Student Nurses in ICU for clinical - page 2

I am wondering anyone's thoughts/experiences on this issue. Before I start, I just want to say that I am totally for education and totally open to helping anyone learn. I am a new grad myself... Read More

  1. by   Vsummer1
    I thought of this post today in our clinical conference. The instructor mentioned that when we do our next rotation we WILL BE the nurse. We will assess the patient and do ALL that is required, including all meds as well as the prn meds and any other thing that comes up. We will be working with whatever nurse was assigned to the patient.

    I asked if we would then be practicing under that nurses license, and she said yes, along with hers (the instructors).

    I thought of you and your license at that point, and wondered if the nurses here get the option to take a student or not? I don't think it would be fair for me to just "pick" my patient and impose upon that nurse and therefore her license. I hope that however things are assigned that the nurse I work with WANTS me there to learn!
  2. by   kimmicoobug
    I find it kind of interesting that I should find this thread TODAY of all days. I am a student and I get to go to ICU tomorrow for the first time. Being that I am a student and these people in ICU are nurses, I really got some insight to your original post. I actually never thought of it from your point of view as to what the nurses know and don't know what we are supposed to do.
    My program is a little different from that program. My instructor is actually an ICU nurse at the hospital I do clinicals with. I have to say that so far he is pretty cool. He always carries a pager and has encouraged us so far to always make use of it when in doubt. He is there for any procedure, although if he has seen us do it satisfactorily with his own eyes, then he lets us loose to do it with the nurse. What you described with that one student has never been an issue (at least I don't think so). He is also there for all regularly scheduled IV meds, except PRN. Rationale being is that they are usually there for nausea and pain, so why make a patient wait, and therefore we can do it with the RN if she is comfortable with it. I guess this particular instructor has to do a good job or he may be the brunt of some gossip from his coworkers. (hee hee).
    I just plan on shadowing my preceptor tomorrow. I definitely don't plan on doing it alone. Just walking through that door was pretty overwhelming and I feel like I need a little hand holding since these people are really sick. And besides, I think that we are supposed to work in tandem with our preceptors.
    I know we posted this awhile ago, so I hope your problem with this instructor has been resolved.
  3. by   kimmicoobug
    PS. I forgot to mention that my instructor will usually let the nurse know if we can perform a procedure with them.
  4. by   Espresso girl!
    I really haven't heard a discussion yet on the quality of nursing instructors out there. I'm in an accelerated program and we have had a mess of a time. One instructor was finally fired, after several students dropped or transferred from the program and the rest of us remaining finally stormed the Dean's office. Found out she had not been in a clinical setting for over 20 years, her pHd was in anthropology. She could not even correctly demonstrate how to do a blood glucose check! The Dept. Chair is now on medical leave, after she was demoted from Dept Chair. Another instructor quit after our first semester. The Dean told us that they have had a very difficult time find nursing instructors--there aren't many out there I guess that want low teaching pay v. clinical work pay.

    We too have had confusion over who can do what. Our supposed preceptors leave us hanging and teach us little.

    We were informed, however, that it is our instructors license that we operate under when going into a facility. I'm sure this is how it is everywhere, otherwise...if the student was operating under the license of nurse-whoever then it would be very difficult to retrace the key issues of who was the patient, who was their nurse, what other nurse may have stepped in for that nurse while at lunch, etc, and which student was also there? You see, it is difficult and convoluted to try and pin this down!

    Hard to believe the instructor would be so lax or negligent over the use of their own license? It's not hard for me to believe at all after the crap I've seen in my program. I will just be thank ful to get out and never have to deal with such an unpractical program again. We get culture, ethnicity, culture and more culture crammed down our throat each day, but do you think we'd ever spend some time on learning how to read a chart or interpret lab values? Of course not.

    Espresso Girl
  5. by   askater11
    I don't currently work with students.

    When I did it was on a step-down unit. The R.N.'s had a 6 to 1 ratio...but the days the students were there we went up to a 12 to 1 ratio. (NEEDLESS TO SAY I MADE SURE I WENT HOME>>>I DIDN"T WANT TO RISK MY LICENSE)


    I asked a legal nurse before if I was legally responsible for the patient care? The legal nurse said I was....and I could never imagine covering 6 of my patients plus overlooking a nursing student.

    I love to teach students/other nurses but I think it's too big of a responsiblity. And the responsibility always falls on R.N.'s. Never anyone else but us.
  6. by   Dr. Kate
    Technically the instructor is the person responsible for the student. You are responsible for the patients assigned to you.

    What I have a real problem with, and this is nothing against you, is letting a student be with a new grad. You're too new yourself to be any kind of a resource to a student.

    Students and their instructors have a tendency to talk about the student "doing everything" for the patient. My experience has been they mean they'll do physical care, meds, and charting. They may do routine treatments, occ can manage an unexpected procedure, rarely can handle interacting with and calling physicians, and never can deal with emergencies. Everything is quite a matter of personal definition.

    I do think your NM and the instructor need to set some parameters so the students get an optimal experience, and so that a new nurse isn't burned before she has a chance to become seasoned.
  7. by   2banurse
    Originally posted by mark_LD_RN
    i would not tolerate such a set up, as that the instructor is just dumping her responsibilities on others. I have seen other instructors in my area do just what you mentioned. I explain my view to the student and tell them to find me the instructor.to see if we can work it out, if not the student gets no where near my patient on my shift. some students have thought i was just being a _______ but they need to understand it is my license and my patient and i refuse to put either on the line unjustly. I am not the students instructor and should not be expected to do so.
    I would have to totally agree with Mark. As you will be held responsible, I would make sure that I get all the I's dotted and T's crossed before I would just let a nursing student become involved with my patient, particularly in an ICU. I am not saying that she may not be a good student or whatever, but still NO.

    On another note, what happens if as a student you are assigned to a preceptor that wants nothing to do with teaching...can a student talk with someone about changing this situation?

    Kris
  8. by   mattsmom81
    I know a nurse who was fired for a mistake made by a student in ICU...so I am very careful with what I allow students in ICU to do. My friend thought the instructor was supervising, she was off the unit and while my friend was with his 2nd patient the student took it on herself to inject a GTube med into a central line. My advice is to be very careful out there, and like Mark said....set your own boundaries and watch 'em like hawks.
  9. by   debmac
    totally unacceptable! i wouldn't be risking my license or my patient's welfare in such a set up. there have to be prearranged rules, guidlines and plan of care...the instructor has to be accessible and has to be accountable. i would have to question a student who is willing to say "we do it all" and expected to be turned loose in a critical care setting...that in itself is dangerous thinking.
  10. by   Mariah
    I was an instructor at a diploma program. Senior students spent 8 weeks in the ICU/CCU. But then in those days, diploma students had over 1500 hrs of practice before they got there. I never did the ICU rotation, but in Med Surg, I was on the unit the entire time. In the morning I made sure each student knew what they were doing, what they had to be concerned about, what their plans were, etc. Assignments were carefully selected depending on the education needs of the students, the complexity and status of the patient, personal desires of the patient, etc. I followed up frequently throughout the day with the student and the status of the patient. Although they were cosigned with an RN and checked with the RN throughout the day, I always assumed that the were also working under my license. Instructors were an integral part of the team on the unit and we worked collaborative with the head nurses. Activity wise - we functioned like a team leader (when team leading was practiced). I just can't imagine a instructor leaving a student there and disappearing.
  11. by   renerian
    Our instructor was in house...........amongst several floors, the staff RN cosigned our notes. Where we ran into some concern when I became staff nurse is ADNs felt uncomfortable with being a new grad of six months or so time, and working with BSN students since they were farther along in most cases-or so we found. We then paired Bachelors to Bachelors nurses are everyone was happy......

    Just a thought,

    renerian
  12. by   New CCU RN
    Well, perhaps that could work BSN to BSN ... however I do have my BSN but still didn't feel as though it was safe or fair to the RNs that we were the ones pretty much instructing the students. Never did we see an instructor....nor did we ever get any sort of guidelines from the school.

    If it was a paired RN-student type situation....where the student was known to the nurse, and the nurse knew that she was mentoring a student, the situation would have been different. However, it wasnt like that.

    And for me personally, I was just out of orientation... still on "protected time" and I was paired with a student.
  13. by   shaz
    as a new RN you may not feel you have the right to question your senior staff when a SN is given to you to look after. but you must set ground rules at the start of the shift. you go to your senior and ask what the student is and isnt allowed to do and sit down with the student for 10 minutes and ask them what their goals are and what do they know about CCU. In australia the legal responsibility lies with the university and the hospital. so if you are practicing within your scope of practice and following hospital protocol you should feel comfortable. and if you are not comfortable with a SN you must speak out because it will be detrimental for you both.

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