Nursing School Patient Loads

Nurses General Nursing

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  • Specializes in Acute Care Cardiac, Education, Prof Practice.

You are reading page 4 of Nursing School Patient Loads

Specializes in Pediatrics, Emergency, Trauma.
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.

https://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.

Specializes in Trauma.

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.

chrisrn24

905 Posts

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!

Clovery

549 Posts

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.

jmdRN

68 Posts

Specializes in community small-town med/icu unit.

My last semester of RN school was split into 2 1/2 semesters. Before spring break we had 2 days in classroom and 3 days on the floor where we had 2 pts and up to 3 in the last week. After spring break we had a 6-8 week preceptorship where we had to complete a certain number of hours (I want to say 120h, but I'd have to look it up) in which we were buddied with a staff nurse. By the time we were done preceptorship, we were expected to be able to take the whole patient load of the buddied nurse.

In my case, I precepted in a rural emerg, and by my last week I often had up to 7 24h-obs or floor holds.

uRNmyway, ASN, RN

1,080 Posts

Specializes in Med-Surg.

I have the equivalent of an ADN. We started clinicals in second semester, one day a week, with one patient. We were responsible for hygiene, vitals, and were to start working on our therapeutic communication. Our clinical instructor would allow us to start giving meds for that one patient, one at a time, when she felt we were ready.

By our last semester we were in clinicals 4 days per week. Depending on the student, our instructor would use her judgment and assign the number of patients she felt we could safely handle. Most had 4, some 5, a few still had 3 I think. We were responsible for everything except direct communication with a doctor (since we couldn't take VO or TO without a nursing license) and IV push meds. We also had to do all tasks, no delegation. There would be heck to pay if we, God forbid, asked a CNA to clean up a patient for us. We could ask for HELP, but not for someone else to do it for us.

Tait, MSN, RN

2,140 Posts

Specializes in Acute Care Cardiac, Education, Prof Practice.
I have the equivalent of an ADN. We started clinicals in second semester, one day a week, with one patient. We were responsible for hygiene, vitals, and were to start working on our therapeutic communication. Our clinical instructor would allow us to start giving meds for that one patient, one at a time, when she felt we were ready.

By our last semester we were in clinicals 4 days per week. Depending on the student, our instructor would use her judgment and assign the number of patients she felt we could safely handle. Most had 4, some 5, a few still had 3 I think. We were responsible for everything except direct communication with a doctor (since we couldn't take VO or TO without a nursing license) and IV push meds. We also had to do all tasks, no delegation. There would be heck to pay if we, God forbid, asked a CNA to clean up a patient for us. We could ask for HELP, but not for someone else to do it for us.

I like the idea of the instructor having flexibility in the assignment. Sometimes people just need more time than others, and I have seen it in new grads and precepting as well.

Specializes in PDN; Burn; Phone triage.

Reading through these responses makes me really, really value my senior year capstone/practicum/preceptorship. Over 500 hours, 1:1 with a RN. It was essentially a new grad preceptorship where we were eventually expected to completely function AS that RN in whatever setting. (Some students did OR, ICU, ER, floor, etc.)

I was on a heme/onc floor. By the end of it, I was taking 4-6 patients on days, doing the bulk of all admissions and discharges (I couldn't do the admission paperwork as a student, and my preceptor would have to do a second admit assessment obviously); talking to doctors and putting in orders, delegating, charting, doing all procedures and meds, etc. etc. The only thing I couldn't do was hang blood, per school policy. Well, or give chemo, duh. I also didn't have Accudose access (although some students who did a preceptorship in the smaller community hospitals DID get their own access) so my preceptor would have to sign in to let me pull meds.

%63theend

400 Posts

Specializes in ER.

I earned my BSN last July (2012). We were expected to take on 5-6 patients autonomously in the last semester. They were not *"total care patients", we utilized techs on the floor the same as the regular nurses. That said the techs didn't respect the student nurses and were often times difficult to locate! So the student nurses did end up doing more for the patients than normal. I did all of my clinicals on weekends so the census was a little lower than what is found on weekdays. I never had 6 patients but I did have 5. I've often wondered if I would've learned MORE if I had been allowed to take LESS patients. I think it is ridiculous they want a STUDENT nurse to take a full load when even as an actual RN with a license, the hospital provides an orientation and the RN doesn't take a full load for at least a couple of months. I don't feel like I benefited from being thrown out there like that.

*Edited to add: I think there may be a difference in the definition of "Total Care" for everyone after reading through the comments. In my school "Total Care" referred to a patient with no tech who was bed bound and needed assistance with all ADLs, required diaper changes or bed pan, bed baths, etc. High maintenance patients without an assistant. We had 1-2 "total care" patients our first semester.

Our last semester we had 5-6 patients "Autonomously" meaning we provided all care for those patients aside from what the tech did. The techs took BP's and helped with bathroom issues IF they were available. My techs were never available and I did the bathroom stuff myself. My techs DID take the vitals and BBGs. That's all. I did everything else myself for my patients. Hung their IVFs, passed their meds, did their assessments, charted on them, etc.

ORoxyO

267 Posts

In my ADN program we worked from 2 up to 4-5 pts each but were allowed to use the techs for vitals in the final rotation. We also did not have access to the Pyxis which really made for some long med passes due to waiting for a nurse to pull out all of our meds. We did 8 weeks on each floor but switched hospitals.

LoveNeverDies

133 Posts

I am currently in an ADN program. Our final semester we go up to 4 patients, no delegation allowed. We are not allowed in the pyxis, so the RNs have to get those meds for us.

PatMac10,RN, RN

1 Article; 1,164 Posts

Specializes in Nursing Education, CVICU, Float Pool.

I've noticed that some schools allow delegation to hospital staff. We are always told to do total care of our patient, regardless of we have 3 or 5 and ask for assistance as needed. Most CNAs won't listen to us anyway, but I like knowing I can care fort patients myself. I know that I must ask for help when I am stretched to far or caught up though. Our school is really big on not putting out dependent new grads, or ineffective delegators, like they have sometimes did in the past.

Most of the units I've applied to/gotten offers at to work don't utilize UAP other than a secretary, so I like that we are pushed to work as a team and be self-sufficient as well.

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