I have a group of clinical students. A few are amazing, a few are average (performing at expected level) and there are three who are not doing well and don't seem to have the self-reflection skills to realize that my feedback might be valuable or helpful to them or how they need to focus their attention. I meet with each individually during the clinical day and review the clinical log he or she submitted the week prior, going over it in detail. Two of them get mad at me and seem like they feel attacked, and will argue silly points with me (for instance, they have to include two different nursing diagnoses, and one submitted the same one twice with two different "R/T" and tried to argue that that made them two distinct nursing diagnoses...and the list goes on). The third just says "ok,ok,ok" throughout all my verbal feedback and then nothing changes. All the rest ask pertinent questions, show insight, make their nursing thinking clear on the logs, get better every week. A student telling me "You said that last week" in a scornful tone is just not leading me to think that she would be a safe nurse...but attitude is subjective, right?
I can't figure out why these particular three have such a difficult time with feedback. This is not even a graded assignment we are talking about. It's just a log, a way to guide their thinking toward the nursing process, which I can facilitate if they will let me.
Any ideas or feedback for me would be appreciated.
I'm in my last semester of RN school, also happen to be 20 years old, so allegedly part of the generation of entitlement. I do not fall in this category, however, and I think feedback from an instructor is critical to growing as a professional-to-be in the clincal setting. Understanding feedback and being able to self-evaluate is vital to succeeding as a nurse, whether one is a new grad or seasoned. I personally think you would be doing these students a disservice to pass them despite them not meeting what your standards are for a competent nurse in training.
I personally think you would be doing these students a disservice to pass them despite them not meeting what your standards are for a competent nurse in training.
graduated in 07 and was 23. in my class the students that had the hardest time with instructor criticism were 35+.
yes the younger generation feels 'entitled' but so do a lot of people living in the land of the free. people probably wont agree with me, but, if these students are passing clinical and theory, by what tangible basis can you NOT pass them? working as a RN for as long as we have, don't we ALWAYS come across someone like that at least once a week? im not criticizing anyone's opinion; just trying to find out IF you cant pass them based on their attitude...
in a perfect world everyone would work well with everyone. but, that's not what we live in... unfortunately..
I have worked with several nurses whose very identity is wrapped up in their performance. Therefore, if their work was critiqued, they felt as though they were being attacked personally and would get defensive.
I work with a nurse now who will literally cry at the slightest critique of her performance, and wonder aloud why is she being attacked? Why is the supervisor being mean to her? She will go on to state her claim that she is a good person, people like her, etc., and doesn't understand why she "got in trouble" over not performing to standard. In other words, she seems to be incapable of seeing the correction as a way to better her practice. She seems to view it as an attack on who she is as a person. In my experience, it is very difficult to help people like see that a correction on performance doesn't mean she's a bad nurse, bad person, etc.
As irritating as it is, I've had to "build" people up when correcting them to let them know that they're not a bad person, they generally do a good job however this issue needs corrected because "what if you were the one receiving care? How would you want your caregiver to respond to A, B, or C? Would you not want them to use best practices to ensure you're recovery and continued good care?" Sometimes it helps, sometimes it doesn't.
But, try to keep in mind that some people have very fragile egos that when challenged, will result in attitude if not outright defiance if they feel threatened. Hopefully, with time, they will learn that criticism is a tool for growth, not a measure of who they are.
Not all learners will respond to the same instruction and cues. For the student who used the same nursing diagnosis for 2 different problems, my question would be "what did you feel that you learned from this exercise?". Then I would explain that 1) the goal of the exercise is to expand the student's critical thinking and 2) at the end of the day, the student is only holding themself back and that you want the student to make the most and not the least of the experience.
As far as feeling "attacked" by the instructor, it sounds like you are dealing with some insecure, hyper-sensitive personalities. You never know what else the student is going through in their personal life and it is possible that they are transferring their feelings about those other personal problems into their "school life". Is it maybe fair to ask them if there are circumstances that are causing them to not focus on your cues?
Getting into my time machine (and I don't remember nursing school as being a highly pleasurable time in my life), the best instructors I had were the ones who were encouraging and offered gentle, sensible, yet firm correction. The majority of my instructors fell into that group.
I had one instructor who was militant and while I learned, I didn't feel like I got the best experience in her class. It was difficult to open my mind and absorb the material when the instructor made things like the number of nursing care plans the priority (as many as were needed- 10, 15, 20!). I would stay up all night doing the care plans on the "standardized form" and then show up for clinicals exhausted after being up until 2am writing up care plans. Half of my classmates failed her course and had to apply for reinstatement.
These students are adults. I don't think it is anyone's job to correct their attitudes but their behaviors. If they are unwilling to correct their attitudes to fix their behaviors, then they will get what they earn and that is a fail in clinical. Unfortunately they may have to learn the hard way.
Quick update. Two of the students whom I have been pushing (and getting pushback from) turned in the most fabulous, detailed, insightful clinical logs this week. So I can see that they get it. The third...not so great...but I really have hope based on this latest batch. This is hard work for me- I'm out of my comfort zone, trying to find the perfect blend of encouragement and holding high standards.
Hi, read your post. As long as the feedback given is constructive, and appropriate, your clinical students should be able to learn from it. The school's policies and practices regarding acceptable behavior in the clinical environment, should also be discussed with these clinical students in addition to your role as clinical instructor. They are adults, and it should be expected that their behavior reflects that. When their behavior borders on insubordination, you should stress to the students that this kind of behavior will not be tolerated, and may result in suspension. Take a firm stance on the communication/behavioral issues of the clinical students, particularly the problematic few in the group.
I've had similar situations happen. I usually just tell the student, "I understand you don't think there is a problem here, but I do, and I'll tell you why. [insert explanations.] It is my job to make sure you are someone I would be comfortable working with, and at this point I am not. I don't want to fail you, so don't make me. Here is what I need to see from you so that I think you won't harm our future patients. [insert improvements.]" So far, it has served as an eye opener for the student in question and I have gotten good results.
As a student, I have noticed clinical instructors who are demeaning and use a rude tone, scolding. No matter what they say to a student when using that tone, the student won't hear anything but attack. It's very difficult to be a self reflective student in light of that. Obviously I have no idea what your tone is, just offering that up. In my clinical, the whole thing felt like a test instead of the learning experience it should be. I don't think it's fair to expect students to already know before learning.
sjalv
897 Posts
I'm in my last semester of RN school, also happen to be 20 years old, so allegedly part of the generation of entitlement. I do not fall in this category, however, and I think feedback from an instructor is critical to growing as a professional-to-be in the clincal setting. Understanding feedback and being able to self-evaluate is vital to succeeding as a nurse, whether one is a new grad or seasoned. I personally think you would be doing these students a disservice to pass them despite them not meeting what your standards are for a competent nurse in training.