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!
Fail her. She is a liability. I've had to work with nurses who hide and nursing assistants because they are lazy. It's very stressful when all the workload is on you and you've no help. Send her to an IV class with a clinical instructor since she's so "nervous" which really is a cover-up. She seems to be passive-aggressive making up excuses all the time. Inform your supervisor and document everything. Maybe, she's only doing nursing for the good pay and benefits. What if a patients is crying out for help for example with chest pain or they fell on the floor and she's hiding, expecting someone else to deal with it. She doesn't deserve to pass because she hasn't pulled her weight and doesn't seem interested in learning. If she has other problems, send her to the employee assistance program (EAP). There may be issues at home or elsewhere in her life but you can't just pass everyone because you feel bad for them. Sorry, you have to be cruel to be kind.
If a patient falls or is crying for help, the person you need is another staff member, not the student. If they can help, great, but the lawyers aren't going to look at the student. Also, employee assistance is for employees, not students. Starting IVs is not a requirement for becoming an RN. You can learn that on the job. Many, many hosptals do not allow students to start IVs. No one in my unit was allowed. And many different ages, states and programs are represented. Anyone that gets that experience is really lucky.
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
If a patient falls or is crying for help, the person you need is another staff member, not the student. If they can help, great, but the lawyers aren't going to look at the student. Also, employee assistance is for employees, not students. Starting IVs is not a requirement for becoming an RN. You can learn that on the job. Many, many hosptals do not allow students to start IVs. No one in my unit was allowed. And many different ages, states and programs are represented. Anyone that gets that experience is really lucky.
Alice could have gotten the experience of starting IVs, and would have been lucky. But she's hiding instead.
Alice could have gotten the experience of starting IVs, and would have been lucky. But she's hiding instead.
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).
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?
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).
Alice didn't say "my program doesn't allow me to start IVs". Instead she deferred to her preceptor to do it. The whole IV issue is irrelevant to her performance. She was not by the preceptor's side throughout the clinical, takes off without telling the preceptor, and blows off the preceptor's concerns. She is looking to skate by just like all of the rest of her group clinicals and does not believe that she can get a failure in this clinical. She doesn't see any consequences to her behavior. If this turns bad for her, she will blame the preceptor because it can't possibly be her fault.
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
Alice didn't say "my program doesn't allow me to start IVs". Instead she deferred to her preceptor to do it. The whole IV issue is irrelevant to her performance. She was not by the preceptor's side throughout the clinical, takes off without telling the preceptor, and blows off the preceptor's concerns. She is looking to skate by just like all of the rest of her group clinicals and does not believe that she can get a failure in this clinical. She doesn't see any consequences to her behavior. If this turns bad for her, she will blame the preceptor because it can't possibly be her fault.
Alice didn't say "my program doesn't allow me to start IVs". Instead she deferred to her preceptor to do it. The whole IV issue is irrelevant to her performance. She was not by the preceptor's side throughout the clinical, takes off without telling the preceptor, and blows off the preceptor's concerns. She is looking to skate by just like all of the rest of her group clinicals and does not believe that she can get a failure in this clinical. She doesn't see any consequences to her behavior. If this turns bad for her, she will blame the preceptor because it can't possibly be her fault.
^^^ This. Thanks for stating it better than I could.
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.
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.
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.
You seem very conscientious, and I understand your indecision on this, failing someone is huge. And sad. And so very much needed in this case.
After I graduated there was a critical care instructor that came on board at my alma mater. Several PTC's I worked with were also nursing students and she was despised by all. She was a total hard orifice, and failed nearly as many students as she passed. The story was during her own clinical rotation she nearly killed a patient by not researching a Rx medication thoroughly enough. This she carried over to her instructorship. Her life ended sadly, and it is a story I can't go into because of the identifiers involved in the murders, but it was really bad.
In this instructor's case many who should've been given a 2nd chance weren't, whereas in your student's case it seems she is on her 50th chance.
You will be doing her a kindness by not passing her along like everyone else, because clinical skills - even rudimentary ones are necessary in a nursing student hoping to be a fully fledged nurse some day. If she keeps going as she is she will have a very difficult time after graduation, not to mention she could kill somebody.
Perhaps after her initial anger and disappointment she will take failing as the gift it is intended to be.
Fail her! People's lives are at risk and you would be doing her a favor anyway. It's a serious job with serious consequences. People like her throw others under the bus to cover for their own mistakes and I would blame you for any of hers. It's also part of your job re evaluation. This isn't about your feelings but future possible lives. You need to be evaluated as well it seems. After so many clues of her deficiencies, you still need reassurance. Fail her, then help her or find someone else to better remonstrate her failings and lack of alacrity.
Failing someone is not easy. There is sometimes fear that the failed person will retaliate violently. The OP in this case seems fair, not someone who rushes to judgment, not given to condemning a student wrongly.
I do understand her reluctance to fail a student, but that is what she needs to do. And she has made this known already to the school, so she is doing what she should, both for the public and the student.
It's sort of like firing someone. That can be scary.
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.
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.
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Skippingtowork
342 Posts
If a patient falls or is crying for help, the person you need is another staff member, not the student. If they can help, great, but the lawyers aren't going to look at the student. Also, employee assistance is for employees, not students. Starting IVs is not a requirement for becoming an RN. You can learn that on the job. Many, many hosptals do not allow students to start IVs. No one in my unit was allowed. And many different ages, states and programs are represented. Anyone that gets that experience is really lucky.