Unfair Clinical Evaluations

[guest723]

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 :(.

[JKL33]

I also think that the examples of critiques described in the OP are petty with the exception of using caution in what is said in front of a patient. I can't imagine having the time (interest) as a staff nurse to report most of those student behaviors. Who cares!! Carry your notebook in your pocket all you want; I think stuff like that shows initiative as long as it doesn't become more important than the patient.

[JKL33]

3 minutes ago, DoneMostAll said:

It is the was the State Board of Nursing REQUIRES it to be done, as well as the facilities.

Can you expand on what you mean? Which specific portion is required by BON and facilities, and where can we reference this?

No sarcasm intended, I just want to make sure we're talking about the same thing.

[DoneMostAll]

JKL, actually I wish I could. I say this, not with sarcasm either but because I've been fighting it for two years. I have even called my BoN, as well as BoN in three surrounding states, along with about 10 schools that do their clinical the same way. I have been told by ALL, not one or two or here and there, but ALL that this was the way the BoN requires it and therefore cannot be changed. In regards to the facilities, I've spoken to the educational department heads and they do not want to give CIs access to computers or allow us to "put hands on patients" for liability reasons. To me, it doesn't hold water because we are there for the students, the students are technically supposed to be in my license...not the staff RN, not the hospital, but mine. So...I have NO choice but to do it like they want. That is why I make myself as visible to my students. Yes, I've helped with meds and procedures, but that is also dependent on the staff and facility. Regardless, I'm there to help the students learn and so far, knock on wood, I've a good track record.

[JKL33]

On 9/4/2019 at 12:04 PM, DoneMostAll said:

I have been told by ALL, not one or two or here and there, but ALL that this was the way the BoN requires it and therefore cannot be changed.

The "it" being the dropping off of students with staff nurses and the expectation that CIs will be hands-off and having no expectations of interactive floor presence?

I can see BONs requiring collaboration between SoNs and facilities, I have just never heard of them requiring ^ that specifically.

On 9/4/2019 at 12:04 PM, DoneMostAll said:

In regards to the facilities, I've spoken to the educational department heads and they do not want to give CIs access to computers or allow us to "put hands on patients" for liability reasons.

? Okay now that is easier to believe...not that it is right but that they have reason (real or imagined) to feel this is higher-liability. I feel they could avail themselves of other solutions and protections, but why would they do that when they can just pile more onto their staff? ??

Well, it sounds like you are trying to be present with the students and I give you credit for trying to figure the rest of it out.

[DoneMostAll]

JKLL, when I went to nursing school, many, many moons ago and in a different part of the US, all the students went to one, maybe two on rare instances, unit. Our instructor was right there. Or at least, that's how I remember it. We also did more clinical hours. Now, they can get by with one day per week, which to me is not enough. No, I don't agree with CIs being hands off but I've worked hard to develop a relationship with the staff and they do come to me with concerns, which does help to offset the negativity from this type of arrangement.

[FashionablyL8, CNA, LPN]

I'm not a nurse yet, I'm an LPN student in my third week of school. So definitely not an expert. OP, you've already gotten great advice from many people who ARE experts with years of experience as actual nurses. My comment is more general in nature. It's very helpful to learn to read people and adapt to their specific needs and communication styles. Obviously, I will act differently when training a new staff than with my supervisor, or a confused, agitated resident vs an alert, manipulative one. Even in a situation where I need to correct someone, there are ways to say things that preserve the other person's dignity and spare feelings.

However, as students, we really don't have any place giving advice or correcting nurses or anyone who is above us. Whether or not we always understand what they are doing or feel that we would do the same, they are NURSES and we are not. I've read here that "we don't know what we don't know". Very true. I feel it's impossible to absorb what I'm being taught if I'm thinking of what I would do differently. And lots of times, I probably won't even understand the logic behind actions until I learn the whole concept and procedure.

Also, I know that the goal of our clinicals is not to make everyone like us, but it never hurts to form a good relationship with others. If I admire someone's skill, attitude, etc- I'll tell them. Not to kiss behind, just because it feels good to give appreciation- and to receive it.

In your shoes, OP, I would try to start over at this clinical site. It probably won't be a great time, but I would just follow any suggestions from them, stay quiet but be ready to do whatever is asked of you, and remember that your goal is to get through this and graduate. IMO, the best way we can get along and learn the most, especially at clinicals, is to be respectful, humble, and remember that we won't really KNOW things until we are actual practicing nurses. Good luck, OP.

[llg, PhD, RN]

As far as hospitals limiting the ability of instructors in their provision/supervision of student direct care activities ... The liability and regulatory concerns are REAL, not imagined. Hospitals are required to assure the competency of those who provide care in their facility -- and we can't do that for faculty who we see only occasionally. Because those faculty members have not been trained/oriented (and supervised) by the hospital, we cannnot assure their competence.

As the liaison between my hospital and the schools who send us students, I have seen schools send us faculty who were in no way qualified to provide care for our patients. A few had never set foot in our hospital until the first day of clinical. Some are not even hired until the semester starts! We can't possibly allow such untrained people provide/supervise actual care. We try to keep such people out of the faculty role when we can. But we always have OUR trained staff retain responsibility for the patient and the care provided. However, we expect the faculty to stay on the unit and involved in overseeing the activities of the students, augmenting any teaching done by our staff, etc. When we see a faculty member doing their homework in a lounge, etc., I call their Dean and tell them to discipline their faculty member, get them to work, or remove them from the facility.

[MotoMonkey, BSN, RN]

Let me, once again, try to get this all straight. Because there is a less than ideal system it is ok for frustrated nurses to punish students or treat them with less respect? Students who do not have a choice as to the nurse they are stuck with or the facility and unit they need to learn on. That is what I am getting out of this. Few acknowledge a lack of professionalism or common courtesy from the nurse who wont have an adult conversation with the student that was assigned to them but rather leaves poor evaluations after the fact. But many are quick to label the student, who has not been in the clinical setting for a decade and is trying to feel out how to act in these clinical situations, as a "jerk" or as someone who lacks social skills and self awareness. Talk about nurses eating their young.

[JKL33]

That's fine, llg, but none of it requires you to pass the CI role onto staff members who are caring for an assignment of patients.

For example, you could choose to allow only CIs who have been through a program of your design that is under your control or that is facilitated by the university but has been vetted and approved by your organization.

You could commence a credentialing process to approve anyone serving in the CI role in your facility.

This students-with-staff-nurses thing is legally and financially convenient for the organizations involved, while disadvantaging patients, nurses, and students...two of those groups of individuals also being paying customers.

[JKL33]

PS @llg- There isn't necessarily anything wrong with deciding that your staff nurses are going to be the de facto CIs, but if the facility is really actually concerned about patients, it would only make sense that they would be sure to staff in a manner appropriate for accommodating and properly instructing students while simultaneously meeting all existing obligations to the patients and also making sure every staff nurse who might serve as a de facto CI is properly prepared for that role. ?

What you are wanting is to cover a particular liability base, in theory, using a preferred solution (not a mandatory one), while your staff nurses fret about getting all their work done on a good day even without students present.

[Wuzzie]

39 minutes ago, MotoMonkey said:

Let me, once again, try to get this all straight. Because there is a less than ideal system it is ok for frustrated nurses to punish students or treat them with less respect? Students who do not have a choice as to the nurse they are stuck with or the facility and unit they need to learn on.

Moto, it goes both ways. The nurses have no choice whether they get "stuck" with a student so you have two people just trying to work with the the hand they are dealt. Also, although this may not be the case with the OP, there are always two sides to a story and we don't usually get both. I have had students and orientees who continually tried my patience with their "unteachability" or unwillingness to change their behavior. On the flip side I've had days where, because of other circumstances, I have not handled things as well as I could have. I fault the schools for putting the facilities in this situation and the facilities for fobbing it off on the nurses who are already doing their best just to get their own work done.

[Nurse SMS, MSN, RN]

2 hours ago, DoneMostAll said:

Well, you obviously haven't either been following my comments, or had difficulty understanding. Not once did I say it should be the sole responsibility of a staff nurse. Not once did I say a preceptor could not refuse a student, you're correct it happens frequently. Also trust, NOT once did I say I couldn't keep up. What was said is that this isn't just the way the school does it. It is the was the State Board of Nursing REQUIRES it to be done, as well as the facilities. So, unless you know how to change the BoN recommendations and requirements or how to let the facilities know this is not always in their best interest, then you might want to hold up on the negativity.

As I said previously, I don't agree with this module and see both pros and cons, but at this point, it is what it is and I have to teach to the best of my ability, with what I am given. To do this, yes I make myself VERY available to students, both during and outside of clinical, I am with them on the units as I round and making sure they are okay, have any questions, need assistance, what have you. I, and may CIs I know, do NOT leave it up to the precepting stuff RNs to do our job. What it seems is you've had some rough experiences and perceive it to b me that way across the board - and all I'm saying is it isn't.

Actually I am an educator myself now ? I am sorry you took my reply so negatively. I feel passionately about the subject and I have never seen the BON requiring the students to function under the floor nurse's license. I seem to have stepped on your toes somehow by verbalizing my opinion and for that I apologize. You are taking something personally that was intended as a discussion point. Perhaps I could have worded things better.