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!
I would fail her. I had a similar preceptorship/capstone in my last semester. By the last week, I was getting/giving report, participating in grand rounds, giving all of the meds, providing all of pt care, assisting w/procedures, heck, I was even initiating conversations w/the critical care docs on the tiny ICU I was in. My preceptor got sick and had to go home early several times. Guess what? He picked an experienced ICU nurse to monitor me for the rest of the shift. I handled it just fine. Flow sheets were updated, meds were passed, vents & heart monitors were observed. I gave report and went home w/o any issues.
If she seems not at all excited to be there, it's probably because she isn't. Do her a favor and fail her. She needs to find a new career.
There are many posters on here with different opinions of the how a student should be when in their final semester. I have noticed that students from different schools have varying degrees of proficiencies. I mentioned in an earlier post about students that had looks of terror on their face. The reason was that they were woefully unprepared due to the types of clinicals the school required previously. Believe me when I tell you that I had 2 students who could not do a basic assessment of a patient. The school later revamped the program because of the complaints.
Like CaffeinatedNurse, I had the grandest time in my practicum, doing everything except IVs (which I wasn't allowed to do), from start to finnish. When my preceptor had to go home sick early in a 12 hours shift, I was told to continue care of my 2 NICU patients and will be supervised by a nurse in the same pod. No problem! I did a lot of research and was able to share what I learned with the other nurses. They said they enjoyed reading my little papers. But I had great clinicals, was self-motivated and was a second-career nurse, even though still young.
I do believe that nursing schools should have students take one of those career tests to see if they are suited for nursing. Then after pre-requisites are completed, an interview with the dean and maybe an informal meeting with a student already in the program. Nursing students, like some allied health programs, should have to shadow a nurse for a certain number of hours, so they know what nursing is about.
One poster suggested sitting at the beginning of the practicum and discussing the student's strengths and weaknesses. I had never thought of doing that, but it's a great idea.
Lastly, I think the entire nursing education system is doing a disservice to students and the profession by not being standardized. Why do some students get to do certain procedures and others do not? Why do some have many hours of clinical time in the acute setting and others have minimal hours. Why do some programs (including advanced practice) continue to fill their programs with classes that can impart knowledge in a 3-day seminar, but ignore training vital to success?
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.
Starting an IV is a bedside nurse function and she has refused to avail herself of the chance to do it on more than one occasion. Despite OP being a CNM, she asked that the student do a bedside care function.
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.
It's not enough to just be there and put in the hours. The hours must be filled with meaningful learning activities, handled competently for a student who is about to graduate.
What was the end result in your own sicko psycho preceptor's mind when she learned that you were seeing, presumably competently, about 3 or 4 times as many pts as required and that other preceptors were greatly with you? Were you able to get her to buy in and change her view of you to more positive? Why did she have such an incorrect perception of you?
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.
Agreed. If she has a problem that makes her hide, laugh inappropriately, refuse to learn how to start IV's, etc., she needs to speak up. OP isn't paid to be a mind reader. Nursing is damn hard work and we don't have time to baby students.
Each person handles things differently. But from what I have learned about this student......I do not want her working for me. I have enough of my own work to do without having to pick up her slack.
What scares me the most is the fact that she is not willing to take these opportunities to learn and hone her skills before she is out on her own.
You made the right choice. Maybe she will take this new opportunity and get as much out of it as possible.
To the nurses in this thread who think "Alice" shouldn't fail, or that she's just a scared, timid student who must be protected at all costs - this is how special snowflakes are made. Students are coddled and given a pass for just showing up, they aren't expected to know their stuff or behave professionally because "they're just students." Well do you think all that will change once they're new grads working on your unit? Or when they're taking care of your family member? Alice is in her final semester, just a few months from graduating, and she was disappearing from the unit, refusing to perform skills, and then she threw a tantrum when she found out she failed! Completely unacceptable, and I would not even give her a second chance in the program. She sounds dangerous and unsuitable for nursing (or any job that requires behaving like an adult).
Personally, I had severe performance anxiety in nursing school, to the point where I felt like I would pass out. I almost cried once when my clinical instructor chewed me out (in front of the patient too ), when I dropped a medication because my hands were shaking so badly. So I can understand feeling "terrified." But I went to the open skills practice lab every week until I felt confident doing skills in front of my instructor and patients. I never ran away or hid, I never left the unit during clinical, and I always treated my instructor and the other nurses with respect. I felt like it was an honor that the floor allowed my clinical group to be there to learn.
During my capstone (surgical ICU), I was expected to perform at the level of a graduate nurse, I helped with everything I could, I gave medications, placed IVs, did vitals and I&Os q1h, assessed post-op patients, hang IV meds, assisted during codes (compressions), suctioned, learned about vent settings, and even assisted with an A-line placement, all with my preceptor supervising. I know the requirements are different for every school, but being professional and available to learn should always be expected of every practicum student.
Specializes in M/S, LTC, Corrections, PDN & drug rehab.
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.
She does not deserve to be in nursing school. I would give my left kidney to be in nursing school. I would do anything to have my practicum in L&D & would definitely soak up every moment.
If Alice acted that way with you, I don't see her changing with a different area or preceptor. I hope she doesn't make it through the rest of her program. I wouldn't want her touching a patient as a licensed nurse.
All I can say is I WISH I had been able to start an IV during my practicum. I got to do a lot of other things, but my school didn't allow IV starts (nor teach it) and the nurses on that floor didn't do IV starts either, they called the IV team. And OP, you sound like a great preceptor!
As for failing, sometimes it is the wake-up call one needs. I had a fellow student in my nursing school class fail their final practicum due to not entering a precaution room with proper precautions. It hurt and that student was very upset and even the student admitted their behavior after learning this was not the best. But that student dusted themselves off, apologized, repeated the practicum on another floor with another preceptor and graduated. And is an awesome nurse today. I hope Alice uses this as a learning experience.
This is a Capstone clinical. As soon as you see this behavior it is time for a meeting. AT THIS POINT THE STUDENT SHOULD BE ADVISED ONE TIME THAT IF THE BEHAVIOR CONTINUES YOUR CAPSTONE DOES NOT AND YOU ARE DONE. END OF STORY!
The OP apprised the school of the student's behavior prior to the end of the term. She should have been read the riot act at that time. By allowing the behavior to continue and giving her a new start, the school is sending the message to future students that laziness, shirking, and hiding are acceptable behaviors for nurses. Wrong answer for the profession.
), when I dropped a medication because my hands were shaking so badly. So I can understand feeling "terrified." But I went to the open skills practice lab every week until I felt confident doing skills in front of my instructor and patients. I never ran away or hid, I never left the unit during clinical, and I always treated my instructor and the other nurses with respect. I felt like it was an honor that the floor allowed my clinical group to be there to learn. 
caffeinatednurse, BSN, RN
312 Posts
I would fail her. I had a similar preceptorship/capstone in my last semester. By the last week, I was getting/giving report, participating in grand rounds, giving all of the meds, providing all of pt care, assisting w/procedures, heck, I was even initiating conversations w/the critical care docs on the tiny ICU I was in. My preceptor got sick and had to go home early several times. Guess what? He picked an experienced ICU nurse to monitor me for the rest of the shift. I handled it just fine. Flow sheets were updated, meds were passed, vents & heart monitors were observed. I gave report and went home w/o any issues.
If she seems not at all excited to be there, it's probably because she isn't. Do her a favor and fail her. She needs to find a new career.