re: failing final practicum at mid-term

[hopeless13]

so i am looking for advice on how to improve and show initiative now given my situation.

I learned at midterm that I am failing my final practicum in the ER. This floored me.

I had a discussion with my preceptor where she asked me how I thought I was doing. I replied that I felt like I was a 'step behind' where I thought I should be. And that I was working to improve my assessment skills so i could be quicker. She asked me how I felt my prioritization skills are and replied that I felt like I was still grasping how this works due to the way that prioritization changes quickly in the ER. I also said that I wanted to take on more responsibility.

She replied that she had felt that I should have taken on more responsibility on the previous week and she felt I should be taking care of my own acute ER patients on my own now. (she had not given me an assignment of my own patients). She said she wasn't sure about my clinical knowledge as I often get answers to her questions correct but she is not sure if I am guessing. At the end of this conversation I reminded her of the need for a mid-term evaluation in a week. she replied that given the progress so far she would be assigning a failing grade but was hopeful that we could work together to be successful.

I had asked for more responsibility although maybe I was too subtle. Anytime I asked if I could do more to help she replied ("not right now we are busy and I am just trying to clear patients"). I tried to restock and run and get things whenever possible. I ask about placing foleys and doing labs etc whenever possible (often she just wants things done fast but sometimes asks if I want to do them). I try to run labs (to tube them) whenever possible (she wont' let me place the labels on them)

My preceptor doesnt ignore me. She does spend time to discuss prioritization and asks me questions about why MDs place orders and what specific drugs are used for. our rapport together is good.

the few days after the conversation I noticed my preceptor spent more time quizzing me on assessments before I did them (often this was just asking me what I would ask "why" and saying "no" or "what next" - I can't emphasize how intimidating this is). She removed my ability to write notes and instead has me write them down on a scrap of paper and then critiques them word by word.

This is the first time she has been a preceptor. (I think she is an amazing ER nurse)

After learning I was going to fail I informed my school and the school contact (who meets with the preceptor and myself a few times a term). The school was relatively supportive and has been suggesting I switch preceptors to something on a med/surg floor. They will also require I do a bunch of remediation sessions in lab to prove I can do the basic skills a nurse does.

I am grateful to the school for supporting me. I am grateful for having a preceptor who teaches and discusses management etc.

But I am wondering if anyone has advice on what to do differently and how I should show more initiative and take on more responsibility. I know I could just say "i'm ready for more" (I was hesitant to do that more here because I was nervous about why I wasn't being assigned more - I realise now I should have been more aggressive than just asking how I could help more - I should have clearly stated that I needed to take on more responsibility)

I also realise that I should have been more proactive and approached my preceptor to 'check in' with how I was doing much earlier - like after the first day or two - and then I wouldn' t be in the hole I am in

as a result of all this I am pretty anxious. I have lost confidence in my skills and am looking to rebuild these.

I really wanted to do ER nursing. I love the ER. I like the pace. I like working with diverse populations. I like the quick assessments and the management/prioritization. I realise I may need to do a year or more of med-surg before looking to ER nursing now (even though this ER is hiring entry level nurses). I am in Canada so nurse residencies aren't a thing here (although i am looking at what courses I can do post-grad). I already have ACLS and will look towards doing PALS.

of course I am a bundle of nerves now and am wondering if nursing is really 'for me'. I have spent a lot of time in reflection on this - although i am also committed to finishing the degree (this is my last placement).

I know allnurses has a habit of chewing up failing nursing students. I'm fine with that. but please consider any advice and feedback you might have for me to show initiative and gain more from this experience.

sorry about the long post. Thank you for listening.

[meanmaryjean, DNP, RN]

I know I could just say "i'm ready for more"

^^ do so ^^

[Triddin]

I would make a detailed learning plan about the areas you want to work on- include skulls and areas like prioritizing and critical decision making. At the beginning of the shift, discuss with your preceptor which goals you want to work on and what you think that looks like. For example " today I want to work on increasing my nursing responsibility. I am going to take on full care of 2 patients (excluding what you aren't allowed to do). I will report back to you my assessment findings and we can discuss my assessments and lab work together. I will ask for help if I need it or feel uncomfortable with a situation, but otherwise I will do full care."

A lot of being a preceptor student is communicating your learning needs clearly, not waiting for your preceptor to notice. You've learned this lesson a bit late but that doesn't mean you won't be successful in the end. I honestly think it will be better for your practice in the long term to do some med surg. You'll have more consistency with having the same patients instead of admitting and discharging frequently.

It is true we can be hard on students, but it's almost always on the students who haven't reflected or don't see that they are at fault for having failed. You've clearly done that. Best of luck in your second semester and definitely post if you have questions!

[silenthunder]

This seems like you have reflected on this. continue to do so.

It also sounds like you may not have been prepared for the ER - or at least you may have seemed that way to your preceptor. It sounds like you are being transferred or something so make sure you work on your communication with your next preceptor.

as the above posters said : plan out your learning with your preceptor. You asked about the initiative - so this is how you can do it - and clearly ask for more responsibility if you need to - it may just be as simple as your preceptor being a bit busy and not realizing that you can take on more. If it is like the situation in the ER they will also tell you if they don't trust you with responsibility and then you can work to build that trust.

[hopeless13]

I wanted to update this in case the respondents were following.

I had my mid-term evaluation with my preceptor and my faculty liaison today.

My faculty Liaison made it very clear to me afterwards that the standard the preceptor had for me was too high. The evaluation was needlessly punitive :it mentioned things like not being as quick as ER nurses when setting up ekg leads and setting telemetry/monitoring etc. and programming a pump (I'll admit sometimes I need to pause to figure out equipment) ; there was mention of breaking the sterile field when placing a foley ( no mention of the foleys I placed without an issue though...). etc.

I will admit that due to the punitive nature of the comments I asked some questions for clarification - and the preceptor expected that after having been guided through the process once and doing it another two times on my own I should be at the same level as others in the department. I'm not sure if that is fair. I'm not the best person with hands on skills. i also tend to go slow for safety before letting myself speed up. I'm still trying to figure out if this is a fair assessment of my skills.

I took extensive notes and there are areas I am going to try to improve on - but it was clear that the preceptor was either trying to get me to quit or else she just beleives a student should be at the level of a nurse by the time they make it to the final placement - either way I don't know if I could meet that standard.

BUT: that doesn't stop me from racking my brain and playing the WHAT IF game.

I'm going to make myself improve from this, but I am also going to try to assimilate all the feedback I had.

Unfortunately one thing I am going to spend a bit of time reflecting on is that this is the second experience like this I have had and I am wondering if I am being targeted because of being different than other students (i'm not going to say how - its along the lines of physical/age/gender etc.) . I am also wondering if I might be better off not pursuing nursing further than my degree because I will keep experiencing this discrimination in the profession.

I have also explored the idea that I might have a bad attitude and a personality issue (I have literally spoken to a therapist about it). I have spoken to other instructors and colleagues and none have validated this idea - although I am still 'working on myself' to improve on my people skills (just because thats something I have worked at for the last few years)

thank you to all the commenters - sorry about my long posts I'll try to make them shorter in the future.