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?

I attended a hospital-based diploma school. We did two fulls days a week of clinical the first year (11 months of study/year -- we got two weeks off at Xmas and two weeks off in the summer), three days a week the second year, and four days a week the third year. I paid tuition to the school. At no point did the hospital or I have any illusions that I was "working." I was a nursing student getting supervised clinical experience as part of my nursing education. How did I like it? I was v. happy to have the opportunity to attend a highly regarded nursing program and get such an excellent education.

Yes, in fourth year we work full time during the school year.

I am happy for the experience, but they treat this placement as a "class." We are not supervised 99% of the time unless we are giving medications, which is 3 times a semester if we're lucky. It is not PURELY a learning experience, it definitely is work. And I wouldn't complain if we weren't paying $1600 a year to work.

I would be HONORED to work and would be happy to pay THOUSANDS if we were performing skills other than bed baths and toileting, and if we were supervised at least 10% of the time. If I wanted to do bed baths and toileting, I would work as a PSW/CNA and at least get minimum wage for it.

Specializes in psych, addictions, hospice, education.

About the paying to work comments--it's standard procedure that students pay for their classes, sometimes even with an extra "lab" fee, including clinical experiences. There's lots of behind-the-scenes work that goes into setting up things to enable students to be able to do it. Anyway, it is as it is. You pay for the supervision of your instructor (since I've been a clinical instructor, I can tell you lots of time is spent doing all that's involved with that, even if I wasn't always present, providing new experiences to each and every student), record-keeping, maintenance of positive relationships with the clinical facility, and evaluation.

About providing positive reinforcement--I'm all for giving praise for a good job when it's earned. I try to find something good in each student's performance over the course of the semester, but am not going to praise things that are expected of a college student. I'm more likely to praise something that is along the lines of what's needed to get through the course and to becoming a better future-nurse. No "woo hoo! you turned in your assignment!" or "good job! you showed up on time!"

Also, positive reinforcement if given for everything, loses its impact...

About the paying to work comments--it's standard procedure that students pay for their classes, sometimes even with an extra "lab" fee, including clinical experiences. There's lots of behind-the-scenes work that goes into setting up things to enable students to be able to do it. Anyway, it is as it is. You pay for the supervision of your instructor (since I've been a clinical instructor, I can tell you lots of time is spent doing all that's involved with that, even if I wasn't always present, providing new experiences to each and every student), record-keeping, maintenance of positive relationships with the clinical facility, and evaluation.

About providing positive reinforcement--I'm all for giving praise for a good job when it's earned. I try to find something good in each student's performance over the course of the semester, but am not going to praise things that are expected of a college student. I'm more likely to praise something that is along the lines of what's needed to get through the course and to becoming a better future-nurse. No "woo hoo! you turned in your assignment!" or "good job! you showed up on time!"

Also, positive reinforcement if given for everything, loses its impact...

I am aware it is going into paying the professors to supervise us, and all of those other factors. However, I feel we are not supervised enough. The professor has a lot on their hands, and can only handle to work with one student at a time. They're on the floor with 8-12 students.

In BC, Canada, nursing students are paid to work. It seems my province is one of the only ones that uses this system, and it is screwed up enough as it is having the highest tuition fees in the entire country. At least decades ago when nurses worked in the hospital in that screwed up system, they were given food and board.

It is very unfair how we do PSW work 99% of the time, and are unable to complete many skills. It is not the professor's fault, because I've seen every one of them try very hard to give us the experience that we need. But many times, he/she can only handle one student at a time, and there are not enough opportunities. To me, and to many nursing students that I've talked to in my program, it IS paying to work more than a "learning experience." There was a huge petition on this subject with over 20,000 signatures to change this.

You are saying the exact point I am trying to make. I completely agree with you.

Don't say it for small expectations, but maybe say, "Good job on that subcutaneous, you handled that well," or "Good job for cleaning up the hallways when you have nothing to do," since that is not entirely expected of them. Whenever they do something better than ordinary, definitely reward them with positive reinforcement, and they will continue to do so.

Exactly. And each student is different in how they receive messages, meaning that you have to be absolutely certain they hear the message. How often do we see posts here in which students say that they are surprised to fail clinicals at the end? Obviously we don't know whether students are not hearing the message during the semester or their educators are reluctant to come out and say it strongly, but this is why continuous feedback is so very important. I am only a few courses in to the "meat" of my nurse educator MSN program, and I have learned so much about these issues. It gives me a new respect for educators and their struggles, just as I am about to take on the educator role in a clinical setting — not with students, but with RN staff.

It is incredibly difficult to fail a student clinically, especially when the objectives don't speak to the issues/problems you are observing. It is also difficult to fail a 'book smart' student, who is passing theory. It is absolutely devastating to say to a student "you are failing (or are in danger of failing) clinical. It sounds mean, any way you say it. But as already stated, when you beat around the bush, they sometimes don't hear it. I can't tell you how any student have said to me "I am doing "fine", "good" or even "great" in clinical, then their evaluation or verbal conversation with their CI reveals an entirely different story. It makes me wonder; are they not hearing it, or did the CI not make it clear?

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.

I am not only a Clinical Instructor, but a New Grad preceptor and Charge Nurse in an acute care hospital. Expecting compliments for doing what is expected and meeting the minimum expectations (like taking vitals in a timely manner) is not only unrealistic, but is setting up the future nurse for disappointments and unrealistic expectations that they will be cheered and championed once they are working for doing their job, for doing what is expected and they signed up for, for being a nurse!

Yes, students (and coworkers/support staff) need encouragement and compliments, especially when they are earned, but not because you think you deserve them, and certainly not to get you to do what is within your job description. My students have a job description, it's called the class syllabus and my written outline of expectations provided to them during orientation on the first day of class. I regularly pass out "good job's", elbow bumps, verbal compliments, and pre/post con shout outs of praise when they are earned.

As to "being in the same situation in nursing school" in regards to "just not getting it", you couldn't be further from the truth. I did get it. I understood that I was paying a lot of $$ for my education, and that competition for a place in nursing programs was fierce, and competition for good New Grad programs was even fiercer! My favorite Clinical Instructor made me cry more times than I care to admit, because she had high expectations of me, and required I fulfilled them in every class. And when I exceeded those expectations, she would pass out praise and compliments, because they were earned.

Many students come into my class (at orientation anyway) thinking that Clinical rotations are supposed to be easy, and we should take it easy on them because they have a test/quiz/paper due in their theory class, or worked the night before, or stayed out late. Sorry, not my problem. My job is to teach you to be a nurse, who's #1 priority is patient safety, and you won't learn that by me shaking my pompoms for you.

Specializes in Family Practice, Mental Health.

I am full time faculty in a nursing program, as well as working on the side at my ICU per-diem job to keep my skills current.

I think it is absolutely fascinating that someone would require verbal/demonstrated praise on an expected basis in order to feel continued motivation. More fascinating, is that the withdrawal of such praise would cause demotivation. All this despite getting passing grades and passing clinicals.

The nursing students here in the US at my college return high satisfaction scores with their current set up, and I can assure you, that when I do praise, it is for an action that is more than a baseline function of nursing duties. I've never had a student give me low marks.

Is an ego so fragile, that motivation is largely buoyed by praise from without, rather than self talk and strong convictions to succeed from within?

I can praise you all day long, but if you harm a patient, that's pretty much the end of your progression through the program; Please do not confuse the roles of nursing faculty with the cheerleaders on the sports teams.

Be aware that the absence of corrective language should speak volumes to an observant person. If you are not getting counseled on errors, that is a VERY good indication that you are doing well.

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?

Who is the ‘group leader'? Watch the group dynamics of your students to see who does a lot of the suggesting”, and you may very well have your solution when you are able to provide direction to that student.

This sounds eerily like everyone gets a trophy, win or lose. This is college now, and it's time for students to grow up and stop waiting for compliments, spoon feeding, and expecting everything to be handed to them. Compliments for failing to perform tasks students were instructed to perform? Sounds like you expect an "A" for failing work.

When (if) you get a nursing job, it will be a terrible shock to you.

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