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Struggling with an unmotivated clinical group

Has 10 years experience.

I have a group of students this semester who are really challenging. I've never had such a difficult group. I laid out my expectations at the beginning of the semester and every day at preconference we discuss the goals for the day. However, I still end up with groups of them congregating at the nurses station needing redirection. Often they haven't met the goals for the day and are just chatting. Other instructors tell me it's not me, this group is just particularly challenging. I'm not a newbie instructor, just really frustrated and feeling ineffective at this point. Anybody have words of wisdom?

Have you given any one an unsatisfactory for failing to meet expectations? That might get there attention that this is serious. Particularly if this group has a history of this type behavior.

Do you have midterm clinical evaluations? Slam 'em on their midterm evaluations and explain why. If they don't shape up, they'll fail the rotation. It's their choice.

If the other instructors are aware of this issue with this group, how have they made it this far in the program? What has or hasn't worked for the other clinical instructors? Have they been doing this previously without being held accountable for the behavior?

emtb2rn, BSN, RN, EMT-B

Specializes in Emergency. Has 21 years experience.

Written warnings, if not already done, then unsatisfactory/fail them if no improvement within the week. Clearly document everything.

nursemeanie

Has 10 years experience.

Midterm evals are this week... They will definitely get the message after that!

I think their last clinical instructor was lax, and that's what they got used to. Their evals will be a wake up call for

sure.

According to the other instructors, it is not just my group, I should have clarified. Other instructors are facing similar issues with their students, to the point that some are not teaching again in upcoming semesters. There is support from the school, but it's just draining to have to deal with!

llg, PhD, RN

Specializes in Nursing Professional Development. Has 43 years experience.

I agree with the previous posters. Hold them accountable.

It's not being mean, it's giving them honest feedback so that they can learn correct behavior. You wouldn't give fake feedback to a patient who needed the truth in order to get better. Care enough about the students to give them the correct feedback now -- in the middle of the course, not just at the end.

"God made bad grades and negative feedback for a purpose."

I had a clinical instructor who would not say a disparaging word to a student until she had them in her office at the end of the term and she was telling them that they failed clinical. Do not be like this! Slam them now and you will get the attention of those who want to succeed. And that will be fair.

rnsrgr8t

Specializes in Peds Urology,primary care, hem/onc.

You have to hold them accountable. They seem to be testing you and not very invested. I would request they come 30-40 minutes earlier to clinicals - have a little "come to Jesus" talk with them. Be firm but don't yell. Give them a written summary of your concerns. Tell them that you will be watching them closely that day and to consider the meeting their warning. If they still muck around, then you fail them. Its tough, but does not seem like they are listening to you. They seem very immature. Maybe no one has ever held them accountable? What is the feedback from the nurses on the floor?

BeenThereDoneThat74, MSN, RN

Specializes in Pediatrics. Has 25 years experience.

I feel like over the last couple of semesters, I have encountered more students like this. I also feel like they are 'getting by' in the previous class, because I can't imagine that they suddenly inherited these behaviors over the break. While the students do need to be held accountable for their actions, I feel that when the standard of professional behavior is not set in the first semester, then these habits are very hard to break.

As for the students, you have to be the "mean one", as I find myself having to do more and more. After one or two general conversations about professional behaviors, I need to then single out the individuals (privately, of course). The other day, I ended up doing it in front of the entire group (as we were in a public area, and I needed to put it to a stop). The student flashed me a pathetic, pouty "why are you yelling at me" look.

You're stuck with them, so please consider this advice FROM A NURSING STUDENT because it will make this whole experience better for you and your students.

Compliment your students on every little thing that they do right.

As a nursing student, even one small compliment from a professor will keep me motivated an entire year. Discipline and negative reinforcement, even one occasion, is what drives students to slack, get unmotivated, and even consider quitting nursing. All humans have one thing in common that differentiates us from any other animal, and that is to feel appreciated.

My reference for this is "Dale Carnegie - How to Influence People and Win Friends." I learned this concept of appreciation, and never fail to appreciate anyone. My life has changed dramatically and I have started my own business while in school. And no, I am not selling this 30 year old book.

I really hope you don't listen to others in this thread about discipline. It will not help at all to motivate them to do anything.

Edited by traumaRUs

You're stuck with them, so please consider this advice FROM A NURSING STUDENT because it will make this whole experience better for you and your students.

Compliment your students on every little thing that they do right.

As a nursing student, even one small compliment from a professor will keep me motivated an entire year. Discipline and negative reinforcement, even one occasion, is what drives students to slack, get unmotivated, and even consider quitting nursing. All humans have one thing in common that differentiates us from any other animal, and that is to feel appreciated.

My reference for this is "Dale Carnegie - How to Influence People and Win Friends." I learned this concept of appreciation, and never fail to appreciate anyone. My life has changed dramatically and I have started my own business while in school. And no, I am not selling this 30 year old book.

I really hope you don't listen to others in this thread about discipline. It will not help at all to motivate them to do anything.

Speaking as someone who has taught nursing clinicals in a few different schools over the years, I have a few different thoughts on this.

First, I agree about positive reinforcement, and have always made a point of providing positive feedback to students at nearly every opportunity. The students I have had would always freak out the first time they got paperwork back covered with notes from me, until they read through it and realized that at least half of my notes were positive feedback and compliments on their work, useful information, etc., and not just criticisms.

However, there is only so much complimenting and appreciating you can do when students are failing to meet the basic expectations/requirements of the course. Many of the students seem to sincerely not "get" what is expected of them, and someone has to explain this to them. How much is the instructor supposed to compliment students for standing around the desk doing nothing??

And last, I don't see it as my job to "motivate" adult students to do anything. They presumably entered nursing school because they want to become nurses. If they don't want to become nurses, or don't want to do the work necessary to do so, that is perfectly fine with me and they are welcome to withdraw (or flunk out, if they prefer). But how and why is it my job to convince unmotivated students that they should want to be more involved and do better? If they want to meet the requirements of the course, I'll be glad to help them to do so in any way that I can. If they don't, that's their choice.

Edited by traumaRUs

Speaking as someone who has taught nursing clinicals in a few different schools over the years, I have a few different thoughts on this.

First, I agree about positive reinforcement, and have always made a point of providing positive feedback to students at nearly every opportunity. The students I have had would always freak out the first time they got paperwork back covered with notes from me, until they read through it and realized that at least half of my notes were positive feedback and compliments on their work, useful information, etc., and not just criticisms.

However, there is only so much complimenting and appreciating you can do when students are failing to meet the basic expectations/requirements of the course. Many of the students seem to sincerely not "get" what is expected of them, and someone has to explain this to them. How much is the instructor supposed to compliment students for standing around the desk doing nothing??

And last, I don't see it as my job to "motivate" adult students to do anything. They presumably entered nursing school because they want to become nurses. If they don't want to become nurses, or don't want to do the work necessary to do so, that is perfectly fine with me and they are welcome to withdraw (or flunk out, if they prefer). But how and why is it my job to convince unmotivated students that they should want to be more involved and do better? If they want to meet the requirements of the course, I'll be glad to help them to do so in any way that I can. If they don't, that's their choice.

I never said to not provide them with educational feedback. I completely agree with you on this point and am glad you are providing them with positive reinforcement. Educating them is certainly not negative. What I'm saying is to not use discipline as your main tool if you want your students to respect you and to motivate them.

I have to somewhat agree and disagree with motivating students as being part of your job. Although it most likely isn't in your job description, it would make a world of difference to a student if you were to apply this in your teaching. You're doing the students a favor, it really doesn't take any effort, and you could make great nurses out of them.

Isn't it better to provide a few encouragements and motivate a student, than have these same students most likely obtain the degree and take out their lack of motivation out on their patients? It's not that hard to pass without motivation, believe me. I know plenty of people who loathe nursing and get the best grades in the entire class.

And to answer you on how the instructor is supposed to compliment them when they're doing nothing, you have to compliment them when they're doing SOMETHING. This will make them more likely to do SOMETHING. You can say something like, "Good job on finishing all of those vitals early," "Good job on cleaning up the unit when you have nothing to do," or "I really like how you sit down and talk with patients." Now tell me, when you were in nursing school and if an instructor were to tell you these things, what is the likelihood you would do it again? For me, it's 100%.

I'm not one to judge, and I wouldn't blame you if you have any resentment against nursing students. Most of us just "don't get it." But I'm sure that you were in the same situation in nursing school as well, and I really hope you find the patience and the time to take my advice, even though it's coming from a nursing student.

vintagemother

Specializes in Med-Surg, Psych, Geri, LTC,.

Hmmm....I wonder how your employer truly views this nonchalant behavior. I ponder this because of my own experiences. In terms 1 and 2, for LPN/VN school, we were asked not to congregate in groups. However, we weren't really allowed to do much on the floors without an instructor present.

Therefore, ones grades weren't impacted by not doing much.

Conversely in terms 3/4, in an RN program, we have to care for 2/3/4 pts and our instructors take "report" from us to ask us tons of questions about the pts labs, hx, presenting symptoms, plan of care, expected discharge, etc.

In this setting, you will fail clinicals and fail the program if you don't do the work required.

For this reason, I have never (ok, super rarely) had time to hang out with my fellow students on the floor.

Furthermore, the staff nurses seem to know our instructors expectations and they ask us, how many pts are you taking today. Then, they hand over care.

We also have required and recommended skills and check offs that force us to do nursing stuff and have our instructor or a staff nurse sign off on.

And to answer you on how the instructor is supposed to compliment them when they're doing nothing, you have to compliment them when they're doing SOMETHING. This will make them more likely to do SOMETHING. You can say something like, "Good job on finishing all of those vitals early," "Good job on cleaning up the unit when you have nothing to do," or "I really like how you sit down and talk with patients." Now tell me, when you were in nursing school and if an instructor were to tell you these things, what is the likelihood you would do it again? For me, it's 100%.

I'm not one to judge, and I wouldn't blame you if you have any resentment against nursing students. Most of us just "don't get it." But I'm sure that you were in the same situation in nursing school as well, and I really hope you find the patience and the time to take my advice, even though it's coming from a nursing student.

I don't see any reason to compliment students for doing something that is a basic expectation of the clinical rotation. I'm an adult, nursing students are adults, and, when I've taught nursing, I've treated the students like adults. Your examples sound like the "everyone gets an award for showing up" approach that people use with small children that many of us feel has contributed to the current sorry situation with so many nursing students. They've spent their whole lives being praised for doing things that are no big deal, nothing special, the basic, minimal expectations for getting through the day. I'm not buying into that.

I wasn't "in the same situation in nursing school" because neither I nor any of my classmates were ever slacking off in clinical. We were expected, from day one, to find something constructive to do in clinical if we weren't directly involved in the care of our assigned clients, and we did. We were corrected by our instructors if we weren't taking the initiative to stay busy and meet the school's expectations in clinical, and nobody thought there was anything wrong or harmful about that. We didn't get praised by our instructors for meeting the basic expectations of the clinical rotation; we were expected to function at a much higher level than that, and most of us did. I've always found high expectations to be much more energizing and motivating than empty, meaningless "compliments." But maybe that's just me.

I don't see any reason to compliment students for doing something that is a basic expectation of the clinical rotation. I'm an adult, nursing students are adults, and, when I've taught nursing, I've treated the students like adults. Your examples sound like the "everyone gets an award for showing up" approach that people use with small children that many of us feel has contributed to the current sorry situation with so many nursing students. They've spent their whole lives being praised for doing things that are no big deal, nothing special, the basic, minimal expectations for getting through the day. I'm not buying into that.

I can see your point of view and I agree with you. Adults should not expect praise for doing the things that they are expected to do.

However, what do you do when adults don't want to do these things? These students are paying the school to work in a hospital for free full-time and/or part-time, have lectures to attend to, most likely another job on the side, maybe even kids. Then imagine receiving criticism after going through hell in lectures, exams, and the job on the side that you have that actually pays. I can see their point of view as a nursing student.

My point is, even adults act appropriately when given positive reinforcement. There are many studies to back this up, and all of them show that positive reinforcement and appreciation = more money for the company, more happiness for the employer, and more happiness to the employees. I did the research because I'm starting my own business.

I don't see how it could negatively affect the students and the clinical instructor, at all, by giving them this positive reinforcement. However, I can see a multitude of ways it could end badly by punishing them at every turn.

I think you're imagining a bunch of whiny students who won't do anything if they're not complimented on wiping their own butts. That's not the case, at least most of the time...

I can see your point of view and I agree with you. Adults should not expect praise for doing the things that they are expected to do.

However, what do you do when adults don't want to do these things? These students are paying the school to work in a hospital for free full-time and/or part-time, have lectures to attend to, most likely another job on the side, maybe even kids. Then imagine receiving criticism after going through hell in lectures, exams, and the job on the side that you have that actually pays. I can see their point of view as a nursing student.

My point is, even adults act appropriately when given positive reinforcement. There are many studies to back this up, and all of them show that positive reinforcement and appreciation = more money for the company, more happiness for the employer, and more happiness to the employees. I did the research because I'm starting my own business.

I don't see how it could negatively affect the students and the clinical instructor, at all, by giving them this positive reinforcement. However, I can see a multitude of ways it could end badly by punishing them at every turn.

I think you're imagining a bunch of whiny students who won't do anything if they're not complimented on wiping their own butts. That's not the case, at least most of the time...

Here's how it could end badly... The student gets a compliment (like they are a child) then decides from that compliment they are excelling at clinicals and don't need to do anything more. Then they stand around even more.

Another compliment? "Wow! I'm really doing everything right this semester. No need to change any of my behavior." = Continues being useless on the floor.

They are students, not children. If they don't deserve a compliment, then they shouldn't receive one as some sort of backhanded way to attempt to make them useful during their shift.

Nurse Leigh

Specializes in Telemetry.

These students are paying the school to work in a hospital for free full-time and/or part-time, have lectures to attend to, most likely another job on the side, maybe even kids.

Could you please explain this part of your post further? Specifically the part about the students paying the school to work in a hospital for free.

Pixie.RN, MSN, RN, EMT-P

Specializes in EMS, ED, Trauma, CNE, CEN, CPEN, TCRN. Has 12 years experience.

I'm an adult, nursing students are adults, and, when I've taught nursing, I've treated the students like adults. Your examples sound like the "everyone gets an award for showing up" approach that people use with small children that many of us feel has contributed to the current sorry situation with so many nursing students. They've spent their whole lives being praised for doing things that are no big deal, nothing special, the basic, minimal expectations for getting through the day. I'm not buying into that.

If I could like this 1,000 times, I would. This participation-trophy mentality is fostering some really weak individuals. "Congratulations for breathing today!" Nope.

I am all for the "sandwich method" of feedback, but that requires that both bread and sandwich innards be present.

Could you please explain this part of your post further? Specifically the part about the students paying the school to work in a hospital for free.

Gladly.

I'm a nursing student in Ontario. We literally pay the school $800-$900 a semester to work in a hospital once a week during the semester, and a whole month at the end of the school year full time. Every other program gets paid $17 an hour for co-op, we pay the school for this "learning experience," working as PSWs for the most part. I get to do medications maybe three times a semester (if lucky), any other skills once a semester, and just clean patients up 99% of the time.

Here's how it could end badly... The student gets a compliment (like they are a child) then decides from that compliment they are excelling at clinicals and don't need to do anything more. Then they stand around even more.

Another compliment? "Wow! I'm really doing everything right this semester. No need to change any of my behavior." = Continues being useless on the floor.

They are students, not children. If they don't deserve a compliment, then they shouldn't receive one as some sort of backhanded way to attempt to make them useful during their shift.

You're seeing this black and white.

Again, positive reinforcement for positive actions. Tell the student to do something, say "good job," and chances are they'll take the initiative to do it again. It's been proven in many studies in many workplaces that showing appreciation to unmotivated workers increases company profit and worker satisfaction.

I understand everyone dislikes "laziness," especially nurses and professors. But if you want to fix laziness, award them when they're not lazy.

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