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Category: Teaching

Burnout Is Everywhere


The students in my current clinical rotation look like the walking dead: dark circles under their eyes, heads hung down, and a constant supply of caffeine with them at all times. At this point, they are trying to survive.

The time right before the holidays is tough when you’re in nursing school. They are SO ready for a break and are trying to push through until the end of the year. And it feels like a push, too. It’s just like rolling that proverbial boulder up that hill.

Not only are they wading their way through med/surg and pharmacology, they are learning about physical assessment, care plans, and case studies from me. I think some of the students have the idea that all they’ll do in a clinical is take care of patients; they aren’t expected to write any papers, document their findings, and turn all of that in to me, right?

Wrong, unfortunately.

Clinicals are about caring for patients, but there’s more to it. A student has to transfer the theoretical knowledge learned in the classroom into the clinical setting and use it in real-time. They need to think critically and set priorities of care. They have to accept constructive feedback about their performance and claim responsibility for their mistakes. This requires a good deal of humility and self-awareness.

No wonder they’re burned out. They aren’t just learning about nursing, they’re learning about themselves. Sometimes we don’t like what we see, or realize we may not have the goods. Often, we don’t know what we’re lacking until we’re put to the test.

Only time will tell if they survive the fire and live to tell the tale.

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Things Are Getting Easier

February 12, 2012

My newest clinical group is a breath of fresh air. There are no behavior issues, nobody is showing up late, and they all seem interested in learning how to become great nurses. If you’ve read some of my previous posts, you know this isn’t always the case with my clinical groups. So I am grateful any time I have a group of nursing students that not only make my job easy, but truly enjoyable.

Thanks guys.

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What Do You See?

April 8, 2012

I often wonder what my students see when they look at me. By default there is some anxiety and trepidation. After all, I am their clinical instructor, and they’ve heard that I’m tough. I’m tough but fair. I try to put them at ease during those first couple of weeks because clinicals are stressful enough without the added worry that your instructor is a drill Sergeant.

Once they get to know me they realize I’m not a student nurse destroyer. We work together to help them learn things they never thought they could. They will survive and come out on the other side with more confidence, lots of skills, and the unexpected and weird ability to think critically at six in the morning.

So what do you see, my fledgling little nursing students?  I hope you see a little of yourself in me. That scared little newbie I once was is still in there, and she understands. She really does.

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Are We Too Sensitive?

July 8, 2012

I remember being in nursing school and how afraid I was, afraid of hurting a patient, failing my med/surg exam, or not passing my clinical rotation because my care plans weren’t good enough. I was also afraid of some of my instructors, especially the ones with strong personalities or those who appeared unfriendly.

Some instructors are mellow. Nothing you do rattles them and they find a way to work around your petty tantrums and still teach you something. Others lead by intimidation. I’m thinking of my Ob/gyn instructor. She was a part-time instructor and I only worked with her for a couple of weeks, but those weeks were some of the most challenging of my nursing program.

They weren’t challenging because of the skills or the content but because this instructor was not an open or warm person. She did not welcome questions–about anything. Once she told you to do something, she expected you to do it, end of story. Any further requests for clarification met a withering stare. I felt shut down around her, like I couldn’t be myself. It sucked.

Now I’m the instructor. I sometimes hear from my students (after the fact, when they’re filling out their student satisfaction surveys) that I am intimidating, even in those moments when I think I’m being chill. I look back at my own clinical experiences and see that I was overly sensitive to my instructors’ feedback. One negative comment could send me reeling into a spiral of self-doubt. Maybe it’s the same for my students.

I think our teachers, if we respect them, hold the power to shape our belief of what we’re capable of and who we are in those moments of doubt and fear. But we shouldn’t let this affect our ability to handle constructive input. As an instructor, I can give three students the same feedback. One student will take this information and use it to become better in their clinical practice. The second will take it as proof that they truly aren’t as smart as everyone else. Yet a third student will convince themself they should just quit altogether.

Whether it’s a romantic relationship or the classroom, we all carry our own emotional baggage into each situation. We are full of opinions and judgments about ourselves and others, but I tend to resist the notion that I can control a student so thoroughly that my personality supersedes their own. I am not that powerful. I can influence their behavior, but only to a certain point. People will still be who they are.

Which brings me back to my original thought: are these students intimidated because of me, or because they have always been intimidated? Who is ultimately responsible for that perception, and how much do I allow that to influence how I teach?

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Under the Influence

December 23, 2012

This week is the end of a module in our nursing program. As a clinical instructor, I must give the students their final evaluations, a sometimes painful process in which I sit down with each one and tell them whether or not they’ve passed the clinical rotation.

For the most part, giving and receiving evaluations is a happy, even fun, experience. Students are truly excited and proud to learn they did so well. They are spending a lot, both in time and money, and they are busting their tails to succeed. They have a lot at stake.

If you ask each student why they chose nursing,  you’ll get a different answer from each one. But often there is one theme that runs like a vein through every answer: someone in their family–usually their parents–wants them to become a nurse. It wasn’t the student’s idea, but they are going along to make their parents proud.

This rotation one student did not pass the clinical. She was one of the weakest in the rotation. Unable to transfer theoretical knowledge into the clinical setting, she can’t give rationales for her answers to NCLEX review questions, and she struggled and failed to pass the math and dosage calculation tests. I worked with her, tutored her, and offered assistance with her care plans, but ultimately none of this helped. She simply didn’t rise to the level expected.

There was something else: she wasn’t coming to me for help on her own. Other than the times we had mandatory math tutoring, I never saw her. Also, she didn’t seem upset about the fact that she was doing so poorly. She wasn’t resigned, she was indifferent.

When I sat down with her and explained why she did not pass, a single tear leaked out of her left eye and trailed down her cheek. Then she said, “Okay.” That was it. Nothing else. It surprised me that she wasn’t more upset, but I can never gauge exactly how a student will respond to failing. I assumed she was a little stunned and that’s why her reaction was so minimal.

Later that day, she went and spoke with my Program Coordinator. After the student left the office, I sat with the Coordinator and asked about her conversation with my clinical student.

“Well, her tears dried quickly when she told me that she doesn’t want to be a nurse.” What? I thought. I had no idea.

My Coordinator continued. “I asked her why she enrolled in the program. She said her mother wants her in nursing. I asked why she thinks her mom wants her to do this. She said, “My mom wants me to have the title.”” Clearly, this is not what the student wants. After hearing this, her indifference made sense to me.

Nursing is a hard profession, but it’s especially hard if you don’t want to do it, if you’re just appeasing someone else. Are you willing to deal with all of the unpleasant aspects of nursing: the smells, the long hours, not being able to go to the bathroom for hours on end, not being able to eat for hours on end, and unappreciative patients and doctors? If the answer is yes and you love what you do, you can work around the other stuff.

What you can’t do is allow others to influence what you choose for your life’s work. That decision is too important, so base it on your passion to do a certain type of work and your belief that it is your calling.

If you do that, everything else will fall into place.

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How Do You Know When It Is Real?

February 13, 2013

On the eve of Valentine’s day, I’m ruminating on a different kind of interpersonal devotion: the devotion some nursing students feel towards their instructors. Or should I say, the devotion some nursing students pretend to feel towards their instructors. Sometimes I can’t help but wonder whether everything said to me by my fresh-faced students is the real deal.

I have had so many amazing students pass through my clinical rotations. In my mind, the list is long of wonderful personalities, compassionate and thoughtful patient care, and well-crafted care plans. The students work so hard, are so committed, and are so chronically sleep-deprived. It takes a special kind of masochism to put yourself through nursing school, but they endure it. At the end of the rotation, I am fortunate to hear most students singing my praises, telling me how much they appreciate how much they’ve learned and how great I am.

Then there are those I can’t quite believe.

Often it’s a compliment about my hair or the sweater I’m wearing. These are students who never speak to me outside of class or the clinical, but all of a sudden my fashion choices are inspiring. The smile always gives it away: it is too bright, too toothy, too…needy.  And I know my bullshit meter is not finely calibrated enough to tell the difference between sincere appreciation and false flattery. If you’re a student and you’re lying to me about being sick or your missing care plan, I can smell a rat a mile away. But if you fool me with praise, I get all turned around and can’t find my way back on the path.

What does it matter, you may ask. It matters because I pride myself on being a straight-shooter. What you see is what you get, and I like the same in return. I don’t do well with subterfuge, and I don’t like feeling that people need to put up a facade in order to interact with me. I like real, whether it’s the boyfriend who expresses their love on Valentine’s day or the student who swears I am “The most awesome–ever.” If you don’t truly feel that way, just don’t say anything.

Does my lack of finesse in this realm make me a bad teacher, weak, or foolish? I don’t know. I try to remember that for so many of these students, it feels like their life and their future are on the line. They are desperate to make a leap in a positive direction and will do all kinds of things (some honest, some manipulative) to get to the finish line.

I can’t fault them for their tenacity, I just wish I was better at figuring it out.

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