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What to do When Your SRNA is Failing

When your student is failing!!!

One of the hardest things to do as a CRNA is precept students. Although precepting is an expected part of the job, not all CRNAs know how to teach effectively. Some, I have found, have very little interest to precept SRNAs altogether. Some SRNAs are not easily taught, either. The hardest part of precepting, in my opinion, is trying to teach a student that is failing, or not meeting their goals/ milestones. There are so many reasons why an SRNA might be failing clinicals. Personal life issues, poor time management, an overabundance of confidence, or poor teaching skills of the preceptor, are some of the contributing factors that can cause a student to fail. The job of the CRNA preceptor is to identify these reasons and address them early on with the student.

We assume, as I’ve mentioned before, that nurses go into CRNA school of their own accord and are committed to learning and studying while in the program. It is assumed that SRNAs come into the clinical setting with at least a few years of nursing experience and that they will build on that experience while in the OR. It is also assumed that every SRNA is capable of learning and succeeding in the program, otherwise they would not have been selected for their class. So why is it that some students do very poorly in the clinical setting? Why are some SRNAs able to adapt to anesthesia practice with ease, while others struggle the whole time they are in school? It is important to remember that not all students have the same capacity to learn and adapt to the clinical environment. Some students may require a lot more guidance and “hand holding”. Others are able to perform tasks they’ve seen only once. The CRNA preceptors have to recognize each student’s ability and learning style and adjust their teaching techniques to fit each student. Sometimes all it takes is a little bit of patience. Don’t assume that every SRNA is at the same level or is advancing on the same timeline.

What do you do when all other options have been exhausted? You’ve spoken to the student several times about their need to improve. You’ve taken the time to show them and direct them through certain skills. You’ve gone over the curriculum and expectations, and made it clear that you’re here to help not degrade. Still, the SRNA continues to make the same mistakes and their clinical growth has stopped. How do you handle such a situation without getting too emotionally invested? After all, no one wants to fail someone out of their program. No one wants to be the person that tells someone they are not cut out for this work. No one wants to be the person to put bad evaluations on a student’s clinical day and cause issues for them with their professors. The problem is that this way of thinking can be very dangerous, and in the long run detrimental to the SRNA and our profession. The longer you let a failing student remain in the program, the more likely the chances are that they will do something detrimental to a patient. The longer an issue goes unresolved, the worst it will become. The longer a failing student is allowed to stay in a program, and essentially “strung along” only to be dismissed from the program later on, the more loan debt they accrue (with no higher degree to afford payback).

As a rule, I first have a talk with my SRNA about the issues that I’m seeing. I tell them what I expect from them at this stage in their program, and what I want to see them achieve in the next days, weeks, months. I always start out a student’s clinical rotation with me by setting clear guidelines and goals for them. When I meet the student every morning, my first question to them is, “what do you feel you need to work on today? What skills are you not getting or understanding?” I tailor our day around those things identified by the SRNA and areas that I see need improvement. It doesn’t always work out, but I think it’s a great way to be on the same page with your student.

Unfortunately, some nurses are not cut out for this high level of patient care that we provide. Some students don’t understand the gravity of what we do, don’t take it seriously, don’t apply themselves properly. It doesn’t matter what you do to help, some students are just not cut out for this line of work. The important thing is to identify when an SRNA is just having a bad day, and when there is clearly a lack of understanding or progression that must be addressed. It’s very easy to say, “they just don’t get it”; but that’s not always the case. It’s our duty as CRNA preceptors to not only teach, but to mentor our SRNAs during their clinical rotations with us. Our main job, and I say this to my students often, is to make sure we build the foundation for them to become safe anesthesia caregivers once they leave our OR.

I know how hard it is to tell someone that they are failing, and maybe not good enough to be a CRNA. I know how tough it may feel to fail your SRNA for the day because of mistakes made at clinicals. It’s not easy to precept future CRNAs, and honestly it shouldn’t be. If being a CRNA was easy, a lot more people would do it. The truth is that some students will not make it to graduation day. They either lack the focus, capability, or self-training to make it through such a tough program. It shouldn’t matter if they are nice, or friendly, or have built a relationship with the OR staff; if they can’t get the work done or meet their goals, it’s our duty as preceptors to take disciplinary action until we see improvements. The only two questions that you need to answer when debating whether or not a student should be failed for the day or from the program are, “do I want this person representing our profession when they graduate?” and “would I let this person provide anesthesia to my family member?” Answer those two questions and you’ll know what to do.

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