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

[PANurseRN1]

"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?

Here we go again...another post denigrating experienced nurses. Heaven forbid you should mention the countless nurses who mentor new nurses. That's not tantalizing enough. Far better to perpetuate hurtful, hateful stereotypes.

Turn it around: How many new grads make life miserable for experienced staff because the new nurses "know it all?"

How many new nurses have taken the time to genuinely thank the experienced nurses who took on the added responsibility of precepting them?

Do you have any idea how stressful it is to be responsible for your own pt. load plus try to "be there" for the new nurse?

[saphira]

I graduated from an ADN program in May 2005. Fortunately I went to a good program that tried its hardest to give us a variety of experiences. Unfortunately, I ran into a lot of experienced nurses who did not want to deal with me unless I was doing scut work and emptying bedpans. On the plus side, I also ran into a lot of experienced nurses who loved to teach and loved the students and were willing to let me do what my little sign off card from the school said I could do. If it was signed off, many of those nurses would watch me do it once and then let me do it. Those nurses always got thank yous and hugs. And they're the nurses who students routinely went to with questions.

I worked as a nurse's aid from the time I began prereqs (in the year before I actually started nursing school) and the first year and a half I was in nursing school. After my third nursing course I took my LPN boards, passed, and worked as an LPN for 8 months till graduation. Both experiences were good. What I found was that as I gained experience both as a student and as an LPN that I got more out of clinical. And as an aide, the nurses on my floor were willing to let me watch and help with procedures, dressing changes, etc. I even got to help in a few codes. Nothing that would break the law or the State Practice Act, but I saw a lot.

As a nurse, I wish I had only 4 patients. Right now I work on a busy med-surg floor, I'm night charge, and I have an average of 7 patients a night in my own group. Most nights I have those 7 patients and have to oversee the staff and a total patient load of 31. And many nights I'm the only RN on a floor with PICCs, Mediports, and Central Lines. I love being a nurse--I have no time to be a nurse. I'm a traffic cop. I'm switching jobs because of that and going to in patient psych nursing. I'll be one of two RNs on the floor for 30 patients, but I won't be managing acute care. I'll be able to spend one to one time with patients and discuss comorbidities and management of physical illnesses. And I'll have time to volunteer at the free clinical and do primary care.

Nursing can be frustrating, the system is broken, many nurses are frustrated with the working conditions and many are leaving the field. Many student nurses hate nursing school because too many nurses do eat their young. The best advice I can give you is "Remember what you don't like and how you'd like to be treated and then fight for it. And treat the next generation of students like you wish you had. Join nurses associations, fight for better patient care conditions. Don't give up." And also "There's lots of different routes to take with an RN. Find one that works for you, even if you have to move around a bit."

[AfloydRN, BSN, RN]

Sound like they put you w/ the wrong preceptor. Talk to your clinical instructor and ask for a new preceptor. Tell her of your experience and why you feel you would benefit from someone else. Just because you are an RN does not make you a good preceptor. Some RN's don't want to be and are forced to.Hence the bitterness.

[Megsd, BSN, RN]

Sound like they put you w/ the wrong preceptor. Talk to your clinical instructor and ask for a new preceptor. Tell her of your experience and why you feel you would benefit from someone else. Just because you are an RN does not make you a good preceptor. Some RN's don't want to be and are forced to.Hence the bitterness.

Sometimes this isn't possible. In my rotation this quarter I get assigned a patient on Wednesday, I do prep that night and do care for that patient on Thursday and Friday. I work with whatever nurse is assigned to that patient. The charge does not make assignments for the day based upon who is good with students... they make assignments based on acuity of patients and other things. I have been very fortunate to have patient and understanding nurses to work with this quarter, but I'm not sure my instructor would have the power to do anything if I were stuck with a crummy nurse.

[marilynmom, LPN, NP]

I'm in a BSN program and we have had a great clinical experience and I have learned a TON. Part of it is my clinical instructor is great and the nurses I work with are great....they are all about teaching and when there is something new to learn they will come find us so we can be in on it. I have loved it so much!

This is our first semester and we do total patient care (no IV or IV meds until our senior year though). Before we were in nursing school we had to take and pass Fundamentals so we know how to do caths, NG tubes, subQ, IM,etc before NS even starts so we start clinicals the first week of school having some skills under our belt already....most others school around here the students learn that IN nursing school first semester.

Also if I find that "my" patient has nothing going on I go follow the other nurses around helping them. This may sound bad but rarely do I sit around and just chat with my patient....I go find things to do helping everyone out, I am there to learn.

I really think a lot of clinical experience depends on your clinical instructor and the nurses themselves. Everyone in my program is having very different experience regarding clinicals....some, like me, are having a great experience, and others with different clinical instructors are having a pretty crappy experience.

Hang in there.

[Halinja, BSN, RN]

I have to say, I've been lucky, had GREAT clinical instructors. Preceptors? well, some are good, some aren't, and sometimes they are just having a rotten day. As clinicals have progressed, I've been doing more and more actual nursing duties.

But I realize that what is happening right now is mostly just exposing us to the various kinds of nursing and the hospital setting...when we are really truly going to learn what the job is all about, is when we are on the job. (ugh, bad grammar, sorry)

Take every opportunity to learn...even if its on your own. Take a couple of your books with you, and when you find something in the chart, or in the day's work you don't understand, look it up.

My 'care plans' that I turn in are often peppered with questions. (After I've done my best to find the answers on my own) My instructors have always been great about answering those questions.

I don't mean to sound self righteous though, I've had my days of frustration, and days where I felt like a waitress or janitor (not to diss either of those jobs) I am looking forward to digging into 'real' nursing. (I just hope some hospital is going to give me the chance...graduation is getting closer and its a little scary!)

[ChocoholicRN]

I'm also doing my med-surg clinicals right now and have found that no matter what floor you are on, there are nurses that just don't want to be bothered, even if you are taking some of the patient workload off of them. In order to get the full clinical experience, my intructor told us that as long as we are not too busy with out own patients, we should ask ANY of the nurses if they need IV's started, foleys inserted, NG tubes inserted. These are some of the major and more difficult tasks to master that you may not get to experience during your rounds. Therefore, as long as your instructor gives you the okay, go for it and make the most of your clinicals experience!!

[Sunflowerinsc, ADN, RN]

I've been a RN for over 40 years and I didn't know that answering call lights,calming patients, getting supplies ,checking IV alarms, doing blood sugars and vitals is "grunt work". Its all part of taking care of your patients, I do it over and over every day plus all the other things RN's ,LPN's and CNA do as team members doing good patient care.

[Alexsys]

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.

I love students! Bring em on! When I went to school, I felt the same way, I feel that I didnt get to do much until I hit the floor after passing the NCLEX. You are not alone, but it will get much better

[firstyearstudent]

I've been a RN for over 40 years and I didn't know that answering call lights,calming patients, getting supplies ,checking IV alarms, doing blood sugars and vitals is "grunt work". Its all part of taking care of your patients, I do it over and over every day plus all the other things RN's ,LPN's and CNA do as team members doing good patient care.

In my book "grunt work" isn't derogatory, it just means something that the grunts (in this instance nursing students) are qualified and able to do. The term "grunt" goes back to the Vietnam war -- it meant a U.S. Marine or Army foot soldier. The average RN would probably feel more comfortable having her student take a BP for her than to do and document her assessment. If you do an RN's grunt work he or she may be appreciative and have more time to teach.

[RN007]

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?

Hi, Emma,

I've felt the same things. In fact, I started a thread in the graduate nurses forum asking new RNs if they were happy with their first jobs, to tell me where were they are working and what are the ratios. At the hospital where I'm doing clinicals, the ratio is 1 RN, 1 LPN and maybe a CNA for 10 patients. I definitely do not want to work under those conditions. I don't see how they even get basic assessments done, much less provide care. In fact, I recently helped RN do her a.m. assessments in addition to mine. I appreciated the confidence she showed in me.

I hope to work in an area where I'll be able to spend time with families, too. I love that as much as caring for the pt. I plan to apply for jobs in the NICU, peds, oncology or hospice. Diverse, I know, but I'll have a better chance at hands-on care and developing relationships with families.

Good luck to you (and me!) ...

Linda

[hospitalstaph]

I'm also doing my med-surg clinicals right now and have found that no matter what floor you are on, there are nurses that just don't want to be bothered, even if you are taking some of the patient workload off of them. In order to get the full clinical experience, my intructor told us that as long as we are not too busy with out own patients, we should ask ANY of the nurses if they need IV's started, foleys inserted, NG tubes inserted. These are some of the major and more difficult tasks to master that you may not get to experience during your rounds. Therefore, as long as your instructor gives you the okay, go for it and make the most of your clinicals experience!!

This has been my experience as well. I have also noticed that if you help a nurse with the "tech" work, they are more likely to seek you out when they have something cool to look at or do.

TR