Unfair Clinical Evaluations

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Yeah, you're probably reading the title and are thinking: *eye roll* "Another Nursing student who thinks they deserve a better grade than they earned." I promise you, it's not that.

I am at a clinical site for clinicals, and the evaluations I am getting are absolutely nit-picky and I am wondering if this potentially could constitute as harassment. Why? Because it is negatively affecting my grades. I have gotten written up for the following:

-"Student takes too many notes."

-"Student carries around notebook everywhere. This shows the student is 'carrying around notebook excessively to avoid patient-care encounters'". WTH???

-"Student asked about the IV procedures regarding another clinical site." (They didn't like that I asked that).

-"Student doesn't show initiative." Even though I do! I ask to do things. I insert IVs in patients, I do vitals, I perform tests, I put ECG 12 leads on, assessments, etc. My previous clinical site gave me great evaluations, and this site it's ridiculous.

-"Student made nurses appear stupid to patient by asking to retrieve a warm compress on a patient with difficult veins (Yes, you read that correctly). Additionally, student suggested looking on different areas of an arm before proceeding with contacting an I.V. team, making the nurse appear as though she did not know what she was doing." I was trying to be helpful, and as you can see, taking initiative at this point gets me in trouble (again!)

I've had it with my clinical site, and my director is not helping me whatsoever and I'm tired of it all. I've had so much anxiety around these people it's not even funny. Damned if you do, damned if you don't. I can't take it anymore! Please, anyone have any advice? I ask my director, she says, "Learn to be adaptable." I AM. Some Nurses let me do things, some don't, and the ones that don't write me up for not doing anything. And the worst part is: it's going to drop my average :(.

1 hour ago, Scorio said:

That's exactly what I said. I said, "Would you like for me to get you a warm compress?" I did not say "should", because that's argument from authority, and that would make me look bad. 

Please take what I’m about to say as words coming from someone who really wants you to succeed. A little tough love is in order. Here goes.

If the nurse wanted a warm compress she would have asked for a warm compress. The same thing goes for asking about checking other sites prior to calling the IV team. She did not ask for your suggestions, she did not need your suggestions and she did not want your suggestions. It would have ticked me off too. Especially if you did it in front of a patient. It’s fine to ask after, and away from the patient, something along the lines of “when would you use a warm compress” or “what is the criteria for calling the IV team” but never, ever tell an experienced nurse how to do her job which is exactly what you did no matter how you worded it or what your intention was. I can guarantee you’ve been marked as a “know it all” by the staff and things are not going to be easy for you at this site. Frankly, I would find the nurse from the IV situation and apologize for being inappropriate without making excuses for yourself and spend the rest of your time there with your mouth shut and your ears open. You have clearly shot yourself in the foot but it isn’t a mortal wound and can be fixed. Best wishes.

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51 minutes ago, Wuzzie said:

Please take what I’m about to say as words coming from someone who really wants you to succeed. A little tough love is in order. Here goes.

If the nurse wanted a warm compress she would have asked for a warm compress. The same thing goes for asking about checking other sites prior to calling the IV team. She did not ask for your suggestions, she did not need your suggestions and she did not want your suggestions. It would have ticked me off too. Especially if you did it in front of a patient. It’s fine to ask after, and away from the patient, something along the lines of “when would you use a warm compress” or “what is the criteria for calling the IV team” but never, ever tell an experienced nurse how to do her job which is exactly what you did no matter how you worded it or what your intention was. I can guarantee you’ve been marked as a “know it all” by the staff and things are not going to be easy for you at this site. Frankly, I would find the nurse from the IV situation and apologize for being inappropriate without making excuses for yourself and spend the rest of your time there with your mouth shut and your ears open. You have clearly shot yourself in the foot but it isn’t a mortal wound and can be fixed. Best wishes.

I understand your point. I have already decided to no longer offer advice. I was only trying to help. At my previous clinical site, I would offer things very similar to this and they were appreciative and they would gave me a great review that said things like, "Is very attentive, driven, etc." At this site, they are not appreciative and any knowledge I have that I would like to benefit a patient is almost seen as a threat. I already have apologized for this, and so far since this criticism the reviews I have had have been positive and they said I do take criticism well. It's just that as a student, I am finding it challenging to find out when best to intervene. If I was to ask about the warm compress after patient, it would not put it past me if the Nurse was to say, "So you ask me now for a compress and not with the patient?" And get written up for it. It's like I am screwed no matter what I do. My first semester at this site, I did mostly was advised (wait to be offered things to do, hear etc) and I got written up for not taking initiative. My PD said, "Don't ask to do things, just do them." I did, and I still get in trouble. I'm doing my best, but I certainly won't be perfect at this site

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31 minutes ago, Scorio said:

I'm doing my best, but I certainly won't be perfect at this site

I think just leave it at that. Do your best to learn how to read people; it is a very valuable skill to have. It generally doesn't bother me when students make basic suggestions; it's good for them to recognize situations where they might try apply something they've learned even if I don't use their suggestion. But overall, discretion is in order when offering help and suggestions.

42 minutes ago, Scorio said:

I am finding it challenging to find out when best to intervene.

You are not there to intervene. I think I know what you mean, though...you aren't sure exactly how to conduct yourself, and that is understandable given that your previous interactions at a different site were received more positively than what you are now experiencing. That's just the way it is. Work on relationships, learn how to get a quick decent rapport going with those you don't know well (another valuable skill). Stay on the high road, use careful thought and discretion and you'll come out okay.

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Specializes in ER OR LTC Code Blue Trauma Dog.

I appreciate your enthusiasm and everything, but don't do anything you haven't been specifically instructed to do. This is the sort of thing that annoys clinical instructors and maybe even other nursing staff.

A previous poster summed it up nicely, "eyes and mind open, mouth shut."

Some nurses are going to expose you to different things a little more than others. Just keep in mind that everyone is different in this respect and it's typically a limited situational event. If they do show you something, that doesn't necessarily mean they want you to go around doing it on your own.

So if you just hit the floor running on your own you are going to find that some will praise your enthusiastic activities, and others might think you are out of line. It's weird I know, but we all must be aware of our places in the food chain of things. So that's what I meant earlier when I said go with the flow.

I know you mean well but sometimes it's better to be the fly on the wall, than attempting to position yourself as the leader of the pack.

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Specializes in Medsurg.

Learn to be quiet. Best advice anyone in this thread can give you.

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On 9/1/2019 at 11:46 AM, Scorio said:

I understand your point. I have already decided to no longer offer advice. I was only trying to help. At my previous clinical site, I would offer things very similar to this and they were appreciative and they would gave me a great review that said things like, "Is very attentive, driven, etc." At this site, they are not appreciative and any knowledge I have that I would like to benefit a patient is almost seen as a threat. I already have apologized for this, and so far since this criticism the reviews I have had have been positive and they said I do take criticism well. It's just that as a student, I am finding it challenging to find out when best to intervene. If I was to ask about the warm compress after patient, it would not put it past me if the Nurse was to say, "So you ask me now for a compress and not with the patient?" And get written up for it. It's like I am screwed no matter what I do. My first semester at this site, I did mostly was advised (wait to be offered things to do, hear etc) and I got written up for not taking initiative. My PD said, "Don't ask to do things, just do them." I did, and I still get in trouble. I'm doing my best, but I certainly won't be perfect at this site

I think their idea of taking initiative is different from yours. You thought you were taking initiative by "offering advice" for a warm compress and "advising" the nurse to search for other IV insertion options. I don't expect you to completely understand this as a student. That's why you are being offered constructive criticism. But that is beyond your scope as a student. What IS within your scope of taking initiative is to answer call lights, offer to perform a bed bath, ask for skills opportunities... That's it. Anything relating to a nurse's judgement...steer clear from. You may think you are being helpful, but they clearly are not seeing it that way.

You really need to learn how to read the room. When to silently observe. When to offer "help." I do think part of the problem is on their end of not being specific enough with their criticisms. It's different for a nurse to report back that you are inserting yourself into the nurse's care of a patient than to report, "student not asking for clinical skills opportunities or helping staff by answering call lights and toileting patients."

Basically, when a nurse is providing care, remain silent and observe. Ask your clinical instructor later if you have questions that are really that important. I'm saying all this to help you just get by enough to graduate. Good luck.

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On 9/1/2019 at 8:45 AM, Scorio said:

The notebook is a small enough to fit in my coat pocket. It is very small.

An example of you missing the forest for the trees, or vice versa. Who cares what size the notebook was? You were criticized, according to your post, for your handling of the notebook. The point made, that you seem to have missed, is that the individual thought you needed to lose the notebook. Instead of taking the comments as they were meant, you choose to argue the point that you were "right" because of the notebook's size. No, you were not right, because the instructor made it clear to you that the notebook was a problem. You can not insist on being defensive about everything and then be surprised that your attitude is not going over very well with the people who are giving you feedback at the clinical site. As was said, go with the flow. When you are out of the glare of instructors who can fail you in the class, then do what you want to do, the way you want to do it, and deal with the new set of consequences.

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On 9/1/2019 at 1:30 PM, caliotter3 said:

Who cares what size the notebook was?

I was responding to earlier posts who told me to 'ditch the notebook' and get something smaller.

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On 9/1/2019 at 2:05 PM, Scorio said:

I was responding to earlier posts who told me to 'ditch the notebook' and get something smaller.

And my point was that you need to respond to the instructor's criticism of the notebook, period. You quoted my post and that is why I quoted your response and not the others. But that does not matter. If the rule says you must chew your gum discreetly, and the instructor tells you that you are not discreet enough, what is the easy way to avoid further criticism? Easy. Don't chew gum at all. Then the instructor can't criticize you about gum. If the instructor makes remarks about your notebook, what is the easy way to get away from that criticism? Easy. Don't let her/him see a notebook at all. Whatever the matter, be proactive about the concern that the instructor is making. Respond to their complaint, by removing or altering what they are talking about. Appear to comply, even if in your head you are calling them whatever. Yes, ma'm, no ma'm, three bags full ma'm. And when you have passed the course, then you can moan and groan about how you were right about everything and they were wrong. But you will have gotten what you wanted by giving them what they want. I can assure you what they don't want is return flak from you when they tell you something.

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Specializes in Pediatrics, Pediatric Float, PICU, NICU.
4 hours ago, Scorio said:

It's just that as a student, I am finding it challenging to find out when best to intervene.

I think that may be part of your problem - a lack of understanding of your role and expectations as a student. It is not your place as a student to intervene at all, unless it is essentially delegated to you.

Regardless of whether you are in the right or in the wrong, you need to just stay low, stay silent, and learn anything you can while doing the previous two things.

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Specializes in Nursing Student in Diploma Program..

The best advice I have ever received was from a nurse I have known my entire life that now has their phd. Give them whatever they want. All you have to do is make it through, get that license.

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2 hours ago, MrMurse24 said:

The best advice I have ever received was from a nurse I have known my entire life that now has their phd. Give them whatever they want. All you have to do is make it through, get that license.

Yeah, just remember the classic saying: those who can, do; those who can't, teach/coach.

Feed everyone's ego and just do what they tell you. Ask questions, but don't advise. You're the bottom of the totem pole. Even if you're 100% correct and the nurse is an idiot doing something wrong, unless you stopped a major safety issue, they're too far above you to take that advice. You're almost done, then you'll have your license, and be working, and never have to deal with these people ever again.

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