RN's and the dreaded clinical experience...

[Emma123]

I'm a nursing student on my second clinical rotation on a med-surg floor. Prior to this, I was at a LTC facility (ADL's and basic CNA duties). I thought that hitting the med surg clinical maybe I'd be learning a lot more, seeing new procedures, etc.

BUT....this is the situation: I have one assigned patient. When that pt is discharged, I may get another one. We go in, do our assessment, dig through the chart for meds and labs, do vitals, assist with ADL's. My RN had a busy day; no surpirse there, right? When I asked her a question (the pt's SO had a question; was concerned that the pt hadn't had a BM in the four days she was there, after having a hip surgery), the nurse said, "I don't have time for this now. I have some other important things to do." This was 15 min before the pt was to be discharged, and the SO wanted an answer. I told the pt's spouse that it would be a few minutes and I'd have an answer for him. Not a big deal, I know that a BM isn't nearly as pressing as the other things she had going on that day.

HOWEVER...I asked her a while later (new pt) if I could look at the chart when she was finished with it, she said, "When I'M FINISHED with it" in a rather harsh tone. I just smiled and said "Ok, I'll check back later."

MEANTIME....I'm busy calming a dementia patient, assisting another to BS commode....more CNA type duties......When does the "nursing experience" come?

I don't know any other way to put this but, I'm just wanting to "see" what NURSES responsibilities are....not always doing ADL's. Don't get me wrong, I know that is important and helpful, too.....but we are always being "put off" while the RN's are out doing "nurses duties". We're not allowed to "shadow" a nurse; I asked and was told that "that doesn't work well here".

To be honest, I'm afraid I'll graduate and not have a CLUE what I'm doing.

I thought that if I made myself available, asked questions (of course at the appropriate time), and offerred to help out, that I would be LEARNING. But all I get is "yes, can you help Mrs. A to the bathroom".....

How do I get the most out of my clinical experience? I just feel like I'm not learning much, other than the info that I get out of the chart, looking at the pt's meds, etc.

I would have put this on the nursing student forum, but I wanted to get some feedback from you RN's.

I don't want to be in the way, I don't want to be one of those students who "hides in the pt chart", I want to LEARN NURSING.

Do you have any suggestions for me???

Thank you so much

Emma

[kellyo, LPN]

This is a GREAT thread! I'm in semester 4/5, and we have clinicals 2 days a week/ 6 hours each day. It's not enough. Just when I feel like I'm getting a handle on things, were off the floor and in post-conference. I've already noticed a big difference in the amount of time spent with patients (decreased) now that we have two patients. I love being with patients, and hope that I will be able to share a moment or two with them when I'm running around like a nut.

Next semester, we have a leadership clinical and a preceptorship (the preceptorship is new to our ADN program). In leadership, each member of our group will take over a particular role. One student will be charge, one or two RNs, one or two LPNs and one CNA. Each week, each RN/LPN has a 4 patient load, and the CNA cares for all the patients. The charge, of course is over everyone. We are told that this is when things will all "come together" for us. I sure hope it does, 'cause I really need it!

Does anyone else have a rotation similar to this??

[JentheRN05, RN]

I don't understand why a nurse wouldn't want a student. I appreciate it when I have a student. It helps me out, I get some of my work done for me (of course I am checking on the patient and following up on the students work) but still I love having students. I take every chance I get to have them, because I can help them get the info that I wasn't given :) I did have a few experiences like yours in nursing school and of course I vowed to not allow this to happen to a student of mine when I got my license. Well I got my license June 3rd and have been working with students for the last month. Last week I had two. I loved it! The students like me as well (it's really weird though, I started nursing school with one of them and she was MY student this last week, so that was creepy) but beyond that I thought it was awesome.

[Thunderwolf, MSN, RN]

Emma, I'm glad members we're able to help.

You raised your next question, nurses becoming "disappointed...to find that you didn't have the time for your patients?"

Maybe members can give you their feedback about this issue...new grads AND seasoned nurses. Maybe, it may relate as to why some nurses may feel burdened to having students on their floor. Let's see.

Members, keep the input flowing.

[worldtraveler]

What I am about to say is likely to make some people unhappy.

Nursing school is not where you learn to be a nurse. It is where you get the piece of paper that makes you eligible to sit for a license exam so you can practice. You then learn to be a nurse by doing; find a good first job where you can learn and be taught. Nursing school is where you learn the theory, and learn enough to keep yourself from being dangerous the first few months of your career. Clinicals in school are yours to make; decide what you want to do, involve your instructor and find the experiences you want and need. Take your time to learn to teach, because you are the only asset on the floor who has the time; once you graduate you will have precious little time to do that as a practicing nurse. Learn your ADL assists well; you will have more time to learn to do "real nursing" (as you call it when you work). The nursing education system is BROKEN, it has been for 50 years, and it is unlikely that it will be fixed in our lifetimes. Of course, this is par for the course, because the health care system in the U.S. is BROKEN.

Please understand, these words come from a person passionate about nursing; I started my learning process at age 10 reading my mother's Lippincott and Merck manuals, and I've been at it ever since. I have an interest in teaching academically, so I am not someone who hates being a nurse or anything like that. I am simply a pragmatist.

I couldn't agree more with BSN in Texas! The Current Nursing Ed. System is Broken and is in need of a drastic revamp as is Medical care here in the USA. Otherwise then Medicare for Retirees over 62, we DO NOT have a healthcare system here in the USA. Many times the Nurse whose patient you have simply is unable due to time constraints, to offer more assisitance to students under his/her wing. Sad reality of Nursing today. I was determined to learn so I worked 2-3 Eight Hour Shifts weekly at the same Hospital I was performing my clinicals as a Student Nurse at . Many times , at the End of my Clinical Shift(student),I would go to work in the SAME dept as a Nursing Asst. for the second shift. The 2nd shift charge nurse, in many cases, would turn me loose for 8 hours. I was a mature student(42 at the time) and she/he knew I was not off hiding/sleeping, so they entrusted me with me many many Nursing functions that maybe they should not have. Dc'ing IVs, Passing Meds to my Patients, Catherizing, Accu-Cheks for Diabetic Pts. Letting me do Injections in their presence-I let them know I wanted to do this and was interested in learning! Wound care, Traction ect. I learned more working in this manner then I EVER did as a Nursing student! This same Ortopedic dept was trying to recruit me to join theem after graduation so maybe its why they were so generous with their instruction. By the time I did start working after I graduated, the initial shock(on the floor) was over! Funny, various times, I worked with my Instructors and with the Director of the Nursing School at this hospital as they pulled PRN shifts with the same agency I worked with--we even went out to the neighborhood tavern later to drink beers as an afterwork group. I'm probably one of the few here to say I even had fun while I was in School!:chuckle Maybe you could attempt the same! Work for change also when you graduate as the profession is in dire need of Change.

[Tweety, BSN, RN]

Good luck. You're only in your 2nd rotation, there isn't much you can "do" right now anyway. If all you had to do was watch nurses in action, you'd be bored. So enjoy the hands on experience of ADLs these first few clinicals and keep your eyes are ears open. During your preceptorship at the end you'll get more RN experience.

I agree that most of it comes on the job afterward.

[loriann, BSN, RN]

I'm in an accelerated program and I have experienced exactly what the OP has. So far in my experience, I think that the more the nurses on the unit trust you and see that you can get work done, even if it is just the ADL stuff, medications, etc., with me they seem more willing to let me do more and even explain things to me if my clinical instructor is not available.

I don't know if you have the chance for this at your program, but we also have the opportunity to do independent studies. This semester, I set up an IS in the MICU, and there the nurses let me do just about everything (no IVs) and explain everything. In 1 12-hour shift, I learned more than I feel that I have in my entire clinical. Even though the floors are different (med/surg vs. MICU) the experiences transfer. The nurse I shadowed had a patient that was on a vent, a million different drips, etc. and she taught me suctioning, how to monitor the vent, let me start all the new drips, hourly fingersticks, and gave me the flowsheet to chart all the info. So, if you have the chance for IS, I suggest you do that to learn more. I plan on doing all my ISs in areas where I won't get a chance to do a clinical rotation.

Good luck to you!!

[perfectbluebuildings, BSN, RN]

Thank you for the great support, advice, and suggestions... (snip)...I have another question: Were any of you disappointed when you finally passed NCLEX/or worked as graduate nurses, to find that you didn't have the time for your patients? The reason I ask is because I can honestly say that was my "driving factor" that brought me into nursing to begin with. I see that it is lost, but not the nurses' faults whatsoever...just horrid time constraints. What areas of nursing sort of allow for that time with the patient? My last clinical instructor had written on my evaluation that one of my greatest strengths was being a patient advocate. I'm sure we all are, or else we wouldn't have thought of nursing to begin with though.

Any more ideas for me?

I appreciate your responses and help....and for making me feel welcome to ask these questions. It helps more than you could imagine. You're all great!

~ Emma

It seems like, in doing things like assessments, or IV push meds or things, you can incorporate your quality time with the patient, many times- talk and work at the same time. I am a very new nurse, and I was a little disappointed by having less time to spend with pts than in school... but, I guess I should have expected it. But I'm learning that I can still show I care and am available to a patient and family even when I don't have the time to sit with them right then... like my attitude, being patient, following up on any concerns they voice, not getting all irritated when they hit the call light for the forty-second time that shift... and such... and that really seems to make a difference. And I know it sounds completely elementary and stupid, but just remembering to introduce myself at the start of the shift, it's sometimes hard to remember. I know other people will be able to answer you more eloquently, with their more experience and better ideas of reality in nursing, but that is just my two cents for the moment.

*Edited to add: I am on a pediatric medical/infectious disease floor, just to give you an idea of my perspective, and I usually have 4-5 pts (I know, a much better ratio than a LOT of people out there)

[buwdu]

I am so glad to read this thread. I thought it was just our school! It seems like all the clinical instructors do is yell and intimidate students! You don't dare ask a question or they bite your head off. I remember my 1st semester they never even demonstrated how to check blood pressure. They say do your physical assessment and they have never even demonstrated one! I think they should have a program where you could shadow a nurse. I would learn more watching a nurse doing things. I consider myself to be highly competant but when I graduate I am going to be woefully unprepared to be a good nurse!

[moongirl]

what a bummer! I am a a third semester student at a Community college and we really kick tail as far as learning. We are "mini nurses" taking over total care of up to 4 pts. I hang IV meds, do IV push, re infuse blood( ortho pat), give injections, head to toe assessments, central line dressing changes, PEG feedings and meds, insulin,a dnI have had 5 IV starts! This is all done with the instructor watching for awhile, then we are checked off to do these tasks with our primary. We do no ADLs unless we have time or the CNAs need help. They are prepping us for the real world, and its great. There are other students from another school at this same hospital, they are BSN students who will graduate in December, one semester ahead of me, and they are only taking one pt and stand there with their mouths hanging open as I whiz by them.

I realize reading your posts how lucky I am to be in the school that I am !

Good luck, hang in there, hopefully your next semester will be more hands on!

[firstyearstudent]

I try to stay out of the way and not be a pest but also aggressively look for opportunities to endear myself to my own nurse and others. I offer to do grunt work like answer call lights, calm patients, get supplies, check IV alarms, take blood sugars, vitals, etc. I take initiative but don't overextend my boundaries -- I always double check before taking any action and also make sure I follow through when I say I am going to do something. I smile and am chatty and crack jokes when appropriate. (It makes you an individual and not just another nursing student.) I let them know I am looking for procedures and politely ask to watch or paticipate when something comes along. I offer up information I think might help them but that they might not know, in a nice way: "They look so sad in there. I was looking at the chart and it says the c-section patient's baby has a chromosomal abnormality..." I even directly say, "I know nursing students are more trouble then they are worth. I really appreciate your help" -- even when they aren't being helpful. Always thank your nurse after a clinical day. I sometimes even buy a (very) small gift or give the nurse a chocolate if she has been really patient or helpful. All the students should pitch in and give the unit a treat after a roation.

Do I kiss a**? You bet! The RNs I work with usually give a good resport to my CI also. I wouldn't want them to lie, but positive spin when I screw up doesn't hurt.

If I get nowhere with a particular nurse using these methods. I just relax about it, back off and remain polite. Often even these nurses will warm up eventually unless they really, really, really are not into teaching that day. If that's the case just accept it and don't take it personally.

A good trick is ask an RN you already have had if you can work with her again because you "learned so much," even if she wasn't that great the first time. She will be more trusting/familiar with you and how you work and will be flattered that you picked her.

One last thing, never talk about other nurses with students anywhere near the nurses and never report anything questionable that your RN did to your CI (your CI probably would not take any action but it would be bad form to talk about someone who was helping you in a negative way). If I have a question about something, I pose it in a way that is non-identifying. "Let's say I saw a nurse drop a pill and then pick it up off the floor and give it to a patient. Is that okay?" Or you could post your question here!

[tddowney]

"Nursing school is not where you learn to be a nurse. It is where you get the piece of paper that makes you eligible to sit for a license exam so you can practice. You then learn to be a nurse by doing; find a good first job where you can learn and be taught."

When this nurse goes on the unit as a new hire out of school, how many experienced nurses on the floor are going to bemoan the fact that new grads don't know anything about nursing, and take time away from their jobs?

[tddowney]

I agree that a little judicious a** kissing goes a long way most of the time.

We SHOULD recognize that as students we can often take up more time than we're worth...............in the short run. But, sooner or later we're going to be on the floor as new graduates. Someone will have to train us then.

In the meantime, if we had been given the chance to learn to do a few nursing interventions as students, we would possibly have been able to polish those skills and actually be proficient at at least a couple things. That would make us more able to carry our share of the load as new grads.

The situation reminds me of the old oil filter ads: pay me now or pay me later.