MilieuRN

Wonderful replies, thank you all so much for weighing in on this topic and my personal situation. I returned to work, and sharing the former patient's actions, we are all shocked by her choices. I really appreciate you all taking the time to share your insight and own experiences. It really does help knowing I'm not alone. The experience with this former patient is one I'm sure I'll never forget.

Good morning, nurses. I started my career as a nurse in an up and coming psychiatric hospital. During nursing school, I developed a passion for mental health and for advocating for patient rights while fighting the stigma that surrounds the mentally ill. I had these great aspirations to help make a difference and to provide excellent and safe care. I still do, but I am having somewhat of a problem with personal/occupational morale today. One particular patient I had worked with seemed to have a solid plan regarding how to stay well, and I felt good about her discharge. Yesterday, however, I see that she has been involved in a traffic accident in which she was drunk, with her child in the car. One dead, one in critical condition. When I saw her mugshot attached to the article, it was like a swift kick to the gut. Now, I know I don't have the power to "fix" anyone. I know people get locked into destructive patterns that are difficult to break out of. I feel though, that the system somehow failed her (please note this is attached to emotion, I'm not entirely sure how we could have better assisted her). Normally, I would question the mental health of someone driving drunk with their child, and say "Well, if only we had better mental health care..." etc.. Has anyone been in a similar situation? And how do you deal with processing these events? I have an odd mix of emotions that I rarely experience while I'm assigned to patients in the facility. I am able to intellectualize, compartmentalize, etc., patient stories, behavior and attitude, however this situation is one I haven't encountered before. Thanks in advance for your insight!

Also, that being said, I've talked with many LPNs during my clinicals who are quite happy with what they are doing now, and actively decided not to go the RN route. It might help you to do some research into the differences between the two, to figure out if maybe LPN would be better suited to your timeline and preferences :)

You may thank yourself in the future is you simply pursue ADN or BSN from the start. Perhaps you could consider a community college (where you can earn ADN), and attend academic coaching or join a solid study group. The least stressed and highest performing students (generally speaking!!) make Nursing their priority, and put work on the back burner, and others perform beautifully by being in the part time program. My college offers ADN students graduation from the LPN program after completing the first two semesters. A few are actually leaving school indefinitely after passing their boards to be LPNs. If I were in your shoes, I would find a college that offers coaching, so you can get help with the math, and anything else you might need. If you aim for ADN off the bat, you could easily go on to BSN from there. I am told that to enter an LPN program only to bridge to ADN at a later date is far more complicated and time-consuming than to just go straight for the ADN. I wish you luck, keep your mind open, and remember nursing school is a LOT of hard work!

I am a student at this point, but based on what I have learned thus far, pain does indeed have many physiologic implications. The stimulus of pain causes fluctuations of neurotransmitters, which in turn affects blood glucose, respiration (thus ABGs), blood pressure, heart rate, etc. The sympathetic nervous system is activated during a pain response, which causes the body to enter a state of survival, which in turn delays healing. Depending on the patient's current health problem and health hx, pain control could be the difference between exacerbating a failing body system or supporting it with pain control (among all other supportive interventions), and impacting long-term patient outcomes.

Firstly, sorry you found my posts difficult to follow. I did include a lot of information (I know I certainly vented a lot). That being said, I'm not sure you got the gist of the entire situation. I do realize that I am not going to jive with every instructor, and indeed not every employer, that I have. I think I've made several references to this. Though I agree that advising someone who is having problems that stem from minding other people's business, to "not worry about others" is generally good advice, I do NOT prioritize anyone's business above my own in school. Very good point, but if you were to read all of my postings I think you would see those do not focus on other students. (though yes, I was informed of others grades, which were announced to me, not requested) As for chain of command, we were never instructed as to how to react to situations regarding teacher and student "miscommunication" or "conflict". In fact, I don't believe I've even heard any staff refer to chain of command... I have no idea who my instructor's bosses are, to be honest.I still feel confident in my decision to FIRST consult the guidance department, which is completely separate from the nursing department, so as to no go over anyone's head, or ruffle anyone's feathers. Honestly, all I want is to worry about my patients and my classes. I don't want drama, I don't need to make BFFs, I just want to get along with everyone I will have to work with, help my patients, do my job properly and learn as much as possible. Who needs accusations from instructors of all people? I am INDEED looking forward to a new semester and a fresh start. Good luck to you too.

I did ask her through the first few. She basically read the criteria off of the paper for each "outcome", then told me how she graded me. I did ask how she would have wanted these outcomes to be demonstrated. She simply said, (much in the same way she repeated "So" over and over when I was attempting to explain that I wasn't going through her bag") I just didn't think you earned a 5. I asked for examples in which I could have done better, but she again said "I just didn't see this from you. So." Based on previous experience, I knew I wouldn't get anywhere in trying to figure out what she had wanted to see. There were a couple 4/5 I totally agreed with her on, for which she did cite reasons. I knew at the beginning that these grades aren't generally negotiable, so that wasn't what I was going for, just wanted to know things I could improve on for next semester and nursing in general. In avoiding the instructor, I should have specified that I avoided going to her with questions. I did though, let her know as we are supposed to, when performing skills for the first time. She was happy to do this, and we even had a nice talk about how she is going to try to get us students time and resources in the skills lab, as many times there is a huge gap between when we quickly learn a skill, check off, move on the the next skill, and have no exposure to it again until we go to practice it a semester or two or three later. Anyways, the "favorite" students were frequently checked-in on by her. Several times I spent my entire shift doing patient care or helping PT or wound care nurses with other patients (which is encouraged and within the rules in my program) without ever seeing her. I still obviously learned a lot without her around. This student that I had been helping out had been having issues I didn't mention, because I didn't mean for that situation to become a focal point of conversation, but since you seen curious she asked me questions that she should have done in prework, such as figuring out what her patients were taking certain meds for, or how to give certain meds. I am not saying that she deserved a lower grade. When we talked about our grades together, she said that she figured I would get the higher grade, as I am always prepared, know what is going on with my patients, know what to do (at this level), and she said that I seem to "have things under control all the time". So don't worry, I am not talking smack about her grade, I just felt that I earned a higher mark than what I got. I guess what -really- matters isn't so much my GPA as it is how well I learned and the progress of my competence. GPA is nice for choosing clinical placement during transitions, which is why I guess I am preoccupied with it... I don't feel that my impulse to want to change sites was necessarily rash, and in retrospect I kind of wish I had the opportunity to do that. There were some clinical groups that were able to observe surgeries, perform many skills, etc. I may (or may not) have had more learning opportunities, and I wouldn't have had to be on edge and avoidant of asking questions. You are certainly entitled to your opinion, and the way you stated it did not sound mean. At any rate, the situation is over, and I am looking forward to next semester, stressful as it may be at times, I am really enjoying it!

Thank you for the wish of good luck, and indeed I should not concern myself with the grades of others. I was glad for the other student's grades, but it is true that I compared mine to theirs. I (still) have to remind myself that nursing school uses a very different method of grading than any sciences I have taken previously, where the percentage directly correlates to comprehension and competence. An A is an A!! I am starting to get used to this concept :)

I sincerely do not believe I know more than my instructor, and I'm not entirely sure what part of my post implies that I do? Regarding her judgement of the situation of being committed to the notion that I was rifling through her things and her unwillingness to accept that perhaps I had actually not done this, is where I began to wonder about her judgement, and then when she commented that that she thought that I had perhaps been smoking in the elevator. (These are both very, very odd things to accuse a student of, no?) The reason I mentioned this student's grade as being significant is only because of how much help I had been giving her. There were many skills she did not know how to initiate, or terminology she wasn't familiar with, etc. She actually has told me that she wishes she could be more like me, in the sense that I sit down and study something until I understand it, and that I have confidence when I walk into a room, etc. I'm -not- saying I'm awesome. I do bust my butt to learn what I need to learn, and I am always open to improving and learning and being corrected when needed. I was nice to every person I encountered at the hospital. Even the grumpy doctor who is known for being hard on nurses and especially students. Despite the fact that I was frustrated with the misunderstanding I had with my instructor, I did actually thank her at the end. During clinical, we did make small talk, and I was polite and cordial with her. Never once was I rude, abrupt or dismissive. I was however paranoid at all times following the incidences I spoke about, that something similar would happen again (because of what happened, I was on edge because I felt she expected for me to behave inappropriately.) The group of us got her a nice card, in which I wrote "Thank you for sharing your knowledge and experience with us, see you next year" or something to that effect. We chipped in $5 each for a gift card for her. She sent an email to each of us, thanking us for a "great semester of clinical", and that the card and gift meant a lot to her. I hope that clears up my disposition. In my posting I included only "negative data" because this was my issue. When she did provide help, it was good help. Clean demonstrations and thorough explanations, extremely knowledgeable. But this was only when she made herself available, which was far less for me than for certain other students. I point out other student's grades to illustrate what I feel was favoritism and I only know about their grades because they kept carrying on about it, not because I asked or was even interested before they brought it up. I do agree, it is important to be nice to everyone, even those who seem to dislike you or seem to misjudge you. (I am, actually) And grade-wise, I do need to suck it up when I receive a grade that I feel is unfair. I think I have. The entire premise for my post is the false accusation issue, which I feel shouldn't even be a thing for a student to have to deal with. I don't think she is a horrible instructor, but it isn't ok to accuse a student of doing things like this, especially without proof or probable cause.

Do you have access to ATI? It can be tedious to go through it all and put in the time, but I have found it to be very helpful. If your school offers coaching, I would recommend that as well.

Update:: This clinical is now over. A few other things did happen that I feel shouldn't have, such as being passively being accused of smoking in the hospital elevator, as well the suggestion that I have ADD, and a statement indicating that she felt I would have problems managing 5-6 patients as an RN (I felt this was quite the assumption, as this statement was made after having only worked with me for 3-4 days, with contact compared to students she spent more time with). These things had a negative impact on my clinical experience. The worst being that I then was leery of the instructor's judgement, not just regarding assessment of her students, but I feared of the patients as well. So... I would ask hospital staff (mostly RNs) questions that I would normally direct to an instructor. I would only ask questions when they had time (I asked first whether they had a minute, or if I could ask them some questions when they were free, and learned quite a lot without being a nuisance), and I got some excellent feedback and information in this way. When my questions were very basic, and more suited to be asked of an instructor, I refrained from asking them at all. Prior to this, I had asked my questions freely, and she did comment in my weekly feedback form that my questions were excellent and informed, and that she appreciated that I was asking them. (My basic knowledge and prep work were also adequate, as per her feedback). After the accusations and ADD comment, I felt she was unapproachable, therefore asked very minimal questions. I felt that she also avoided me, or perhaps spent more time assisting her favored students, aside from meds. Feedback from nurses, CNAs, patients and families were all very positive. I was safe, thorough, professional, knowledgeable, personable etc. I asked nurses for feedback on my performance, and they were happy to provide it. This did help me to be successful in my clinical learning experience. (Of course I did not tell them that I was having a "personality" conflict for lack of a better term, with the instructor) Since my instructor was hardly ever with me and my patients, other nurses, families, etc, I feel that she was not able to assess my "student learning outcomes". During my review, she gave me several 4/5 scores. (Our scoring is 5/5, 4/5, 2/5 or 0/5, there is no 3/5 and 2/5 is a fail) When I asked her for feedback on what she would have liked to seen, or how she assesses her students for these criteria, she simply said she "Didn't see me meet the full criteria for 5/5" I did not want to argue with my instructor. I know that as a student, I of course (like any student) need to continuously work at perfecting my practice. As a nurse, I will need to continuously work to be the best I can be. I don't feel that I am remotely close to being perfect, as a season and experienced nurse would be. I feel that this clinical was very successful, though, and that as a student, I did quite well. However, of course she didn't see me work on my "student learning outcomes" because she spent almost no time with me. Despite this, I got a 90%, which for our school is still an A. The two students she worked with the most bragged about their 98%. Another student, who I helped quite a bit and struggled more than I, got a 94%. She was and still is very uncomfortable with patients (as she told me), and lacked confidence and well as understanding of labs, pathophys, skills. I do not resent that her grade was higher than mine by any means, and I do think she will make a great nurse eventually. The instructor did spend a good deal of time with her as well, but I didn't have the same struggles she did. I put a ton of time into prepping, into reviewing how to do skills I knew I would need to perform on my patient, understanding the pathophys and the meds, into digging into the patient history, as well as spending a lot of time just talking with and learning from my patients, and really doing thorough and appropriate assessments. In summary, I feel like this instructor had little faith in me due to her preconceptions. I just wish she had been willing to discuss our misunderstanding, as I feel that it led to her assumption that I would do something such as smoke in an elevator (I'm not even a smoker...), or that I have ADD. She was committed to her belief that I went through her personal belongings, which I feel led to other assumptions about my character and possibly intelligence, ability, mentality, etc., and not spending as much time with me. After I graduate, I plan to write her a letter explaining how that misunderstanding impacted my learning, because perhaps she needs to make fewer assumptions and work on conflict resolution (I will of course be tactful and non-accusatory about it). I hate to think of this situation happening to another student. Thank you for your comments and support, all of you who did so. I wish I had something more interesting to report.

Ugh earlier this semester, I had a presentation that was to make up about 3-5% of my grade. The topics were assigned, and unfortunately, all of the topics that were created for one student a piece were taken, so I had to take a topic I needed a partner for. She put it off, and put it off, while I say and worked on it, doing the research and put in the time. Each time I saw her, she would assure me she would work on it as soon as she got home (it was on google docs, so I could see whether she did anything) and she never did... It was a terrible boring topic, however I made it look excellent and got some great content. She ultimately ended up doing maybe 5% of the entire thing (IF that) It upset me that she was able to freeload off of my hard work. She did, however, get dinged a point for failing to look up from the screen while basically just reading the slides. I'd had the whole thing memorized.

Thank you all for the feedback. I spoke to a school counselor, who is also a Doc with 25+ years of experience, so I would think his perspective will carry weight. He will be talking with the academic advisor regarding my course of action. I also spoke with the Nursing coach about the situation, and she suggested writing an email to the instructor copy Dean of Nursing so he has some idea of what is happening (which I am petrified to do, seeing as how well communication went the first time around). I will be meeting with the counselor on Friday, after clinical. He said that in the meantime, I should document any additional occurrences, and avoid being alone- as in having other students and hospital staff nearby whenever possible. I will continue to focus on my patients, of course. I am still happy to receive any insight into this matter. This isn't the only issue I have had with her, but my OP is already painfully long. I am not the only one who notices her strange behavior. She makes odd comments in general, and is constantly nervously laughing. I think the best thing at this point, since she seems dedicated to just believing what she wants, would be for me to go to a different clinical site, so this is what I'm hoping for. Or I could be in for a lesson in conflict resolution with a party that is unwilling. Time will tell.

She may not have meant any offense. Loans really are a huge concern, and Nursing School actually DOES take up your free time (and often cuts into your beauty sleep) These days, my weekends consist of studying. All. The. Time. I dream about electrolytes and liver enzymes. I dream about patients scenarios. I find myself constantly assessing! I am 30, with no kids or husband, and I am still a bit overwhelmed at times. The good news, is that many schools offer a part time program, and/or summer classes. If you were to take 2 classes at a time, you might just have an easier time being both a good student, and paying enough attention to your family. I would really look into part-time, if I were in your position. I love nursing school, you will be amazed at how fast you grow. First semester can be a bear though, just be ready to give it all you've got :) Don't let other people's assumptions about you keep you down.

So I have a "situation" with my clinical instructor. This happened last week, and I have purposely waited until now to seek help because I was pretty upset by what had happened. I need some advice on how to handle this situation, as it is a very peculiar one. For clinical we are to do prep work, as per usual med-surg or any other clinical. We were told that our assignments would be posted at a specific time the day before clinical. Knowing this information, I decided to go to the site to check over the paperwork that had been corrected, to have some time to evaluate my mistakes and reference my lab book and pathophys, which was about 90 mins before our assignments were to be posted. When I arrived I asked the instructor if I could get my graded paperwork, and she sent me to the back of the room, where she gestured, to go get it. I looked around for a moment, and found a folder sitting next to her bag. I did not find the graded paperwork inside, but did find the weekly evals. I heard her phone vibrate, and made a note to myself to let her know. I let her know that I only found the evals, but not the paperwork, so she and I return to the back of the room, where she picks up the same folder I had been looking in, and states that she hopes she didn't leave that paperwork at home. I mention to her that I heard her phone go off, and she passively acknowledges it, still looking around for the paperwork. It was on a different shelf, higher up and to the side, not in obvious view. She hands me my work, and I went back to where I was seated to look it over. After a few minutes, she asks if I would like to take room ****, and I say sure! I knew that at a certain time, I would be able to go and read my assignment, I had expected to wait for it patiently, so I was excited to be able to start my research early. The day progresses on, and at one point she has left the room to be with her clinical group. I remain there for a couple of hours, as other students filter in to prep. Finally, I am through with my research about my patient, and I go to find the instructor on the floor to clarify some things about the way I had done my paperwork, and I waited and stayed out of the way until I was sure she wasn't busy. (By the way, she did tell us we would be allowed to ask her questions during prep if she had time) We are having a normal conversation, and she tells me what she would like me to look up and learn. I tell her thank you and that I will go home to figure out what I need to. This is where it gets bizarre. I am about to turn back to her, to give her a "Thanks, see you tomorrow" and she meets me with this strange look and these words "Ah, I don't appreciate you looking through my bag." Oh course, I am dumbfounded, and just look at her for a moment. I told her that I hadn't, with a questioning inflection. She held her death stare and insisted that I had, because that folder was inside of her bag. I explained that I had found the folder sitting next to her bag. She insisted that this folder was inside the bag and that the bag had been closed. And also that I knew her phone had rung. I was even more dumbfounded, and defended myself "I really did not touch your bag, and that folder was actually sitting next to your bag." Her response was to take a step back, and say "So" in the wierdest way... I said "I can assure you that I wouldn't touch anyone's things without permission" to which she again said "So" I don't remember what else I said, because I was honestly quite shocked. I have NO idea what to make of this situation. If I were an instructor, I would not trust a student who I knew (for a fact) had been snooping in my bag, touching my things without permission, and looking at my phone. THIS is why I was rather upset. Is it possible that she is trying to test my resolve? What if she really does believe that I am that kind of person, who snoops, disrespects privacy, and then apparently lies about it? I feel that some kind of intervention might be needed, I don't know, with another teacher or something, or other professional? At a later time, she accused me of smoking a cigarette on campus, because the elevator smelled like cigarettes and I had just helped bringing a discharged patient down to valet (which is pretty crazy, since it would make sense to ask valet whether a student was smoking on campus with a patient in a wheelchair rather than make accusations, AND there is no reason to think I smoke... which I don't...) I would LOVE to hear from an instructor!! What course of action should I take? What if she really believes I am not a trustworthy and intrusive student? I fear my grade here is in jeopardy! I have already resolved to not be alone on the floor when possible, so that someone can vouch for me. And I'm sure there is probably some sort of permanent file, which I don't need misrepresentations of me residing in... I would also LOVE to hear from another student that has been in a similar situation. Any and all help is much appreciated.