Nursing Student From Hell

Nurses General Nursing

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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 NICU, PICU, PACU.

Yes, she's a student who will be graduating soon! I have taken on capstone students and the expectation is that we treat them like a new grad and they are expected to be able to function somewhat independently by the end. This is a student who most likely will be looking for a job on your unit. This girl has some issues. That student should be glued to her preceptor, it is NOT her preceptor's job to be hunting her down all shift to remind her of what she needs to be doing.

And four shifts is not enough time to "redeem" herself. She obviously has not picked up skills and shirks her duty. Four shifts, not enough time.

I stick with fail her.

Specializes in Urgent Care, Oncology.

Wish you had been my preceptor.

I mean, my preceptor was great, and by the time I was done I was able to care for 4 patients on my own with minimal to no assistance. But she never stayed late with me or gave me articles!

I wouldn't want her as my nurse. Its your responsibility to make sure patients are safe once she goes out into the real world. If you dont work, you dont pass.

Specializes in Palliative, Onc, Med-Surg, Home Hospice.
I'm a little surprised at all the fail her posts. She's a student. A student. I feel like some of you have way high expectations of students.

I am thankful my school had such high expectations. My preceptorship I was expected to do anything allowed by my school and the facility. That meant, at least attempting IV starts, passing meds, IV meds (no chemo, obviously, no blood per state law), assessments (though I was not allowed to chart them). I did my preceptorship on a critical care unit (bone marrow transplant), and I took advantage of that opportunity.

What the student did in the OP is not acceptable. The student brought this on herself. Not the nurse precepting her. She is weeks or a couple of months at most shy of graduation. I don't know about anyone else, but nothing magical happened to me when I graduated from nursing school that made me more knowledgable about nursing care than when I was still in my practicum. And nothing magical happened when I passed my boards, except that I was now legally a nurse. I knew the same amount that I did when I finished my practicum.

The student is digging her own grave. Should she fail out and not be able to continue, that is on her, not the nurse precepting her. She needs to be held to professional standards. Yes, even as a student.

Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
Expectations have been discussed multiple times with her. The biggest issue is that she just laughs it off when you call her out on disappearing. So I'm walking in to go push with the patient and I saw her in an empty room opening a can of bleach wipes (she later told me she was in the bathroom) but I didn't have time to call her because the patient was about the birth. Later when we had a chance to talk and I said "why did charge have to come find you when our patient was complete and pushing?" she laughs and says "oh I was in the bathroom and didn't know where you were. If I had known where you were I would have been there." I was in our room for almost an hour before she finally showed up.

Failing someone is a difficult thing to do. But you've discussed the issues and there's been no improvement, so fail her you must.

Specializes in SICU, trauma, neuro.

from LovingLife123: "I'm a little surprised at all the fail her posts. She's a student. A student. I feel like some of you have way high expectations of students."

Quote button not working at the moment.

She's not in her first clinical. (Not that hiding is EVER ok). She is in her final practicum. She has finished the classroom portion of nursing school, and has finished her clinicals.

In my practicum (in fall 2002), I worked my way up to managing an entire med-tele assignment by myself, with my preceptor in the wings for guidance. I did all of the tasky things like placing IVs, med administration, and chart checking. I did discharge teaching with my preceptor present (obviously can't discharge someone without an actual nurse present), I checked labs and told my preceptor what I thought about the abnormals. I even had the required pt-related conversations with the drs. Again with my preceptor present, but she was silent as long as I was providing the required info.

Someone days from graduation (4 remaining shifts = days away) has NO business disappearing and declining the offer of practice that she hasn't had. Really, if she'd never inserted an IV yet, why would she NOT be all over it?? I get it's intimidating, but how is watching the RN do them going to get HER competent?

But the disappearing/hiding? Inexcusable. Her presence is a VERY reasonable expectation.

Specializes in Medical-Surgical/Float Pool/Stepdown.
Failing someone is a difficult thing to do. But you've discussed the issues and there's been no improvement, so fail her you must.

Very Yoda-eske Miss Ruby! :smokin:

Specializes in MCH,NICU,NNsy,Educ,Village Nursing.

As a former faculty member, I say document your observations and any factual things you can. Meet again with her faculty and fail the student. It sounds like she would be unsafe. Laziness in a learner is not appropriate at the least.

Specializes in Mental Health, Gerontology, Palliative.
In my program people did not fail clinical unless they repeatedly did something very aggregious. Nothing like what you are describing here. No one failed their leadership/capstone clinical.

Not being able to find the student? A fairly hefty problem IMO

What the OP is describing is similar to what we did as students, a final nine week placement where we were expected by the end of it to be caring for a full load of patients, withback up from the preceptor for the tasks that were outside of the student nurse scope of practice as outlined by our school and facility policy.

We ought not be having a discussion on whether or not you should fail her because that isn't your call to make.

Our preceptors could fully fail us if they found our practice unsafe and they would have had the full back up of our school of nursing.

You sound like a pretty amazing preceptor, in my opinion. Sharing articles, staying after work to further your student's learning: these are not things every preceptor does. You are also providing your student with opportunities. And although it is intimidating to try new skills (i.e. IV starts), it is not an appropriate reaction for your student to hide when these opportunities present themselves. Furthermore, my concern would be that if this student does this now in response to a stressful situation, what will she do when she is on her own in an even more stressful situation (i.e. a code)?

As hard as it is to fail a student, if you truly believe she is unsafe, this student should not pass her practicum. You are an experienced preceptor and know the difference between new nurse jitters and unacceptable behaviours. Failure is not always a bad thing and might be the catalyst this student needs to examine and hone her practice. It might also force her to reflect on why she is behaving in certain ways: maybe her personality is better-suited to a different area of nursing.

Hopefully you have had honest conversations with this student and her instructor (which it sounds like you have) so that this decision won't come as a surprise. And hopefully the student is supported by her school. Good luck and let us know how it goes!

What does she say when you talk to her about her disappearances, and not talking in front of the patient about it, and doing the tasks on her own? That makes a difference in my mind. 6 weeks isn't that long - especially if its 3 days a week or less. I had 20 weeks. However, I was given my own patients almost immediately. I think by the second week I had one patient. 3rd week -2 patients, 4th week -4 patients....and so on. From that point on the preceptor sat in her seat unless I needed help. That wasn't the best situation either. She really wasn't teaching me anything. You sound like youre doing a great job, but maybe she needs more help (build up her confidence - praise, smaller tasks on her own) building her confidence, and taking on the tasks.

I know I wasn't good at IV's for months. Problem was that when there was an easy IV for me to do, even after I was on my own, someone would always zoom by and "hey - I got that IV for ya" - damn. Those were my good practice ones. Then I'd have one that was a hard stick - and I'd hear "well, did you try it on your own first?" - grrrr. If I'd been allowed to do more of those easy ones instead of my preceptor just doing them, or one of the helpers just doing them - but of course they like doing the easy ones too - so....

I'd sit down with her first - have a serious talk if that hasn't been done already - make sure she is aware that she has a problem. Don't keep it from her and tell everyone else. That wouldn't be right.

If she knows - give her a timeline to complete the tasks you need to see her do on her own. Let her know what the consequences will be if she doesn't meet the timeline/tasks.

Be a nurse to both your patients and your co-workers.

I'd agree with you for the most part. However, how did she get to this. Often times what I see is that there is something else going on that she is aware of that is making her feel inadequate, uneasy, and has her questioning her abilities, and lowering her confidence. What is the atmosphere of the unit like? If there are underlying negative attitudes toward new nurses, or if she has overheard any negative comments - or is there other nurses who think they're cute by telling others people are idiots?

Even if they are not saying these things about her - maybe about another nurse, if she hears them, it is likely she will assume that if they are being negative about other new nurses, they are probably doing it to her when she's not in the room.

Trust me, a toxic environment toward new nurses has a HUGE effect on the new nurse and her confidence levels. A new nurse is already worried about making a mistake -but then to worry about making a mistake and having rude know it all nurses make fun of you - will make you avoid a situation in fear of making a mistake.

Take a look at political atmosphere around you, and how she's treated, how all the new nurses are treated, or talked about. You could be doing a great job, but that kind of stuff will hold her back, and make her feel like she's not ready.

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