Nurturing Confidence In Nursing Students

[AOx1]

As I work on my latest research, one common theme is evident in nursing students. Many lack confidence. Among several areas of research interest, I am most passionate about several issues: nursing students and bullying, predictors of nursing student success, and the relationship between a student's expressed level of confidence and their ability to persevere in nursing school. As a child, I saw a comic strip called Pogo, and the most famous comic strip they released said "We have met the enemy and he is us." I did not understand what this meant when I was young. I believe that I am beginning to understand now.

As a nurse educator, my role is multi-faceted. I believe it is both my duty and privilege to serve as an example of professionalism and life-long learning, to teach students both the information and the skills that they need to succeed, and to help them develop professional habits and coping skills to deal with the reality of nursing. When I first began researching students' experiences with bullying, I noted that students often referred to feeling worthless and unsure in their abilities as a nursing student. These feelings appeared to be especially common in first-semester students. Students reported wishing that they could hide at clinicals, feeling unsure in their skills, and experiencing pressure and feeling like a failure when their skills are not perfect and their knowledge is not complete.

One of the most difficult aspects of nursing education is releasing control, allowing your student a measure of free reign to learn and to succeed, while ensuring patient safety and excellent care. The first time that I saw a student start a foley catheter, it was all that I could do not to grab it and do it myself! This was not due poor technique on the part of the student, but simply to my inability to relinquish control! It took me time (and learning to put my hands behind my back) to watch my students and to demonstrate trust, while still offering support and guidance.

When nursing students encounter dark humor in the clinical setting for the first time, it can be shocking. Hearing a nurse joke about death can lead to the view that the nurse is cruel or callous. I believe there is a similar phenomenon in education. Someone from outside our practice setting is less likely to understand our particular challenges. It is difficult when you put everything you have into nurturing students, only to have the only thing that is mentioned on your evaluation be the thing that you did "wrong" in the eyes of the student. It is frustrating when you try to create fair rules, only to have a manipulative student flout them. When you catch a student cheating, it can destroy your trust. However, as educators, we have a duty to manage our own stress, and not to take this out on the students. That majority of the students are excellent and hard-working. We also have a responsibility to demonstrate open dialogue with students and to "think out loud" as we educate them and perform skills.

For example, one of the things I have noticed with beginning students is the confusion they face when learning a new skill. For example, when starting and securing an IV, the student may see several methods of securing the IV catheter, and be unsure which is "right." They fear failing a skills check off when they see several methods and each instructor insists that their way is best. I believe we owe it to the students to convey which aspects of the skill are essential, such as preparing the site, vein and IV catheter selection, and how we dress the site so that we can view it. However, we should also convey why some areas of a given skill are a matter of personal preference. We should also back up our practice with current evidence. I remember my time as a student, watching a "real nurse" perform a skill, and just knowing that there was no possibility that I could ever replicate that skill, and yet in time I learned to do so.

What your nurse educators often fail to convey is that we've all been there. We've all been the student who felt like an idiot at clinical despite adequate preparation. We've been the student who wanted to hide from the instructor because we were afraid of not knowing. Many of us have been near graduation, terrified that at any moment someone would discover that we are not competent and refuse to allow us to graduate. I spent the first year in the ICU in mortal fear that I would make a mistake, that I would kill someone, that someone would find out that I was really just an imposter, not worthy of caring for patients. As the year went on and I learned to love the ICU and grown in confidence, I could recognize that same look in the faces of most students and new graduates.

The response to a student or new graduate who lacks confidence can vary from bullying the weak to nurturing them. It has taken me years to find the right balance of high expectations, but delivered with compassion and with an understanding that students often lack confidence. I have had so many students tell me in the course of my research that they felt belittled, demeaned, and constantly in fear of failure or reprimand as students. Are nurse educators the enemy? We can be, if we are not transparent. I believe it is a good thing to be transparent, to be human. I tell my students that I know how they feel. I have felt like an idiot on every "first day" I've ever had, from kindergarten to my doctoral education, and at every new job I've ever held. The key is to know what you do know, what you still don't know, and try your best to learn. Have faith in yourself and your ability to learn in time. You will never know it all!

As an educator, we can avoid being the enemy. Never back down on your standards or expectations, but explain to your students why you hold them. I hold high expectations of students because I know in time that they will be capable of meeting them. I want them to be the best. I want to see them move from a point of fear and uncertainty to a point of confidence and security. I see glimpses of this while they are in school. I see their potential begin to come to fruition when they return to visit and tell me of their latest accomplishments in their career. Tell your students early and often that the lack of confidence that they feel is normal, but that it is not a permanent condition! Encourage them to reach their highest potential. I do believe that as educators we can have a great influence on whether our students are confident and whether they love to learn or if learning is something that is motivated only by fear of failure.

[BeenThereDoneThat74, MSN, RN]

Many good points are raised in this thread. I'm too tired to quote and paraphrase; I was up half the night (as I am usually twice a year opinion may and December) pondering why I do this for a living. OP, I agree that as educators our job is very challenging, often thankless, but always bittersweet.

This confidence thing (with the students) is getting worse and worst each semester. I really feel it is an issues in society-at-large, afflicting mostly the younger, traditional students. However, the majority of the students I teach are non-traditional. I have been told that I am very non-threatening, and student feel relaxed when I am with them in lab and clinicals. The students who tell me this are always the weaker ones. I often feeling like I am too relaxed with some, and that they don't take me serious enough. Thankfully (and I say this in references to the OPs paragraph about evaluations) my clinical evals are consistently positive.

However, over the last few semesters, the ones who lacked the confidence and were clinically on the fence, end up failing the next class, either theory or clinical. With the clinical ones, my colleagues in the puller semesters feel these people cannot function more independently at a higher level. Thus, I feel like I did them wrong (I will not take complete ownership though), by coddling them, and telling them (after they have made a mistake) "it's ok honey, everyone makes mistakes, you're a student and you're learning", when I know, deep in my heart that they are not going to make it (God for if I haste that sentiment in some way, despite the fact that I've been around long enough to know who will and who won't). At this point, their confidence has not increased in any way- they may feel it has (because I didn't yell and scream and them, or grab the needle out of their hand), and may thank me for my patience. But in the end, they are really no better off, statistically, in the nursing program. There are the few and far between excretions. But too few.

[RunBabyRN]

However, over the last few semesters, the ones who lacked the confidence and were clinically on the fence, end up failing the next class, either theory or clinical. With the clinical ones, my colleagues in the puller semesters feel these people cannot function more independently at a higher level. Thus, I feel like I did them wrong (I will not take complete ownership though), by coddling them, and telling them (after they have made a mistake) "it's ok honey, everyone makes mistakes, you're a student and you're learning", when I know, deep in my heart that they are not going to make it (God for if I haste that sentiment in some way, despite the fact that I've been around long enough to know who will and who won't). At this point, their confidence has not increased in any way- they may feel it has (because I didn't yell and scream and them, or grab the needle out of their hand), and may thank me for my patience. But in the end, they are really no better off, statistically, in the nursing program. There are the few and far between excretions. But too few.

I imagine, as an educator, there's a fine balance with this. You don't want to be discouraging, and if someone CAN dig deeper and make it happen, you don't want to be the one that squashed them, but at the same time, you want to give them a realistic prognosis. Those gray areas, like most in life, have got to be the hardest to sort out. I, personally, like to be pushed hard but accepted if I DO make a mistake. I think some have a harder time with the pushing, especially during those heavy load semesters.

[Natasha A., CNA, LVN]

Great thread!