Nursing School Patient Loads - page 7
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
Apr 4, '13Again, your post was extremely helpful and I plan on using it as a template to plan my clinical day. I hope you are mentoring up and coming nursing students in your program - you seem to have a handle on how to tackle the sometimes not-so-reasonable expectations.
Apr 4, '13That actually sounds like a great idea! If you are immersed day after day in that environment you keep taking steps forward without the loss of momentum in having several days off. I'm just hoping to make it to my final semester..I'm repeating my third semester due to my inability to advance to more patients efficiently and safely (I was going from 2 to 3).
Apr 4, '13Wow. I must say there is some definite wisdom there thought I'm sure not all would agree with the length of time it takes to get up to speed. I think your situation suits a student like myself better. I was having a challenging time maintaining safety in my third semester going from 2 to 3 patients. For our last semester, it will be a preceptorship with the expectation that you can get up to 5 patients.
Apr 4, '13Quote from PediLove2147Yes. I've been offered a position on the CVICU where I did my preceptorship and the typical load there is 3 patients unless you have a new CABG patient. When we're in clinical the only time we talk with the primary nurse is when we tel them our abnormal asseesemt findings, need a med confirmed, hang blood, or need something out if the Pyxis. Our instructors are really as hands off as possible in clinical bc we are on Team Nursing. So the student charge nurse makes the assignments and managed the other student nurses on the floor. We all give report to our instructor and then start our day. When we fall back on someone it is primarily of our team members so that we can cultivate habitual teamwork. If our instructors have to step in at this point for trivial thing we will get an Unsatisfactory clinical grade for the day. At our school, you can only get 2 overall unsatisfactories and one the 3rd one you are dismissed from the program.
This is great as long as you are learning to care for 3-5 patients. We did the whole "total care" thing too but we got a max of 2 patients. There are new orders, procedures, admits, discharges, ALL expected by the nurse and you don't have someone (like the primary RN or clinical instructor) to fall back on.
There are a lot of hospitals that don't utilize CNAs so it's great if nurses come into it knowing how to do it all but it scares me how little NURSING you do in nursing school. Schools that have a 1:1 experience in the last semester is ideal. You at least start to realize how much you are responsible for.
Nurses around here take a patient load of 6, in school we take 3-5 and still must keep track of our new orders, give our own meds, do all procedures that we are qualified to do, call/communicate with the providers, discharge people etc... Like instated earlier, we do work as a team when we are unable to do certain things, but at this point we are expected to be able to hold our own for the most part.
It has been a challenge trying to keep up, but the majority of the class has done it. It is hard, but with a balance of team work and personal initiative we are succeeding thus far.Last edit by PatMac10,RN on Apr 4, '13
Apr 4, '13I graduated from nursing school in 2010. We only had one patient during our clinical rotations. For my adult med-surg rotation, we were given the opportunity to take care of two patients towards the end, which I volunteered to do, and my instructor praised me because I was the only one in my group to do so. I wanted to see what it was like to have more than one patient.
For my senior practicum, we had a full load of patients with the RN we were following. I precepted on a cardiac stepdown that had a built-in 8-bed VICU (vascular). Nurses on the stepdown had 3 patients per nurse.
Apr 4, '13I am at the end of my partnership on a busy Med-Surg floor (and only 37 days until graduation)...I have had 4-5 patients since day two. I have learned time management, prioritization, critical thinking, delegation (and yes, the CNA's pay attention to me), med safety, and many, many skills. My preceptor was always there for me to assist, teach, and make sure I was getting everything done. I have been offered a job on the same floor, so I guess I have done ok. I think it is important to do all the "nursing" duties and not "everything" for 1 or 2 patients. Doing what I have been doing is what my job will be, and is what the nurses on the floor do every shift.
I am a CNA and work on another floor. I am certainly not above doing "tech work" and have made many beds and wiped many bums during my partnership. My point is that you need to learn to be a nurse and that is what I am doing!
Apr 4, '13I agree that we need to learn to be a nurse, but i personally believe it to be very difficult to do that without participating in nursing at its base/most simple state, which is what CNAs do. The basic "CNA" concepts are what have allowed me to get to the point I'm at now, where I'm about to enter practice as an RN.
Basic care and comfort has been identified as one of the weaker areas in NCLEX testing in recent years, basic care and comfort is largely what is considered "Tech work".
I work in the float pool as a CNA at the hospital we do 90% of our clinicals at, I have for going on 3 years, straight out of high school. It's because of me having 12 patients, of which 7 were total care, and 4 on contact isolation, that I learned to prioritize and manage my time better. There are so many things that have made me the successful young nursing student I am now, to working as a CNA.
Of course, CNAs can't do the RNs job for them, so delegation is something that must be utilized, but in a balanced manner and with a teamwork mindset. That's why I am glad that my program, and apparently many of the programs students on this thread are enrolled restrict the use of CNAs in the beginning so that you learn to first become self-sufficient and work as a team, then try your hand at delegation. It works, for me at least.
Just my $0.02
Apr 5, '13In my last semester of the ADN program I graduated from May 2010 we had 4 patients. There were 8 or 10 students (forgot exactly how many) but 1 student was the primary RN and the other student was the PCA. The next week we switched. Our clinicals were every Saturday and Sunday, from 0700 to 1530, with post-conference afterward. It definitely helped in getting a realistic view of the real world of nursing.Last edit by Shuggypie on Apr 5, '13 : Reason: left out a word
Apr 5, '131-2 patients, but often help out with other patients. Can't do meds without instructor so when it's our med day, we do "district meds" and do meds on many patients, but that's pretty much all we do for the day. Often get set up with a willing nurse to do other things during the day, which I feel teaches me the most. Clinical is once a week for 9 hours in an AAS in nursing program. Not sure how prepared I feel to go out and work in a hospital soon as I graduate in May, but all the nurses I've asked ensure me that there will be a lot of on the job training- most hospitals in my area give new grads a 3 month orientation till they're on their own with patients. We'll see...
Apr 5, '13That having been said, I need to clarify that we did total care for 1-2 patients, including ADL's, baths, assessments, meds...during our sophomore semesters. This gave us the experience; the senior year is geared more towards being an RN.
Apr 5, '13I graduated in 2005... During our final 6-week course we worked 1:1 with a preceptor (and no Pyxis code) we were expected to take a full patient load for that floor. I was on a step down unit with open hearts so that was 3-4 patients.