Supporting learners & staff

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This topic contains 4 replies, has 2 voices, and was last updated by  Sandra Purnell 5 years, 9 months ago.

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  • #773 Reply

    Margaret Potter

    Recently, an educator made contact with me to describe a difficult situation relating to a grad who is struggling with her rotation. The grad nurse was described as hard working, but feeling unsupported in the workplace.  The grad also described being humiliated and feeling bullied by staff who supervise/manage her. In turn, the staff have complained about that grad saying she has a poor attitude and communication skills.

    From an educator point of view the following actions were taken:

    1. Provision of support by putting an action plan in place with weekly follow up.

    2. Ensure preceptors put in place

    3. Held a meeting with the manager as well as the grad which went quite well and was well received by both parties.

    Have others experienced this situation?  If so, do you have any other suggestions on what could/should be done to support the grad and keep onside with staff?

    #779 Reply

    Vickey Brown

    Hi, not a simple one!  Issues – feeling bullied, unsupported, being humiliated, poor attitude, poor communication skills.  All familiar to me!  If it were possible I’d be assessing the clinical prac placement – find out if the Grad is speaking the truth.  Is there a bullying culture at this palcement?  If there is – I’d be reporting higher up the chain – but I would ensure I had solid examples.  Most hospitals look down on bullying.  However you also need to be “keeping the peace” as it were. You say the Grad is “a hard worker” – so I would engage in discussion with the grad and eventually ask her to aim to prove the accusers absolutely incorrect.  I would encourage the Grad to become the best she can possibly be.  Get the Grad to ensure she does absolutely everything she is asked to do as well as once she has finished doing what is required of her – she goes to individual staff members and asks “Do you need a hand with anything?”  The general gist is to prove them wrong – so work with the Grad & upskill her to be a very good communicator.  Get her to report patients’ conditions always – I’d even suggest something like the following – eg. say she is doing something like a dressing and she notices something she feels needs to be seen or reported – get her to report it – she can cover the wound with a sterile drape & go a fetch a senior to look at the wound.  When she seeks the “expert” advise she tanks them.   She could even ask “I thought when wounds look like this you should use XXX product as the dressing?”   Is the Grad asking questions when she doesn’t know things?  The Grad has to prove them wrong!  Documentation also needs to be spot on.  Have you read her reports at all – if not – do and make recommendations to her on how to improve them.  It’s not always easy to keep onside with the staff – so perhaps you could talk with them – I would.  Ensure the easy things are done – always, always always say hello – ask them “How are you today?”  “What is the ward like?”  “Are you busy?”  Basically become their friend.   Smile – always.   These are only recommendations but if the Grad truely is a good worker – they will be able to demonstrate their ability to be one of, if not the BEST grad they have ever had.  Good luck with it.

    #782 Reply

    Fiona Lake

    A challenging situation and I must say most impressively dealt with (?resolved).

    I am not entirely sure of the educator position in terms of relationship with the ward team and how well they know the ward team – is this suprising to hear of bullying, or not?  Similarly, how has the Grad nurse gone before?  I think a good position to start from is both sides are well meaning and trying but something is not working.   Really important even if you think there may be some degree of a problem on either side- we know great wards can have difficult periods as can Grad nurses.

    By taking the focus off the acusations and focus on what both are trying to achieve, it may diffuse the situation OR make it obvious one or other side is not contributing the the training relationship as you would expect. This requires lots of listening on the side of the educator without passing judgment on what they have heard, discretion (do not talk about it t anyone else peripherally involved – I call this gossip and gossip  is really destructive) and then agree on outcomes amongst the key senior folk and the student, then monitor and followup.  Hopefully resolution without loss of face. We need wards to train our students and we need students to get through – and in general I think it is folk under stress whose high standards slip (both staff and students) rather than bad folk.

    #790 Reply

    Anne Kimberley

    Hi, a challenging situation, especially when so many staff have their own interpretation of what the problems are i.e. the grad percieves being unsupported, humialiated and bullied and the local staff interpret the grads behaviour and attitude as poor. I would want to explore and clarify the basics first on each ‘side’ which it sounds like you have done.

    What support does the grad see as reasonable, is this possible to achieve and if not what other statategies would help her feel supported. What behaviours by the staff are being interpreted as bullying? What is the cause of the poor attitude…if I felt I was being bullied and not supported I would have a poor attitude too!! so which came first in this case??

    For the local staff what are their expectations of the grad, are they achievable. How is feedback on the grads performance provided to the grad to be given the opportunity to consider any issues and improve? As educator I might undertake an educational history (TOTR Supprting Learners Workshop 4: PAAR model) to better undertand and guide the situation.

    Then as Fiona mentioned focussing on the collabortive outcomes (common goal) as they relate for the patient, grad and the staff would keep the forward looking momentum. Good luck!


    #892 Reply

    Sandra Purnell

    These are challenging and sensitive areas to manage.  Added to this situation, when managing your learners is the “who is most at risk” element when problems develop.  In my own medical education experiences with the junior doctors I work with, all of the groups identified in the Supporting Learners module are very common.  Add to the mix of a learner being a type A high achiever, often being self critical, stressed or fatigued, there are type A consultants & senior doctors from different specialty areas adding their points of view about what they expect from the junior doctor. The tribes of medicine can be very strong at times! Junior doctors can become very stressed dealing with these conflicts .  If the junior doctor follows advice from one senior doctor over another, the junior doctor can feel like the “meat in sandwich”.  Comments such as “ignore what he says” can fuel confusion & stress. The senior who’s advice wasn’t acknowledged may perceive the junior doctor being disrespectful & refusing to take on advice. If the junior doctor is placed in the situation needing to defend his choice, this can be looked upon as being arguementative & not willing to take advice.  When the PARR framework is used, problems can be identified as interelated  – system-supervisor-learner. To analyse, interviews are required with the junior doctor & both clinical supervisors to understand the various perceptions that arise. The learner may need guidance with comunication srategies.  Collaborative meetings are required to reflect on the junior doctor’s scope of practice & reporting lines. The Term Supervisor of the unit the junior doctor is working in should followup with the junior doctor to check whether milestones are reached within arranged timelines.  The Medical Education Unit in the advocacy role, must  ensure the junior doctor doesn’t go from stressed to distressed.  Various avenues available to support junior doctors should always be promoted prior to commencement of duties.

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