As a clinical preceptor for level-2 nursing students, I encountered a particularly challenging situation with a student I will call Maria. While Maria displayed strong theoretical knowledge in classroom settings, she struggled significantly with medication administration in the clinical environment. Her performance became concerning when she was assigned to administer oral azithromycin to a patient with a respiratory infection.
I observed Maria as she prepared to administer the medication. She correctly verified the medication against the order but became visibly anxious when attempting to explain the purpose and side effects to the patient. When the patient asked if the antibiotic would interact with their other medications, Maria provided incomplete information and appeared uncertain. I noticed she was about to administer the azithromycin without checking if the patient had any allergies to macrolide antibiotics or verifying when the patient had last eaten, which is essential for absorption considerations with azithromycin.
Using our pre-established nonverbal cue (a light touch on the shoulder), I completed the assessment and provided the missing information to the patient. Afterward, Maria appeared defeated and quietly stated she was not cut out for nursing, which concerned me about her declining confidence. This situation presented multiple challenges. First, Maria's confidence deteriorated with each clinical day. Second, patient safety was potentially at risk due to incomplete assessment. Third, Maria had begun avoiding medication administration opportunities rather than seeking guidance, making skill development impossible. When I attempted to provide feedback immediately following the incident, she became defensive and tearful.
To address these challenges, I implemented several evidence-based strategies. First, I arranged a private meeting in the conference room away from the clinical area to discuss my observations (Needham et al., 2016). I began by asking Maria to reflect on her experiences with medication administration rather than immediately addressing performance issues. This approach, aligned with the elaborative feedback model described by Courtney-Pratt et al. (2012), helped establish psychological safety.
Maria revealed she had witnessed a medication error during her first clinical rotation, during which a patient experienced an allergic reaction. This incident created significant anxiety around medication administration. This insight helped me understand her hesitation and defensive reactions to feedback. Together, we developed a structured learning plan focusing specifically on oral medication administration. We created a step-by-step checklist for medication administration that included all safety checks for antibiotics specifically (Ke et al., 2017).
I modified my teaching approach to include more direct supervision and side-by-side practice. We simulated potential patient questions about antibiotics, particularly azithromycin, so that she could practice her responses. I also encouraged her to review common antibiotics and their teaching points the evening before clinical days to build confidence.
The outcome was a gradual but significant improvement. By acknowledging Maria's anxiety without judgment and providing structured support, I helped create what Hook (2019) describes as a psychologically safe learning environment. By the rotation's end, Maria could competently administer oral medications, including antibiotics, with appropriate patient education. She developed a personal system for organizing medication information that helped her feel more confident when patients asked questions.
This experience reinforced that effective clinical teaching requires adaptability, empathy, and recognition that emotional barriers often underlie performance issues. Creating a safe space for mistakes and learning is essential, especially for level-2 students who are still developing their clinical identity (Bhana, 2014). I have since incorporated these approaches with other students facing similar challenges with medication administration.
References:
Bhana, V. (2014). Interpersonal skills development in Generation Y student nurses: A literature review. Nurse Education Today, 34(12), 1430-1434. https://doi.org/10.1016/j.nedt.2014.05.002
Courtney-Pratt, M., Fitzgerald, K., Ford, K., Marsden, A., & Marlow, A. (2012). Quality clinical placements for undergraduate nursing students: A cross-sectional survey of undergraduates and supervising nurses. Journal of Advanced Nursing, 68(6), 1380-1390. https://doi.org/10.1111/j.1365-2648.2011.05851.x
Hook, G. S. (2019). Communication skills training: The ultimate guide for public speaking and conversation, persuasion, relationships, workplace, and interviews. Effective communication for business professionals. Amazon Digital Services LLC.
Ke, Y. T., Kuo, C. C., & Hung, C. H. (2017). The effects of nursing preceptorship on new nurses' competence, professional socialisation, job satisfaction and retention: A systematic review. Journal of Advanced Nursing, 73(10), 2296-2305. https://doi.org/10.1111/jan.13317
Needham, J., McMurray, A., & Shaban, R. Z. (2016). Best practice in clinical facilitation of undergraduate nursing students. Nurse Education in Practice, 20, 131-138. https://doi.org/10.1016/j.nepr.2016.08.003