct term) many students in the ED where I worked. These practicums lasted 9 weeks and were intense. The student did everything from VS to IV's including all medication formats and even compressions during codes. The instructor was not on the floor and may not even be in the hospital. If my student repeatedly disappeared, refused to do the tasks necessary to care for the patient and then laughed when I tried to have a discussion with her you bet your sweet bippy I'd fail her. Because, bottom line, she would not have met the objectives of the clinical assignment. Those of us who agree to doing this kind of one-on-one education of nursing students (usually without remuneration) have a special commitment to the future of nursing and put our hearts and souls into it. To call us "nothing" is vile and reprehensible and speaks volumes regarding your lack of knowledge about the subject at hand. With attitudes like yours it's no wonder it's so hard to find people willing to take students.
I've had a number of these "capstone students" in the ICU -- they were all wonderful and I learned something from each of them. But it is a great committment in time, energy and teaching and completly without renumeration. To call us "nothing" is disrespectful unkind.
I'm thinking about my "senior focus" in the ED in a regional trauma center. I was mostly on the clinic side which was not what I was expecting or hoping for but one day I was brought into a trauma code and instructed to place a catheter. There was A LOT of activity going on starting IV's, EKG, intubating, doctor issuing orders rapid fire etc and I'm trying to remember my sterile technique. I was just a baby back then and it was awesome actually. We got to do a lot of stuff between school and our extern positions. I was 23 when I left acute care and went into Home Health. We started IVs, dropped NGTs, hung blood, drew blood, trach care, saw vented patients..didn't think twice about it. Could also take a scolding without wilting. BSN program, too. I WISH our new nurses came out of school/1st year with that kind of skill set.
What a shame that this student didn't take advantage of opportunities for more advanced care. Personally I like to get my *money's worth*, uncomfortable or not.
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
No where did I say the student is being mistreated. In fact, I think the preceptor has gone beyond the call of duty. What I am saying is that this student may have a problem that has not been disclosed and we do not have the right to give advice such as "fail her" without more information. This clinical rotation by itself, is not going to make or break her as nurse. She clearly won't start in L&D. She may be overwhelmed and may be precepted at a higher level than what her class calls for. No matter what, I think a conversation between the preceptor, the teacher and the student is the best way to address concerns. The student's behavior is to be looked at as an aberration. The preceptor is moving on, but has many opportunities to precept students who are at a higher level, which is sorely needed.
It was my understanding that the meeting with the student and instructor had already happened. Assuming that the student's behavior is not an aberration, you would be OK with failing her?
Wuzzie
5,238 Posts
I could be wrong but it seems from this comment that you think Alice is being mis-treated. Can you tell us how you came to this conclusion? Myself I don't see evidence of that from what the OP posted. I think Alice is either unstable or rude for laughing about her clinical insufficiency when confronted. I would probably overlook the IV thing but not everything else, especially her attitude.