About Me

undergrad RN
I'm a twenty-something Canadian student. After stumbling through a few years of college, I finally managed to get into the nursing school of my dreams, where I hope to graduate in 2012 with a nursing baccalaureate degree. I want to offer an honest look into how a modern nurse is educated, both good and bad. Eventually I hope to compare my education to my day-to-day career and see how it holds up. Whatever happens, it should be somewhat entertaining. Find me on allnurses.com!
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Friday, February 4, 2011

The maternity wrap-up Pts 1 & 2

I originally started this post last night while I got ready for my final clinical evaluation today. Because I am having a total mindfuck of emotions right now, I'll break it into two parts: Part 1 was written last night and Part 2 written now.

Part 1 [Last night]:

Thank you all for your patience while I get back into the groove! I had an a-maz-ing week at the CNSA National Conference, as you can tell by my various phone updates, and I will recap it for you as soon as possible. I came home on Sunday and it has been a total whirlwind since then, which is pretty much my life during clinicals.

@Cartoon Characters: Thank you for your awesome supportive comments. I really appreciate you stopping by to say something! Especially given your career :)

Today marked the last day of my experience in Maternity. I have mixed emotions about it - since my final evaluation is tomorrow, I wanted to really reflect and consolidate my patient experiences before going into my eval. I don't feel especially confident in my instructor's appraisal of me, partly because I have NO IDEA what she thinks of my practice, and mostly because I have found her pretty hard to gauge.

A word about instructors... I think one of the most important traits to have is transparency in your opinion. If you think I did great, please say so. If you think my practice sucks, PLEASE say so. But even more than that, it is so important to have an instructor who is willing to share in my challenges and in my victories. I had a huge win yesterday - I'll explain in a bit - and I wanted to share that with SOMEBODY, and so I turned to my instructor. She gave no opinion at all and just stared at me with a blank face until I trailed off and awkwardly walked away. It didn't diminish my feelings of success because I KNOW that I did well and no one's lack of championing my actions can change that. But it would have been nice to have some external validation as well.

Part 2:

She slid the evaluation towards me.

"Do you have anything you want to say?" She asked, eyes glittering, lips in a tight smile.

My heart was pounding in my chest and tears blurred my vision. I had a lot to say, but I was too overwhelmed to get any words out without falling apart. I scrawled a signature accepting my grade and gathered my books quickly, charging towards the door before I lost control.

I was reeling from the evaluation. It felt like series of accusations. Fails to show professional behavior. Fails to maintain professional-social distance. Does not know what she should know. Incompetent. She told me that she didn't think it would be in my best interest to act as a reference for a undergrad nursing position this summer.

As she read these phrases out to me, it felt like she had to be talking about someone else. Fails to maintain professional distance? What could she possibly mean? I wanted to ask but could not; I didn't want to start an argument that I couldn't win. The grades had already been assigned.

I mulled it over and over, trying to pinpoint a time I may have breached that professional boundary - moreso, trying to imagine a time that she might have actually been around to witness it. The only moment I can think of is where she breached the professional boundary and made an off-color comment to one of my families, jokingly referring to their (first, miraculous) post-term baby as a "peeler" and asking the father if he had any stories about 'The Peelers'. He was mortified ("Uh, no, actually, I am not into that at all....") and so was I.

Incompetent? How could this be? I'll be the first to admit there's a lot I don't know. But I ask. I work within my scope of practice and I ask as I go. I practice safe care, I keep my eyes and ears open, and I study at home to try and learn something for next time.

Nothing made sense. My patients expressed nothing but gratitude for the care they got. I independently assessed a need for breastfeeding support on several of my patients and got them the help they needed. I coached new moms through that initial latch and encouraged them to listen for the swallows of their feeding infants. I intervened on a gagging baby and got him to burp the biggest burp he'd probably ever made in his short life. I talked a young couple through how they felt about their changing from a couple to new parents. I demonstrated initial baths to several proud dads and their cameras. I found twin heart beats for an NST on my first try. I palpated fundi, I provided comfort measures, and I once dug through a bag of nasty post-birth laundry to retrieve a pair of tiny baby socks when everyone told me they were as good as gone. And not once did anyone say anything less than thank you with that look that said they meant it.

About that big 'win' I mentioned earlier - I left the hospital on my second-last day knowing I did good for someone. I had spent the entire day providing postpartum care to a new family stuck up in Caseroom until a Postpartum bed opened.

The mom delivered at about 0600 and was still up in the caseroom at 1230. Baby had been showing early signs of hunger but was also quite sleepy. She was an anxious mom, asking about feeding her baby, and the L&D nurse assigned to her provided very vague answers about how to get started with breastfeeding. I stepped in when the L&D nurse deferred their questions, and they had lots of them, like new parents should. I hunted down a pillow and helped prop her up in bed. I stole some breastfeeding pamphlets from Postpartum and sat down with her for close to an hour of teaching.  I coached her on positions, and we finally settled on 'football'. I showed her how to get baby nice and awake, and ready to eat. Eventually, with plenty of teaching, patience, and false starts, mom and I got baby with a solid latch and feeding like a champion.

Elated, I went to find my instructor and show her, and further convince anxious mom that she was doing well. I found my instructor getting her hair trimmed by a service aide in the utility room, but I digress. Instructor came in and saw mom and baby feeding well and applauded mom. A few minutes later, at the desk, my instructor told my assigned RN that mom was successfully feeding babe despite all of the challenges and concerns she had before. The RN was happy and asked my instructor if 'we' did that. My instructor reiterated that mom was successfully feeding babe.

I was honestly crestfallen with that statement. I had, in my mind, been a huge advocate for this family; despite their staying up in the L&D caseroom all day, I made sure that they had the same quality Postpartum care (to the best of my ability) that they would have gotten on that unit. Nobody guided me to make these interventions. I saw the need for them to learn, so I stepped up my game and taught them. It was like opening flood gates: they asked about SIDS risks, carseats, skin-to-skin, jaundice, and the list went on. That family was so thankful and grateful for the time I took to spend with them, helping them transition into the role of new parents. That was the family who left their new baby's tiny socks on the birthing bed when they finally did get transferred to Postpartum - the ones I ran back upstairs and convinced Housekeeping to let me dig through dirty laundry bags to find.

So yes, I *did* do that - in the sense that if I hadn't intervened, that mom and baby might not have had the same outcome. They didn't transfer downstairs for another hour, and shift change wasn't for another 90 minutes after that, and I'd bet my stethoscope that poor baby would be screaming blue murder if he had to wait that long for his first meal. Screaming baby + already anxious mom = anxiety through the roof, and who knows, that anxiety could have shaken them so badly that baby would be on formula by now.

And where was my instructor? Selling me short, and telling me in my final evaluation that I was not knowledgeable and crossing professional boundaries.

To think that I started this clinical terrified that I was going to screw it up. If it wasn't for the incredible response I've received from my patients, peers, and especially the unit staff - who frequently expressed how glad they were to have us, and often gave me a high five or a hug at the end of the shift - I would finish this clinical convinced that I am a shitty nurse. If it wasn't for how I felt going home a few days ago, when I KNEW I'd made a lasting difference with my families, I would doubt myself. But I know I did well. One voice to the contrary can't change that.

One thing did jump out at me at my evaluation. Despite all of the bullshit incompetencies on my final evaluation, there was not one bad thing my instructor could say about the quality of care I gave. There was absolutely nothing wrong with my practice as a nurse. The angles she took to undermine me were personal and nebulous. I really wish I had asked for concrete examples of these incompetencies; I would have liked to hear her try to describe them as specific situations.... but I was just too upset with disbelief to argue the point.

I think of the few times she was around to witness my practical skills - Vitamin K injections, initial baths, newborn assessments. She said I did them fine. I even asked her for critique and she had none.

I think of all the times she was around me as a person, not as her student. Very clipped responses, sarcasm, awkward silences.

And I wonder - what on EARTH had I done to make her dislike me so much that she would want to attack me like this. I still draw a blank. Maybe I reminded her of someone.

The lasting damage has been done. Her appraisal of me as a future RN has been decided, written, and filed away somewhere to inevitably reappear when I want to apply for a cool opportunity at my school. I will not let this define me. I will continue to advocate for my patients and provide them with exemplary care, and I will not let personal grudges EVER get in the way of that.

As my peers told me later while I cried into a cup of coffee, I grew so much through this clinical and I did it without my instructor's guidance. I became a better nurse despite her instruction, not because of it.


Cartoon Characters said...

whoa. Your instructor mentioned peelers in relation to their baby???? And was found having her hair cut in a back room instead of doing her job? Why am i not surprised. I had an RN program instructor that told me I did "excellent-A level clinical" but he was going to only give me a "B" because he didn't believe in giving out an A on a first run. He was also the one that gave lower marks in presentations to gals that didn't wear tight pants and revealing tops. He was also the cause of my sis in law's sister to quit the RN program because she rejected his advances - he told her she would be a crappy RN and she went on to graduate from the Psych nurse program and became a very good Psych nurse. I also had an instructor that was just as meanspirited as yours and when I later worked with her on a Surgical unit, found out not only could I work circles around her but she was downright dangerous on the unit and fell apart and quit after a couple of shifts....

I survived and no one ever asked for my marks after graduation. But why does it have to be this way at all???

There should be some way you could appeal. Hearing your side of it would be the fair thing to do. I really believe that marks given are mostly subjective. I also believe that students should be allowed to also do an appraisal of the performance of their instructors.

To sit back and have to "take it"....is something I did as a student but refused to do once I graduated. It certainly is intimidating. I believe it is also an abuse of power on the part of the instructor.

You give very good specific examples of your competency which, by the way, is part of what we do to prove our competency and maintain our RN license - using our Standards of Practice as an RN. Your instructor did not present examples where you "failed". Your description of events present a very good argument in your favor.

If it weren't so exhausting...it might be worth a try..? Good luck if you do.

I am just gobsmacked that this still is allowed to go on today. Really. Your school of nursing needs to review her performance. After all, there are others out there who could do a much better job - and we really NEED future nurses like you.

cellar_door said...

That's shocking. I don't know how it works over there, but over here we are told that we should never be surprised by what is said in your final evaluation (called a tripartite over here, and with your nurse mentor and a tutor from the college present) because if your mentor has any concerns they are expected to raise them both with you and the college before the end of the placement to give you a chance to improve. And they have to offer concrete examples if they have concerns.

You are one of the most involved, conscientious students I know (admittedly, only via internet) and I hope you manage to move on from this. And if you have the strength, I would definitely challenge this woman to give you examples.

raised by the sea. said...

I'm sorry to hear that you had a poor final evaluation. :-( I'm always terrified of receiving the same and I can only imagine how terrifying it must be. The fact that she never had any complaints about your performance throughout the rotation but then completely blindsided you at the end warrants suspicion to me. I would definitely bring this issue to a higher-up person at your university. Although I only read of your performances through the internet, I think you seem like a very confident, competent, highly skilled student nurse. Certainly, how you behave throughout your clinical rotations deserves merit, not disapproval. As a student nurse myself, I can only wish to be half the nurse that you are.

Frazzled-Razzle-RN said...

What a terd she was, don't let that get you down! You rock UndergradRN!

Anonymous said...

Clearly there is no advice I need to give you, you already described how to perfectly handle the situation. No point in wasting energy with her, and like Cartoon said, it won't matter once you are done anyway.

So proud of you at the CNSA conference, sorry we missed the chance to have an in-person talk. However, I have no doubt that we will be in touch. You are going to do awesome things, and already becoming an stellar nurse.


undergrad RN said...

*sniff* You guys are the best. Thank you.

Anonymous said...

I feel for you but I would definitely send a note to someone regarding her behavior. This is how the nonesense keeps on going. If no one does anything and just accepts this, it leaves the rest of the poor souls coming after you to suffer the same fate. Some people are not meant to be teachers and she should be accountable for her actions.

As for your future clinicals is there a way to ask before you start what the specific expectations are for that clinical? That way, while you go through it you can document what you did to fulfill those expectations without wondering if you did everything.

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