Nursing School Patient Loads - page 5

by Tait

8,295 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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    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.
    PMFB-RN likes this.
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    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 likes this.
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    Quote from Jeweles26
    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.
    Rizz and uRNmyway like this.
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    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.
    PMFB-RN likes this.
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    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.
    Last edit by Rizz on Apr 3, '13
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    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.
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    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.
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    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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    Quote from Rizz
    *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.
    I specifically meant "total care". I was on a neuro floor where most patients where bed bound, needed assistance with all ADLs, trachs, restraints, comatose, the whole deal.
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    I should also add for clarification. The way that we have been assigned patients really depends on the clinical instructor and charge nurse for whatever semester and floor we are working on. I have had instructors who chose our patients for us, after discussion with the charge and seemed to pick patients that had dx that went along with whatever system we were studying in the didactic portion of our clinical. Other instructors have allowed us to go in the day before and choose whatever patients look interesting and had the most procedures going on. During my last semester, we were assigned a team lead for each week. That person went in the day before, and discussed the patients with the charge nurse, and they assigned us patients accordingly - the instructor had nothing to do with it. By the end of the semester, we were assigned to an RN vs. patients. This allowed us to follow the RN throughout the day and learn how she prioritized her day. It also helped us to understand a lot of things that you don't get to see in nursing school like care conferences (which we attended), discharge planning, and orders...(I could not understand how orders were entered into the computer until my last semester).


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