Nursing School Patient Loads - page 3

There is a discussion going on in the Nurse Educator forum related to clinical expectations. Anyway something that has come out of it is the amount of patients this student is responsible to take on.... Read More

  1. 1
    I went through an ADN program in Northern California. In our last semester we were responsible for full care of 4 patients under the supervision of an RN. We had full pyxis access, but were required to double check medications and verify patient identification with an RN. We were responsible for all charting, although our nurses were usually happy to help. We spent the majority of the semester on the same unit, but had brief rotations (1-2 shifts) to ICU, OR, ED, and Cath lab. We rotated out to OB for 6 shifts. We did not have a preceptorship in my program, and I have been told by other nurses and interviewers that my school "screwed me over" in that regard. They have since reintroduced a preceptorship to my school. In our 1st semester we had to complete a detailed 8 page careplan on our 1 patient load. In our final semester we had to complete a brief one page careplan on only 1 of our 4 patients, until our clinical instructor decided we were competent enough to not have to write it out and turn it in (of course we still had to make a verbal report/care plan if asked).
    onewill likes this.

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  2. 1
    So it definitely looks like there is a lot of variation in the programs.
    hiddencatRN likes this.
  3. 0
    In my last placement I started with one and had worked my way up to full care of 5 by the end.
  4. 0
    I was in an ADN program in Northern California and we had 1 patient 1st semester, 2 the 2nd, 3 the 3rd, and 4 the 4th. By the time we completed our preceptorship we were expected to be doing the entire nurse's assignment (usually 4-5 patients) except for having Pyxis access and calling MD's/receiving orders. Usually my preceptor was glad to have SOMETHING to do
  5. 1
    In my 5 semester ADN program, now, we take do total care for 1 med/surg patient all first semester. That one patient would start of being mild but by the end of the first semester we cared for 1 higher acuity patient, total care. The 2nd semester we had to do total care for 2 stable patients a minimum of 3 times in the semester. During summer semester we had a mix if med Surg and LD/OB, we had one to 2 patients on those rotations, doing total care. On Med-Surg, we started with 3 patients, 2 mild care and 1 slightly higher acuity, all total care.

    My fourth semester we started team nursing and each student rotated to act as "Charge Nurse", that student took responsibility forsaking pt. assignments that day and functioning as a charge nurse, carrying partial responsibility for all patients assigned. Team members during team nursing take anywhere from 2-4 med-surg patients with various blends of acuity, still total care, but if you needed help we have always been encouraged to work as a team. The group, typically made of 5 or 6 students, can only have a max of 14 patients (actually its really according to which instructor we're with bc some like to push us to see how good we are, safely) and a minimum of 10. Nobody gets less than two patients, but we mostly all get at least 3 patients with one or 2 people getting 4 and we rotate that so everyone gets the opportunity to have that kind of pt. load at least twice a semester. Of course our clinical instructor facilitates during the whole team nursing process, double checking to see if they agree with the patient assignments and etc... After hearing report.

    My current semester the first 1/2 of the semester we must do 120 hours of an individual practicum or preceptorship on a desired/assigned unit with an assigned hospital employed preceptor, I chose CVICU.

    By the end of preceptorship all students in my program must be able to manage the care of at least 4 mild-moderate care med-Surg patients safely, independently, or with little guidance. If you completed your practicum in a specialty or critical care unit (L&D, ICU, PACU, ER), we are expected to be SE care for a patient load that is typical for a new grad on that specific unit, for me that was 3-4 CVICU patients, unless I had a fresh CABG, which I would do one one care for.

    Because we must share preceptors and sites with other schools, we can only do 120 hours of individual practicum and have now returned to Team Nursing with our instructors for the remainder of our final semester. We are now taking 2-5 mixed acuity patients, according to which instructor we have. When we have 5 patients or 4 "difficult"we still get our own vitals, but the Morning care can be delegates.

    I'm in SE NC!
    Last edit by PatMac10,RN on Apr 2, '13
    onewill likes this.
  6. 1
    My ADN program, I had two pts. all of my last year. We did mother/baby and med/surg. I am now in a six month internship, as a nurse ( new grad program, but I worked for 8 months in a LTC rehab unit). I have started with 2 pts, total care with a preceptor. I will eventually get up to 4-5 at the end of my 6 months. The rationale is that when we learn slowly and methodically, we learn properly. I can't imagine being safe as a student with 5 pts. I am NC as well. eastern.
    onewill likes this.
  7. 0
    Last semester here in a BSN program. In my practicum, our patient assignments depend on our units and how the preceptor wants to shape the experience. I started off with 1 patient at the beginning this semester and have progressed to I'd say 3.5 out of 4 . My preceptor at this point primarily will bring me meds as I don't have access to the Pyxis and has to handle drips like diltiazem or insulin as I'm not permitted. It's been great; she's figured out my weaknesses and can help push me along when I need it.
  8. 0
    First two semesters it was 1, unless the instructor thought you could handle 2. Last semester was 1 during clinicals ( all critical care ) but during our internship it was expected that we took the entire load of of the nurse for whatever unit you were on.
  9. 0
    I'm currently in a 6 semester BSN. We do 14 week rotations (actually 16 weeks but last 2 weeks are non-clinical). Clinicals are 2 days a week and we are generally on the floor for 10 hours. 1st semester we took one patient and assisted CNAs with anything they were doing, answered call lights, etc. 2nd semester we took 2 or 3 pts. depending on acuity. 3rd semester was OB and peds. Peds we started with 2 pts and ended with 4. For l&d we only took one pt in hopes that we could assist with deliveries but generally followed our RN and assisted with all of her pts. In mother/baby we took 4 mothers (so technically 8 pts). 4th semester was complex care and we started with 2 patients and were expected to handle all pts for the RN we were assigned to by the end of the semester.

    Our 6th semester is either an ICU or ER preceptorship so I suppose our location will determine how many patients we handle.

    In all semesters except for the 1st we are expected to do total care, full charting, assessments, and pull meds as well as IV starts, even in peds and EXPECTED to communicate with the physicians and other members of the health care team. Pt is scheduled for dialysis? We were fully expected to pick up the phone and call down to dialysis to see what time they were planning to pick up pt, communicate labs and meds and to find out which meds we could be expected to give!.
    In my program. we must obtain RN and instructor verification before administering intravenous cardiac meds, narcotics, or insulin. We also are not allowed to adjunst PCAs by ourselves or chart from the care plan (in Epic) our Dar notes and assessments are labeled "student note" but we were expected to follow the care plan and chart accordingly. However, by the end of our 4th semester most of us were allowed to chart from the careplan.. Depending on the pt, we also need the RN with us for certain types of trach care, such as when cleaning and removing/replacing non-disposable cannula.
  10. 0
    By the 5th qtr of my ADN program (6qtrs total) we had a full load. I was on oncology and a full load was only 3-4 so I was lucky. Our rotations were five weeks long. My last quarter was in PACU and I took 1-2 patients (same as the RNs) but no critical patients by myself.

    Clinical days would drag if you only had one or two patients.......

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