I'm having issues with my instructor

In My Humble Opinion
1

So I’m a little over halfway through my second semester in Nursing school and I’m doing well in everything except the clinical rotation. FYI, it’s an all women’s Med-Surg floor.

So I’ve been making some mistakes along the way. Some are actual, but most are just potential mistakes caught beforehand, but none of them have resulted in any harm to the patient. There are too many different instances too go into great detail, but simply put when I say “potential” mistake, it means giving the wrong answer. For example, in response to the location for an insulin injection, I replied, “the abdomen, shoulder, thigh, buttock.” She said that was wrong and I quickly realized it was the back of the arm and made this known. Still, I got written up for it.

I’m feeling like there is a serious breakdown in communication here. She told me in the beginning of the semester that I needed to communicate better, and I’m making an effort to do this. But the problem is how am I supposed to communicate with her, as a student, if simply saying the wrong thing is going to get me written up?

Now, to be honest, I think she’s a great teacher in some ways. I’m learning some very fundamental points early on to being a good Nurse. One thing that has become abundantly clear is that I need to be completely prepared before every intervention, and have all materials ready, and know step-by-step the process I need to take.

So, I feel like her method of teaching is effective, but I think her grading is not being fair. She makes some mistakes as an instructor, and I can accept that since she is very busy, so I think she deserves some leniency. But, I am being granted absolutely zero in return.

I’m making many efforts to fix my problems quickly, not make the same mistakes, do everything she tells me, and give evidence to prove it. But the semester is winding down and I only have 3 more clinical days left.

I think at the end of the semester I’m going to have to put together a case proving with clear examples that I have learned from my mistakes and will be a competent nurse. If that’s not good enough, I’m going to have make some clear objections to point out how and why I feel I’m being treated unfairly. If that’s still not good enough, I’m going to need a second opinion.

However, these instructors are not known for being reasonable and granting much leniency. Furthermore, I know it’s not my place to question their judgment but I don’t feel like I have any other option. So, I’m going to risk pissing them off on top of failing me, making things more difficult when I re-take the course.

But, I feel I have to. If she’s going to grade me this harshly, I feel that some pushback is in order.

Advice?

2

Think of these little quizzes not as an informal back and forth dialogues, but as verbal pass/fail exams. In your example (injection site), you failed. That wasn’t the teacher’s fault, that was your fault. Eventually getting around to giving the correct answer is not good enough, because when you’re on your own you won’t get the benefit of a 2nd answer.

Improved communication skills doesn’t ever excuse lack of knowledge/preparation. At this point in the game, you should be giving the correct answer every time, the first time. Because once in the field, these “potential” mistakes will turn into “actual” mistakes. And an “oops” will lead to a patient’s injury or death.

My advice is to hit the books so that you are better prepared. If with 3 days left in clinicals, you are still giving incorrect answers to basic questions, then you should fail the course. If I were you, I’d WANT to retake the course because the potential for harm is so great. To be frank, your demand for “leniency” troubles me. Medicine is one field where there should be very little room for leniency. You either know the information, or you don’t. By your own admission, you don’t.

3

Nurses eat their young. This is well known, frequently cited, and exists for an excellent reason- the one explained above. You don’t have to put up with outright hostility and abuse, but what you’re describing is not only par for the course, it’s necessary.

If you’re looking for fair, you’re in the wrong line of work. If you think you can complain about being written up for getting answers wrong, you’re shooting yourself in the foot. It will not work out in your favor.

4

Darn edit window… please amend the second paragraph to this:

If you’re looking for fair, you’re in the wrong line of work. If you think you can complain about being written up for getting answers wrong and think you wont end up shooting yourself in the foot, youre wrong. It will not work out in your favor.

Also, you’re shadowboxing. Why are you convinced that you are going to fail the course? Because of the writeups? IME, you’d know well before three days til course’s end that you were going to fail, and they would politely ask you to not finish the course. Stop riling yourself up and do the best you can for the remainder of your time- for all you know, you’ll get a passing grade with an acknowledgement of the growth you’ve shown over the semester. And then won’t you feel silly for entertaining the idea of complaining to her boss about your harsh treatment?

5

I agree with this. I am not a nurse, but my sister is an OR RN, and has told me about her clinicals during University as well as what it’s like being a nurse. You can not make mistakes. Ever. You are the one that’s supposed to catch mistakes before they harm the patient.

However, you say you are in your second semester. Are you doing an RN degree or LPN diploma? If an RN, you have three years yet to improve, and I wouldn’t sweat it too much, but would work to improve, stat. If an LPN, how much time do you have left? I would agree with possibly doing the clinical again if you are making a lot of mistakes still. Be open to your instructor’s criticism and ask her for suggestions on how you can improve. If she says you need to work on communication, ask for examples on your poor communication, etc.

Good luck. :slight_smile:

6

Since you’re looking for advice, I’ll move this to our advice forum, IMHO (from MPSIMS).

7

Sounds to me like you’re having issues with lack of knowledge.

Yet.

As you have been, including getting written up. Consider what the consequences will be for you – and your patients – if you’re let loose with this shaky knowledge and start DOING the wrong thing. Harsh grades are nothing compared to malpractice or manslaughter charges.

In music performance, the cliche is “an amateur practices until he gets it right, a professional practices until he can’t get it wrong.” In health care, I don’t see many gigs for amateurs. Study/practice until you can’t get it wrong.

8

I have to say I find some of the responses in this thread surprising. As a medical student, it’s expected that you won’t know the answers to all the “pimp” questions during clinical rotations, and in fact attending physicians will often ask more and more difficult questions until you get one wrong.

How does your knowledge base compare to your peers? Are the questions you get wrong and the mistakes you make typical for your level of training?

9

Ok, just to clarify. It’s an RN, but it’s an associates degree, so it’s only two years. I have about 3 weeks left in the course and the clinicals are only once a week.

I understand that the patient is my full responsibility and mistakes can cause harm. I’m doing my best to ensure that I am safe, accurate, and thoroughly prepared. I agree that the position should provide very little leniency. I’m not trying to absolve myself of my failures, but this is about responsibility on both ends.

But let me give another example. I had a patient who was admitted the previous evening, diagnosed with “Nausea.” When I came in to see her, she reported being a little “nauseous”, but ok. She was not vomiting or having diarrhea, for the most part she was sleeping. On her chart, she had a PRN (as needed) IV push medication. We are not allowed to administer this. I reported to my instructor her complaints of nausea while going over charting, she told me to put it in but no recommendation was made at all. A couple of minutes later, a case manager came up to question me as to “why the Zofran hadn’t been given?” I did not have a good answer. I got wrote up for it.

She said that I needed to communicate nausea to the nurse and recommend the Zofran. Technically, she’s right. That was my responsibility, and I failed.

But, FYI, according to our textbook this patient did not meet sufficient indications. I understand that this is nit-picky and hospitals have their own policies regarding this, but still I’m a student, not the hospital RN.

Why is it ok for her not to provide teaching, but it’s unacceptable for me to not know the correct procedure?

10

Shmendrick, I feel that I know the material very well. I’m studying my ass off and doing the best I can. But, I lack experience.

Also, I’m not trying to garner sympathy. I’m asking these questions honestly looking for the correct answer. I do feel however that she is being quite harsh on me. Every single thing I’ve been called out on, I have corrected and not made the same mistake again. Every single thing she’s told me to do, I’ve done. IMO, the good outweighs the bad, but I don’t think she’s going to take that into account.

11

I used to teach college and also have 2 years of high school teaching under my belt.

The difference between high school and college is in high school if a student doesn’t do well, it is your fault (not saying it is right but that is society’s expectation). In college if your student fails it is the students fault.

I noticed at the time and noticed since I left teaching the attempted ‘creep’ of this ‘blame the teacher not the student’ expectation. I’ve also pleasantly noticed much resistance to that creep.

There has to be a point where nothing else matters except whether or not the student is capable. It doesn’t matter if the instructor sucks. It doesn’t matter if the student has a learning disability. It doesn’t matter if the student has home issues or mental issues or whatever issues…ALL that matters is whether or not the student is capable and so should be passed/graduated.

You have reached that level. The only person responsible to becoming a nurse is you. All other items affecting you are barriers to be overcome. This includes what you perceive to be an unfair/bad instructor.

12

Why don’t you try talking to her and ask her if she will be taking “the good outweighs the bad” into account.

Personally, it looks to me like your instructor is looking for you to make a transition from “everything I’ve been told to do, I’ve done” to “I saw what needed to happen there and did it without being told to.”

13

Your answer was “because her complaint did not meet the criteria for medication according to my textbook and my instructor asked me to note it but gave no instructions for administering it.”

You’re not communicating why you made the decision you did, which leaves the case manager thinking that you either were ignorant of hospital policy (which, you were, apparently) or you ignored it.

Hospital policy trumps textbook information. If you haven’t figured that out, you need to. Medical practice is not just book knowledge. It’s book knowledge, life experience, ethical concerns, legal requirements, administrative policies, and patient and family needs. Not knowing hospital policy is just as bad as not knowing the technical information.

Because it is not your teacher’s job to hold your hand through every clinical experience. It’s not her job to open your skull and dump things in, and it’s not her job to anticipate every way you might make a mistake. It’s YOUR job to make sure you are prepared to do the work, and it’s YOUR job to take initiative and ensure that you’ve done everything you need to, including clarifying whether or not to give a medication.

This is not going to get better until you stop blaming others and take responsibility for yourself.

14

What is this crap? First you’re right, and got written up. Then, technically, you were wrong. Then according to your textbook, you were right.
Yes, you need to improve your communication skills.
And, pushback isn’t in order. It never is, in a training or medical situation. Or, even if the instructor is wrong. Snap out of it, and get to learning. You have lives to save.

15

You know what, you’re right. I get it now. Thanks for clearing this up for me. You just saved me a world of trouble.

I’ve been a little resentful and didn’t feel like I was being treated fairly. In the Insulin example, she told us at the start of the semester that we could talk about things before we go into the room, but once we go in, we’re on our own. We were outside the room, but due to my track record thus far, I didn’t deserve this kind of leniency. Here was a perfect chance to prove that I’m competent and I blew it.

There’s been a couple of other situations now that I realize could have caused serious harm to the patient, and been a potential liability for myself, the instructor, the school and the hospital.

I think this stems from a lack of understanding due in large part to being unprepared. I know what I have to do to fix this. I’m going to make comprehensive guides on all of the critical skills expected of us, and other minor skills as well.

Also, I feel that I need structure to guide my thinking. But the brain can only retain so many tasks. So, before performing any intervention, these are the questions I’m going to ask myself:

Is it safe?
Is it accurate?
Is it a priority?
Is it caring?
Am I completely prepared?

What do you guys think?

I’d like to dedicate this to all of you. :slight_smile:

16

panaccione - It’s also your responsibility to ask questions. If your instructor hasn’t been clear enough, ask. In the example above, maybe you should’ve asked if you should administer the Zofran. If there’s an instance when your textbook advises one thing and the hospital policy another, ask for clarification. In doing so, you show that you understand both hospital SOP and the coursework. “Excuse, Nurse Smith? I know that normally we would administer 10 mg of healmequick, but the textbook calls for waiting two hours until it’s administered. How would you like me to proceed?” Then you look smarter than the average bear because you know both the textbook knowledge and the real-world application.

And I will say, that if you have only 3 weeks left in the course and you’re still floundering, it doesn’t sound like you’re ready to make it unsupervised in a real-world setting.

StG

17

St. Germain, have you read my last post?

I appreciate the input, but I’m going to have to disagree with you. I think I’ve learned some fundamental lessons here and know what I have to do to correct them.

I’m not sure that I’m going to pass. But, I’m only more confident now and can continue to work on my weaknesses.

18

Awesome, good job. :slight_smile: I am not a nurse so don’t know if those questions are all appropriate and encompassing, but I’d say it’s a good start.

19

panaccione - Actually, I did read your post. The one thing you didn’t address was your apparent communication issue, which is basically what my post is all about. You have to open a dialogue with your instructors, and with your supervisors and doctors when you do graduate. In other words, don’t just ask yourself those questions, ask others, too.

StG

20

Those are absolutely the questions you should be asking yourself. They are also the questions you need to ask yourself before NOT performing an intervention. Because sometimes doctors get busy and don’t remember to order something that needs to happen. That’s why it’s so, so very important for you to not be able and willing to follow orders, but to be able and willing to look at your patient proactively and communicate any concerns you have about what is or isn’t being done. And that is why your instructor is so harsh on you, why all nursing instructors are so harsh. If you’re not already proactive and willing to stand up for yourself and your patient, they have to push you into that by whatever means necessary. If you can’t stand there and tell your instructor that the patient’s situation didn’t seem to meet the guidelines for Zofran because of X,Y,Z, how are you going to tell a doctor that you think he ordered the wrong drug or dosage because of A, B, C?