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 Med Surg/ICU/Psych/Emergency/CEN/retired.
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.
This is an unfortunate ending for everyone. But I feel you do a disservice to the student by passing a student, not to mention patients, who does not meet the minimum standard. There is just too much at stake. I have found that a good attitude is the most important attribute for a student, or anyone in a learning situation. I sincerely hope Alice can learn from her mistakes and move forward with a different plan. Koodos to the preceptor for giving her best effort, and may your next student be very very different. Finding preceptors can be challenging for schools, and you don't want to burn them out with bad experiences.
I feel like a lot of people are shocked by Alice's antics. I hate to break it to you, but a lot of graduate nurses are like that. We had an orientee on our floor, started out with me, who left the hospital after 6 months accusing the staff of bullying when in fact she showed the same disinterest in putting her proverbial foot forward like this Alice chick. I even got pulled in by management to give my assessment of the "bullying" situation...in which I said there was none, cause that was the truth. Some people aren't cut out for nursing; I don't know what they're thinking when they signed up, or why they stuck around even after seeing the mounting evidence that healthcare is not a joke, people's lives are in fact in our hands, there are serious consequences to our actions, and everyone pretty much craps on the nurse. My co-worker was literally having anxiety attacks at the thought of getting on the phone with a doctor. I can only imagine the kind of stuff that she probably swept under the rug during her 6 month stint.
I'm doing my Practicum/Capstone in my BSN Program. I start IV's, foleys, EKG, run labs, vitals, triage and chart (w/ sup), pt. Discharge, teaching, give subcut, IM etc...
That's the #1 complaint Hospitals have students are not anywhere near ready. My BSN cut some of the fluff classes this year and replaced it with a practicum, hallelujah.
The way I see it the only differece between a nursing student at the end of their last semester and a Fresh New Graduate Nurse is the NCLEX. Alice needs to step up her game.
OP, thanks for returning with the update. I was incredibly privileged to have outstanding preceptors like yourself, and it is really too bad that Alice didn't realize the opportunity she had before her, particularly in a coveted specialty area. At least in my region, students will claw each others' eyes out for an L & D or NICU spot.
Just had to add, I'm stunned at the number of student/new grad posters? who either didn't get a practicum/capstone or who experienced such an extremely limited amount of hands on clinical education. Blows me away. Whatever the focus area, my program required that a successful practicum was carrying a full patient load, or if in ICU, a load commensurate with what a newly oriented RN would be carrying. The preceptor was there for a resource and questions and to assist. This was all well established by the Uni before practicum even started. We have 4 major programs in our area, and all but 1 have similar expectations. (2 BSN and 2 ADN)
As practicum students we were allowed to perform any daily activity that an RN would normally perform with the exception of blood administration (we could be the 2nd check and do vitals) and IV chemo. We did not pull IJs in ICU. LVAD patient's also have a more limited student scope at my facility due to the regulations governing our program. That's it. The vast majority of students I've encountered have raved positively about their practicum experience and how far it went to help prepare them for practice.
I also read a comment (Stepney, I think) about students who looked at patients in terror. I don't mean to pick on you or your statement at all... but I just cannot relate to this. I mean, nerves, yes... second guessing of self, yes... varying degrees of confidence issues here and there.... but to look at a patient in terror? I feel like basic communication skills should be there - a level of comfort speaking to a patient, to another individual, in a professional way. I feel that once the outside-the-room/pre-procedure nerves are blown off while gathering supplies, most move forward professionally and push on when faced with the actual task at hand.
I may be way off base because I was a second career nurse myself who had a diverse background, but I don't think I saw this in anyone in my cohort or in any of the students I've hosted to date. This would really worry me. I don't know any other way to say it.
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.
I guess you didn't bother to read that the OP, the student, and the student's Clinical Instructor met and the OP was told that the student was take on all care, and that the OP was to back off and simply be a resource. So you are completely wrong here.
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.
Again, that is not the case in this scenario. Your experience cannot be extrapolated to every nursing school/clinical rotation.
It seems odd that you never saw any inkling of this side of your student until she had to be primary. It sounds like you did a lot of work with her, staying after shift, discussing A&P related to pregnancy and labor, and reviewing various policies. It sounds like you had pretty decent exposure to this student and you don't mention feeling like she wasn't getting the concepts. In fact you say you saw improvement. Once she is required to become lead, this is where things go off the rails, not enough for you to take over pt care, but crashing and burning because she was honest enough to say she isn't comfortable starting an IV. Several co-workers have commented on her behavior and you've confronted her, maybe she feels defensive and that's why she's hiding out? It's not a good way to cope but I honestly don't see this as an example of crashing and burning or as some posters have called her, lazy.
You've worked with this school for years so I'm sure you wouldn't agree to working with their students if you thought the program let just anyone through. Most nursing programs are pretty good about weeding out the students who aren't going to make it or aren't cut out for nursing. I'm not saying they all weed out the crap students but other than frustration at a student who needs to build confidence and work on her skills, I can't see failing her.
I just finished my last practicum Feb and I must say I can work on that unit without further orientation if I was hired according to my preceptor. I made sure I grabbed every opportunity my preceptor gave me. My preceptor, best woman ever. She was so nice and very proud of me; not sure what she told my professor but my professor is really proud of me. I made sure I come in before my preceptor and ofcourse wipe down our COW and stethoscopes before every start. My last day was emotional, I cried lol she told me if I need anything or even a reference I should contact her. The unit manager and all nurses I met were all nurse and wish they always had a student like me on their unit(i don't know why) lol. So I will suggest you talk to your student first, before you guys started, did you ask her about her strength and weakness and what goal she has set to accomplish before her practicum was over?
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.
I like preceptor like you that gives your student the opportunity to do basic things. Your student had more opportunities than me like doing IVS, I really wish I had that opportunity. My first day of practicum with my awesome preceptor , I started doing vitals and then progressed to the point where I do patient's admission, observations, teachings and discharge while my preceptor observed me. I must say, she was really proud of me. And I look up procedures I don't know and asked her questions. I made calls as well to our discharged pts to know how they are doing, I'm really grateful.
Specializes in Assistant Professor, Nephrology, Internal Medicine.
My advice is fail her as well. She isn't taking a proactive approach in her education, nor is she even doing the bare minimum to be considered satisfactory in an advanced practice role. For what you described, I was performing at a higher level than 'Alice' during my first rotation in NP school. If a student was like this around me, I would discuss their behavior at midterm- if it didn't improve, I would fail them.
A CNM is not doing the work of a bedside nurse and the primary role is different. A fully seasoned nurse transferring to an L&D would not be able to do a whole lot. I see it all the time. Most of learning occurs on the job and over a period of time. Many people talk as if they know more than they actually do, sometimes so they aren't criticized. It takes time to become comfortable and proficient. What primary role could a student take with a woman in labor? Repeat after me "NONE." This is a high risk area and there are enough nurses in L&D who aren't proficient without adding high expectations on a poor student. Even as an experienced nurse I would quake if I had to go to L&D. When I had my last child, I welcomed the student in the post partum unit, but a student during my labor would have only been useful as a helper.
That should have been discussed with the faculty member. Alice had specific directions from her instructor.
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.
You gave her every opportunity and she didn't take advantage of them. SHE failed, not you.
Perhaps this failure will be the wake-up call Alice desperately needs, and she'll straighten her **** out and take things seriously. And who knows, this blow might even be the start of making her into a great nurse.
Or perhaps she'll not change anything and fail out of another practicum.
foggnm
219 Posts
God grant me the serenity
to accept the things I cannot change;
courage to change the things I can;
and wisdom to know the difference.