I was recently hired as a clinical instructor for a high school level CNA program. The students are seniors, graduating in June. Most are interested in nursing careers.
In the three weeks we have been in the clinical area, one of the students has escalated from pouting about her assignments, to challenging my authority, to threatening to make her own assignment decisions. Last week she disregarded the assignment I gave her and disappeared when my back was turned. I searched the entire facility and found her working with her favorite CNA. I called her out of the room, told her she had exhibited unsafe practice and unprofessional behavior, and I sent her home.
When I tried to discuss the situation with her privately and in more detail on our next clinical day, she became hostile and accusatory. I ended the meeting and consulted the same day with the lead instructor and program director (an educator) who informed me the student had been involved in a bullying incident at the beginning of the school year.
In the ensuing three days, the student has become increasingly belligerent, refusing to look at me and faces the back of the class during my classroom lecture.
Both the lead instructor and I do not trust this student in the clinical setting and believe she is unsafe, however I am told there is nothing to prevent her from moving forward and becoming licensed as a CNA because her skill level is satisfactory and her grades are at the top of the class.
Although I cannot prevent her from becoming a CNA, I do feel an ethical responsibility to protect the public from this student if/when she becomes licensed as a CNA.
Dear Nancy replies:
This student sounds like she may not have the personality or professionalism to be a CNA, despite her satisfactory skill levels and high grades. Not everyone is suited to work with people despite their intelligence and skill sets.
You did not say how students were evaluated for their eventual graduation other than their skills and grades. In any program where individuals are trained or educated to provide care to the public, the evaluation of the student should include such characteristics as the ability to think rationally, the ability to get along with others, the provision of care in a safe manner, the ability to take and follow directions, managing one’s own feelings, the ability to respect others and other factors that are seen as an essential part of the role of the CNA.
The evaluation of such characteristics in a program should carry the same importance as other evaluative indicators and also should be required to be met if the student is to complete the course and graduate to become a CNA.
If these factors are not evaluated by an educational course, it would be difficult to answer any questions of the agency that licenses individuals to become a CNA that would be required for the license (e.g.: Has the individual displayed a caring attitude toward patients? Does the individual work well with others?). What factors would you have, other than your own bias or your own partiality of a particular student?
You might want to raise this issue with your lead instructor and take your concerns to the person who oversees the entire CNA course. This type of situation will more likely than not occur again, and the course needs to be prepared to handle this type of student fairly, but with the ultimate concern of the public and fellow health team members in mind.