Wednesday, October 12, 2005

Well. Well, then.

This is going to be a bad day for somebody.

You remember Weepy, right? The student nurse who didn't know where the lumbar area is? The one who asked me to "refresh" her memory when it came to taking a blood pressure?

Well, I fired her yesterday. Her and all the other student nurses in her group.

More than that, I filled out an evaluation form for her, and I was not nice. It's not just that she lacks basic A & P knowledge, or that she's a little rusty on some skills: she argues, doesn't do what she's told, and doesn't do her research. She doesn't come prepared. (And I'm not meaning to sound like a despot; there are some times when you simply should not argue and you really ought to jump when somebody yells "jump". There are times when there's not time to ask why.)

I finally went to the Idiot Instructor myself after seeing what some of the other students in the group were up to and told her, essentially, "they're fired." This after a patient one of the students was caring for vagaled out and fell over, and the student a) never showed up in the room after being called and b) didn't check up on her patient later.

And this was the student who is already an LPN. Not a very good one, I'd bet.

I'll admit that I'm pretty demanding when it comes to teaching. If a patient has one pupil that's blown to ten millimeters and another that's reactive and four millimeters, I expect you to notice that during your assessment. I really do expect you, despite whatever fairy tales you might've heard, to do some research on neurosyphillis and know what it does to a person. And if somebody's getting a nasty chemotherapy drug for dermatomyositis, I expect that you will know enough about that nasty drug not to want to handle it with ungloved hands. Especially if you're of reproductive age.

But I really, really did try to cut Weepy some slack. I gave her mad props when she did something right, and I put down on her evaluation form that she's got excellent interpersonal skills. She does. I understand that the finer points of assessment, like interpreting what the hell that breath sound is, will come with practice. And I know what it's like to do stupid things like reaching into a trash can with an ungloved hand, because I've done that myself, so I didn't count some of that against her.

Still, I had to fire 'em. I told our education director "This is it; I ain't takin' no more o' them students" because I'm not safe when one of them is around. I have to literally follow whatever student I have every minute of the day, which leaves my other patients vulnerable and un-looked-in-on.

I spent last evening feeling like I'd kicked a dog. A small, yappy, not very bright and not very likeable dog, but a dog nonetheless. With this poor of an evaluation, Weepy will not graduate. She's spent the last four years getting a BSN, and she will not, now, at the midterm of her last semester, get to see it through. It's not like I have Phenomenal Cosmic Powers when it comes to making or breaking students, but the instructor really can't ignore a two-page written evaluation in my crabbed and tiny handwriting.

Still, she's not safe. That's the bottom line. She simply does not have the basic knowledge or the chops to keep up, even in a small community hospital. I think she's trainable, but it would mean starting from square one. That is not my job.

The instructor--and this is the weirdest part of all--was venting to me about how eight of her ten students are, in her words, incompetent. She couldn't understand why she'd been saddled with a cruddy group, and was sure that somebody somewhere must hate her.

It took me until after dinner last night to realize that the reason I felt weird was that the instructor was treating me *as a peer*, not as a recently-graduated student or a still-attending student. Like I'm actually a nurse, you know?

I guess I am. And I guess part of that whole others'-lives-in-your-hands thing is having the absolutely shitty job of saying "I'm sorry, but you're just not good enough" once in a while, if it means saving other people from something worse.


Anonymous said...

Hey Jo,
I'm sad for you that you had to do this, but very glad for you (and your patients, and all patients) that you did it. I too have teaching responsibilities in my position, and I too had to fail someone for incompetence, which led to them being unable to continue their program. I'm saying this not to freak you out, but to share how convinced I am that you were right. My ex-student sued the program ... and after a couple of depositions and other bs, it was finally tossed by the court. I was never a named party (never at personal financial risk), and I doubt you would be either (it seems that, in a burst of sanity, instructors are pretty well protected when they fail students). Regardless, it was a real pain in my keister for about 2 years. But, it's over now, and this person will not be entering my profession. And, you know, it was worth it. To know I did the right thing, and to know I kept the patients safe (well, safe from that one, at least). As an aside, I would encourage you to write up for yourself everything you can remember about what Weepy, Whiny, Lazy, etc did, and your thought processes about how you decided to fail them (just in case). But, you really, really, really did the right thing, and I, as a fellow professional and eventual patient (as we all are) am very grateful. Thanks!

Anonymous said...

Jo .. You don't know it yet and neither does your student, but you did HER a HUGE favor. By taking her off the floor, you saved her the experience of making an unrecoverable mistake and all that follows. She has the opportunity to use her knowledge base for something else and work in a more comfortable (for her) setting. That you feel awful for derailing her train after four years on the track is admirable. To have taken her off the track is more so. djsloan/houston

Special Sauce said...


Honestly, you did her, and any potential future patients she might have had, a favor. The other students too.
Unleashing them on an unsuspecting public could have dire consequences- ones that could make you feel even worse if you had let this slide.

It just sucks that sometimes, doing the right thing really makes you feel like crap. But I, and anyone they may have treated, thank you for doing it. Someday, I hope the nurses can realize the favor you've done them too.

Anonymous said...

You did the right thing. As a physician, I NEED to work with a nurse that's got a brain & sense. If I can't trust you, my patient's dead.

You did not let Weepy & her ilk down. It was all the spineless ones before you that passed her on so that she could arrive on your floor so totally unprepared.

You must do what's best for the patient. End of story. You done good.


HypnoKitten said...

Most of what I could say has already been said by the other comments, so I'll just give you a *standing ovation* (which, honestly, was my reaction while reading that)!

You are absolutely in the right for what you did if they're even half as bad as you make them out ot be. I guess advocating for patients takes on a lot of different faces, because ultimately this seems to be what you did. I applaud you for being the nurse you are.

shrimplate said...

Oh well.

Unknown said...

It sure irks me when fellow students aren't prepared, ask stupid questions, and otherwise give good, hard working, careful students like me a bad rap by association. Sorry they suck! I'm totally on your side.

Anonymous said...

I think you have a bad attitude towards nursing students in general from the way you describe things...I remember all too well what it was like to be in their shoes and remember certain nurses treating some fellow nursing students like they were the gum on their shoes but they didn't mind having the students act as nursing assistants and not bother showing them actual procedures that would give them the hands on training they would benefit from when actually out there as a nurse when the time came. I am a nurse as well and look back on my clinical time as not much of a learning experience but more like free maid service....

Anonymous said...

If the student doesn't know how to take a blood pressure reading or where the lumbar area is, no nurse worth two cents would show the student anything. You don't let a baby run a buzz saw, and you don't let a completely unprepared newbie loose on a patient.

UnsinkableMB said...

I think you did the right thing. If the student doesn't have the basics down at this point and has NO MOTIVATION to get up-to-speed, then she is pursuing the wrong profession. Medicine is always changing and we need people who are ready and willing to keep up with it!

Anonymous said...

What kind of an institution would not teach an individual these basics before charging them for this program. I think you took all of your frustrations at the institution who provided you with these individuals and caused these students to fail. You should have helped them!!!!! You want to help every other tom dick and harry. Well, hopefully they can get someone to teach them what they need after giving up their lives for so long for something they feel a passion for. Who are you GOD