The vast majority of nursing students are respectful and professional people who are motivated to learn, do their best to care for their assigned patients, and are a joy to teach. Occasionally, however, there is the student from Hades who consumes a disproportionate amount of an instructor's time and energy.
Melissa was the type of student that educators dread. She did not take responsibility for her choices, always had an excuse for her inappropriate actions, was manipulative, dramatic, and histrionic, and sincerely believed that the clearly-stated rules should apply to everyone but her. It didn't take long for a troubling pattern of behavior to surface.
On the first day of clinical orientation, Melissa was a "no show." She claimed she never received the e-mail memo detailing the instructions for the first clinical day. On the second day of clinical, she was 10 minutes late to the clinical site and "forgot" to remove her nose stud jewelry. During the third clinical day, Melissa was found texting on her smart phone, rather than taking care of her assigned patient. When quizzed by the instructor at the medication cart later that day, Melissa was unable to give the safe dosages, reasons, possible side effects, and precautions for her assigned patient's medications. Fed up, the instructor sent the wayward student home. To make matters worse, her clinical paperwork was shoddy in quality and often turned in late. By the fourth clinical day, Melissa had been suspended from the nursing program for numerous violations of school policy.
Clearly, Melissa did not put forth the necessary effort to learn, nor did she conform to the rules of the program. The sad result was an enormous waste of taxpayer money and inefficient use of scarce educational resources. Her seat in the nursing program and the opportunity for a marvelous career and brighter future, which another applicant could have used, was squandered. Melissa's disruptive behavior deprived the other students in the clinical group of positive learning experiences. Even worse, her lack of preparation and lackadaisical attitude made her unsafe to care for vulnerable patients on the unit. Melissa was ultimately dismissed from the nursing program, but only after a long arduous appeals process during which she tearfully accused the instructor of being "mean," "a terrible teacher," and "always picking on me."
Dealing with manipulative, careless, and recalcitrant students like Melissa can be wearisome and demoralizing, especially for a novice instructor.
What, then, is the best way to handle "problem" behavior in students?
First and foremost, KNOW your nursing program's policies and procedures. Then, carefully and consistently FOLLOW them.
Make sure all expectations are clearly communicated to the students in writing. The syllabus is the official contract between the educator and individuals enrolled in the course. Expectations for learners, along with consequences for unacceptable behavior, need to be meticulously spelled out. There should be a clause in the syllabus to remind students that they are responsible to follow the guidelines in the Student Handbook, including requirements for patient care and stipulations for professional behavior on the clinical floor.
Be proactive and not reactive. Deal with objectionable behavior early on ("nip it in the bud"), rather than simply ignoring it. Problematic behavior, if left unattended, only tends to get worse, and it can spread to others in the group. On the other hand, if such behavior is addressed early, it sometimes can be successfully remediated.
Patient safety is paramount and should never be compromised. If a student is unprepared or careless, then immediately remove the student from the clinical area.
Take care to only address the specific behavior and explain why it is unacceptable; never attack the person. Stay on target and do not digress into irrelevant matters. Never devalue, demean, or threaten the individual or use derogatory terms. Instead, calmly and factually spell out the consequences of the student's problematic behavior, should such behavior persist.
Discuss strategies the student could use to be successful. At the same time, emphasize that the student, as an adult learner, is ultimately responsible for his or her own learning and this requires total commitment on his or her part. No one can do the learning for the student. This emphasis on personal accountability flies in the face of the "victim" mentality so prevalent in contemporary society.
Always be objective, calm, and consistent. Do not allow emotions to cloud your judgment.
Model professional behavior at all times and cultivate an atmosphere of mutual respect.
Avoid favoritism at all costs. What applies to one student should apply to all students.
And last, but certainly not least - document, document, document! Keep a detailed paper trail of your interactions with the student. The paperwork is irrefutable proof of attempts at remediation and retention, as well as student acknowledgment of the disciplinary process. The detailed record will also substantially increase your chances of successfully defending your actions in an appeals process or court of law, should it come to that. Learning contracts are a marvelous tool for this type of documentation. For your convenience, I have attached two learning contract templates that I have used over the years with positive outcomes.
Thankfully, the vast majority of nursing students are respectful and professional people who are motivated to learn, do their best to care for their assigned patients, and are a joy to teach. Occasionally, however, there is that one student from Hades who consumes a disproportionate amount of an instructor's time and energy, is disruptive, and wields considerable negative influence within the clinical group or classroom.
What have been your experiences in dealing with "problem" students such as Melissa? What strategies have you found to be most effective?
There were so many disruptive students at my nursing school. Push finally came to shove one day when the "top of the class" student in the cohort below me took off his shoes and threw them at the teacher for giving failing students "extra points".
Specializes in Gerontological, cardiac, med-surg, peds.
There were so many disruptive students at my nursing school. Push finally came to shove one day when the "top of the class" student in the cohort below me took off his shoes and threw them at the teacher for giving failing students "extra points".
I was preceptor to a grad nurse similar to the one mentioned; she spent more time texting than checking on her patients, when asked about specific things concerning her assignment, she always looked surprised and would say "oh, I wasn't aware of that"; shes out there working, hopefully safe
I want to offer a balanced comment. I too saw my fair share of folks getting off light in nursing school. There were the people who missed clinical days with made up excuses or who showed up with no homework and a bad excuse. There were even those that seemed to get chances at making up days and tests because they pled some special circumstances. Of course, I hated it. I was a single mom and I busted it to get everything done like I was supposed to.
I also saw a fair bit if inappropriate behavior from the nursing faculty to students. I saw several males being labeled as unfit for nursing because they werent the instructors version of caring. I saw one of them booted out of the program after an instructor sent him back to lab to work on his skills and the lab coordinator insisted on instantly checking him off on every skill and failing him without a witness. I had another instructor take issue with a student who corrected her about a test question about cardiac rhythms because well, she was wrong andnhe pointed out the text book page that demonstrated the same. I even missed a family vacation so my ob instructor could start class with a math test and checkoff four days before the semester actually started because she didn't feel she could shorten the curriculum into the time allotted in summer semester. If you no showed? She booted you off the roster and you would have to fix it with registrars office. (good luck, right?)
I picked up at school and here that some professors think they have some given right to who would make a good nurse. It's important that we have a fair and impartial system that promotes tolerance of very "type" of person that wants to be a nurse and allows the redress of concerns from students and faculty alike.
We are in week one of OB - our last semester, and have a new clinical instructor at a site that is new to most of our class.
At the beginnig of our orientation day "nurse Ratched" is cautioning all of us on the importance of being discrete because the community is small and any information you let "slip" will eventually come back around to bite you. ... because people can put 2 & 2 together... yada, yada, yada! Well, After orientation we took a walking tour of the hospital and the OB ward.
Once we left the hospital, "nurse Ratched" proceeds to tell one of the staff nurses what a bunch of 'cry-babies' our class is, and how irresponsible we are!
I'm sure there are whiners in every group, but (I'm sorry) that kind of talk is just blatant un-professionalism! But, how do you combat that when we are relying on her to pass us? She holds our grades and everything we have worked toward, for the last two years or more, in her hands.
I guess we have to just take-it for now... Graduation is on the horizon!
Instructors: Remeber you wield a lot of power and influcene (even if it doesn't seem that way sometimes!), so please use it wisely!
For our test review there is a no question policy. We take the test on the computers, and once everyone is finished the instructors review questions and will make corrections if necessary (They look at problems that a majority got wrong and change if needed). We come back in the room, sign in, and we get to look through the test. If anyone asks a question the review is cancelled for the entire class. IF we signed in we can schedule a meeting to go over questions. Test-reviews are very quiet at my school for all of the above reasons :)
I think it also allows time for students to calm down and really think about the answer. I know that there is usually more than one right answer, but there is a more correct choice. Putting that much effort into getting a one-on-one test review weeds out a lot of the knee-jerk-gimme-points reactions.
Specializes in Early Intervention, Nsg. Education.
I'm a "two decades ago students were fail because of XYZ" nurse as well, but our class had a "Melissa" of sorts, proving that truth is stranger than fiction all right. Let's call her Melissa Dayglow Moonshine...
She was in my clinical group, always the first to start and the last to finish. We never saw her on the floor, and barely checked in with her instructors. One day a classmate had a pt in the same room as hers and found out why. Ms. Dayglow Moonshine was spending her time lecturing her patients on the dangers of Western health care and the conspiracy between doctors, hospitals, and the pharmaceutical industry; basically, meds are designed to imbalance something or other in the body and that's what leads to illness. Lucky for her pt's, she knew the secret to curing everything from athlete's foot to brain cancer through magic crystals and magnets, and coincidentally she even had the "treatments" to sell them! Needless to say she disappeared from the class roster. We never found out if she was just flunked or if anyone brought charges against her...I hope they did.
I have a feeling she's hocking potions online now, probably making 5 times as much as she would have earned as an RN.
We have a student in our program that sounds very much like the one you describe. The difference here is that no one does anything about it. Instead of taking action, the clinical instructor gets mad at her and takes it out on the other students. Its almost like she is intimidated by the student. If I were the instructor, I would send her home but she is allowed to remain, day after day, disrespecting everyone in the unit along with the policies, rules, and regulations.
There were so many disruptive students at my nursing school. Push finally came to shove one day when the "top of the class" student in the cohort below me took off his shoes and threw them at the teacher for giving failing students "extra points".
This has happened every single semester since I've been in nursing school. You don't pass? That's okay because we'll "find" some points to help you pass. In fact this last semester, the girl sitting next to me had test grades of 40, 60, and 68. Those were our only 3 tests but she "passed". Amazing, right? I guess they were able to "find" a LOT of points...
I would imagine the BON would frown on this but...
This has happened every single semester since I've been in nursing school. You don't pass? That's okay because we'll "find" some points to help you pass. In fact this last semester, the girl sitting next to me had test grades of 40, 60, and 68. Those were our only 3 tests but she "passed". Amazing, right? I guess they were able to "find" a LOT of points...
I would imagine the BON would frown on this but...
Specializes in Gerontological, cardiac, med-surg, peds.
We have a student in our program that sounds very much like the one you describe. The difference here is that no one does anything about it. Instead of taking action, the clinical instructor gets mad at her and takes it out on the other students. Its almost like she is intimidated by the student. If I were the instructor, I would send her home but she is allowed to remain, day after day, disrespecting everyone in the unit along with the policies, rules, and regulations.
Not to excuse this, but:
The instructor may not feel supported by administration. In some learning institutions, there is incredible pressure to give poorly-performing students passing grades, because they are "paying customers" or "we need to improve our retention rates to satisfy the public/ politicians/ media in our prudent use of tax dollars."
If he/she is a novice, your clinical instructor may not have any faculty mentors. The instructor simply may not know what to do or where to turn for help, and is truly feeling intimidated by this student.
Or, the instructor may be feeling overwhelmed and exhausted. It is often simpler to pass a "problem" student along to the next semester's faculty, than take the enormous time and effort necessary to appropriately deal with the student issues right then and there. Failing a student can take hours and hours and hours of faculty time.
Sorry that you are having to deal with this situation and its fall out. One thing that you might consider is anonymously reporting this situation in your clinical group to administration.
:eek: 
.thumb.gif.557c5203bd6f06724ecab47703960500.gif){kind=small}
tothepointeLVN, LVN
2,246 Posts
There were so many disruptive students at my nursing school. Push finally came to shove one day when the "top of the class" student in the cohort below me took off his shoes and threw them at the teacher for giving failing students "extra points".