Students who fight back at instructor feedback

BCRNA · Mar 4, 2015

Are they in their early 20's? I teach undergraduate nursing, and I am shocked at the general attitude that they should be given good grades for showing up, and that they generally ignore all constructive criticism. If your not telling them they are great, they don't want to hear it. It is one of my personal pet peeves that the younger generation thinks success should be given to them. Personally, I would talk to the other instructors to see how they are doing in their other classes and clinicals. I don't think there is anything wrong with giving a bad evaluation explaining that they aren't open to suggestions. With that said, the only thing you can do is try to keep a calm demeanor and explain that your job is to give constructive criticism, and that you are just trying to help. For the student who said it was a different diagnosis, I would ask them to define a diagnosis and a symptom. Changing the symptoms does not change the diagnosis, they are two completely different elements. You will have to make a judgement call on if you think the student is becoming a safe nurse. Nurses can have bad attitudes, but bad attitudes that foster unsafe practices should not be allowed to graduate without correction. It will make the school look bad.

I personally hate having to give bad grades to students, I would love to give all A's. I understand your dilemma because it is easy to give advice, and completely different to actually have to do something. If they are unresponsive to your advice for improvement, it should be stated in their evaluation. Students need to learn that job performance does have direct implications, and that there are no rewards without earning them.

SHGR, MSN, RN, CNS · Mar 4, 2015

Thanks for your reply. I don't see a correlation between age and attitude in the group. Two of the students in their early 20's have the most open and hardworking attitudes. One of the poor-feedback takers here is in her 30's. I think you are right though that it is an entitlement attitude where they think they somehow know it already and I am trying to block them from the nursing profession when really it is they themselves are blocking their own improvement.

I hope that the objective testing in the didactic portion of the class will weed out those who truly are not understanding the material. I do have one graded care plan assignment that they will lose points on if it is not done correctly.

I think I will have to impress on them that poor communication skills does impact patient safety and can lead to poor outcomes including sentinel events. I could share the link below. I thought about going through some of the QSEN KSA's with them, but it's so abstract.

http://www.jointcommission.org/assets/1/18/SEA_40.pdf

Does that sound like a good plan? Correlate openness with safety?

kalycat, BSN, RN · Mar 4, 2015

I'm not an instructor but a new grad (non traditional student) and one the things that was emphasized throughout my program was the importance of being a reflective practitioner -- to truly and objectively view yourself and your practice and work towards growth. Part of this is reflecting on the guidance other team members or leaders give you, and I found this information particularly meaningful. Communication and team work were emphasized in a similar fashion to the link you just shared, via an emphasis on safety and by viewing the multi-level failures that often go along with sentinel events or med errors; we would read case studies and discuss interventions sometimes during post conference. For us, however, post conference was an actual class period that had presentations, grand rounds, homework, etc. not just a brief meeting after clinical, so I'm not sure how easy that would be to incorporate if your program doesn't use a similar system. There are a few good, but brief, YouTube videos on the subject from well publicized medical error cases. I wish I could remember the names; I know there were several TED talks also.

I used to teach/mentor people with alternative learning styles and am married to a college prof, so you truly have my support!! I feel that I am a much more competent entry level nurse because of the faculty and preceptors who took the time to give me feedback. So, know that teachers like you really do make a difference!! :)

organichombre, ADN, BSN, MSN, LPN, RN · Mar 4, 2015

Sounds like these are both lazy and close minded individuals. There is no place for this in nursing. Bottom line, we are evaluated all the time by fellow staff, management, families and patients alike, and evaluation is a learned behavior just like figuring out an aline. Give the eval (as long as they sign that they received it you are free and clear), have them tell you what their improvement plan is and how they will address it. I'm curious what is their evaluation of themselves? Obviously they have issues that I suspect have come up elsewhere in the program. Network with other staff and identify if this is a trend or an anomaly...chances are they have had problems with authority figures before. Sorry if I am so blunt but I teach both ADN and BSN students and I will not tolerate a student that cannot effectively give me a reason not to fail them. There are too many competent and eager students out there to waste my time on slackers!

psu_213, BSN, RN · Mar 4, 2015

First, let me say that I am not an instructor.

I think you only have to look at some of the posts here on AN to see this is a problem. How many times are there posts on "My CI hates me for no reason," "Help! My mean CI wants to fail me for no reason," or "My CI keeps bullying me."

Then the threads almost always follows a predictable pattern. First, person posts that the CI hates them, bullies them, etc. Person points out how he/she is perfect. Then, another, more experienced member of AN comes along suggests that maybe there is more to the story; that maybe the student should examine the situation more closely and see if the CI is trying to help the student. Student comes back "No, I am perfect. My patients love me, and my uniform is always pressed. You (the experienced AN member) are a bully too. Why does everyone have to be a crust old bat?!!" BTW, this is not how every student acts. Some do take the constructive criticism well on here, but others are not willing to look at the other side of things.

The point--some individuals cannot see their own flaws. They cannot see how they possibly could have done even the smallest thing incorrectly. Heaven forbid if someone, like their CI tries to point that out.

We have a sub par nurse who got a not so great evaluation from our manager. Not because the manager told us, but because the nurse felt the need to come and ***** and moan about it. She came to us and told us "that review was BS. I am the best [not one of the best, the best] nurse here. This place would fall apart if they lost me. And now they want to give me a bad reviewâ€¦just because they are scared of my talents." Quite frankly, it was one of the most ridiculous things I have ever heard. But it goes to show that there are people out there with that attitude, and that attitude can continue after nursing school.

To the OP, continue to fight the good fight, and don't be thrown off your game by unteachable students.

caliotter3 · Mar 4, 2015

Extrapolate the behavior of the three less than adequate students to their behavior on the future job. Do you want to deal with this as a colleague? Should they be caring for sick and vulnerable patients? I would do my best with them, offering the help they need, and if at the end of the term, they have not met standards, I would rate their performance accordingly. You can only lead the horse to water.....

blackvans1234 · Mar 5, 2015

I had an instructor tell me I was too friendly with my patient after she overheard me asking where my patient was from and telling them where I was from.

I said okay and kept my mouth shut even though I thought (and still believe) that she was wrong in her assessment.

Im still friendly with my patients. I believe it helps create a connection with my patients, which fosters a therapeutic relationship.

*shrugs*

SHGR, MSN, RN, CNS · Mar 5, 2015

I had an instructor tell me I was too friendly with my patient after she overheard me asking where my patient was from and telling them where I was from.
I said okay and kept my mouth shut even though I thought (and still believe) that she was wrong in her assessment.
Im still friendly with my patients. I believe it helps create a connection with my patients, which fosters a therapeutic relationship.
*shrugs*

I am not complaining about you. I am talking about students who, for instance, are not able to tell me whether a med is scheduled or PRN and why it matters, then tell me that it doesn't matter.

SHGR, MSN, RN, CNS · Mar 5, 2015

PSU_213, they are probably on here telling everyone how perfect they are and that I am so, so very mean.

SHGR, MSN, RN, CNS · Mar 5, 2015

Sounds like these are both lazy and close minded individuals. There is no place for this in nursing. Bottom line, we are evaluated all the time by fellow staff, management, families and patients alike, and evaluation is a learned behavior just like figuring out an aline. Give the eval (as long as they sign that they received it you are free and clear), have them tell you what their improvement plan is and how they will address it. I'm curious what is their evaluation of themselves? Obviously they have issues that I suspect have come up elsewhere in the program. Network with other staff and identify if this is a trend or an anomaly...chances are they have had problems with authority figures before. Sorry if I am so blunt but I teach both ADN and BSN students and I will not tolerate a student that cannot effectively give me a reason not to fail them. There are too many competent and eager students out there to waste my time on slackers!

I have been talking with the didactic instructor and talking with the other faculty (amazingly supportive). If anything, I am naturally too non-confrontational, and started out too nice (assuming they were going to be doing the right thing, coming prepared, etc).

I am quickly developing a thick skin and I am going to start using your phrase above as a mantra. "Give me a reason not to fail you." (not out loud, of course).

walkingdeadhead · Mar 5, 2015

I've been on nursing faculty for a couple of years. I agree with some of the other posts that there is a sense of entitlement with nursing students. With students who tell me "ok, ok, ok," to everything I say, I have them write me a few true paragraphs that reflect on what was said (how they feel about what was said, if they agree and why or if they disagree and why I may perceive them in that way, what they need to work on, and their plan to change). If they continue to show no improvement, I pull out that plan and ask why it's not being implemented or how it needs to be revised. This way the student understands that they are responsible for the grade they receive.

For the students that refuse to believe they are not Nightingale reincarnated, I am extremely honest. "When you turn in an assessment that is only half done, it leaves me with the perception that you do not care and are okay with turning in sloppy work. If I feel this way, others may also view you this way. If you do not care about how I and others are seeing you, continue doing what you are doing, but you will not be successful in this clinical. If this perception bothers you, let's talk about the behaviors I'm seeing and what needs to change." I learned this from a lecture Susan Luparell gave on incivility, and it actually works. Most students don't want to be seen this way.

It also helps to lay down ground rules on the first day. I ask the students to raise their hand if their goal is to be a mediocre nurse, (of course no one raises their hand) or a competent one (everyone raises their hand). And then I tell them that my goal is to assist them in becoming competent nurses and that I will not pass anyone that I do not feel is demonstrating that this is their goal. I explain the importance of feedback, and that my job is to be honest. I tell them everyone will be told what needs to be improved. I also tell them that we will make a plan to improve together but that it is their job to implement it. You cannot make every student listen to you or accept what you say. It is really important to document your conversations, feedback given, and what plan was made. If you still are not noticing improvement document that too. The course instructor needs to know they are not demonstrating clinical objectives.