Students who won't listen---what to do?

morte, LPN, LVN · Mar 25, 2009

i am usually pro student, having had one of "those" instructors......but this one needs a big wake up...or she NEEDS to flunk......no one is doing her a service in letting her slide........it would seem she could already be considered unsafe

Whispera, MSN, RN · Mar 25, 2009

I'd take her aside, away from others and gently reinforce the ABCs---airway, breathing, circulation, and make it clear that passing the course requires she focus on those from now on... If she doesn't, one more warning with a repetition of the requirement, then she fails...

You have already told her what's required. Get it specific and put it in writing if you need to. She's not getting it and needs to pretty much be hit in the head with it before she does something that hurts a patient!

Trauma Columnist · Mar 25, 2009

Totally agree with whispera: pull her aside (get another instructor as witness if you think necessary), put expectations in writing as well as corrective action expected and let the chips fall where they may.

No point in getting the pt to poop if they are in v-tach!

impress0508 · Mar 25, 2009

I have a student in MedSurg II who wll not prioritize. She has it planned in her mind what's important, mostly issues like ROM, feet elevation, etc. and will not pay attention to the clinical situation. For instance, if the drip bag is empty, she will not notice the beeping or respond to my request to put that before worrying about encouraging the patient to eat more fiber. Her nursing diagnoses center around risk for skin breakdown and pain instead of airway and arrhythmias. When I try to talk to her she acts hurt, then angry, and today complained about my annoying her in front of her patient! I cannot seem to reach her and I'm afraid that she will wind up flunking clinical. Any ideas?

This issue at hand is why is she concerned about tasks? Some students by my observation has either limited critical thinking skills so they focus on simple tasks. As you noted, the nursing diagnosis is focused on other issues instead of actual acute problems. May she has not idea what to do about the acute problems. I have also experienced the same, and not matter how many times I give correction, I receive the same information. These students have problems with analysis and are more likely CONCRETE thinkers. Time and time again, they see the forest but not the trees. Just have to document this information with each clinical day. Not sure what these students believe is the job of the nurse? :typing

Whispera, MSN, RN · Mar 25, 2009

It's typical for those who are new to nursing to focus on tasks. They feel they have things they must get done, so they set about to get them done. That leaves little room in the brain for thinking about the other things that crop up unexpectedly. If you haven't read it already, I'd recommend Patricia Benner's From Novice to Expert. It's wonderful for explaining the limited thinking students (and new nurses, as well as those new in any profession) have.

Being in the concrete thinking stage doesn't make their caregiving safe, though. They're riding on your license and the patients need competent care! Our job as instructors is to gently force them to do what we see should be done, if they can't see it for themselves.

allnurses Guide · Mar 27, 2009

When I try to talk to her she acts hurt, then angry, and today complained about my annoying her in front of her patient! I cannot seem to reach her and I'm afraid that she will wind up flunking clinical. Any ideas?

I'd say she's already flunking. She needs to get clear on the difference between facts and feelings: "she acts hurt"?!! I agree with the above posters about pulling her aside and developing a written plan. Tell her if she can't act professionally when she is corrected, she won't finish the day. And that crack about annoying her, well, you've got more patience than I do because that would have set me off royally. "My job and my duty is to correct and guide your learning how to practice nursing. If you aren't willing to accept that, you may not remain here in my clinical group." Period.

Whispera, MSN, RN · Mar 27, 2009

When she's acting hurt and angry and complains about you annoying her IN FRONT OF A PATIENT, it's totally inappropriate. At that I'd ask her to come with me and talk it out away from patients and the staff.

I'm thinking she might not realize she's inappropriate in being overtly emotional. Sometimes it takes students awhile to figure that out. I'd say gently tell her what's what, in privacy, and let her know it can't happen again, and also talk to her about what she's doing wrong with her clinical experience. Students are concrete!

I've sent students home for disrespecting me, telling them they can come back the next day and try again, but I don't send them home for a bit of a tantrum, if it's their first. Then I just remove them from the public area until they can be more professional. Second tantrum is another thing.

We have to remember that our students are our "customers." Without them, we wouldn't have a job teaching. We have to help them get where they need to go, appropriately, nudging them in the right direction, and sometimes nudging them with more force than other times!

AOx1 · Mar 28, 2009

I couldn't agree more Whispera. The student needs to realize that the behavior was unprofessional. Also, you might show a previous example of a great care plan and explain to her why her prioritization is not correct. It might help to explain that while we certainly want to promote skin integrity, it is less important than airway. Work through Maslow and ABCs with the student again. And document all of your conversations and the behaviors you have witnessed. If the student continues to be disrespectful and unable to prioritize, the student isn't safe and shouldn't pass.

If you suspect the student still isn't passing, ask if another instructor can supervise and assess the student's performance for a few days. Hearing it from a 2nd source may help the student, and if not, will show a pattern of unsafe care.

llg, PhD, RN · Mar 28, 2009

I agree with the others. Take her aside. Counsel her as to what is appropriate and expected -- and what is not. Develop a written plan and monitor her progress daily. Meet with her regularly to review her progress. If she shows improvement, praise her. If she does not show sufficienct improvement ... well ... That's what "F's" are for.

truern · Mar 28, 2009

I have a student in MedSurg II who wll not prioritize. She has it planned in her mind what's important, mostly issues like ROM, feet elevation, etc. and will not pay attention to the clinical situation. For instance, if the drip bag is empty, she will not notice the beeping or respond to my request to put that before worrying about encouraging the patient to eat more fiber. Her nursing diagnoses center around risk for skin breakdown and pain instead of airway and arrhythmias. When I try to talk to her she acts hurt, then angry, and today complained about my annoying her in front of her patient! I cannot seem to reach her and I'm afraid that she will wind up flunking clinical. Any ideas?

I'm afraid that she WON'T and will continue to get passed thru until she's an employer's problem and a patient's worst nightmare.

She needs to be counseled and put on notice that she's in danger of failing if she doesn't get up to par. Acting hurt, and especially getting angry, shouldn't be tolerated in the clinical setting. And you suggesting that she change an IVF in front of her patient "annoys" her?!?

HazeKomp, BSN, RN · Apr 4, 2009

I have a student in MedSurg II who wll not prioritize. She has it planned in her mind what's important, mostly issues like ROM, feet elevation, etc. and will not pay attention to the clinical situation. For instance, if the drip bag is empty, she will not notice the beeping or respond to my request to put that before worrying about encouraging the patient to eat more fiber. Her nursing diagnoses center around risk for skin breakdown and pain instead of airway and arrhythmias. When I try to talk to her she acts hurt, then angry, and today complained about my annoying her in front of her patient! I cannot seem to reach her and I'm afraid that she will wind up flunking clinical. Any ideas?

OK, #1... this is her LAST clinical before graduating, and she is NOT "getting it" at all!! Please document every incidence of her poor prioritizing and her lack of professionalism when critiqued. Please limit her care plans by telling her diagnoses that she cannot use any more. (by mid-semester, I forbade any "pain", limited mobility, or nutrition diagnoses, as students tended to use them over and over.)

#2... please, please FLUNK her if she does not make a complete turn around in her clinical skills! I do NOT want her taking care of MY family members... or ME!!!

sorry to sound harsh, but there are indeed students who should NOT become nurses!

Haze