Nursing School Patient Loads - page 4

by Tait

8,278 Views | 62 Comments

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. In my ADN clinicals back... Read More


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    We did 3 tele patients in our last clinical. With the unit size and our group size, it honestly would have been hard to have 5 patients (aside from the fact that that also wasn't the ratio the nurses had themselves on this unit). We still needed supervision to give meds, we supposed to be delegating to the CNAs (and boy was THAT awkward: "hi, I'm a guest on your unit having an educational experience, so let me tell you what to do...."), and it was still a handful sometimes. This was an accelerated BSN program.

    I'm totally jealous of the folks that got to do preceptorships (just didn't fit in the time frame of the program I was in) but in the end I feel like I transitioned well as a new nurse.

    EDITED TO ADD:

    We had subject-based clinicals. We had 1 clinical 1st quarter that was med-surg/rehab, 3 clinicals 2nd and 3rd quarter (maternity, med-surg, psych, peds, another med-surg, and community health) and 2 clinicals 4th quarter (geriatrics and "critical care" which was on telemetry and step down units, not ICUs). Our set up was the instructor assigned us patients, we got and gave report to the nurse and touched base with the nurse regarding our assessments, but meds and any procedures we needed supervision with were done with the instructor (unless we were done with our patients and were tagging along with a nurse on the floor to see something cool, and for L&D we were paired with a nurse and stayed with her for the shift).

    This meant we started out with a certain amount of independence simply because our instructor couldn't be in 5-8 places at the same time (our class size range for clinicals), which made me feel like I still knew nothing about how to manage a shift by the end (compared to working as a new grad with a preceptor who initially went in to every room with me every step of the way and gradually backed off over my orientation. Personally I think a little more hand holding in the beginning just gave me a much better grasp on how to actually prioritize and time manage and juggle multiple tasks).
    Last edit by hiddencatRN on Apr 2, '13
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    Quote from PatMac10,SN
    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!
    ^Similar...did this in PN and in BSN school in PA...also depends on the nursing instructor, and the program. My area has TONS of nursing schools, so to have an opportunity to be able to shadow and closely follow nurses during each of my program's clinicals, it MENTALLY prepared me to face the floor work, no matter how steep the learning curve.
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    For all who are interested, this is the recent thread where there was some question about what is a right amount of patients for a student to take. Many, many people on this thread I posted were quite rude to the OP, and basically told her to suck it up and shut up. I don't think it's appropriate for a student to have more than a couple of patients, yet when OP said she had 5, people were like "so what? that's the real world!"

    I get that, but you also have to understand that these are students, and many need their instructor with them to do certain medications, and can't get into the medication machines, and have never done many skills and need assistance, and then if their instructor okays something, they still have to go and find the supply room and figure out what the hell the nurse means when she is looking for Kerlix, or a drain sponge, for example. Both of those things I had no idea what they were when I started nursing. Nursing tasks and skills are things that you learn on the floor, not in the classroom, but it is entirely inappropriate to be thrown to the wolves on a floor in the name of learning. You need intensive, one on one training.

    It's unrealistic for a school to throw five patients at a student nurse and expect them to go, yet nurses on the floor get weeks of supervised orientation to the floor. You either need one on one clinical instructor with an instructor from the school, or a smaller patient load so your clinical instructor isn't stretched so thin.

    http://allnurses.com/general-nursing-student/clinical-nursing-student-817516.html


    onewill likes this.
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    We were expected to provide care to 4 total care patients during our final semester of the BSN program. That's still the standard for many universities in Canada.

    I graduated in 2010.
  5. 0
    Quote from hiddencatRN
    We did 3 tele patients in our last clinical. With the unit size and our group size, it honestly would have been hard to have 5 patients (aside from the fact that that also wasn't the ratio the nurses had themselves on this unit). We still needed supervision to give meds, we supposed to be delegating to the CNAs (and boy was THAT awkward: "hi, I'm a guest on your unit having an educational experience, so let me tell you what to do...."), and it was still a handful sometimes. This was an accelerated BSN program.

    I'm totally jealous of the folks that got to do preceptorships (just didn't fit in the time frame of the program I was in) but in the end I feel like I transitioned well as a new nurse.

    EDITED TO ADD:

    We had subject-based clinicals. We had 1 clinical 1st quarter that was med-surg/rehab, 3 clinicals 2nd and 3rd quarter (maternity, med-surg, psych, peds, another med-surg, and community health) and 2 clinicals 4th quarter (geriatrics and "critical care" which was on telemetry and step down units, not ICUs). Our set up was the instructor assigned us patients, we got and gave report to the nurse and touched base with the nurse regarding our assessments, but meds and any procedures we needed supervision with were done with the instructor (unless we were done with our patients and were tagging along with a nurse on the floor to see something cool, and for L&D we were paired with a nurse and stayed with her for the shift).

    This meant we started out with a certain amount of independence simply because our instructor couldn't be in 5-8 places at the same time (our class size range for clinicals), which made me feel like I still knew nothing about how to manage a shift by the end (compared to working as a new grad with a preceptor who initially went in to every room with me every step of the way and gradually backed off over my orientation. Personally I think a little more hand holding in the beginning just gave me a much better grasp on how to actually prioritize and time manage and juggle multiple tasks).
    ^This...is more similar to my BSN program...my experience is between yours a Pac's post I responded to.

    Maybe it's me, but I am more if an advocate of more opportunities for theory applications in nursing...you will still have to acclimate to a nursing unit, and practice, but those intangibles like time management, safety, preparing and identifying complications, leadership and advocacy (for yourself, your patients, and as a team member) can really prepare entering in the profession...

    When you have people buning out, fearful of taking breaks, ie not having time to pee and a ton of other issues, I just wonder, if done right, would it be minimized by really having a true "practicum"???
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    My last semester of nursing school was a mixed bag- leadership and critical care in the same clinical. The first week, we oriented to a med surg floor and took one patient. The following 3 weeks we took a full team. My patient load was 5; some students at the other hospital site took 8-10. In other semesters (except peds/OB), we started with one but were expected to take two about midway through.
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    Quote from chrisrn24
    For all who are interested, this is the recent thread where there was some question about what is a right amount of patients for a student to take. Many, many people on this thread I posted were quite rude to the OP, and basically told her to suck it up and shut up. I don't think it's appropriate for a student to have more than a couple of patients, yet when OP said she had 5, people were like "so what? that's the real world!"

    I get that, but you also have to understand that these are students, and many need their instructor with them to do certain medications, and can't get into the medication machines, and have never done many skills and need assistance, and then if their instructor okays something, they still have to go and find the supply room and figure out what the hell the nurse means when she is looking for Kerlix, or a drain sponge, for example. Both of those things I had no idea what they were when I started nursing. Nursing tasks and skills are things that you learn on the floor, not in the classroom, but it is entirely inappropriate to be thrown to the wolves on a floor in the name of learning. You need intensive, one on one training.

    It's unrealistic for a school to throw five patients at a student nurse and expect them to go, yet nurses on the floor get weeks of supervised orientation to the floor. You either need one on one clinical instructor with an instructor from the school, or a smaller patient load so your clinical instructor isn't stretched so thin.

    http://allnurses.com/general-nursing-student/clinical-nursing-student-817516.html

    With all due respect, PLEASE don't rehash THIS...while you and a few though a few nurses (including myself) were not being realistic, I BEG to differ and told YOU so.

    Too many nurses burn out because "they did not sign up for this." Or they have NO idea the investment you make in this profession...if anything many were HONEST. No "tone" or post told the OP to "shut up"...so let's not let emotions get in the way of actual POST...

    No means to hijack the thread...I'm just not going to have a post trading TRUTH on emotions, and deter a logical conversation on the benefits of bare-bones practicum.

    If more schools had this rigorous program requirements, and were upfront about it, I believe, IMO, that it will either a) show who's SERIOUS about being a nurse; and b) prepare the student adequately on honing their practice. It ultimately benefits the student, in turn benefitting the pt long-term.
    hiddencatRN likes this.
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    Second semester ADN student and I would pull my hair out I get so bored. We get one Med/Surg pt each. Here was my last clinical... 0645 get report and go get vitals. Give vitals to clinical inst so she can enter them. 0745 gave meds, 1 PO and 1 SQ, inst must pull meds and be with us to give meds. School policy will not allow us to do IV push this semester. 1100 get vitals and turn in to inst. 1200 lunch. 1400 give 1 PO med w/ inst. 1500 vitals. 1700 go home. The only thing I did all day that took more than 10 mins was eat lunch. I told one of the nurses that liked students, I'm gonna hang out with you and your patients today. I would do what was needed for my pt then I would help her out. Made my day go by quicker. Over 1/2 of my clinical group just brings their books to clinicals and does schoolwork between vitals and med passes. After the first day of clinicals I decided to take charge of my clinical experience. It has worked out well because so far I have d/c and started an IV, inserted a Foley, did a bladder scan, helped change a wound dressing, did non-disposable trach care, and many other things most of my clinical group have not done yet.
  9. 0
    Quote from LadyFree28

    With all due respect, PLEASE don't rehash THIS...while you and a few though a few nurses (including myself) were not being realistic, I BEG to differ and told YOU so.

    Too many nurses burn out because "they did not sign up for this." Or they have NO idea the investment you make in this profession...if anything many were HONEST. No "tone" or post told the OP to "shut up"...so let's not let emotions get in the way of actual POST...

    No means to hijack the thread...I'm just not going to have a post trading TRUTH on emotions, and deter a logical conversation on the benefits of bare-bones practicum.

    If more schools had this rigorous program requirements, and were upfront about it, I believe, IMO, that it will either a) show who's SERIOUS about being a nurse; and b) prepare the student adequately on honing their practice. It ultimately benefits the student, in turn benefitting the pt long-term.
    I thought this OP might care to see more discussion on it and I added my opinions on it. If people would like to keep discussing it, by all means they should!
  10. 0
    I recently graduated from an ADN program. We had two patients during the last two semesters. Our clinical groups were 8 or 9 students, so we would switch off alternating weeks who was giving meds. The reason for this was because we didn't have access to the PYXIS; we needed our instructor to pull meds. We didn't rely on the floor nurses for anything... We would hopefully get report from them after explaining we were caring for their patients that night, if we were lucky they'd invite us to follow them, but they weren't required to help us at all. If we weren't giving meds that week, we charted a full assessment for two patients on the computer (we always had to do assessments, we just didn't chart them if we were doing meds that week). Our instructor had to read and sign off on all of our assessments and there was only so much time. We were often looking for things to do, but we kept busy answering call bells, taking vitals for the floor, watching the tele monitors, relieving the 1:1 sitters, etc. The PCTs were happy to hand off their responsibilities to us. If we were lucky there was an RN who liked students and would invite us along with her. I wish we had more patients but our instructors were very busy and I don't see how they could have done more.


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