So I have heard time and time again from nursing professors and clinical adjuncts that "4.0 students often have a hard time transitioning to the floor, B or C students make better nurses". While I totally get that there are some people out there that are so cerebral that they don't do well on the floor, I think this blanket statement is a bunch of bunk.
I bring this up because I am a 4.0 student. I am also involved in clubs and student groups, volunteer outside of school, and often get complimented in clinicals. However, even with that I still hear the comment over and over that A students don't make as good of nurses as B and C nurses.
What do you nurses who are actually out there on the floor think?
Lucky me, I was a CNA for 8.5 years in the 80's in a nursing home. In the old days, we got on the job training. They still were allowed to train LPN' snad RN's on the job, but as time went on, lobbyists have made it so everything has to come through the colleges first, so now you have RN's who have never been a CNA first. My last job, I was helping another nurse get a urine sample via straight cath and she didn't know how to roll the pt back and forth to remove wet chucks. She tried to yank it out causing skin abrasions.
That's just bunk. Although I have worked with BSN and even MSN educated nurses that can't even place a Foley. I think it has all to do with your willingness to work with your hands as well as your head.
My unit hired quite a few new grads in the past 2 years. All were "A" students in nursing school since it is a very competitive program to get in. Not all did well. Those who did better were the ones who asked questions and did not act as "know it all"; also those who had life experience and were mature enough to handle stresfull situations and difficult personalities (both staff and patients).
The same would have been true if all the new grads hired were B and C students. Some would have done okay, others would not have. It's not like the B students would have all failed because they were more "book smart" than the C students, and the C students would have excelled over them for the mere fact that not making higher grades conferred some sort of magical ability to be better nurses.
Once upon a time (several weeks ago) I had a s/p CABG patient unexpectedly convert into atrial fibrillation with RVR and the Lopressor I prescribed was not touching her and her heart remained ticking away in the 150 BPM range. Her BP dropped to 78/52 from her original 132/80 after I gave her 5mg total, with advice to the RN (with 20 years experience) to push it in 2.5mg intervals to avoid sudden hypotension; but alas, sometime each person's sympathetic nervous system just has a mind of its own. With nervous eyes, the patient asked me if she would be okay. I sat on her bed held her hand the entire time and promised her that what she was experiencing was normal...she noticed the cross on my neck and asked if we could pray, so we did. One 250mg bolus later, and after a touch of Amiodarone, her BP stabilized, and her heart rate finally eased to a moderate 80 BPM while she gently converted into a NSR soon after. She thanked me for making her feel safe.
At that moment, she did not see me as the top of my class from a highly respected BSN program in the Midwest. Nor, did she see me as a 4.1 GPA alumni of the #1 public nurse practitioner school in the country who was recently inducted into the top honors society for all disciplines across the entire United States. She saw me for a person who was there to help her during her time of distress, and that is all that I am.
Oh, and did I mention that the experienced RN still looked for my guidance during the situation...even though I just turned 26.
Just making a point. We are all here for one reason - to subtly change the world one patient at a time. We need to embrace the unique gifts of each nurse in our profession and work together to truly make a difference.
I have been in nursing education for years. There is no correlation between grades and compassion. I have had A students that are absolutely wonderful at the bedside. I have had A students that were too analytical at the bedside to give care appropriately. I have a had the same situation with B and C students. The didactic grade is how well you test....How well you apply what you know.... Clinical is actually doing it. Not just talking the talk but walking the walk... It's hard to have it all no matter your grade.
Specializes in Med Surg/ICU/Psych/Emergency/CEN/retired.
I have been in nursing education for years. There is no correlation between grades and compassion. I have had A students that are absolutely wonderful at the bedside. I have had A students that were too analytical at the bedside to give care appropriately. I have a had the same situation with B and C students. The didactic grade is how well you test....How well you apply what you know.... Clinical is actually doing it. Not just talking the talk but walking the walk... It's hard to have it all no matter your grade.
I think it has to do with being flexible and able to bend the rule sometimes to get things done. I noted it too. High academic achievers tend to be very disciplined, detailed, to the point of OCD, they follow directions very well and perform their tasks diligently. On the floor things are chaotic, decisions are constantly made, remade, discarded and rules are violated. The toxic culture of the floor nursing shocks high achievers as they try to cope with the environment that is very very different from what they learned in school. Real life nursing is the opposite of textbook nursing and it doesn't come with the student manual.
I have done some teaching -- but mostly have worked with student externs and new grads as a Staff Development Specialist. This is a big, important topic for me. This is my perspective:
1. I don't like to generalize too much because I believe it is a matter of personality that varies from individual to individual.
2. However, I have definitely seen a constellation of troublesome behaviors in many students and new grads with exceptionally high GPA's that can make it the transition period difficult. For me, the super high GPA is a "red flag" that warns me to pay special attention to this person so that I can help him/her avoid some of problems I have seen. Those problems include:
A. Not accustomed to receiving negative feedback -- and therefore, not responding to it well. Sometimes, they over-react and blow it out of proportion. Other times, they refuse to believe they need to change. It's particularly bad if the negative feedback comes from someone whose educational level or perceived intelligence level is below theirs. They "consider the source" and disregard the valid critique.
B. Competitiveness. They are used to being #1 and don't like it when other orientees are doing better, receiving more praise, progressing faster, etc. Not being used to that situation, they may not cope well.
C. Dislike of ambiguity. They are used to knowing the right answer -- and real nursing doesn't always have "1 and only 1 right answer."
D. Paralysis due to fear. They are afraid to act until they are 100% sure because they are afraid to take the risk of being wrong or making a mistake. So they double-check everything ... and then check it again ... and then ask for a 2nd opinion before they do anything. So they can be exceedingly slow and not get their work done on time. I remember 1 case in which the new grad was just too afraid to do anything on her own at all. Nursing requires well-reasoned risk-taking and more than a little bravery.
E. Sometimes, the behaviors rewarded by faculty members (with praise and good grades) are not appreciated by staff nurses and preceptors. Example: Asking too many questions, raising controversial issues or challenging the nurse at the wrong time, getting extra double-checks before doing anything, reporting possible deficiencies in the practice of others, etc.
F. Some can be dismissive of people who they deem less intelligent or less hard-working or in some other way lacking. Since they were not satisfied with "B's," they don't respect people who were happy to get "B's." Attitudes like that don't lead to good teamwork. Teamwork is critical for a successful unit -- and anyone who doesn't fit in well with the team is a "problem employee."
As a person who has always achieved high grades, I have to admit that most of this is true. Your C. And D. were the big ones for me when I first started, although on D., I was very efficient, so slowness wasn't the problem. I think that's why it took me about a year and a half to feel comfortable with ambiguity and to stop asking for second opinions often.
Negative feedback still makes my mouth go dry instantly...a frighteningly real fight or flight reaction. I'm not sure where that comes from, but I do know that as a lifelong high achiever, anything less than perfection was met by my parents with a disproportionate anger and disappointment, followed by the silent treatment, that scared me. (My parents didn't win any rewards for their nurturing skills.) Because I'm now in my 40s, I can control the outward reaction to negative feedback with maturity, but inside, I'm still the 10 year old girl who feels worthless. I don't think I'll ever get over it.
With F., I do have issues with lazy people. Because I tend to doubt myself, there are relatively few people I deem less intelligent; I genuinely feel I can learn something from anyone.
Negative feedback still makes my mouth go dry instantly...a frighteningly real fight or flight reaction. I'm not sure where that comes from, but I do know that as a lifelong high achiever, anything less than perfection was met by my parents with a disproportionate anger and disappointment, followed by the silent treatment, that scared me. (My parents didn't win any rewards for their nurturing skills.) Because I'm now in my 40s, I can control the outward reaction to negative feedback with maturity, but inside, I'm still the 10 year old girl who feels worthless. I don't think I'll ever get over it.
It's up to the individual to define who they are as a nurse..what other's say or think doesn't define who you are as a person..there are good and bad nurses everywhere..'A' to 'D' nurses is a matter of choice. If you are there to serve then you are there for the right reasons.
I did a new grad critical care residency program. Every single one hired had top grades. To read some of these posts, I would have to conclude that most of them couldn't function in the unit. But that wasn't the case. Everyone transitioned from classroom to unit to solo practice very well, with the exception of one. That individual ended up "not working out." But the reason wasn't that she was too book smart and unable to apply her knowledge to practical situations. It was because she called in constantly. After being given an appropriate amount of opportunities to remedy the situation with no luck, the unit manager fired her.
I've never heard that B and C nurses do better on the floor. What I have heard is that know-it-all types do worse on the floor when they realize that no, they DON'T know it all, compared to people who come into nursing with the mindset of knowing what they don't know (which, when you're fresh out of nursing school, is just about everything). Many of those with know-it-all attitudes are the ones with the straight-A's. But I've seen B students also have this attitude, so who knows?
Focus on what's important - taking care of the patient. If you don't know something, ASK. Don't let pride get in the way - you know how many times I've been 99.9% certain of something only to be proven wrong about it later? Had I not asked, I could have possibly caused a patient harm.
Apologies for getting a little off topic, but I felt it to be relevant.
whisperingsage
55 Posts
Lucky me, I was a CNA for 8.5 years in the 80's in a nursing home. In the old days, we got on the job training. They still were allowed to train LPN' snad RN's on the job, but as time went on, lobbyists have made it so everything has to come through the colleges first, so now you have RN's who have never been a CNA first. My last job, I was helping another nurse get a urine sample via straight cath and she didn't know how to roll the pt back and forth to remove wet chucks. She tried to yank it out causing skin abrasions.