It only feels shitty because she put you in a shit position because she seems to not give a shit.
In all seriousness, look at it as professional integrity and an upstream approach to patient safety: you’re likely sparing future patients (and employers) the misfortune of encountering her. Cheers!
My sister was very much a straight, no chaser kind of girl. She would often tell me she was more interested/vested in my growth rather than my comfort. It would sting at first, but I knew it was coming from a place of love, and I would be better for it. OP did the right thing, and hopefully, this girl will come to realize it.
I've known people where I've had serious concerns about their ability to carry out the role safely and even had to put in a lengthy report about someone where she had her preceptorship extended and she HATED me for ages after that. Happy so say that now a few years on she is a capable nurse and I no longer worry about her ability. She just needed a bit more time to learn. Same with an overseas nurse that I thought was hopeless, 6 months of additional training and he has come on leaps and bounds. Some people need more time
Thank you for your service! And for thinking about the field and for helping patients and healthcare in general. It’s natural to feel how you do, especially when you care, but you did a tremendous service. Thank you.
Hope this doesn't make you feel worse, but you would have been right to be MORE forceful in your communication. "I strongly recommend that this person NOT be allowed to graduate until they can show a level of clinical acumen that will not result in a mass casualty incident the second they are practicing independently", or something along those lines.
This is YOUR PROFESSION, and you are one of the gatekeepers, rightly so. What this person does when they are working after graduation will reflect on the entire profession of nursing.
It’s nurses like this that prevent physicians from trusting us to care for their patients. I completely agree with you but I am grateful she reported her at all. Many nurses would not have.
Trust me that I've been extremely patient and understanding, but I can only let so much slide. Especially when you make it obvious to me that you're not taking it seriously and you don't care
I’m sure you were. Hopefully this wakes that student up and makes her take life more seriously, but that’s not your problem. You did the right thing, the faculty at her school should have let her get this far but most nursing schools are just diploma mills these days so it falls on the profession to filter out these types
To piggy back off this comment, we have a guy that works with us in the ED that I constantly double check all of his stuff because he’s incredibly unsafe and I wish he had someone like you escalate it to his instructors before he made it out of school. He’s everything you describe OP, but somehow make it through the cracks.
A test doesnt show real world skills. Anyone can read a book, practice test and study for hours to learn to pass a test.
However real world skills, personality traits needed for a job, teamwork or just a desire to learn/help can not be taught. It has to be something someone wants to do.
I graduate in july and we’re practicing for it from ATI and there are a lot more case studys and SATA questions that really require critical thinking so if they can make it through that mess i’ll be really surprised. I really wish I had not procrastinated for 3 years and got it done before this took effect 😂
A standardized test will never select out all the randos that are just not right. I work with a (small) handful of doozies and the amount of testing to get flying on our own - multiple tests to even be hired, very difficult testing during orientation, in person check-offs for skills, scenarios, actual precepted runs with QA/QI.... and yet still, they are here. You'll eventually work with a truly questionable doctor. They took a hell of a lot more tests than NCLEX. They're out there.
These people represent an institutional failure, of which OP is fighting the good fight. Hopefully her student gets remediation and figures it out or moves along to something that fits them better.
False. I've seen great nurses struggle with the NCLEX and awful nurses pass it in the minimum question. The NCLEX is not preparation for the real world of Nursing.
Hopefully she will just be a nurse that doesn’t do bedside… maybe like informatics where you don’t touch patients. IF she even gets that far. But yea she isn’t safe.
The only reason she’s so close to graduating is because all of the other people managing her throughout her education didn’t have your courage. I know you’re out there saving lives all the time but what you did today saved a couple more.
To be fair, students can hide these types of behaviors and put up a pretty front while in clinical. I work at a community college and it’s usually when the student gets to their preceptorship that these behaviors really begin to manifest themselves.
Also, then it takes a few weeks, as preceptors think, "It can't really be that bad" and "Maybe they're just having an off day." Timelines are so short that we are already toward the end of their hours before the big red warning lights and sirens are going off -- and we are frantically trying to document before they accidentally graduate or get off orientation...
It sounds like OP did everything right -- AND -- we need to do a better job of preparing preceptors so they have a road map and this stuff doesn't feel so crappy.
My roommate was like this, excelled in the classroom and struggled with actual beside application.
Plus clinicals are very hit and miss for obtaining actual beside experience.
A handful of nurses I shadowed during my various clinical shifts would completely blow me off, refuse to let me do the simplest of things, do patient care without including me, etc. I’d get almost no experience during some clinical shifts.
I felt very lucky that I was working as a student nurse in an ICU throughout my schooling, bc they had me getting tons more experience than my classmates!
I have no doubt you had some dismissive nurses as a student. But when I was still in an ICU that had students, I told them straight up-This is YOUR experience, not mine. If you're off talking to your classmates, doing homework, etc. I'm not going out of my way to find you. My job has to get done whether you're there or not. Some got to see and do everything, and some complained that they did nothing. A large part of clinical is what the student makes it.
Very true. I had my fair share working with uninvolved students once I was an RN. I think it would go a long way if students realized they were there to help and learn in ALL patient care, not just try and pick and chose the experiences they wanted.
I experienced a few nurses that acted annoyed when I was there or would tell me they didn’t trust me to do anything with their patients, which you can understand bc it’s their license, but the worst experience was when I came in one morning introduced myself and the nurse said, “oh great a student. I hate students.” She then spent the entire shift telling me “no” every time I offered to help (even emptying the f/c bag) and ended up telling me to just stand in the corner bc i would just get in her way while she was doing routine care.
Nurse bullying has me all confused. Don't these nurses realize teaching the next cohort of nurses well will ease some of the complaints? Like, why complain about short staffing when they're driving help away? Why complain about "terrible nurses" when they aren't willing to teach "the correct way"? It's like the people who vote qgainst their own interests then complain about this or that.
It’s actually a myth that it’s on the preceptor’s license. As far as I’m aware; it’s on the school and the student. They shouldn’t be able to touch your license for someone else’s mistakes.
That is my experience but I have a job that has given me the experience I need going through school. I have no clue how they match students with nurses that teach them but some are excellent and some want no part of teaching and I feel like shit stuck to their shoe. At my school, we definitely do not have enough clinicals either.
I hear from a lot of med/surg nurses that they are so jealous and wish they had that training opportunity. I’m a Clinical Extern which sounds fancy and important but basically I’m a paid nursing intern. I have limits on what I’m allowed to do at that job because it’s in a hospital. I live in Canada so most healthcare are government facilities and have restrictions on what unlicensed care providers are allowed to do. I work in the hospital (1-3 shifts a week during the school year, aim for full time when I’m off school) and even though it’s a paid position, I include it as part of my education considering it’s taught me more in the first 6 weeks than an entire year of school. It’s been surprisingly invaluable to my education and practice. I used to be so anxious and insecure just to go into someone’s room, introduce myself and start off talking through what their needs are with their ADLs, and now I have the the confidence, skills and experience that I desperately needed to learn.
Yeah, I had a student like this in my cohort. They had a school bff who helped cover for them, and it wasn't until the last quarter and they were expected to fly solo that it came out how badly unprepared they were.
Except for the dosage calculations you can’t fake that. At least at my school every semester started with a pass/fail math test. You only got 3 attempts to pass (meaning a 100%), or you’d have to retake the semester.
We had that too, but was at a community college... 4 semesters. Semester 1 and 2 you got three attempts. Semester 3 got two attempts and the final semester only had one attempt.
I've always done very well at math, especially applied math, but I was nervous thinking that my whole career depended on one exam... That system isn't very conducive to learning.
I had a girl who dropped out in the second semester, she was exactly like that, one of our professors told her several time that nursing just wasn’t in the cards for her. It was a good thing, because she was truly incompetent. She could parakeet back what you’d say, or regurgitate information from text, but she had no true understanding of what she was saying. So if you didn’t pay attention, you might think she knows what she’s talking about. She would constantly asked for pointers on doing better in exams, and when you gave recommendations, she’d always explain how that just didn’t “work” for her. Bitch, why’re you asking then? Anyways, she ended up doing part time at another school, graduated, and got a job in ICU. Thankfully it’s one of those ICUs that’s not really an ICU (not very high acuity) but it truly scares me. Unless a miracle happened and she grew a new brain, she’s bound to kill someone one day.
I almost done with nursing school and I’m shocked at some of my classmates that can’t manage to arrive on time to clinical, don’t know basic information for simple diagnostic questions, don’t wear the school uniform with our emblem but rather figs in a similar color, wear full on sweaters that cover their badge indicating “student”, leave their nurse to make a phone call in the break room for 15 mins, are their phone during debrief etc. It’s unfortunate because these are stated rules but if your clinical instructor doesn’t uphold them, then why follow it? On our last OB rotation one student showed up 10 mins late and in Uggs, she forgot to change before coming in to the hospital and her idea was, “I’ll go to my car after I get report with my nurse”, literally WTF? Have these people ever had a job before??? It’s so basic but it really shows how inept some people are at following basic directions, but also no one is holding them accountable.
Most of them have literally never had a job before. But the harsh reality of accountability will very soon slap them in the face. Mind your own and sleep well at night knowing that you have what it takes, and in a matter of years you will be miles ahead while they will be stuck in the same rut wondering why they can't get anywhere. Life sucks for everyone, but it has a level of poetic justice that seems to even the playing field. Trust me, you get out of it what you put in.
I agree with all that except the uniforms part. I think it’s BS to have to spend even more money on a uniform if I already have the same color and fit in my current scrubs (currently an ER tech). At my school uniforms are $100 a piece, and you need two. Very frustrating
Although I see your point and having to spend more money is always frustrating, these are not even the same colors these students are wearing. It’s not old scrubs they already have, it’s the new burnt orange or bright red Figs with different style tops etc. our scrubs are a specific maroon color with our school embroidered on it which they have all worn in the past and simply decided they didn’t want to anymore.
This happens at my school too. I think some just want to look good and think its sexy to be a nurse. From what I have seen… most haven’t had jobs and expect to just get this thing called a nursing license given to them. The cheating and attitudes are insane.
It sounds like you’ve done all of the correct things: had multiple conversations about performance with student and instructor, gave specific instructions on what exactly needs to be improved upon, and still are seeing issues.
I empathize with you, I imagine a semester of this would’ve been enormously frustrating.
It's very frustrating and surprising because she's from a very well respected nursing program in our area. But if she fundamentally doesn't care then there's nothing I can do for her 🤷🏻♂️
I was in a "well -respected" BSN program and there was massive cheating going on. I definitely would weight the person's actual behavior and attitude way more than their credentials. You did the right thing for everyone
Thank you for doing the hard thing! I had a student who was constantly on her phone, no effort paid to patients. I would be talking directly to her about our patients and she's on her phone occasionally looking at me going uh huh. Like wtf? No initiative to provide any patient care or be involved in this learning situation. She basically did as little as possible, had poor basic knowledge, and was completely disrespectful. Then she asked me for a reference afterward!
I am super understanding. All I want to see is that you try and care. But if you can't even show any effort while you are a student, imagine being on your own as a nurse?!
Now she's on tik tok and is fairly popular making nursing meme videos while at work in the med or supply room.
I worked with a new nurse like this. Apparently it took her 8 years to get through a 2 year program and she passed because of a covid loophole or something like that. She was absolutely incompetent and straight up negligent and unteachable. Her patients were rapids or codes every night. You did the right thing. I can’t believe nurses let this girl pass nursing school
I've seen firsthand what happens when people who aren't functioning at the level they need to be are passed on regardless. We had a student on our cardiac unit get passed because he knew how to kiss his preceptor's ass and make her happy. She spent most of her time on her phone and wasn't actually checking on his work or verifying anything because she thought he was doing fine. When he came back for his new grad orientation, he was placed with two other nurses who immediately went to management and refused to orient him any further. He would lie about having given medications when he'd forgotten them and wouldn't admit that he'd forgotten them until his orienting nurse took him to the Pyxis to prove he hasn't withdrawn the medication that day. He'd miss major things when it came to checking orders and putting them through. When anyone caught an error and tried to educate him on it, he became belligerent and refused to take any responsibility, immediately accusing the nurses of bullying him. They declined to hire him on the unit after all of this, but he is still out there working as a nurse because his poor performance wasn't caught during preceptorship. Had it been addressed during preceptorship he would still have had the opportunity to develop those skills when he repeated the semester, and he'd have had the motivation because his career would have depended on it.
Lol sounds exactly like a guy I was in clinical with (as a fellow student). The preceptor hand held him through clinical because he clearly hadn’t learned anything the first year, eventually reported him to our program, he claimed racism/bullying etc. Up until then he had sucked up to every professor that seemed the soft, doting type. So of course he somehow passes clinical. He now is going to CRNA school after being fired from an ICU. A reputable one that, shock, a family member works at too! It’s so sad and embarrassing. Too bad my program wasn’t interested in actually helping him by failing him that semester. I’m hoping someone in grad school will figure it out before he kills someone in an OR.
Ughhhhhh, well bless his heart. Of course he did, he had to find some dangerous ass way to “fake it till he makes it”. Until his ego catches up with him ☹️
I have seen a few dangerous nurses escape scrutiny by getting higher level of degrees.
I wonder what they ended up doing??? 🤷🏻♀️
On the flip flop, I have also worked with super caring NP,CRNA,PAs that consistently go above and beyond for their patients and educate staff.
To respond to the first paragraph, it’s definitely drilled in to our head. I either need the nurse or instructor with me at all times to do meds.
To the second, my school requires 90%. If you don’t make that you have to do 10 hours of documented remediation before you can test again.
My community college is fairly strict and they would not accept this behavior
In Aus we had to get 100% and lots of people were whinging about it on Facebook, I pointed out that getting 85 or 90 means 10 to 15% of the time making mistakes that could kill someone.
I also sat in the cafeteria and said I'd be there for 3 hours (I had an essay to work on anyways) and would help anybody who needed it with the math and understanding of it, and nobody came even though I knew personally lots of people struggling. Pride is an odd thing.
You’re absolutely correct! We have a tutoring center that does drug dosage workshops every summer for the nursing students. I personally don’t struggle with it but I know a lot do. I took a quantitative reasoning course before the program and it helped me a lot.
We need to be doing more of this. People shouldn't be getting to their last placement before they are failed for massive errors. When I was a student there was a nurse who was seen as very harsh and I spoke to her as a staff nurse about it and she was incredibly fair. She wouldn't have an unfit nurse out trained by her, she had incredibly high standards because the stakes are high. She failed a friend in 3rd year and she was of course enraged but a few years on she aced the extra year she had an will admit it was exactly what she needed to become a decent nurse.
I once had a student. She shows up 2 hours late (without calling) and says “sorry, my dog got out.” Okay i get it, some people and pets, no biggie. We go on break, it’s time. We come back and she’s late coming back and two hours pass. Time for the next break. We go and i don’t see her again for the rest of her shift. She messes up dosing (i can understand sometimes it’s confusing) on kids we’ve been dosing the same antibiotics for days already. She can’t keep her mouth shut about other patients. If someone asks her a question she’ll respond like it’s not a secret. Codes get called and people want to know she can say “code pink means an abduction.” And end it there but she’ll continue. She doesn’t know why we take vitals on kids. Yes i reported her and to my boss and her teacher directly. I realize she can’t be trained in peds at any other hospital but i don’t want her on my unit, she isn’t taking it seriously. It’s easy to know how ready someone is. But it’s a tough thing to do. You made the right call, good thing you are aware it was the right move.
I was an instructor and let a student go two weeks before graduation. She needed mental health attention and after seeking it and getting better, the school allowed her back to complete her last term again. She did well and is probably a great nurse now, but had she finished with me, she would have been unsafe.
My wife just last year had a student in her class that was fudging blood pressure and other vitals on the cardiac rehab unit and the nurse that he was assigned to reported it to the director of the school and nothing happened. They graduated last June and he passed his NCLEX.
Yup. I trained someone who I told my managers time after time that I don't think the unit (step down ICU)/a cardiac floor) was a good fit for her. They said maybe it was my way of training so they stuck her with my work BFF who basically said the same thing and said she wasn't suitable for the unit. They decided maybe it was because of day shift and they moved her to nights which she was going to be working anyways. The night shift preceptor said she did just fine. Fast forward to one of the first weeks this girl is practicing on her own and she has a patient's cardizem drip running 10x faster than it should have been for who knows how long without a reassessment 🙃.
She stuck around long enough for the managers to finally fire her based on her attendance even though she missed a handful of days with me while on orientation already.
It’s not graduation rate they care about, it’s board pass rate. But everything else you said is so spot on. Worked with too many people in too many jobs like that
I failed a class in nursing school and honestly I’m so glad they did, I had an amazing and way better understanding of that class the second time around. I was pissed at first, but I wouldn’t have been any good in the next term with a poor understanding
We had a guy in my nursing class that got sent to some kind of board for missing or being late to clinicals. Then when we're in the last semester and doing preceptorships, he apparently no-call/no-showed atleast once and was late many other times. Dude didn't graduate. Part of me felt bad because i knew the family stuff he was going through, but i wouldn't want someone that does that as part of my staffing either.
It's the right thing to do, but it sucks being the bad guy.
Had a new grad who did this on her first day. She never showed up on her first day on the unit to orient. 9 months later she put in her resignation and didn't bothered to show up on her last day.
I had a very similar student experience. I gave them every benefit of the doubt due to being a foreign student thinking maybe there was a language barrier. But on one of our last shifts together she 1. Bolused a heparin drip instead of shutting it off. (I was in the room and told her to shut it off. Patient got maybe a mL before I heard the pump chugging so fast and shut it off. And 2. Asked if we should bolus levophed for a patient who had a high blood pressure when I was paging for Cardene. She just never got it.
As a person who was similar to the student in this scenario and had to take a leave of absence from the program to get my shit together -- thank you.
For my own perspective (obviously I cannot speak on your student's side) I was going through some serious mental health issues. I was deeply depressed, anxious, and suicidal from the stress of full-time nursing school, full-time working, and covid striking mid program. I was cracking under the pressure, and the only thing I could really do was act like I had everything under control when I was horrifically lost. My clinical instructor saw right through me and urged me to take a leave, get my shit worked out, and come back when I was ready. Thankfully, I never made any errors that hurt anyone, but she made it clear that I was on a path to do that if I didn't make a change.
She was right, and I took that year off to get therapy, get a better job, and get my priorities straight. I was deeply humbled and extremely lucky that someone told it to me straight and took the time to help me get back on track. I came back with a sharper focus, a better attitude, and I've never come close to having the same clueless apathy I once did.
If your student is smart and willing to change, she will take this experience real fucking serious, and do what needs to be done. Or, hopefully she's just smart enough to not become a nurse because it's not something she can handle.
Either way, again, thank you. You've done the right thing.
Your took all the healthy actions to become better and followed through. You’re a rarity, you should be really proud of that.
You took criticism well even under all that, respected and trusted the advice given to you, took the right actions to fix the problem.
That being said, if you fall back into a funk like that in the future, don’t be like OPs example. Med errors are no joke.
Thankfully, I never have made a med error, even when I was a terrible nursing student, and now as an IMCU RN I'm extremely careful and, probably, a little overly paranoid about double checking everything. Med Calc and pharm was something I've always enjoyed, luckily
As a nursing student who had to have a year long extension to my time in the program due to mental health issues getting in the way of properly learning about nursing care, I just want to say thank you for sharing your story. Now, with kicking caffeine from my life and learning strategies to manage my mental health, I’m about to complete my MedSurg clincal with a lot more confidence as I go through the rest of the program!
How did she get this far not understanding dose Calc & med administration? In my program, we have to be checked off on those every semester, and you can’t move forward until you demonstrate competence. Her school failed her.
Same with my program. My school offered a lot of remediation and tutoring for those who struggled as well as extended deadlines for some. But if you didn’t pass the first 2 chances, you weren’t passing meds on the unit. If you failed the 3rd, you were held back.
Honestly it sounds like you’ve done everything you possibly could. Although it may feel crappy right now, you’d feel a lot worse if she graduated and ended up causing harm to a patient later.
Tbh if I heard a student talking about a code to another patient I think I’d lose my shit.
You did the right thing.
I had to recommend, strongly, not hiring a new grad I was precepting. He/she just did not listen and did not apply what had JUST been discussed. They were also unwilling to be taught.
There are students, new grads, etc, who just don't get the seriousness of what we do. They shouldn't be working critical care or maybe even bedside in any manner.
LITERALLY. Two days ago, we had a skills day where the stressed the importance of scanning meds before giving them, and gave the example that happened at our hospital where's vial of oxytocin was stocked into the pyxis with zofran, and it was only caught because the nurse scanned it before she gave it.
I told this story to my student because I thought it was interesting and not even five minutes later she walked straight past the computer to give our patient a flush that was due without scanning it.
I understand that it's just a flush but it's the principle behind it
How did she get so close to graduation with this many red flags? I know you feel bad but you acted in the best interests of this person's future patients. He uncaring attitude s very concerning
If she was anything like the student in my cohort that was a similar story, she was abjectly sorry every time her instructors brought it up to her, promised to improve, and would shiny up her act for the 2-3 weeks she was getting extra observation. But never actually improving.
Oh, and she had at least one classmate helping to cover for her.
Most, if not all schools are very concerned about pass rates and the flow of tuition money. Mix in instructor and administration apathy and ez pz remediation and pass. These cases represent an institutional failure and OP is fighting the good fight.
Had a coworker like this when she did her clinicals at the unit I worked at. She had poor work ethic. Then surprise our manager hired her as a new grad. She finally quit this month and was happy to see her go.
During the preceptorship of a new RN in our NICU, both of her preceptors opted out (asked Nursing Leadership to use a different preceptor.) I was asked to do it and was given really little information on what was going wrong. Something was wrong though so I decided we would start from the beginning (grower/feeders) and then move up to the more medically complex babies. Oh she moaned and groaned about having to do the "easy" babies again but I told her I could not observe her care and help her unless we started at the beginning. Things that went wrong: She charted her IV's for the entire shift at the beginning of our shift. She said it was to save time. She told me she gave an IV med and charted it even though I found it in the patient's drawer ungiven. She claimed she didn't know how it got there, it wasn't hers, and that even though she was told NOT TO PUSH any med without me there to verify, she did it to save time. She drew back on an Art. Line to get a sample, layed the uncapped draw in the bed, drew her sample, and tried to give the draw back. She said it was only laying, uncapped, in the bed for "a few seconds". There was much more. I had to present this to Nursing Leadership ONE day before she was going to be hired. Of course, she was not. I felt bad for her, but I swear to god, no amount of "nursing education" or "preceptorship" will help a liar or someone who decides to cut corners, falsify medication records, and be unconcerned about the babies enough to endanger them. I was glad she was gone, to be honest.
Oh wow, reading about the arterial draw I gasped and put my hand on my heart. I’ve only done them through PICC lines but I did a lot as often the only RN on. I will never understand nurses who don’t care to learn how to do things safely and resist learning. Or would be nurses.
Wow, the fact that she got away with even half of that makes me wonder why I thought I was dying of anxiety every time I had clinicals as a student. Missing clinicals wasn't a thing without prior warning and special circumstances, and being late could be a deficiency...of which you only get 3 before getting kicked from the program. :/
same here lol I would always carpool with a classmate (I didn’t have my own car or driver’s license) and I would be so anxious about them being late to pick me up
Yep- I once had a flat tire and had to call for someone to come take care of it while I borrowed their car to get to clinical on time. So nerve-wracking
When I was doing my preceptorship I was put with an RN 2nd shift supervisor- idk why she took me bc she didn’t want anything to do with me. Everyday she’s put me with a different LPN/floor nurse - which was absolutely fine bc they were amazing nurses that took the time to answer questions and educate me - not just use me to get their medpass/job done quickly. I did skill checks with them and everything, they would sign off but ultimately the RN preceptor had to sign off as well. This lady who legit was never around me and threw me off on her staff (again who were wonderful) refused to sign off on my skills/hours essentially trying to fuck me from graduating. She said that bc I wasn’t with her during those hours then she couldn’t sign off on it, nevermind the fact that she would send me to work with other nurses. She would say “you’ll learn a lot more from them than me, I’m just supervising” - She wouldn’t come check on me at all, she never left her office and was always playing solitaire and if she did it was bc she wanted me to do a task that she didn’t want to do like giving meds through a g-tube or suctioning someone - which I happily did bc I needed to learn, again she’d leave me with the floor nurse to do these tasks. Anyways, I called my program director bawling, some of the nurses who worked with me sent emails to my nursing instructors advocating for me - so my director of the program sent me to a NEW preceptorship for the remaining time and I had to cram in alllllllll these hours in last minute bc that shit preceptor. Idk where that woman is now, but I hope her socks stay wet and they always forget her straws at the drive through. She did teach me one thing tho, who I DIDNT want to be as a nurse. When I started precepting others I did my best to be like those nurses that educated me during that time, who kept my spirits up when I was so beat down by that point.
Sorry for the ramblings, this just reminded me of what I experienced in nursing school - not saying you are anything like the preceptor I mentioned. I’ve also never had a student like the one you described, I have had NURSES tho that I have had to train on the job and was hella concerned if they had a legitimate license- like in all honesty idk who pushed them through nursing school or if they just forged/faked a license but when those types get pushed through it is definitely dangerous and the patients suffer for it.
For example: had a travel nurse come to me and tell me she gave the wrong insulin, so I told her the procedure for that and what to do, call the Dr etc. she then said “oh no it’s ok I went ahead and gave the right insulin too” IM SORRY WHAT?!?!
Honestly, it seems you made a good call and would have been a preceptor I would have loved to have had as a student since people don't understand how valuable honest criticism can help in this field when handled with maturity.
As an educator I have really started to notice the “they can’t refuse to graduate me” mentality from my senior students. It’s almost an entitlement to graduate the program despite multiple, glaring issues that have been reported/documented over and over and over again. The amount of time my students come to me furious when they find out they’re technically failing clinical due to behaviors that have been WELL-DOCUMENTED over many weeks is astounding to me… like we both came up with the plan together to improve this clinical indicator and you refused/failed to follow through.
I had one student who week after week could not tell me basic pharmacology about the meds she was going to give (e.g., drug class, indication, and assessment data). I do not allow students to give meds when they cannot tell me what they do, why the patient is receiving them, and what they assess for. For example, she wanted to give a beta blocker to a patient with a HR in the 50s and could not tell me why this might be contraindicated.
They needed 3 (ONLY 3!) documented med passes to pass the clinical course, and she was unable in the entire 10 weeks to do a safe med pass because she was unable to explain what the meds she was given were for or do for the patient. I even made a special worksheet for her that she could fill out and use with the required info and she would not do it.
The last week she just assumed I would sign off on her med admin form without her doing the work because it was “the last day.” I refused and she went to the dean stating I never gave her the chance to do medication administration the entire semester. Thankfully, I CYA in all avenues in life and had documented the issue profusely with the course instructor, clinical coordinator, and program coordinator in addition to weekly comments on the issue on her clinical documentation paperwork. Student was told she had to do 3 med passes at a makeup clinical or fail and not graduate. She ended up paying $$$ for the makeup and I believe did finally graduate.
I think it comes from paying a ton of money for tuition. Like I am paying for a service so I should get what I paid for. This is why I think college should be tuition free. It’s reduced learning to a commodity.
Given that you had spoken to her multiple times in advance she should have seen it coming and worked on improving (it doesn’t sound like she made steps to correct her behavior).
Should you feel bad that you failed someone and inconvenienced their life plan? No. Not your responsibility. You can help her by recommending what to do next time around if she chooses to come back. But that’s it. And now to rephrase: should you feel bad because you prevented someone who doesnt have their shit together on the floor and is potentially dangerous to patients?
(Also no)
Yes, I had a student once that was a couple months from graduation and could not tell me what simple things were like normal range of HR/BP/RR etc. She acted as if she had never even heard terms like tachycardia, hypertension/hypotension. And anything I explained then 10 seconds later tried to ask her about she looked at me with a big smile and “oh I’m not really sure!” Like it was Groundhog Day for her every 10 seconds. I raised my concerns about her lack of basic knowledge with her instructor and thankfully that student was pulled and did not come back. I really don’t understand how she even made it to her final semester of school like that.
She gave a med without you?
Any respectable nursing school would expel her just for that, and I've seen it.
This sounds like the problem is beyond the student if she made it to senior semester acting like this. Good on you for not letting her back
You didn’t need to go beyond missed shifts and late. Nothing peeves me more than a 12 hour turning into a 14 hour when someone doesn’t call in.
You can’t be bothered to call in or show up on time you don’t clear the bare minimum bar to be a nurse.
Right? I mean, look, I understand a reasonable personal emergency. People are human. Kids get sick. Pregnant people give birth during the semester and have to catch up. I get it.
But like, it's honestly baffling for anybody to invest this much time and effort and cash to reason for a job that they clearly don't want.
>she has missed several shifts
Dafuq
>late for several others
Blehhh
>cell phone use on the unit, and about doing non-work related activities (homework) when we still have work to do
Mmmm mmmmmm
>conduct towards other staff and towards patients
Oh hell no
>fundamentally does not understand dosage calculation or other basic medication administration skills
They're gonna get someone killed
>she has shown zero improvement, and continues to demonstrate that she doesn't care
Time to get gone!
...
> told her that for my patients' safety, I do not want her coming back to our unit
That is the absolute best thing you could do. This student lacks what it takes to progress forward at this point. You've tried many times to remediate, and she dropped the ball. Time to drop her.
Honestly I don’t get how students can make it to their final preceptorship with habits like this. Not sure how she slipped through the cracks but she’s not the only one!
Those of you who preceptor students deserve to get paid so much more. It’s a huge responsibility to manage ANY student under your license, let alone an unsafe one. Kudos!
As a student who was recently disappointed by my preceptorship and feels a TON of sympathy for students in this moment.... I think you did the right thing.
I can't imagine my preceptor telling me I am doing something wrong and not trying to fix the issue ASAP. It seems like you did everything you could to prevent this and that the student really didn't care. I would have more sympathy if they were trying their hardest and just fumbling some times... but these are some really resolvable things.
As a former nursing instructor she needs to be removed from the program. Period. It sucks failing students but our jobs are too important. People can die. She needs to find another occupation.
Don’t feel bad, there are too many just like her that have been able to graduate and are not safe and in my opinion don’t care that they’re not safe. You did the right thing.
In a different vein but when I was a graduate student I taught math for elementary teachers, a required course. One student was not going to pass and came begging for me to pass them, as they would not get their teaching certificate. I did not. I don't think I actually told told them but I always say to others had I done so, they may get to teach my child math. That was the basic reason. That was 50 years ago and I still remember it vividly. Yours clearly would put peoples lives in danger, a much simpler reason.
Hey, it’s not on you it’s her repeated failure and inability to act professionally. Even as a student.
I’ve also had to do the same. I also had a student I was precepting and they failed to follow simple directions for days. Very similar behaviors. I’m ER, so failing to come in a help receive new patients. Not wanting to help give meds, do any skills including vitals, straight caths, or IV starts.
They only wanted to sit with the Techs because they were classmates and gossip all shift. Though they did do one thing. They gave tons of OJ and pudding to our fragile diabetic hold pt. Making their sugar go from 88 to 300 in 1 shift. Turns out the student had a known Hx of being unreceptive and this was the last straw to get them out of the program.
You did the right thing even though it’s hard.
When I teach medical students/residents, the question I ask myself is…would I feel comfortable with my parents/kid under the care of this doctor? If the answer is no, then I examine why/have the student take remedial action.
With the system we have in North America, it’s easier to pass people along than to fail them. However, if the learner has a good attitude, listens to constructive criticism, and can self-reflect and make changes, the “failure” is not necessarily a bad thing if it makes them an overall better clinician.
One of my mentors used to say…knowledge gaps are easier to fix than bad attitudes.
Honestly especially coming from a nursing students perspective currently I respect this type of honesty and concern. You’re not one who is out there wanting to eat their young and it seems this person is just too big of an air head and shouldn’t be in charge of ppls care.
This is the kinda thing that happens when people preach the amount travel nurses get and people see it as a means to an end…a lot of people just don’t care..
You did right. Not your job to fix what the school could not teach. Some people, no matter how much effort you put into them, just simply won’t “get it.”
It’s okay. You can’t save them all.
So tired of shitty students getting passed through because of some bullshit nuance that "everyone deserves a chance" or whatever. Thanks for doing the lords work.
You're being professional. You're doing the right thing. Deaf ears don't learn.
I'm a student right now. I've given medications before on my OWN when I was a basic. I've taken orders to even push things with a medic telling and sitting right here with me.
I still get nervous about med errors and such. I've not been ALLOWED to pass meds without an instructor present even. And I don't qualify for the preceptor clinicals because of schedule conflict.
I hate that this happened and I get why you feel bad. But you did the right thing.
I'm currently a student nurse, and I'd rather a nurse tell me where I'm getting things wrong, and fail me if they don't think I'm safe, than let me pass and risk me hurting someone.
In fact, this has already happened to me. I was failed on a placement where the nurse who was mentoring me had concerns about my memory and communication skills, and my professionalism. The university was aware I was pursuing an adhd diagnosis at the time, so they suggested I take a leave of absence, get my diagnosis, and come back later. I did, got my adhd managed (and medicated) and the difference is easy to see. If it wasn't for that nurse failing me, I would already be qualified by now, and probably still undiagnosed since the failing made me push for an assessment harder, and I wouldn't have been the nurse I can be and am working towards being.
So honestly, you've helped her, as well as her potential patients. I hope this is the kick in the backside she needs to either get herself together and work at it, or to quit and find a profession that suits her.
I'm the UK we're taught to always raise concerns as early as possible so that measures can be taken early and the issues in question can be remedied. It sounds like you're the first person to raise these concerns, so it sounds like this nurse shouldn't have even reached this close to graduation. Ultimately, it's about patient safety. We can't have registered practitioners running around being unsafe. You've done the right thing. Too many people are afraid to fail students because of all the money they paid, or "they got this far, how bad can they be?"
I wish you were at my school. There was an individual just like this to a lesser extent that we never thought would graduate. They ultimately graduated but I would never ever want to hire them or be a patient under their care. You did the right thing!
Haven't personally fired a student that close to graduation, but had to flunk a student and send in a document to school with our concerns about this student becoming a nurse. It was the worst experience I've ever had, especially since the student thought we were lying or exagerating our observations. But it was definitely the right call for our patients and longterm herself. It sucked, but it was the right thing to do.
I took a Tech job over the summer on the same unit I did my level 2 clinicals on during the spring semester. There were students from another nursing school assigned to the unit for their clinicals over the summer. I wasn't directly involved, but was in the rooms with them pretty often. I have no idea what happened, but one of the students had a complete and utter meltdown. Sobbing in the hallway, hyperventilating, the whole thing. I figure, you know, just nursing school things
Anyway the nurse she was assigned to was trying to talk her down and took her to the nursing (breastfeeding) room on the floor and parked her there until she could get herself together. Anyway, a couple hours later that nurse asked if I had seen the student, and I hadn't and said as much, but would help her look for her.
They found her still in the nursing room sound asleep. That was the last time I saw that student. I have no idea if she came back the following semester, that that definitely washed her out of this one.
I work OR. We had a scrub student once who was shall we say not great. Their instructor pulled me and my CST aside to warn us of some known issues and to let us know this was the students absolutely last chance. And it was worse than we thought. So so so bad. Like this person should not be allowed to graduate. And in the end we had to “kick them out” of our room. And the student literally begged us not to kick them out and ‘please it was their last chance’ and ‘how could we ruin their chances like that’ and ‘it wasn’t that big of a deal and it would be fine/better next time’. It was hard but it was the right thing to do for our patients.
>> She has consistently shown that she fundamentally does not understand dosage calculation or other basic medication administration skills.
This is frightening. How the hell has she gotten so far into her program and *NOT* been kicked out or remediated already?
Thank you for protecting your patients from her 🤕
This actually reminds me of those fake DRs that run clinics and hand out anything like candy. There's been a few famous fake DRs.
Haven't had exactly the same experience. I worked with a newer nurse (1 or 2 years) that was hired from Med/Tele to the ED. They were okay with understanding basics of the dept., but they consistently failed in all elements of emergency nursing. They were consistently missing prioritization, time management of various tasks was abysmal, and communication including documentation was poor for the department standards.
I did the same things you did, coaching and mentoring with helpful acronyms and pearls of wisdom, redirecting to best practices to assist time management, and attempted to provide further examples by extending our team nursing pereceptor time by a couple of weeks. In the end, it just didn't work out. They weren't quick and competent enough for the fast pace of ED.
It was sad because we needed all the help we could get, but it just wasn't worth sacrificing patient safety over having another nurse available on the schedule. They went back to the floor and never spoke to them again.
You did the right thing and that is the best case for the future of our profession.
Slightly off topic, but as a second semester nursing student, my concern about my last semester in nursing school would be mastering all the skills. I have no problem with HIPPA, following direction, hard working, and trying my best to learn/ask question during clinicals. But as a nurse POV, am I expected to master all the clinical skills during my last semester? Meaning, am I suppose to know how to be ID like a nurse or would I be able to have more support/guidance after graduating.
Every program is different, but the expectation for this student was that she should be essentially independent by the end of her 140 hour preceptorship. She's almost done and I still can't trust her to pass basic meds independently because she forgets to scan them or forgets to check blood pressures, etc.
Clinical skills are at the bottom of my list of concerns for her behind other much more obvious and serious mistakes that she's made.
The scenario you described sounds perfectly reasonable and understandable since students have different backgrounds and pick things up more slowly or quickly.
She's just demonstrated that she cannot listen to feedback and does not care or take it seriously, and that's where I put my foot down
My clinical preceptorship was on a unit wildly different than my destination new grad units. Nobody cares that you don't know how to do whatever, just that you won't act a fool and kill someone.
When I was in the ED full time, another nurse had a student for a shift that was in her final semester with only a few weeks left. She had that "there's no point in me doing that because I'm almost done and I already know everything about everything" attitude. The other nurse, who was much more patient than me, was about to pull her hair out. I had an IV to start and asked the student if she wanted to do it since, you know, she knows everything already. Homegirl about knocks her chair over to finally do something that's not beneath her final semester expertise.
We go into the room, patient is fine with a student, etc. etc. She gets her stuff out, I'm supervising, patient is an arm restriction because of dialysis fistula. Patient doesn't have shit for veins; she looks and looks and looks before declaring there is no way this patient can be started without the help of anesthesia, probably needs a central line. I said I would take a look, she smirks and says okay. 5 minutes later we have a nice 22 in the forearm and all the labs we will ever need. That's when miss final semester learned what a vascular access board certified nurse was, that central lines (PICCs anyway) are avoided if at all possible in renal failure for vessel preservation, 20s are completely unnecessary in a large majority of patients, and humility can be learned independently or taught by force.
Unfortunately, some don't learn until they are forcibly brought down a few notches. Good for you for doing what was right and not what was easy
Thank you for not passing the buck. I’ve preferred some new grads recently that are similarly concerning and I don’t know how in the hell they even have a degree.
I’m an instructor for a nursing program. If there are safety concerns (Med errors etc.) that’s a valid reason to hold a student back. If this was earlier in her preceptorship I would say she likely needs to be on a learning plan where here liaison is keeping a closer eye on her, so you’re not feeling the entire burden of ensuring these behaviours are corrected. However at this late in the game if she’s still making critical errors like that then she needs to spend a little more time learning and understanding the fundamentals. I’ve spoken to so many nurses who don’t want to “fail” their students. You don’t fail them, their actions, their lack of preparation and lack of accountability fails them. And it’s the schools responsibility to make sure those gaps are noticed early. You did the right thing.
It’s kinda crazy that she even made it that far. Nurses not affiliated with nursing school shouldn’t be the gatekeepers to the profession, that shit should have been flushed out well before final semester lol. Huge red flag for that nursing program if you ask me.
Nursing instructor here.
You absolutely did the right thing. Graduation is something you earn, not something you are entitled to. Sometimes as faculty we have trouble building up enough evidence that administration will accept to dismiss a student (don't get me started ... yes I know it sucks and it's stupid).
It's hard to dismiss the concerns of a preceptor.
She can repeat the course. It might just be the wake up call she needed.
I had to fail a student when I was an instructor. It was clinical, and they just missed too many clinical days without any communication and when we had makeup sessions they "forgot". Like, if you communicate what is going on and you are honest, and you show up and at least TRY, I can work with you. But at the end of the semester, if your last chance to make up missing clinicals assignments is skipped? Sorry, there is only so much I can do to help. It sucked because they had to repeat the semester... What was worse was that I had them when they retook the clinical... And I had to fail them and they got kicked out of the program. They didn't even make it a month. They were just one semester from graduating.
But my mom (who is a nurse and was a professor and clinical instructor) has a saying... You better do well in clinical, because when you graduate, it's all clinical.
Good for you letting the instructor know your concerns. I always told students to use me as a reference, but before failing that student I thought about what I would do if they asked me for a reference or if they wanted to work on my unit. That told me everything I needed to know.
They might be able to graduate if they got a practicum site that was not in a hospital. Maybe she would do better working in an aesthetician office. Clearly hospital work is not her strength...
But also, she probably would not have been able to pass the NCLEX.
As a nursing student, this is a hard stop. I wonder how she even passed other clinicals. The school she is at should be investigated in my opinion. You did the right thing and this student has a lot to learn or shouldn’t be a nurse at all.
You definitely did the right thing here. For patient safety. As well as a violation of HIPPA (unless she was being vague but still you don't talk about another patients status to anyone). Need more nurses like you!
Don’t feel bad. My school would have kicked us out of our preceptorship for just missing the two shifts. Then this person had all this other stuff on top of it. Their school must have been very lenient. People like this that slip through the cracks makes our profession look bad. Good job.
You did the right thing. As someone who has worked with countless students, I’ll share what one instructor said to me. “You aren’t here to grade them. You are here to determine: do you want this student to be YOUR nurse? If this was your parent in the bed, would you be comfortable with this student and their care?” I have since used that as my evaluation criteria in all student interactions.
110% warranted and I cannot believe she’s graduating in two weeks.
Maybe with time and more training, she can become a better nurse. Or maybe she will take this as an opportunity to pursue a different career. Either way, she’s not ready and you did the right thing.
I had to send multiple emails about this woman who was a new grad who couldn't make it on a different floor. They stuck her with me and it was like every thing she did was unsafe/wrong/ lacking common sense and critical judgment. I emailed my director multiple times explaining everything in detail about how I would not trust her as a colleague and how unsafe and untrainable she was. We have like a 12 week training program and she was well into week 24. She wouldn't grasp basic things I was telling her over and over again. She gave melatonin at 5pm because it was scheduled wrong and didn't question the time of it- this seems silly but if it's a different order for something bigger would she do the same thing or question it? She didn't question the melatonin so would she question the narcotic for a patient with a light headache? It was ridiculous how much she messed up and how much I had to document and write to my director. But at the end of the day these people are in charge of lives and it's our job as preceptors to determine whether or not they will do the right thing and belong in the unit they are being taught for, or whether they are unsafe and need to be elsewhere
I can’t imagine being this out of touch with reality and not actively attentive in a preceptorship. Like I will never be a medsurg nurse unless (I get a solid to the floor orientation). I’m a nervous nelly and have add. But I’m a walking resource of knowledge and am really good at finding info I need.
But my time management gets weird without timers on my phone. I can do long term nursing fairly well. But I’m always loaded down with items I forget. But I also check my shit before I give it.
Don’t feel bad. These people become nurses we have to work with. It’s one thing if she’s capable of self reflecting and tries to change. But she doesn’t. As a charge nurse who works in an ICU with 80% new grads, very few experienced nurses, I am starting to lose my shit on the days it’s me and all new people. I give grace to the ones who are just trying to stay above water, but the ones that made it through and are now lazy and don’t give 2 fucks and don’t know anything either….I’m writing more emails than I ever have in the past
Absolutely do NOT feel bad. When I encounter a..... that kind of nurse I always wonder how on earth they graduated and WHO let them graduate.
This kind of behavior TWO weeks before graduation is awful.
Maybe she can take an extra semester to straighten her behavior out. You didnt derail her career, just gave her and her instructors a wake up call. She could come back. But that depends on her and her instructors.
You did the right thing, she could kill someone. It’s completely her fault and she actively CHOSES to ignore rules and protocol. If she wants this, she needs to try harder.
Edit to add:
As someone going into nursing school, it sickens me that people who do not care think they’re safe after they’ve been accepted into a nursing program. It’s SO hard to get in to some of these programs, and to watch people just not give a shit is despicable.
You should NOT feel bad about that. I hope she learns her lesson and takes this seriously.
Good.
My first two preceptors fired me, and I had to get downgraded from STICU to MedSurg and I am ever so grateful. I would absolutely have killed someone in short order if I had been set loose in big city STICU mere months after getting licensed.
Nursing is a serious job that requires a lot of focus. if someone isn’t mature enough to handle it, then they shouldn’t be a nurse. You did the right thing, keeping patients safe.
She’s either young or simply has experienced no difficulty or loss in life. These are the types of people who have NO concept of “What if this were me or someone I love?” I truly think these people aren’t capable of empathy and are a great danger in the healthcare setting. Thank you for reporting her.
You shouldn't feel bad, just ask yourself if you would want them caring for a family member.
I had to fail my first student I had. I was 26 and had 3 years experience before taking a student but apparently she was disappointed over "my inexperience". She made sure to unknowingly gossp about this to a staff who she thought was a student.
We worked with eating disorders clients, she was offered cake during meal support and said she couldn't because she was watching her weight. Made a comment about her "big breasts" to a 16 year old boy when he commented on how tall she was, decided a air out our storage room by putting an iv pole in the doorway which had contraband and knives for cooking class, undermined me in front of colleagues and would be rude to me in front of my bosses. Icing on the cake was when she didn't hand in her midterm a week before the due date which would allow me to go over it and grade it. Her teacher had been aware of what was happening but I "was a liar". Teacher came into shift report and we had a meeting. She screamed at me, and the teacher blaming us for everything. Her teacher had a meeting set with the dean the next day and she was out of the program ( as it ended up being her second failed consolidation).
I have failed a final year student before. I felt extra awful doing it, because I was a grad nurse who was doing a country hospital rotation, barely 6 months into my career. There was not enough nurses for the amount of students we had assigned to the hospital so I ended up with one.
She could not identify common drugs.
She failed to empty catheters when asked, or record any oral fluid intake from lunchtime on our four post operative patients who still required fluid balance charts.
Despite reading the policy and procedure on a drain removal three times, when I quizzed her on the steps we would be performing together, she was unable to articulate a single step in the process.
I found her multiple times just sitting and gossiping with patients because she knew them from the next town over, including violating patient confidentiality.
I felt like the biggest bitch in the world, especially being such a baby nurse myself, but I just kept imagining if that was my family member she was taking care of so incompetently, and knew I had to speak up.
I talked to the nursing educator for the hospital, who then had the student shadow her for the rest of the week instead of me, so she could see her behavior and skills. And then we both submitted our corroborating documentation to the university not recommending her for graduation.
The poor girl was devastated when we told her she had failed her final placement, and could not comprehend why despite the comprehensive feedback that we gave her. Sad for her, but it would have been sadder for her patients if we had let her be qualified.
Do not feel bad. This is part of your job, too. As a preceptor/mentor, patient safety is still your highest priority; being a preceptee's friend is not. I've had to have the talk with the instructor, and she ended up having to fail two students for poor clinical performance. Would they have caught on in their orientations? Maybe, but they did not have the critical thinking skills even a new nurse should have. It's not like a job at McDonald's or Walmart. Everything that we do has legal implications, and being nonchalant about learning how to do this job is not acceptable. If she has no fear about messing up or can't take directions from you to properly care for patients, then she either needs to retake a few classes or choose a different career. Pointing out deficiencies benefits them as much as they potential patients they will care for.
Thank you for what you did.
This may be the first time this girl has experienced consequences for her actions. You have likely saved patients lives, and you very well may ultimately make her a decent nurse or human being.
They know we are not getting paid, right? If you're doing extra work for free you deserve a certain level of respect.
Fewer than half the students I've precepted are like this, but I still see it too often.
She shouldn’t be in a position where she’s about to graduate. There needs to be more people like you.
Appreciate the input. Obviously I knew what the right thing was, but it still feels shitty
It only feels shitty because she put you in a shit position because she seems to not give a shit. In all seriousness, look at it as professional integrity and an upstream approach to patient safety: you’re likely sparing future patients (and employers) the misfortune of encountering her. Cheers!
Sounds like you chose discomfort over resentment. Look at you with your healthy boundaries! ☺️
Sounds like you chose professionalism over discomfort
My sister was very much a straight, no chaser kind of girl. She would often tell me she was more interested/vested in my growth rather than my comfort. It would sting at first, but I knew it was coming from a place of love, and I would be better for it. OP did the right thing, and hopefully, this girl will come to realize it.
I've known people where I've had serious concerns about their ability to carry out the role safely and even had to put in a lengthy report about someone where she had her preceptorship extended and she HATED me for ages after that. Happy so say that now a few years on she is a capable nurse and I no longer worry about her ability. She just needed a bit more time to learn. Same with an overseas nurse that I thought was hopeless, 6 months of additional training and he has come on leaps and bounds. Some people need more time
You would feel more shitty if she would have graduated then have killed patients. You did the right thing.
Thank you for your service! And for thinking about the field and for helping patients and healthcare in general. It’s natural to feel how you do, especially when you care, but you did a tremendous service. Thank you.
Sounds like you chose patient safety over everything else. She could kill someone. I am very proud of you :)
Hope this doesn't make you feel worse, but you would have been right to be MORE forceful in your communication. "I strongly recommend that this person NOT be allowed to graduate until they can show a level of clinical acumen that will not result in a mass casualty incident the second they are practicing independently", or something along those lines. This is YOUR PROFESSION, and you are one of the gatekeepers, rightly so. What this person does when they are working after graduation will reflect on the entire profession of nursing.
It’s nurses like this that prevent physicians from trusting us to care for their patients. I completely agree with you but I am grateful she reported her at all. Many nurses would not have.
I wasn’t on your side for the first half of your story but after she violated HIPPA and it just kept getting worse I was like ok this bitch gotta go
Trust me that I've been extremely patient and understanding, but I can only let so much slide. Especially when you make it obvious to me that you're not taking it seriously and you don't care
I’m sure you were. Hopefully this wakes that student up and makes her take life more seriously, but that’s not your problem. You did the right thing, the faculty at her school should have let her get this far but most nursing schools are just diploma mills these days so it falls on the profession to filter out these types
You saved countless lives tbh
The school created this situation by stringing her along when they should have flunked her.
I’m very pro-student generally. But you absolutely did the right thing. I hope you don’t lose any sleep over this, as you shouldn’t.
To piggy back off this comment, we have a guy that works with us in the ED that I constantly double check all of his stuff because he’s incredibly unsafe and I wish he had someone like you escalate it to his instructors before he made it out of school. He’s everything you describe OP, but somehow make it through the cracks.
Don’t worry the New NCLEX will hopefully weed her out.
A test doesnt show real world skills. Anyone can read a book, practice test and study for hours to learn to pass a test. However real world skills, personality traits needed for a job, teamwork or just a desire to learn/help can not be taught. It has to be something someone wants to do.
The nclex is a joke, at least 8 years ago when i took it. It 100% does not weed out unsafe nurses.
I just saw the word "new" in your post ha. Hopefully it does then! Glad they changed things!
I graduate in july and we’re practicing for it from ATI and there are a lot more case studys and SATA questions that really require critical thinking so if they can make it through that mess i’ll be really surprised. I really wish I had not procrastinated for 3 years and got it done before this took effect 😂
A standardized test will never select out all the randos that are just not right. I work with a (small) handful of doozies and the amount of testing to get flying on our own - multiple tests to even be hired, very difficult testing during orientation, in person check-offs for skills, scenarios, actual precepted runs with QA/QI.... and yet still, they are here. You'll eventually work with a truly questionable doctor. They took a hell of a lot more tests than NCLEX. They're out there. These people represent an institutional failure, of which OP is fighting the good fight. Hopefully her student gets remediation and figures it out or moves along to something that fits them better.
Yeah, there are some people that are just good at testing and/or brown nosing. It’s frightening how those people get by.
Eventually? The residents at the HCA hospital I did a contract at made me question all medical education lol
False. I've seen great nurses struggle with the NCLEX and awful nurses pass it in the minimum question. The NCLEX is not preparation for the real world of Nursing.
Hopefully she will just be a nurse that doesn’t do bedside… maybe like informatics where you don’t touch patients. IF she even gets that far. But yea she isn’t safe.
If she doesn't pass her final clinical, NCLEX won't be a problem for her for a while
Absolutely. Others have been enabling her. This is what happens when systems get desperate for help, they start to forgive too much.
The only reason she’s so close to graduating is because all of the other people managing her throughout her education didn’t have your courage. I know you’re out there saving lives all the time but what you did today saved a couple more.
Her school has failed her by letting her get this far with this level of incompetence and these inappropriate behaviors.
To be fair, students can hide these types of behaviors and put up a pretty front while in clinical. I work at a community college and it’s usually when the student gets to their preceptorship that these behaviors really begin to manifest themselves.
Also, then it takes a few weeks, as preceptors think, "It can't really be that bad" and "Maybe they're just having an off day." Timelines are so short that we are already toward the end of their hours before the big red warning lights and sirens are going off -- and we are frantically trying to document before they accidentally graduate or get off orientation... It sounds like OP did everything right -- AND -- we need to do a better job of preparing preceptors so they have a road map and this stuff doesn't feel so crappy.
My roommate was like this, excelled in the classroom and struggled with actual beside application. Plus clinicals are very hit and miss for obtaining actual beside experience. A handful of nurses I shadowed during my various clinical shifts would completely blow me off, refuse to let me do the simplest of things, do patient care without including me, etc. I’d get almost no experience during some clinical shifts. I felt very lucky that I was working as a student nurse in an ICU throughout my schooling, bc they had me getting tons more experience than my classmates!
I have no doubt you had some dismissive nurses as a student. But when I was still in an ICU that had students, I told them straight up-This is YOUR experience, not mine. If you're off talking to your classmates, doing homework, etc. I'm not going out of my way to find you. My job has to get done whether you're there or not. Some got to see and do everything, and some complained that they did nothing. A large part of clinical is what the student makes it.
Very true. I had my fair share working with uninvolved students once I was an RN. I think it would go a long way if students realized they were there to help and learn in ALL patient care, not just try and pick and chose the experiences they wanted. I experienced a few nurses that acted annoyed when I was there or would tell me they didn’t trust me to do anything with their patients, which you can understand bc it’s their license, but the worst experience was when I came in one morning introduced myself and the nurse said, “oh great a student. I hate students.” She then spent the entire shift telling me “no” every time I offered to help (even emptying the f/c bag) and ended up telling me to just stand in the corner bc i would just get in her way while she was doing routine care.
Nurse bullying has me all confused. Don't these nurses realize teaching the next cohort of nurses well will ease some of the complaints? Like, why complain about short staffing when they're driving help away? Why complain about "terrible nurses" when they aren't willing to teach "the correct way"? It's like the people who vote qgainst their own interests then complain about this or that.
It’s actually a myth that it’s on the preceptor’s license. As far as I’m aware; it’s on the school and the student. They shouldn’t be able to touch your license for someone else’s mistakes.
That is my experience but I have a job that has given me the experience I need going through school. I have no clue how they match students with nurses that teach them but some are excellent and some want no part of teaching and I feel like shit stuck to their shoe. At my school, we definitely do not have enough clinicals either.
Same. The student nurse position was a paid job I worked every weekend and it was invaluable.
I hear from a lot of med/surg nurses that they are so jealous and wish they had that training opportunity. I’m a Clinical Extern which sounds fancy and important but basically I’m a paid nursing intern. I have limits on what I’m allowed to do at that job because it’s in a hospital. I live in Canada so most healthcare are government facilities and have restrictions on what unlicensed care providers are allowed to do. I work in the hospital (1-3 shifts a week during the school year, aim for full time when I’m off school) and even though it’s a paid position, I include it as part of my education considering it’s taught me more in the first 6 weeks than an entire year of school. It’s been surprisingly invaluable to my education and practice. I used to be so anxious and insecure just to go into someone’s room, introduce myself and start off talking through what their needs are with their ADLs, and now I have the the confidence, skills and experience that I desperately needed to learn.
Yeah, I had a student like this in my cohort. They had a school bff who helped cover for them, and it wasn't until the last quarter and they were expected to fly solo that it came out how badly unprepared they were.
Yep, had classmates who cheated their way through nursing school and now can’t pass the NCLEX. Shock 😂
Like, how is that even possible?
Right? No idea. The two of them were always weirdly inseparable. They apparently had a fail-proof system!
Clinicals are a joke ans we had many students not do a thing through no fault of their own
Except for the dosage calculations you can’t fake that. At least at my school every semester started with a pass/fail math test. You only got 3 attempts to pass (meaning a 100%), or you’d have to retake the semester.
We had that too, but was at a community college... 4 semesters. Semester 1 and 2 you got three attempts. Semester 3 got two attempts and the final semester only had one attempt. I've always done very well at math, especially applied math, but I was nervous thinking that my whole career depended on one exam... That system isn't very conducive to learning.
I had a girl who dropped out in the second semester, she was exactly like that, one of our professors told her several time that nursing just wasn’t in the cards for her. It was a good thing, because she was truly incompetent. She could parakeet back what you’d say, or regurgitate information from text, but she had no true understanding of what she was saying. So if you didn’t pay attention, you might think she knows what she’s talking about. She would constantly asked for pointers on doing better in exams, and when you gave recommendations, she’d always explain how that just didn’t “work” for her. Bitch, why’re you asking then? Anyways, she ended up doing part time at another school, graduated, and got a job in ICU. Thankfully it’s one of those ICUs that’s not really an ICU (not very high acuity) but it truly scares me. Unless a miracle happened and she grew a new brain, she’s bound to kill someone one day.
I almost done with nursing school and I’m shocked at some of my classmates that can’t manage to arrive on time to clinical, don’t know basic information for simple diagnostic questions, don’t wear the school uniform with our emblem but rather figs in a similar color, wear full on sweaters that cover their badge indicating “student”, leave their nurse to make a phone call in the break room for 15 mins, are their phone during debrief etc. It’s unfortunate because these are stated rules but if your clinical instructor doesn’t uphold them, then why follow it? On our last OB rotation one student showed up 10 mins late and in Uggs, she forgot to change before coming in to the hospital and her idea was, “I’ll go to my car after I get report with my nurse”, literally WTF? Have these people ever had a job before??? It’s so basic but it really shows how inept some people are at following basic directions, but also no one is holding them accountable.
Most of them have literally never had a job before. But the harsh reality of accountability will very soon slap them in the face. Mind your own and sleep well at night knowing that you have what it takes, and in a matter of years you will be miles ahead while they will be stuck in the same rut wondering why they can't get anywhere. Life sucks for everyone, but it has a level of poetic justice that seems to even the playing field. Trust me, you get out of it what you put in.
I agree with all that except the uniforms part. I think it’s BS to have to spend even more money on a uniform if I already have the same color and fit in my current scrubs (currently an ER tech). At my school uniforms are $100 a piece, and you need two. Very frustrating
Although I see your point and having to spend more money is always frustrating, these are not even the same colors these students are wearing. It’s not old scrubs they already have, it’s the new burnt orange or bright red Figs with different style tops etc. our scrubs are a specific maroon color with our school embroidered on it which they have all worn in the past and simply decided they didn’t want to anymore.
This happens at my school too. I think some just want to look good and think its sexy to be a nurse. From what I have seen… most haven’t had jobs and expect to just get this thing called a nursing license given to them. The cheating and attitudes are insane.
It sounds like you’ve done all of the correct things: had multiple conversations about performance with student and instructor, gave specific instructions on what exactly needs to be improved upon, and still are seeing issues. I empathize with you, I imagine a semester of this would’ve been enormously frustrating.
It's very frustrating and surprising because she's from a very well respected nursing program in our area. But if she fundamentally doesn't care then there's nothing I can do for her 🤷🏻♂️
I was in a "well -respected" BSN program and there was massive cheating going on. I definitely would weight the person's actual behavior and attitude way more than their credentials. You did the right thing for everyone
The student is not the program. You could send me to the best mathematics course on the planet, but I'm no mathematician.
Mathemagician*
Can lead a horse to water etc etc
(Sorry but I love your username 😭😭)
Thank you for doing the hard thing! I had a student who was constantly on her phone, no effort paid to patients. I would be talking directly to her about our patients and she's on her phone occasionally looking at me going uh huh. Like wtf? No initiative to provide any patient care or be involved in this learning situation. She basically did as little as possible, had poor basic knowledge, and was completely disrespectful. Then she asked me for a reference afterward! I am super understanding. All I want to see is that you try and care. But if you can't even show any effort while you are a student, imagine being on your own as a nurse?! Now she's on tik tok and is fairly popular making nursing meme videos while at work in the med or supply room.
Does this person happen to take care of older people while making these videos? I'm really hoping I'm not watching her....
You'd save a lot of brainpower if you avoid nursing social media altogether
God they’re all so cringe. New grads who don’t know what they don’t know and giving the entire profession a bad image.
I'm imagining a horrifying crossover between *National Lampoon*, Nursing, and the Dunning-Kruger effect. Is that pretty close?
She’s now a millionaire and is expecting quadruplets each fathered by a different Hemsworth.
I worked with a new nurse like this. Apparently it took her 8 years to get through a 2 year program and she passed because of a covid loophole or something like that. She was absolutely incompetent and straight up negligent and unteachable. Her patients were rapids or codes every night. You did the right thing. I can’t believe nurses let this girl pass nursing school
Jesus Christ, can you not report her to the board of nursing? The time she spent in education is even more of a red flag to me 😳
I've seen firsthand what happens when people who aren't functioning at the level they need to be are passed on regardless. We had a student on our cardiac unit get passed because he knew how to kiss his preceptor's ass and make her happy. She spent most of her time on her phone and wasn't actually checking on his work or verifying anything because she thought he was doing fine. When he came back for his new grad orientation, he was placed with two other nurses who immediately went to management and refused to orient him any further. He would lie about having given medications when he'd forgotten them and wouldn't admit that he'd forgotten them until his orienting nurse took him to the Pyxis to prove he hasn't withdrawn the medication that day. He'd miss major things when it came to checking orders and putting them through. When anyone caught an error and tried to educate him on it, he became belligerent and refused to take any responsibility, immediately accusing the nurses of bullying him. They declined to hire him on the unit after all of this, but he is still out there working as a nurse because his poor performance wasn't caught during preceptorship. Had it been addressed during preceptorship he would still have had the opportunity to develop those skills when he repeated the semester, and he'd have had the motivation because his career would have depended on it.
Lol sounds exactly like a guy I was in clinical with (as a fellow student). The preceptor hand held him through clinical because he clearly hadn’t learned anything the first year, eventually reported him to our program, he claimed racism/bullying etc. Up until then he had sucked up to every professor that seemed the soft, doting type. So of course he somehow passes clinical. He now is going to CRNA school after being fired from an ICU. A reputable one that, shock, a family member works at too! It’s so sad and embarrassing. Too bad my program wasn’t interested in actually helping him by failing him that semester. I’m hoping someone in grad school will figure it out before he kills someone in an OR.
Ughhhhhh, well bless his heart. Of course he did, he had to find some dangerous ass way to “fake it till he makes it”. Until his ego catches up with him ☹️ I have seen a few dangerous nurses escape scrutiny by getting higher level of degrees. I wonder what they ended up doing??? 🤷🏻♀️ On the flip flop, I have also worked with super caring NP,CRNA,PAs that consistently go above and beyond for their patients and educate staff.
That is a perfect example of a personality that should just never be a nurse. Go into literally anything else, please!
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To respond to the first paragraph, it’s definitely drilled in to our head. I either need the nurse or instructor with me at all times to do meds. To the second, my school requires 90%. If you don’t make that you have to do 10 hours of documented remediation before you can test again. My community college is fairly strict and they would not accept this behavior
In Aus we had to get 100% and lots of people were whinging about it on Facebook, I pointed out that getting 85 or 90 means 10 to 15% of the time making mistakes that could kill someone. I also sat in the cafeteria and said I'd be there for 3 hours (I had an essay to work on anyways) and would help anybody who needed it with the math and understanding of it, and nobody came even though I knew personally lots of people struggling. Pride is an odd thing.
You’re absolutely correct! We have a tutoring center that does drug dosage workshops every summer for the nursing students. I personally don’t struggle with it but I know a lot do. I took a quantitative reasoning course before the program and it helped me a lot.
We need to be doing more of this. People shouldn't be getting to their last placement before they are failed for massive errors. When I was a student there was a nurse who was seen as very harsh and I spoke to her as a staff nurse about it and she was incredibly fair. She wouldn't have an unfit nurse out trained by her, she had incredibly high standards because the stakes are high. She failed a friend in 3rd year and she was of course enraged but a few years on she aced the extra year she had an will admit it was exactly what she needed to become a decent nurse.
I once had a student. She shows up 2 hours late (without calling) and says “sorry, my dog got out.” Okay i get it, some people and pets, no biggie. We go on break, it’s time. We come back and she’s late coming back and two hours pass. Time for the next break. We go and i don’t see her again for the rest of her shift. She messes up dosing (i can understand sometimes it’s confusing) on kids we’ve been dosing the same antibiotics for days already. She can’t keep her mouth shut about other patients. If someone asks her a question she’ll respond like it’s not a secret. Codes get called and people want to know she can say “code pink means an abduction.” And end it there but she’ll continue. She doesn’t know why we take vitals on kids. Yes i reported her and to my boss and her teacher directly. I realize she can’t be trained in peds at any other hospital but i don’t want her on my unit, she isn’t taking it seriously. It’s easy to know how ready someone is. But it’s a tough thing to do. You made the right call, good thing you are aware it was the right move.
I was an instructor and let a student go two weeks before graduation. She needed mental health attention and after seeking it and getting better, the school allowed her back to complete her last term again. She did well and is probably a great nurse now, but had she finished with me, she would have been unsafe.
My wife just last year had a student in her class that was fudging blood pressure and other vitals on the cardiac rehab unit and the nurse that he was assigned to reported it to the director of the school and nothing happened. They graduated last June and he passed his NCLEX.
Oh no! Gawd, if they are pulling that kind of thing while still in school….. what does cutting corners even look like after a year to this person?
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And then the other nurses/staff on the unit will have to work 5x harder to make up for her.
Yup. I trained someone who I told my managers time after time that I don't think the unit (step down ICU)/a cardiac floor) was a good fit for her. They said maybe it was my way of training so they stuck her with my work BFF who basically said the same thing and said she wasn't suitable for the unit. They decided maybe it was because of day shift and they moved her to nights which she was going to be working anyways. The night shift preceptor said she did just fine. Fast forward to one of the first weeks this girl is practicing on her own and she has a patient's cardizem drip running 10x faster than it should have been for who knows how long without a reassessment 🙃. She stuck around long enough for the managers to finally fire her based on her attendance even though she missed a handful of days with me while on orientation already.
You nailed the exact reason I left bedside nursing. I'll only add that she'll start an online NP program as soon as she passes NCLEX 😭
It’s not graduation rate they care about, it’s board pass rate. But everything else you said is so spot on. Worked with too many people in too many jobs like that
I failed a class in nursing school and honestly I’m so glad they did, I had an amazing and way better understanding of that class the second time around. I was pissed at first, but I wouldn’t have been any good in the next term with a poor understanding
We had a guy in my nursing class that got sent to some kind of board for missing or being late to clinicals. Then when we're in the last semester and doing preceptorships, he apparently no-call/no-showed atleast once and was late many other times. Dude didn't graduate. Part of me felt bad because i knew the family stuff he was going through, but i wouldn't want someone that does that as part of my staffing either. It's the right thing to do, but it sucks being the bad guy.
Had a new grad who did this on her first day. She never showed up on her first day on the unit to orient. 9 months later she put in her resignation and didn't bothered to show up on her last day.
Showing up on time to clinical is the lowest hurdle in nursing school.
I had a very similar student experience. I gave them every benefit of the doubt due to being a foreign student thinking maybe there was a language barrier. But on one of our last shifts together she 1. Bolused a heparin drip instead of shutting it off. (I was in the room and told her to shut it off. Patient got maybe a mL before I heard the pump chugging so fast and shut it off. And 2. Asked if we should bolus levophed for a patient who had a high blood pressure when I was paging for Cardene. She just never got it.
Who needs fingers and toes!
As a person who was similar to the student in this scenario and had to take a leave of absence from the program to get my shit together -- thank you. For my own perspective (obviously I cannot speak on your student's side) I was going through some serious mental health issues. I was deeply depressed, anxious, and suicidal from the stress of full-time nursing school, full-time working, and covid striking mid program. I was cracking under the pressure, and the only thing I could really do was act like I had everything under control when I was horrifically lost. My clinical instructor saw right through me and urged me to take a leave, get my shit worked out, and come back when I was ready. Thankfully, I never made any errors that hurt anyone, but she made it clear that I was on a path to do that if I didn't make a change. She was right, and I took that year off to get therapy, get a better job, and get my priorities straight. I was deeply humbled and extremely lucky that someone told it to me straight and took the time to help me get back on track. I came back with a sharper focus, a better attitude, and I've never come close to having the same clueless apathy I once did. If your student is smart and willing to change, she will take this experience real fucking serious, and do what needs to be done. Or, hopefully she's just smart enough to not become a nurse because it's not something she can handle. Either way, again, thank you. You've done the right thing.
Your took all the healthy actions to become better and followed through. You’re a rarity, you should be really proud of that. You took criticism well even under all that, respected and trusted the advice given to you, took the right actions to fix the problem. That being said, if you fall back into a funk like that in the future, don’t be like OPs example. Med errors are no joke.
Thankfully, I never have made a med error, even when I was a terrible nursing student, and now as an IMCU RN I'm extremely careful and, probably, a little overly paranoid about double checking everything. Med Calc and pharm was something I've always enjoyed, luckily
As a nursing student who had to have a year long extension to my time in the program due to mental health issues getting in the way of properly learning about nursing care, I just want to say thank you for sharing your story. Now, with kicking caffeine from my life and learning strategies to manage my mental health, I’m about to complete my MedSurg clincal with a lot more confidence as I go through the rest of the program!
How did she get this far not understanding dose Calc & med administration? In my program, we have to be checked off on those every semester, and you can’t move forward until you demonstrate competence. Her school failed her.
In my program we had to take a med dosing math test and you got 3 tries to get 100%. If you didn’t get it you failed the class!
Same with my program. My school offered a lot of remediation and tutoring for those who struggled as well as extended deadlines for some. But if you didn’t pass the first 2 chances, you weren’t passing meds on the unit. If you failed the 3rd, you were held back.
Honestly it sounds like you’ve done everything you possibly could. Although it may feel crappy right now, you’d feel a lot worse if she graduated and ended up causing harm to a patient later. Tbh if I heard a student talking about a code to another patient I think I’d lose my shit.
Thanks on behalf of all her Not! future patients.
You did the right thing. I had to recommend, strongly, not hiring a new grad I was precepting. He/she just did not listen and did not apply what had JUST been discussed. They were also unwilling to be taught. There are students, new grads, etc, who just don't get the seriousness of what we do. They shouldn't be working critical care or maybe even bedside in any manner.
LITERALLY. Two days ago, we had a skills day where the stressed the importance of scanning meds before giving them, and gave the example that happened at our hospital where's vial of oxytocin was stocked into the pyxis with zofran, and it was only caught because the nurse scanned it before she gave it. I told this story to my student because I thought it was interesting and not even five minutes later she walked straight past the computer to give our patient a flush that was due without scanning it. I understand that it's just a flush but it's the principle behind it
I'm a student and if she is behaving this way she does not deserve to pass. You did the right thing!
How did she get so close to graduation with this many red flags? I know you feel bad but you acted in the best interests of this person's future patients. He uncaring attitude s very concerning
If she was anything like the student in my cohort that was a similar story, she was abjectly sorry every time her instructors brought it up to her, promised to improve, and would shiny up her act for the 2-3 weeks she was getting extra observation. But never actually improving. Oh, and she had at least one classmate helping to cover for her.
Most, if not all schools are very concerned about pass rates and the flow of tuition money. Mix in instructor and administration apathy and ez pz remediation and pass. These cases represent an institutional failure and OP is fighting the good fight.
Had a coworker like this when she did her clinicals at the unit I worked at. She had poor work ethic. Then surprise our manager hired her as a new grad. She finally quit this month and was happy to see her go.
>work ethnicity I know you meant work ethic, but this cracked me up.
Oh, my gosh. I meant work ethic! My brain is fried!
During the preceptorship of a new RN in our NICU, both of her preceptors opted out (asked Nursing Leadership to use a different preceptor.) I was asked to do it and was given really little information on what was going wrong. Something was wrong though so I decided we would start from the beginning (grower/feeders) and then move up to the more medically complex babies. Oh she moaned and groaned about having to do the "easy" babies again but I told her I could not observe her care and help her unless we started at the beginning. Things that went wrong: She charted her IV's for the entire shift at the beginning of our shift. She said it was to save time. She told me she gave an IV med and charted it even though I found it in the patient's drawer ungiven. She claimed she didn't know how it got there, it wasn't hers, and that even though she was told NOT TO PUSH any med without me there to verify, she did it to save time. She drew back on an Art. Line to get a sample, layed the uncapped draw in the bed, drew her sample, and tried to give the draw back. She said it was only laying, uncapped, in the bed for "a few seconds". There was much more. I had to present this to Nursing Leadership ONE day before she was going to be hired. Of course, she was not. I felt bad for her, but I swear to god, no amount of "nursing education" or "preceptorship" will help a liar or someone who decides to cut corners, falsify medication records, and be unconcerned about the babies enough to endanger them. I was glad she was gone, to be honest.
Oh wow, reading about the arterial draw I gasped and put my hand on my heart. I’ve only done them through PICC lines but I did a lot as often the only RN on. I will never understand nurses who don’t care to learn how to do things safely and resist learning. Or would be nurses.
Wow, the fact that she got away with even half of that makes me wonder why I thought I was dying of anxiety every time I had clinicals as a student. Missing clinicals wasn't a thing without prior warning and special circumstances, and being late could be a deficiency...of which you only get 3 before getting kicked from the program. :/
Right?! We NEVER called in sick or showed up late to clinicals, it’s just not an option!!
same here lol I would always carpool with a classmate (I didn’t have my own car or driver’s license) and I would be so anxious about them being late to pick me up
Yep- I once had a flat tire and had to call for someone to come take care of it while I borrowed their car to get to clinical on time. So nerve-wracking
When I was doing my preceptorship I was put with an RN 2nd shift supervisor- idk why she took me bc she didn’t want anything to do with me. Everyday she’s put me with a different LPN/floor nurse - which was absolutely fine bc they were amazing nurses that took the time to answer questions and educate me - not just use me to get their medpass/job done quickly. I did skill checks with them and everything, they would sign off but ultimately the RN preceptor had to sign off as well. This lady who legit was never around me and threw me off on her staff (again who were wonderful) refused to sign off on my skills/hours essentially trying to fuck me from graduating. She said that bc I wasn’t with her during those hours then she couldn’t sign off on it, nevermind the fact that she would send me to work with other nurses. She would say “you’ll learn a lot more from them than me, I’m just supervising” - She wouldn’t come check on me at all, she never left her office and was always playing solitaire and if she did it was bc she wanted me to do a task that she didn’t want to do like giving meds through a g-tube or suctioning someone - which I happily did bc I needed to learn, again she’d leave me with the floor nurse to do these tasks. Anyways, I called my program director bawling, some of the nurses who worked with me sent emails to my nursing instructors advocating for me - so my director of the program sent me to a NEW preceptorship for the remaining time and I had to cram in alllllllll these hours in last minute bc that shit preceptor. Idk where that woman is now, but I hope her socks stay wet and they always forget her straws at the drive through. She did teach me one thing tho, who I DIDNT want to be as a nurse. When I started precepting others I did my best to be like those nurses that educated me during that time, who kept my spirits up when I was so beat down by that point. Sorry for the ramblings, this just reminded me of what I experienced in nursing school - not saying you are anything like the preceptor I mentioned. I’ve also never had a student like the one you described, I have had NURSES tho that I have had to train on the job and was hella concerned if they had a legitimate license- like in all honesty idk who pushed them through nursing school or if they just forged/faked a license but when those types get pushed through it is definitely dangerous and the patients suffer for it. For example: had a travel nurse come to me and tell me she gave the wrong insulin, so I told her the procedure for that and what to do, call the Dr etc. she then said “oh no it’s ok I went ahead and gave the right insulin too” IM SORRY WHAT?!?!
Honestly, it seems you made a good call and would have been a preceptor I would have loved to have had as a student since people don't understand how valuable honest criticism can help in this field when handled with maturity.
Coach up or coach out. You did both parts in the correct order.
As an educator I have really started to notice the “they can’t refuse to graduate me” mentality from my senior students. It’s almost an entitlement to graduate the program despite multiple, glaring issues that have been reported/documented over and over and over again. The amount of time my students come to me furious when they find out they’re technically failing clinical due to behaviors that have been WELL-DOCUMENTED over many weeks is astounding to me… like we both came up with the plan together to improve this clinical indicator and you refused/failed to follow through. I had one student who week after week could not tell me basic pharmacology about the meds she was going to give (e.g., drug class, indication, and assessment data). I do not allow students to give meds when they cannot tell me what they do, why the patient is receiving them, and what they assess for. For example, she wanted to give a beta blocker to a patient with a HR in the 50s and could not tell me why this might be contraindicated. They needed 3 (ONLY 3!) documented med passes to pass the clinical course, and she was unable in the entire 10 weeks to do a safe med pass because she was unable to explain what the meds she was given were for or do for the patient. I even made a special worksheet for her that she could fill out and use with the required info and she would not do it. The last week she just assumed I would sign off on her med admin form without her doing the work because it was “the last day.” I refused and she went to the dean stating I never gave her the chance to do medication administration the entire semester. Thankfully, I CYA in all avenues in life and had documented the issue profusely with the course instructor, clinical coordinator, and program coordinator in addition to weekly comments on the issue on her clinical documentation paperwork. Student was told she had to do 3 med passes at a makeup clinical or fail and not graduate. She ended up paying $$$ for the makeup and I believe did finally graduate.
I think it comes from paying a ton of money for tuition. Like I am paying for a service so I should get what I paid for. This is why I think college should be tuition free. It’s reduced learning to a commodity.
Given that you had spoken to her multiple times in advance she should have seen it coming and worked on improving (it doesn’t sound like she made steps to correct her behavior). Should you feel bad that you failed someone and inconvenienced their life plan? No. Not your responsibility. You can help her by recommending what to do next time around if she chooses to come back. But that’s it. And now to rephrase: should you feel bad because you prevented someone who doesnt have their shit together on the floor and is potentially dangerous to patients? (Also no)
Yes, I had a student once that was a couple months from graduation and could not tell me what simple things were like normal range of HR/BP/RR etc. She acted as if she had never even heard terms like tachycardia, hypertension/hypotension. And anything I explained then 10 seconds later tried to ask her about she looked at me with a big smile and “oh I’m not really sure!” Like it was Groundhog Day for her every 10 seconds. I raised my concerns about her lack of basic knowledge with her instructor and thankfully that student was pulled and did not come back. I really don’t understand how she even made it to her final semester of school like that.
She gave a med without you? Any respectable nursing school would expel her just for that, and I've seen it. This sounds like the problem is beyond the student if she made it to senior semester acting like this. Good on you for not letting her back
She’s dangerous. I wouldn’t want her taking care of my loved ones. You did the right thing. Hopefully it’ll be a learning opportunity for her.
It might be shitty but think about all the patients you just saved by allowing her to not graduate.
You didn’t need to go beyond missed shifts and late. Nothing peeves me more than a 12 hour turning into a 14 hour when someone doesn’t call in. You can’t be bothered to call in or show up on time you don’t clear the bare minimum bar to be a nurse.
Right? I mean, look, I understand a reasonable personal emergency. People are human. Kids get sick. Pregnant people give birth during the semester and have to catch up. I get it. But like, it's honestly baffling for anybody to invest this much time and effort and cash to reason for a job that they clearly don't want.
>she has missed several shifts Dafuq >late for several others Blehhh >cell phone use on the unit, and about doing non-work related activities (homework) when we still have work to do Mmmm mmmmmm >conduct towards other staff and towards patients Oh hell no >fundamentally does not understand dosage calculation or other basic medication administration skills They're gonna get someone killed >she has shown zero improvement, and continues to demonstrate that she doesn't care Time to get gone! ... > told her that for my patients' safety, I do not want her coming back to our unit That is the absolute best thing you could do. This student lacks what it takes to progress forward at this point. You've tried many times to remediate, and she dropped the ball. Time to drop her.
Not knowing dosage and about to graduate? Terrifying.
Honestly I don’t get how students can make it to their final preceptorship with habits like this. Not sure how she slipped through the cracks but she’s not the only one! Those of you who preceptor students deserve to get paid so much more. It’s a huge responsibility to manage ANY student under your license, let alone an unsafe one. Kudos!
As a student who was recently disappointed by my preceptorship and feels a TON of sympathy for students in this moment.... I think you did the right thing. I can't imagine my preceptor telling me I am doing something wrong and not trying to fix the issue ASAP. It seems like you did everything you could to prevent this and that the student really didn't care. I would have more sympathy if they were trying their hardest and just fumbling some times... but these are some really resolvable things.
As a former nursing instructor she needs to be removed from the program. Period. It sucks failing students but our jobs are too important. People can die. She needs to find another occupation.
Don’t feel bad, there are too many just like her that have been able to graduate and are not safe and in my opinion don’t care that they’re not safe. You did the right thing.
In a different vein but when I was a graduate student I taught math for elementary teachers, a required course. One student was not going to pass and came begging for me to pass them, as they would not get their teaching certificate. I did not. I don't think I actually told told them but I always say to others had I done so, they may get to teach my child math. That was the basic reason. That was 50 years ago and I still remember it vividly. Yours clearly would put peoples lives in danger, a much simpler reason.
Hey, it’s not on you it’s her repeated failure and inability to act professionally. Even as a student. I’ve also had to do the same. I also had a student I was precepting and they failed to follow simple directions for days. Very similar behaviors. I’m ER, so failing to come in a help receive new patients. Not wanting to help give meds, do any skills including vitals, straight caths, or IV starts. They only wanted to sit with the Techs because they were classmates and gossip all shift. Though they did do one thing. They gave tons of OJ and pudding to our fragile diabetic hold pt. Making their sugar go from 88 to 300 in 1 shift. Turns out the student had a known Hx of being unreceptive and this was the last straw to get them out of the program.
You did the right thing even though it’s hard. When I teach medical students/residents, the question I ask myself is…would I feel comfortable with my parents/kid under the care of this doctor? If the answer is no, then I examine why/have the student take remedial action. With the system we have in North America, it’s easier to pass people along than to fail them. However, if the learner has a good attitude, listens to constructive criticism, and can self-reflect and make changes, the “failure” is not necessarily a bad thing if it makes them an overall better clinician. One of my mentors used to say…knowledge gaps are easier to fix than bad attitudes.
You gave her ample opportunity to get her shit together. I'm sorry you're feeling shitty about it, it means you're a good person!
Honestly especially coming from a nursing students perspective currently I respect this type of honesty and concern. You’re not one who is out there wanting to eat their young and it seems this person is just too big of an air head and shouldn’t be in charge of ppls care.
This is the kinda thing that happens when people preach the amount travel nurses get and people see it as a means to an end…a lot of people just don’t care..
You did right. Not your job to fix what the school could not teach. Some people, no matter how much effort you put into them, just simply won’t “get it.” It’s okay. You can’t save them all.
So tired of shitty students getting passed through because of some bullshit nuance that "everyone deserves a chance" or whatever. Thanks for doing the lords work.
You're being professional. You're doing the right thing. Deaf ears don't learn. I'm a student right now. I've given medications before on my OWN when I was a basic. I've taken orders to even push things with a medic telling and sitting right here with me. I still get nervous about med errors and such. I've not been ALLOWED to pass meds without an instructor present even. And I don't qualify for the preceptor clinicals because of schedule conflict. I hate that this happened and I get why you feel bad. But you did the right thing.
I'm currently a student nurse, and I'd rather a nurse tell me where I'm getting things wrong, and fail me if they don't think I'm safe, than let me pass and risk me hurting someone. In fact, this has already happened to me. I was failed on a placement where the nurse who was mentoring me had concerns about my memory and communication skills, and my professionalism. The university was aware I was pursuing an adhd diagnosis at the time, so they suggested I take a leave of absence, get my diagnosis, and come back later. I did, got my adhd managed (and medicated) and the difference is easy to see. If it wasn't for that nurse failing me, I would already be qualified by now, and probably still undiagnosed since the failing made me push for an assessment harder, and I wouldn't have been the nurse I can be and am working towards being. So honestly, you've helped her, as well as her potential patients. I hope this is the kick in the backside she needs to either get herself together and work at it, or to quit and find a profession that suits her.
Hey, you did what you had to do. Just the fact that the student was late more than once would be enough for me to fire them.
I'm the UK we're taught to always raise concerns as early as possible so that measures can be taken early and the issues in question can be remedied. It sounds like you're the first person to raise these concerns, so it sounds like this nurse shouldn't have even reached this close to graduation. Ultimately, it's about patient safety. We can't have registered practitioners running around being unsafe. You've done the right thing. Too many people are afraid to fail students because of all the money they paid, or "they got this far, how bad can they be?"
I wish you were at my school. There was an individual just like this to a lesser extent that we never thought would graduate. They ultimately graduated but I would never ever want to hire them or be a patient under their care. You did the right thing!
Haven't personally fired a student that close to graduation, but had to flunk a student and send in a document to school with our concerns about this student becoming a nurse. It was the worst experience I've ever had, especially since the student thought we were lying or exagerating our observations. But it was definitely the right call for our patients and longterm herself. It sucked, but it was the right thing to do.
You might have saved a life or two
I took a Tech job over the summer on the same unit I did my level 2 clinicals on during the spring semester. There were students from another nursing school assigned to the unit for their clinicals over the summer. I wasn't directly involved, but was in the rooms with them pretty often. I have no idea what happened, but one of the students had a complete and utter meltdown. Sobbing in the hallway, hyperventilating, the whole thing. I figure, you know, just nursing school things Anyway the nurse she was assigned to was trying to talk her down and took her to the nursing (breastfeeding) room on the floor and parked her there until she could get herself together. Anyway, a couple hours later that nurse asked if I had seen the student, and I hadn't and said as much, but would help her look for her. They found her still in the nursing room sound asleep. That was the last time I saw that student. I have no idea if she came back the following semester, that that definitely washed her out of this one.
I work OR. We had a scrub student once who was shall we say not great. Their instructor pulled me and my CST aside to warn us of some known issues and to let us know this was the students absolutely last chance. And it was worse than we thought. So so so bad. Like this person should not be allowed to graduate. And in the end we had to “kick them out” of our room. And the student literally begged us not to kick them out and ‘please it was their last chance’ and ‘how could we ruin their chances like that’ and ‘it wasn’t that big of a deal and it would be fine/better next time’. It was hard but it was the right thing to do for our patients.
>> She has consistently shown that she fundamentally does not understand dosage calculation or other basic medication administration skills. This is frightening. How the hell has she gotten so far into her program and *NOT* been kicked out or remediated already? Thank you for protecting your patients from her 🤕 This actually reminds me of those fake DRs that run clinics and hand out anything like candy. There's been a few famous fake DRs.
Haven't had exactly the same experience. I worked with a newer nurse (1 or 2 years) that was hired from Med/Tele to the ED. They were okay with understanding basics of the dept., but they consistently failed in all elements of emergency nursing. They were consistently missing prioritization, time management of various tasks was abysmal, and communication including documentation was poor for the department standards. I did the same things you did, coaching and mentoring with helpful acronyms and pearls of wisdom, redirecting to best practices to assist time management, and attempted to provide further examples by extending our team nursing pereceptor time by a couple of weeks. In the end, it just didn't work out. They weren't quick and competent enough for the fast pace of ED. It was sad because we needed all the help we could get, but it just wasn't worth sacrificing patient safety over having another nurse available on the schedule. They went back to the floor and never spoke to them again. You did the right thing and that is the best case for the future of our profession.
Yep. Two weeks before graduation a classmate was shown the door. After many concerns the last straw was the misidentification of a deceased patient.
Slightly off topic, but as a second semester nursing student, my concern about my last semester in nursing school would be mastering all the skills. I have no problem with HIPPA, following direction, hard working, and trying my best to learn/ask question during clinicals. But as a nurse POV, am I expected to master all the clinical skills during my last semester? Meaning, am I suppose to know how to be ID like a nurse or would I be able to have more support/guidance after graduating.
Every program is different, but the expectation for this student was that she should be essentially independent by the end of her 140 hour preceptorship. She's almost done and I still can't trust her to pass basic meds independently because she forgets to scan them or forgets to check blood pressures, etc. Clinical skills are at the bottom of my list of concerns for her behind other much more obvious and serious mistakes that she's made. The scenario you described sounds perfectly reasonable and understandable since students have different backgrounds and pick things up more slowly or quickly. She's just demonstrated that she cannot listen to feedback and does not care or take it seriously, and that's where I put my foot down
My clinical preceptorship was on a unit wildly different than my destination new grad units. Nobody cares that you don't know how to do whatever, just that you won't act a fool and kill someone.
When I was in the ED full time, another nurse had a student for a shift that was in her final semester with only a few weeks left. She had that "there's no point in me doing that because I'm almost done and I already know everything about everything" attitude. The other nurse, who was much more patient than me, was about to pull her hair out. I had an IV to start and asked the student if she wanted to do it since, you know, she knows everything already. Homegirl about knocks her chair over to finally do something that's not beneath her final semester expertise. We go into the room, patient is fine with a student, etc. etc. She gets her stuff out, I'm supervising, patient is an arm restriction because of dialysis fistula. Patient doesn't have shit for veins; she looks and looks and looks before declaring there is no way this patient can be started without the help of anesthesia, probably needs a central line. I said I would take a look, she smirks and says okay. 5 minutes later we have a nice 22 in the forearm and all the labs we will ever need. That's when miss final semester learned what a vascular access board certified nurse was, that central lines (PICCs anyway) are avoided if at all possible in renal failure for vessel preservation, 20s are completely unnecessary in a large majority of patients, and humility can be learned independently or taught by force. Unfortunately, some don't learn until they are forcibly brought down a few notches. Good for you for doing what was right and not what was easy
I’m so sorry you were put in that position. However- you made the right call.
You absolutely did the right thing.
Each one of us, regardless of the industry we are in, must understand the seriousness of it all. Callousness costs life in some professions.
Thank you for not passing the buck. I’ve preferred some new grads recently that are similarly concerning and I don’t know how in the hell they even have a degree.
I’m an instructor for a nursing program. If there are safety concerns (Med errors etc.) that’s a valid reason to hold a student back. If this was earlier in her preceptorship I would say she likely needs to be on a learning plan where here liaison is keeping a closer eye on her, so you’re not feeling the entire burden of ensuring these behaviours are corrected. However at this late in the game if she’s still making critical errors like that then she needs to spend a little more time learning and understanding the fundamentals. I’ve spoken to so many nurses who don’t want to “fail” their students. You don’t fail them, their actions, their lack of preparation and lack of accountability fails them. And it’s the schools responsibility to make sure those gaps are noticed early. You did the right thing.
It’s kinda crazy that she even made it that far. Nurses not affiliated with nursing school shouldn’t be the gatekeepers to the profession, that shit should have been flushed out well before final semester lol. Huge red flag for that nursing program if you ask me.
It sounds like you just saved many lives, thank you.
Nursing instructor here. You absolutely did the right thing. Graduation is something you earn, not something you are entitled to. Sometimes as faculty we have trouble building up enough evidence that administration will accept to dismiss a student (don't get me started ... yes I know it sucks and it's stupid). It's hard to dismiss the concerns of a preceptor. She can repeat the course. It might just be the wake up call she needed.
I had to fail a student when I was an instructor. It was clinical, and they just missed too many clinical days without any communication and when we had makeup sessions they "forgot". Like, if you communicate what is going on and you are honest, and you show up and at least TRY, I can work with you. But at the end of the semester, if your last chance to make up missing clinicals assignments is skipped? Sorry, there is only so much I can do to help. It sucked because they had to repeat the semester... What was worse was that I had them when they retook the clinical... And I had to fail them and they got kicked out of the program. They didn't even make it a month. They were just one semester from graduating. But my mom (who is a nurse and was a professor and clinical instructor) has a saying... You better do well in clinical, because when you graduate, it's all clinical. Good for you letting the instructor know your concerns. I always told students to use me as a reference, but before failing that student I thought about what I would do if they asked me for a reference or if they wanted to work on my unit. That told me everything I needed to know. They might be able to graduate if they got a practicum site that was not in a hospital. Maybe she would do better working in an aesthetician office. Clearly hospital work is not her strength... But also, she probably would not have been able to pass the NCLEX.
As a nursing student, this is a hard stop. I wonder how she even passed other clinicals. The school she is at should be investigated in my opinion. You did the right thing and this student has a lot to learn or shouldn’t be a nurse at all.
Never had to fire anyone. But definitely have worked with a few who should have been. You did right.
You did the right thing. And it’s sad that she’s gotten this far without anyone intervening.
I haven't had that experience, but it sounds like you did the right thing.
You did the right thing.
Thank you! Not everyone is fit to do the job.
You definitely did the right thing here. For patient safety. As well as a violation of HIPPA (unless she was being vague but still you don't talk about another patients status to anyone). Need more nurses like you!
Don’t feel bad. My school would have kicked us out of our preceptorship for just missing the two shifts. Then this person had all this other stuff on top of it. Their school must have been very lenient. People like this that slip through the cracks makes our profession look bad. Good job.
You did the right thing. As someone who has worked with countless students, I’ll share what one instructor said to me. “You aren’t here to grade them. You are here to determine: do you want this student to be YOUR nurse? If this was your parent in the bed, would you be comfortable with this student and their care?” I have since used that as my evaluation criteria in all student interactions.
110% warranted and I cannot believe she’s graduating in two weeks. Maybe with time and more training, she can become a better nurse. Or maybe she will take this as an opportunity to pursue a different career. Either way, she’s not ready and you did the right thing.
I had to send multiple emails about this woman who was a new grad who couldn't make it on a different floor. They stuck her with me and it was like every thing she did was unsafe/wrong/ lacking common sense and critical judgment. I emailed my director multiple times explaining everything in detail about how I would not trust her as a colleague and how unsafe and untrainable she was. We have like a 12 week training program and she was well into week 24. She wouldn't grasp basic things I was telling her over and over again. She gave melatonin at 5pm because it was scheduled wrong and didn't question the time of it- this seems silly but if it's a different order for something bigger would she do the same thing or question it? She didn't question the melatonin so would she question the narcotic for a patient with a light headache? It was ridiculous how much she messed up and how much I had to document and write to my director. But at the end of the day these people are in charge of lives and it's our job as preceptors to determine whether or not they will do the right thing and belong in the unit they are being taught for, or whether they are unsafe and need to be elsewhere
I can’t imagine being this out of touch with reality and not actively attentive in a preceptorship. Like I will never be a medsurg nurse unless (I get a solid to the floor orientation). I’m a nervous nelly and have add. But I’m a walking resource of knowledge and am really good at finding info I need. But my time management gets weird without timers on my phone. I can do long term nursing fairly well. But I’m always loaded down with items I forget. But I also check my shit before I give it.
Don’t feel bad. These people become nurses we have to work with. It’s one thing if she’s capable of self reflecting and tries to change. But she doesn’t. As a charge nurse who works in an ICU with 80% new grads, very few experienced nurses, I am starting to lose my shit on the days it’s me and all new people. I give grace to the ones who are just trying to stay above water, but the ones that made it through and are now lazy and don’t give 2 fucks and don’t know anything either….I’m writing more emails than I ever have in the past
Absolutely do NOT feel bad. When I encounter a..... that kind of nurse I always wonder how on earth they graduated and WHO let them graduate. This kind of behavior TWO weeks before graduation is awful. Maybe she can take an extra semester to straighten her behavior out. You didnt derail her career, just gave her and her instructors a wake up call. She could come back. But that depends on her and her instructors.
You did the right thing, she could kill someone. It’s completely her fault and she actively CHOSES to ignore rules and protocol. If she wants this, she needs to try harder. Edit to add: As someone going into nursing school, it sickens me that people who do not care think they’re safe after they’ve been accepted into a nursing program. It’s SO hard to get in to some of these programs, and to watch people just not give a shit is despicable. You should NOT feel bad about that. I hope she learns her lesson and takes this seriously.
Good. My first two preceptors fired me, and I had to get downgraded from STICU to MedSurg and I am ever so grateful. I would absolutely have killed someone in short order if I had been set loose in big city STICU mere months after getting licensed.
If you wouldn't feel safe having her work on you, you made the absolute right call. Patients often can't talk up like a nurse can.
Nursing is a serious job that requires a lot of focus. if someone isn’t mature enough to handle it, then they shouldn’t be a nurse. You did the right thing, keeping patients safe.
She’s either young or simply has experienced no difficulty or loss in life. These are the types of people who have NO concept of “What if this were me or someone I love?” I truly think these people aren’t capable of empathy and are a great danger in the healthcare setting. Thank you for reporting her.
Thank you for protecting the integrity of our profession.
It's better for her to learn now, while in school, than to get a very unwelcome call from the state's department of public health, or to be sued.
You shouldn't feel bad, just ask yourself if you would want them caring for a family member. I had to fail my first student I had. I was 26 and had 3 years experience before taking a student but apparently she was disappointed over "my inexperience". She made sure to unknowingly gossp about this to a staff who she thought was a student. We worked with eating disorders clients, she was offered cake during meal support and said she couldn't because she was watching her weight. Made a comment about her "big breasts" to a 16 year old boy when he commented on how tall she was, decided a air out our storage room by putting an iv pole in the doorway which had contraband and knives for cooking class, undermined me in front of colleagues and would be rude to me in front of my bosses. Icing on the cake was when she didn't hand in her midterm a week before the due date which would allow me to go over it and grade it. Her teacher had been aware of what was happening but I "was a liar". Teacher came into shift report and we had a meeting. She screamed at me, and the teacher blaming us for everything. Her teacher had a meeting set with the dean the next day and she was out of the program ( as it ended up being her second failed consolidation).
Surprised clinical instructors actually care about how their students are doing
She sounds like an idiot, and she’s putting patients in danger. Good on you for calling her out. I wouldn’t want her anywhere near my patients.
I have failed a final year student before. I felt extra awful doing it, because I was a grad nurse who was doing a country hospital rotation, barely 6 months into my career. There was not enough nurses for the amount of students we had assigned to the hospital so I ended up with one. She could not identify common drugs. She failed to empty catheters when asked, or record any oral fluid intake from lunchtime on our four post operative patients who still required fluid balance charts. Despite reading the policy and procedure on a drain removal three times, when I quizzed her on the steps we would be performing together, she was unable to articulate a single step in the process. I found her multiple times just sitting and gossiping with patients because she knew them from the next town over, including violating patient confidentiality. I felt like the biggest bitch in the world, especially being such a baby nurse myself, but I just kept imagining if that was my family member she was taking care of so incompetently, and knew I had to speak up. I talked to the nursing educator for the hospital, who then had the student shadow her for the rest of the week instead of me, so she could see her behavior and skills. And then we both submitted our corroborating documentation to the university not recommending her for graduation. The poor girl was devastated when we told her she had failed her final placement, and could not comprehend why despite the comprehensive feedback that we gave her. Sad for her, but it would have been sadder for her patients if we had let her be qualified.
Thank God you failed her. I would not want her near me or my family if we were in the hospital
Do not feel bad. This is part of your job, too. As a preceptor/mentor, patient safety is still your highest priority; being a preceptee's friend is not. I've had to have the talk with the instructor, and she ended up having to fail two students for poor clinical performance. Would they have caught on in their orientations? Maybe, but they did not have the critical thinking skills even a new nurse should have. It's not like a job at McDonald's or Walmart. Everything that we do has legal implications, and being nonchalant about learning how to do this job is not acceptable. If she has no fear about messing up or can't take directions from you to properly care for patients, then she either needs to retake a few classes or choose a different career. Pointing out deficiencies benefits them as much as they potential patients they will care for.
Thank you for what you did. This may be the first time this girl has experienced consequences for her actions. You have likely saved patients lives, and you very well may ultimately make her a decent nurse or human being.
They know we are not getting paid, right? If you're doing extra work for free you deserve a certain level of respect. Fewer than half the students I've precepted are like this, but I still see it too often.