Problems with Rn's in clinicals

kmrmom42 · Apr 10, 2005

Why do you need a BP machine?
I have been a nurse for 11 years, and have generally done manual BPs. They are more accurate, and less of an infection risk.

For the latest recommendations on blood pressure assessment from the American Heart Association see this article:

Pickering, T.G.; Hall, J. E.; Appel, L. J.; Falkner, B. E.; Graves, J.; Hill, M. N.; Jones, D. W.; Kurtz, T.; Sheps, S. G.; & Roccella, E. J. (2005) Recommendations for blood pressure measurement in humans and experimental animals: Part 1: Blood pressure measurement in humans: A statement for professionals from the subcommittee of professional and public education of the American Heart Association Council on high blood pressure research. Circulation. 111(5):697-716.

The author's state:

"The oscillometric technique has been used successfully in ambulatory blood pressure monitors and home monitors. Comparisons of several different commercial models with intra-arterial and Korotkoff sound measurements have shown generally good agreement,47-49 but the results have been better with ambulatory monitors than with the cheaper devices marketed for home use. Oscillometric devices are also now available for taking multiple measurements in a clinic setting."

As an old timer in health care who had done thousands of blood pressures by the manual auscultation method I never really trusted the automatic blood pressure machines. However, I can tell you that when I don't trust a result and take a manual pressure to double check it is almost always in agreement with the machine's results. Also, I know that all staff at our hospital are trained to use the automatic B/P machines and are EXPECTED to use them as they are considered actually superior to the auscutatory method because it is believed it removes some of the variation related to human fallibillity.

Sorry, this got off the topic of what do do about unsupportive floor nurses but I thought this information might be useful?

kmrmom42 · Apr 10, 2005

I regret that you do not care for my post.
I was merely pointing out to the poster that I referenced that Nursing Students are additional work. You might not like to think so, but they frequently are a hindrance.
You do not have to like it, but that is my experience with students. You will have your experience with students soon enough.

I LOVE having nursing students. I don't consider them a hindrance but an opportunity to share some of what I know with eager individuals. It can be lots of fun to work with students and I try to make it fun. I want to be sure that they get the most out of their experiences with us because I know that soon they will be out on the floors as graduate nurses and will need all the knowledge and experience they can get! :nurse:

Lots of things create more work for us, that unanticipated rush to surgery, the patient that all of a sudden crashes, the new nurse or new doc who needs extra support to work safely, meetings, broken equipment, floor waxers, etc. etc. etc. Student nurses aren't any different and if we handle the situation correctly they can actually be a huge help! They are eager to take on many of the tasks we find boring or onerous. They are fresh and haven't developed those attitudes yet. Maybe you can try to find ways that they can make your life actually EASIER when they are around. I truly believe that it can be done!

Marie_LPN, RN, LPN, RN · Apr 10, 2005

Sometimes students CAN be a hinderance. The majority ARE great, though.

It's never failed when we've had a student, they do help do SOMETHING in our room. Whether it's to get another bag of LR, or to help tie someone's gown, or to help transfer a pt., we always wind up giving them something to do lol (mainly because everyone else's is busy doing something else).

LPN1974, LPN · Apr 10, 2005

You had to be a student one time, none of us were born nurses, that was exactly my point. If you don't teach the young ones, you will have no one to relieve you when you are tired and overworked. I understand that nurses today are tired, heck you can see it in their faces but the students shouldn't be treated as garbage because of that.
I hopefully won't ever come in contact with you because having such a sour outlook on students that I KNOW you once were, makes me sad. My mother and numerous friends of hers are nurses and they do everything in their power to teach others. Now, work comes first and foremost I know that and if students in the past have bugged you I am sorry for that. But every nursing student has to do time on the floor, you may not like it but it is a fact of life. I have a friend of mine who is in her sixties and went to nursing school at 38, she helps me more than I can ever thank her for. In fact the nurses on the floor I work with keep asking me when I am going to be finished with school because they want me to come up there and work with them. You know why??? Because I stayed out of their way and when I had to ask a question, I didn't stop whatever they were doing, I usually ended up walking with them wherever they were going and talked to them as they walked. I am not a young student, I am 39 and I bust my butt every week to prove that I deserve to be in this program due to the fact that the majority of the program is made of young people. Maybe its due to the lack of respect that SOME and I make a point to say some because I have ran into probably 90% of the younger students I go to school with who have that respect for the older nurses, but there are some who have no respect but for themselves.
I have taught classes in the past and my ultimate goal someday when I retire it to be a nursing educator, so I cannot have the attitude that you have towards students or I would be a lousy instructor. I love to learn and I love to teach something to others that I know. Its a wonderful feeling to know that you have passed on something worthwhile to the next generation. And yes I already have two degrees so this is not my first time around. I worked for 17 years at one job and decided I needed a change.
Jodi Levins, Student Nurse and proud of it.

I agree, and you seem to have a good attitude, a desire for learning, respect for others, and a good head on your shoulders.

Students have to learn. Where would be if we didn't have students?

Eventually all the nurses would just die out.

This thing about students and nurses not having respect for each other....I think THOSE people would be that way in any job they worked in.

That's a shame, but we do have them in nursing also, and we just have to learn to deal with it.

The cream of the crop of nursing students will rise to the top regardless of the bad ones anyway, and the good nurses will teach regardless of the bad nurses anyway, we just have to somehow get the good hooked up with each other and just forget the bad.

This argument is going to go on for as long as we have students, nurses, hospitals and teaching institutions, because we are PEOPLE.

We are human. Some are a$$wholes and some are not.

That's my opinion and I'm sticking to it.

snowfreeze, BSN, RN · Apr 10, 2005

There are good nurses and bad nurses out there. The good ones will show you things that will help you in becoming a nurse, the bad ones will show you bad habits and dangerous short cuts. Trying to work with a nurse who is having a bad day is not a good idea nor is working with someone who just dosen't want to or isn't comfortable working with you. You will have to deal with both during clinicals unfortunately. Let your instructor know that things are not working out that day in clinicals and just work on something else. I offer foley insertions, IV starts, dressing changes, NG insertion, watch while a doc puts a central line in etc. to the students instructor. Sometimes the students need that experience, sometimes it isn't part of this clinical experience. Even when I am really busy I can use a students assistance in what they are trying to learn. If I grab you and say, hey..come help me for a minute please do so. During the time you help me put a patient back in bed you can ask questions and I can show you how to deal with a dementia patient who is experiencing delirium, psychosis, sundowning or just a reaction to medications. Ask lots of questions during and after. If I say not now or later that means that the answer to your question will probably upset the patient. Sometimes you ask questions in the presence of family members, visitors and other patients whom this subject is none of their business. I am not being rude when I suggest we discuss this later.

Learning team work is part of becoming a really good nurse.

Remember that sometimes your instructor is the problem, not the nurses on the unit and not the students.

And to end with a bang, I turned in a nurse during my clinicals 16 years ago for taking the morphine himself that was intended for the patient. I found him slightly conscious in the dirty utility room. My instructor advised me not to report him, but I still did. He got rehab, (I met him later I am sure cuz he looked so much the same) and I finished nursing school and am proud of that mess I made as a patient advocate.

snowfreeze, BSN, RN · Apr 10, 2005

Oh yeh, stop whining and just get busy learning. And good luck to all of you.

HisAlone · Apr 10, 2005

Wow, it sounds like my nursing program was BOOT CAMP compared to some. We hit the floor at 0545 to gather info on Dx, H&P, recent orders, med lists, labs and diagnostics for the last three days, etc from the patient charts. We had to have manual vitals and a quick assessment done and written up to give to the RNs at report. We did total patient care throughout the shift on from 1-5 patients: head-to-toe assessment, all ADLs and linen changes, all meds and treatments, all documentation, etc. We had to do hand written med cards from Davis on every med and report on each to the instructor as we were prepping them before giving them. At the end of the shift we had to provide the assigned RN with a written report that included VS and pain assessment, I&O, diet consumed, BMs, Meds held, any significant assessment findings, etc. (Of course we had to document throughout the shift and report anything significant - in writing - ASAP). Each morning we had to hand in a 5 page report on the Dx and patient care performed (from the previous day) in charting format, a report on the results of all the labs and Dx, a list of 3 nursing dx in each of 5 patient categories and full care plans on the top three. When we left clinical we didn't go home - we went to four hours of lecture and testing. By the time we graduated we were also certified for blood withdrawal and IV therapy. And this was an LVN program! The biggest problem I had with the floor nurses was having to continuously apologize profusely for our instructor. We took a lot of grief over that. She was a real drill sergeant.

punnit_square · Apr 10, 2005

I guess my biggest problem with the RNs we had to deal with this semester is the disappearing act. just because I have 2 of your patients does not mean that at some point you won't be needed. As LPN students we are not allowed to touch anything IV. Some of these RNs expects us to keep track of everything we need to do plus run and find them (which usually takes at least 30 mins) and let them know if meds need to be pushed IV. OUr instructor has told them several times that this is unappropriate. I don't know where they go and hide but I know it is not near the patients. My biggest issue is with the aides. they hide the BP machines on us so we can't find them. they sit there and talk sh*t about us and one end of the hallway and then will come and ask us for help because they are behind. I got screamed at by one (old enough to be mom) because I called her a Nurses "Aide" and not Nurses "Assistant" I just looked her in the eye and said " I am just going by the title on your badge, If you have a problem with it talk to HR about a title change" then this paticular aide and another are complaining that we are not doing any baths or bed changes. well we know have 4 patients to take care of and our instructor posted a sign at the nurses station that we are now taking care of 4 patients and will be passing meds, doing assessments, dressings etc. We will NOT be giving baths, taking vitals, or changing beds. so these two are yammering about how we are not doing anything blah blah. So as I walk pass i hear this and say " The duties we are supposed to be doing are clearly posted at the nurses station if you have any questions, otherwisou the patient in blah blah is requesting a shower" My instructor said I did a great job and wasn't snotty or rude. we have several of the aides and it is like they are jealous or something. As i was walking by a room I heard one call out for help so I went. She had a rather large patient on the toliet and needed help to get her up and wipe her. so I asked what I should do (like wipe or hold her up) she said you are going to be an LPN right? well you had better wipe, you will need the practice. so I wiped, but when got into the hallway, I told you will never treat me like that in front of a patient again. i was so pissed at her. My instructor finally had to have a talk with the charge nurse of th floor because we were getting treated so bad. helped a little but not much so she had to spend most of her time on this floor but the students on the other had really good nurses so she could spend more time protecting us as she put it!!

I can relate. One hospital I did clinical at was horrible. One LPN had issues and gave attitude to all RN students (our clinical instructor forewarned us) and the CNAs felt that because students are on the floor, this meant vacation time. I did politely put an aide in check by telling her I am here to learn nursing, not becoming a CNA. I will help you but I also have my assigned duties to do. At least your instructor had a talk with the charge nurse. I have heard from one of my fellow students that a nurse yelled at her for taking up too much of her time (and in front of the instructor), and the instructor defended the nurse to the student by saying, "She is a very good nurse". Instructors need to be advocates or else why are they there?

TStewartfan · Apr 11, 2005

To the one who says they had a boot camp instructor, it sounds like my clinical instructor, we have to be in preconference at 6:15 and at report at 6:45, we have to have VS done by 8 am, we pass 9 am med and prior to that must read Davis and analyze the meds to tell the instructors prior to even comparing the MAR to the drugs pulled. If there are VS to be assesed prior to giving med they must be done, we pass out meals, change linens, do bed baths, and then we find things to do that are part of our objectives that we have learned such as Foleys and stuff. Then we have do VS before we leave, make sure that the patient is taken care of before we go and give report and then leave the floor, then we go to post conference with the instructor and have to tell others what we have learned. Then we have clinincal notebooks which have to be turned in three days after clinical is over with. We have twelve objectives that we must meet everyweek, they aren't simple either. We have ratings of 1-4, our instructor HAS NEVER given out a 4. Other instructors have but ours does not, she is extremely tough on us and never gives us a break, neither does our adjunct. We only have a day and a half left of clinicals and I am depressed about it. We have psych nursing next and I am anxious about it. I was anxious about this but got over it quickly. I love taking care of patients. I have to tell a story though, last week we were assigned two patients, both of mine were elderly and the one was lonely because his wife would not be at the hospital until 6 at night when she got off. Well he needed a bath and wanted his hair washed. I told him that I would get to it and I kept getting dragged away. I went to lunch and my friend went it to check on him at lunch and she told me that she offered to give him his bath and he told her that he wanted me to do it. That made me laugh. I got to give him a quick bath before they dragged me off the floor at 2 pm.

I think a problem is that sometimes they think we can do anything, an assortment of classes goes through the floor including LPN in transition to RN and they can do a whole lot more then us "baby" Nursing I students (there are five sections to the nursing program) and we tell them at report what we can and cannot do. They will come to the instructor and say, I have a Foley that needs to be inserted on patient X and she will grab two of us and we will go off. What our instructor says is "Observe one, Do one, Teach one"

Our instructor is a stickler for time too, she is constantly looking at her watch to make sure we all make it to clinical on time.

indigo · Apr 18, 2005

I am just getting ready to graduate as a registered nurse. At times, I feel we students have been treated in a hellish, disrespectful manner by nurses and nursing assistants alike. We are doing our clinicals in a small hospital in a small town in a rural state. This hospital has never had student nurses before. We really had to carve our own inroads. It has been a learning experience for all of us, including the registered nurses who are now our preceptors. Now, finally, I feel like we students are getting the respect we deserve. But we had to go through a process of proving ourselves. I can't say it made things any easier, but that's how it all worked out.

I will never forget how terrible and small I felt many times driving home from clinicals. Please let no one ever discourage you from pursuing a career as a nurse. Keep doing your very best. Student nurses need to be humble, but student nurses always deserve the utmost respect and support. All people do.

kbtully · Apr 23, 2005

:rotfl: Does any one else have problems with Rn's in the hospitals when attending clinicals? I guess they forget they were students once, or they think they were born a nurse. I do not understand this type of treatment. We are all in this profession to help people, and it seems like they would welcome the help. Our instruction has been a RN for 27 years and is a GREAT!! instructor. And she can not understand this either. We have all approached the nurses with great respect, and this does not work at all.
HELP :uhoh21:

As a nursing instructor and a practicing RN, I can see exactly where you are coming from. The CNAs can be extremely disrespectful to the LPN students. I have also worked as a clinical unit manager, and I tried to make sure our students on the unit were treated well. Most of the students were great, but there are always a coule of exceptions. This can make it difficult for all the students in the group. I make sure the staff on the unit I take my students to for clinicals are aware of exactly what we will do. I no longer assign "beds and baths". We are at the point where we perform skilled nursing tasks. I don't want a student to miss doing a foley cath or sterile dsg because they are doing a bath. They've already become experts at bathing. This doesn't mean we leave a pt. in a mess. I expect my students to jump in and help with whatever comes up on the floor. This is part of the clinical experience. I just refuse to allow the CNAs to "send" a student to do their job, while they sit in the breakroom. The staff has to realize there is only one instructor for ten students, and I must be with a student who performs any procedure. This is another factor most staff has forgotten. Just hang in there and remember your experience in clinicals when you are on the other side.

fab4fan · Apr 24, 2005

indigo wrote:

This hospital has never had student nurses before.

This might be a big part of the problem. The staff may be frustrated because more than likely no one has given them direction on how to work with students. And if they're understaffed, I can see why they might be less than thrilled about having to take on students.

It is very easy to be judgemental of staff when you're a student. I'm not excusing bad behavior by staff nurses, but please remember that your only experience right now is as a student. You are seeing life through a student's eyes. Once you graduate and start practicing, you may see things from a different perspective.

It is unfair to thrust precepting onto a staff nurse who doesn't want to do it, and it is unfair to the student, too. Often, though, staff have little if any say in the matter. Just because someone is an RN does not automatically mean he/she is a good teacher.