Struggling with an unmotivated clinical group

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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?

Specializes in Critical Care, Med-Surg, Psych, Geri, LTC, Tele,.

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.

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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.

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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...

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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.

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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.

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Specializes in EMS, ED, Trauma, CEN, CPEN, TCRN.
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.

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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.

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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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Specializes in EMS, ED, Trauma, CEN, CPEN, TCRN.
It's been proven in many studies in many workplaces that showing appreciation to unmotivated workers increases company profit and worker satisfaction.

Read "Why Nothing Works" by Harris. A fascinating look at the shift in our culture in which people have become uninvested in their companies' products.

But we're talking about students, not workers. Workers are extrinsically motivated by a paycheck, among other things. Students have to want to be there. If they don't show the desire, their lack of academic success or lack of degree completion is on them.

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Specializes in Telemetry.
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.

So because the school receives money from you, you are entitled to compliments when not truly deserved?

And only passing meds a few times in a semester and doing a lot other types of patient care is not uncommon. But you are not working for the hospital or making things easier on them.

People earn both compliments and criticisms. Lessons can be learned from both.

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Specializes in PACU, pre/postoperative, ortho.

"You're stuck with them..."

(Well, maybe not. Being present doesn't equal a passing grade. There is such a thing as minimum requirements, ie passing clinical expectations as set by the program & instructor.)

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

(Just like at work, right? Oh, wait...😂)

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Read "Why Nothing Works" by Harris. A fascinating look at the shift in our culture in which people have become uninvested in their companies' products.

But we're talking about students, not workers. Workers are extrinsically motivated by a paycheck, among other things. Students have to want to be there. If they don't show the desire, their lack of academic success or lack of degree completion is on them.

I don't know where you went to school, but where I am, students WORK in clinical placements, for FREE. Actually, I pay the school $800 a semester to work. I don't know what your definition of "worker" is.

And you're absolutely right, students have to WANT to be there. In the studies I have read, workers were motivated with positive reinforcement and appreciation, nothing to do with a raise in salary. If we apply the same principle to nursing students who are working in their clinical placements, it would most likely have the same results.

Of course it's the nursing student's responsibility. Who said it wasn't?

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