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!
Specializes in Psych, Corrections, Med-Surg, Ambulatory.
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).
Who cares what her reasons are for hiding and shirking? It's unacceptable. A student at the tail-end of her formal education should be practicing thinking and acting like a graduate nurse. This is the last time she's going to have this much support.
This is her last chance to get the most out of her schooling, and it's also a time to evaluate her readiness to graduate. She's just not demonstrating readiness. If she has a legitimate reason, then she needs to identify it, get help for it and return to school when she is able to meet the requirements. At this point it's up to her to take initiative.
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?
I think that the first meeting was to discuss that the student take the lead. Of course if I found out that this was her track record and there is nothing going on with her, I would not have a choice about her evalaution. Most of the people I have come across with that behavior had a reason for it. Most nursing students are quite interested in learning. Also, laughter is not always a sign of disrespect or dismissive attitude. Sometimes it really is related to nerves. Not diagnosing her, but OP will benefit from sitting with her and her teacher. If the girl fails, OP will feel more confident in her evaluation.
Fail her. She clearly doesn't know how to be a nurse. She is about to graduate and can't provide safe care. I wouldn't want her looking after me or my family.
I think that there is something else going on here. Perhaps I am completely off base. I'm going to wager a guess that this student did not want to be on this unit. It sounds like the school was desperate for a preceptor and the OP was gracious enough to lend her time/energy. Perhaps this student did not want to be on L and D but had no choice in the matter because of the limited preceptors. I'm just thinking back to my time in undergrad. I was lucky enough to get my first choice in SICU but had I gotten L and D, I would have been miserable. I just have zero interest in it and quite frankly, when I did my rotation through, I always felt really uncomfortable.
I am not condoning the student's behavior at all. I think nursing often times is trying to make the best of a bad situation. But if this student has no interest in L and D and does not forsee herself working in this type of environment, she may be angry and just showing up to clock the hours. And in terms of the OP, (please don't take this the wrong way), that you have probably overwhelmed her from the beginning. Assigning extra reading and work on top of her other classwork probably just stressed her out even more. I have precepted and I always tend to forget initially how much knowledge I have now and how much they don't have. Too much at once makes their eyes glaze over and they just tune you out. It can't be helped, no one can retain that type of information overload.
My suggestion is to sit down with her and have a frank discussion. This should have happened awhile ago. I mean, at this point, failing her seems pointless and quite honestly, vindictive. You haven't discussed this with her faculty, it sounds like. So doing it now just creates trouble for everyone. I had a preceptor in my MSN program who was far more demanding than any other preceptor. I was seeing almost all of her patients (25/day) in my second year and it wasn't until my end of semester eval with my faculty member that I learned that she thought I was lazy and incompetent. The university expectation was to see 6-8 patients per day. I had glowing remarks from my other preceptors so my faculty member was very confused and I was honestly, crushed. That she thought so little of me that she didn't even say it to my face. So my advice is to let it go.
For all of you suggesting she wasn't interested in L&D, you are incorrect. She chose L&D and wanted to be hired on our floor after this rotation.
I am a new grad CNM and am finishing my time as a bedside L&D RN, she is not being asked to do anything advanced or beyond the basics. Mostly vitals, head to toe assessments, electronic fetal monitoring, IV starts, foleys, and repositioning as well as some patient eduction and medication education with my direct supervision. She has observed all of this for the first half of her clinical with some guided participation and voiced confidence in each portion before she was asked to do it independently. I am always in the room with her for her to ask questions. For an IV, she gets one poke. If she doesn't get it I take over, same rules I use with all my students.
I have been in communication with her faculty about my concerns and we did have a meeting in which Alice tried to blame me for not making her feel welcome and for "pushing her too hard." Her faculty member literally told her that what I was asking of her was the basics and that she could have been asked to do more.
Alice was told last night that she failed her practicuum and would have to repeat it with another preceptor and in another area. I have never seen such a tantrum thrown by an adult before. I know for sure now that all my suspicions were true about Alice. She skated by in group clinical as never drawing attention to herself. I pity her future patients and hope no one I love ever comes into her care if she ever becomes a full fledged RN. At least I know that I did not take part in passing her along.
Thank you for coming back and clarifying. The situation was as I expected it although I'm sure there are people here who will continue to believe that the failure was on you. I wouldn't be surprised at all if we get a new poster here complaining of being failed because of NETY and other such BS. Precepting...damned if you do-damned if you don't.
For all of you suggesting she wasn't interested in L&D, you are incorrect. She chose L&D and wanted to be hired on our floor after this rotation.
I am a new grad CNM and am finishing my time as a bedside L&D RN, she is not being asked to do anything advanced or beyond the basics. Mostly vitals, head to toe assessments, electronic fetal monitoring, IV starts, foleys, and repositioning as well as some patient eduction and medication education with my direct supervision. She has observed all of this for the first half of her clinical with some guided participation and voiced confidence in each portion before she was asked to do it independently. I am always in the room with her for her to ask questions. For an IV, she gets one poke. If she doesn't get it I take over, same rules I use with all my students.
I have been in communication with her faculty about my concerns and we did have a meeting in which Alice tried to blame me for not making her feel welcome and for "pushing her too hard." Her faculty member literally told her that what I was asking of her was the basics and that she could have been asked to do more.
Alice was told last night that she failed her practicuum and would have to repeat it with another preceptor and in another area. I have never seen such a tantrum thrown by an adult before. I know for sure now that all my suspicions were true about Alice. She skated by in group clinical as never drawing attention to herself. I pity her future patients and hope no one I love ever comes into her care if she ever becomes a full fledged RN. At least I know that I did not take part in passing her along.
Well then I certainly retract my statements. Her behavior is inexcusable.
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.
No, from the OP's explanation of the scenario, I do not think her expectations of the student are too high because she is also a CNM. On the contrary, it seems she has gone above and beyond for this student, to no avail. She's not asking the student to be a proficient nurse, but rather act appropriately for a final semester capstone student, and the student is failing miserably, by her report. I will repeat my opinion that a student who is nowhere to be found over and over again, flat-out lying about what she was doing, deserves to be failed.
I disagree that if she has passed her other rotations, she is "OK." As someone who has gone through both a BSN and an MSN program within the last 10 years, I think nursing education (actually higher education in general) has become extremely lax in who is passed on, with a lot of grade inflation as well. A lot of instructors don't feel like putting in the effort it takes to fail someone, or they feel that the administration won't back them up if they do, so they pass poor students. I have witnessed it personally.
For all of you suggesting she wasn't interested in L&D, you are incorrect. She chose L&D and wanted to be hired on our floor after this rotation.
I am a new grad CNM and am finishing my time as a bedside L&D RN, she is not being asked to do anything advanced or beyond the basics. Mostly vitals, head to toe assessments, electronic fetal monitoring, IV starts, foleys, and repositioning as well as some patient eduction and medication education with my direct supervision. She has observed all of this for the first half of her clinical with some guided participation and voiced confidence in each portion before she was asked to do it independently. I am always in the room with her for her to ask questions. For an IV, she gets one poke. If she doesn't get it I take over, same rules I use with all my students.
I have been in communication with her faculty about my concerns and we did have a meeting in which Alice tried to blame me for not making her feel welcome and for "pushing her too hard." Her faculty member literally told her that what I was asking of her was the basics and that she could have been asked to do more.
Alice was told last night that she failed her practicuum and would have to repeat it with another preceptor and in another area. I have never seen such a tantrum thrown by an adult before. I know for sure now that all my suspicions were true about Alice. She skated by in group clinical as never drawing attention to herself. I pity her future patients and hope no one I love ever comes into her care if she ever becomes a full fledged RN. At least I know that I did not take part in passing her along.
Didn't see this before my previous post. Just...wow!
She chose L&D and wanted to be hired on our floor after this rotation.
Alice was told last night that she failed her practicum and would have to repeat it with another preceptor and in another area.
She sure burned that bridge.
Hopefully, she learned her lesson (but I doubt it) and performs better the second time around. Maybe this will trickle down to the next class and prevent another slacker for making the same mistake.
The sad thing is that there are many students that are near graduation with a desire to go into L&D that would have given anything to have Capstone in L&D and hopefully shine enough to get hired after graduation and this girl just wasted her opportunity.
For all of you suggesting she wasn't interested in L&D, you are incorrect. She chose L&D and wanted to be hired on our floor after this rotation.
I am a new grad CNM and am finishing my time as a bedside L&D RN, she is not being asked to do anything advanced or beyond the basics. Mostly vitals, head to toe assessments, electronic fetal monitoring, IV starts, foleys, and repositioning as well as some patient eduction and medication education with my direct supervision. She has observed all of this for the first half of her clinical with some guided participation and voiced confidence in each portion before she was asked to do it independently. I am always in the room with her for her to ask questions. For an IV, she gets one poke. If she doesn't get it I take over, same rules I use with all my students.
I have been in communication with her faculty about my concerns and we did have a meeting in which Alice tried to blame me for not making her feel welcome and for "pushing her too hard." Her faculty member literally told her that what I was asking of her was the basics and that she could have been asked to do more.
Alice was told last night that she failed her practicuum and would have to repeat it with another preceptor and in another area. I have never seen such a tantrum thrown by an adult before. I know for sure now that all my suspicions were true about Alice. She skated by in group clinical as never drawing attention to herself. I pity her future patients and hope no one I love ever comes into her care if she ever becomes a full fledged RN. At least I know that I did not take part in passing her along.
DWelly14, sending a cup of tea to you. But here's a thought: All of the posts were made without the above information. You mentioned in your original post that you had a meeting with instructor and Alice was now to take the lead. Then you noticed her behavior and e-mailed the instructor. That was it as far as communication. Now you say you were in constant contact with the instructor. There just was not enough information in the original post for anyone to say fail her. As someone who has gone through both undergrad and graduate school, I think if were glaring flags in someone who wanted to be in L&D, she should have immediately beein reassigned. Sometimes people choose areas like L&D, ICU, NICU, ED because they think it's exciting and glamorous, but have no clue about what it really entails. If the instructor was aware of her MO, then the instructor failed both of you.
As for the instructor saying that the procedures were basic requirements, yes, they are basic for L&D nurses, but stressful for a student. I can tell you stories of experienced L&D nurses doing fetal monitoring on babies when one was dead. Someone thought they were a good nurse. With so little knowledge, this woman and many others would be overwhelmed.
A person who is removed from one environment and placed in another may very well improve and shine later. A bad start or failure in one area does not preclude success in another.
The positive aspect of this scenario is that even though you failed her for L&D, you did not fail her from school. She has an opportunity to redeem herself and if she does not do well, it will be on her. This time I hope the instructor shows up frequently to see how things are going.
Even though this was a bad experience for you, it is also a learning experience. As preceptors, whether undergraduate or graduate, we don't always have the ideal student and part of life is learning to deal with people who are not what we expected, without destroying them or becoming sour on teaching. Continue to share your knowledge. As I said before, preceptors willing to put in the type of effort you have are needed, but unfortunately very rare.
TriciaJ, RN
4,328 Posts
Who cares what her reasons are for hiding and shirking? It's unacceptable. A student at the tail-end of her formal education should be practicing thinking and acting like a graduate nurse. This is the last time she's going to have this much support.
This is her last chance to get the most out of her schooling, and it's also a time to evaluate her readiness to graduate. She's just not demonstrating readiness. If she has a legitimate reason, then she needs to identify it, get help for it and return to school when she is able to meet the requirements. At this point it's up to her to take initiative.