RN's and the dreaded clinical experience...

  1. 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
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  2. 38 Comments

  3. by   Thunderwolf
    Excellent post. Thank you for it. I agree, let's keep this in this forum. You should receive good input here. Ok, nurses, how can we help out our sister member? She raises some good questions that maybe seasoned nurses can answer. Let's provide her some good input.
  4. by   Little Panda RN
    Quote from 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
    Hi Emma, I am an LPN student in my clinical experience. Is your clinical instructor on the floor with you? We have our clinical instructor on the floor with us and anytime an IV bag needs to be hung or we need to pass meds or do any type of procedure we just beep her. She watches us do these things and checks us off so the next time we just let her know what we need to do and she will let us do it. We also are assigned one patient during are clinicals. And yes the nurses we are with are also very busy and don't always have time for us. When and if this does happen I contact my clinical instructor for instruction. Sure hope it gets better for you, clinicals can be tough. I am sure alot tougher than my LPN clinicals. Good Luck!
  5. by   SouthernLPN2RN
    I would discuss this with your clinical instructor. She or he may speak with that floor's NM, or find you another nurse to work with.
  6. by   jesshopper12
    I, too, had experiences like this during my clinical experience. I graduated in May, and have since started my nursing career. My advice to you is to take advantage of the situation, and to see the traits in this nurse as what you will NOT be like as a future nurse. Not all clinical experiences are positive, and sometimes you really have to struggle to get something out of it. Tell your instructor of your concerns and ask what it is you can do during clinical to possibly help that nurse out. It may be the case that you can be assigned to a patient not under the care of this nurse. Hope this helps a little - good luck in clinical!
  7. by   BSNinTX
    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.
  8. by   Roseyposey
    Quote from BSNinTX
    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 too am having the same experience as the OP. While I do not expect to learn everything in nursing school, I would like to learn something. If I wanted to learn to be a CNA, I would have taken a three week CNA course for $300 instead of spending $6,000 a year, spending hours upon hours studying, and missing out on time with my kids to go to nursing school. I do not mind helping and know it is important to learn and be competent at hygiene, feeding, etc. But, that is not the only thing I'm going to school for. It's gotten so bad where I am at right now that we are treated like extra CNAs (all they while the nurses treat us like garbage, but expect us to be at their beck and call). ok..vent over
  9. by   LeesieBug
    I am in the beginning of my senior year (four year BSN program), and I really had NO IDEA what it would be like to be a Registered Nurse until my senior preceptorship last rotation (did precepting at the beginning of my senior year). My experiences during my first two years of clinical were similar to yours...I did the work of a tech or an aid, with occassional meds and treatments thrown in for my ONE (very occasionally two) patient. Lots of hanging around answering call lights- getting water, helping people to bathroom etc.

    I have been wanting to quit this entire time, on and off, because I thought I was going to hate being a nurse. When I did my senior practicum, however, I was ECSTATIC!!!!!! It was wonderful, and never, throughout the entire program, have I been more excited about being a nurse. Everything started clicking and I actually got to USE MY JUDGEMENT, APPLY my knowledge, make decisions.....just incredible. I now feel like I understand exactly what the heck my job responsibilities
    will be.

    Don't know what to tell you, except hang in there. Hopefully towards the end, once they are sure you are able to function safely and know when to ask questions, you will be allowed more autonomy, as we are.

    P.S. Preceptorship is now over, and I am now back to being the go-fer for my last 3 rotations....with a little bit of nursing thrown in here and there
    But at least now I have an idea of what is waiting for me after graduation in May!
    Last edit by LeesieBug on Oct 29, '05
  10. by   FirstYear2005
    i've been in school now (first year) since August and hear alot of the same complaints from my classmates about the fact that we are really only doing ADl's and Head to toe assessments. I AM SCARED TO DEATH about when I really do get out, I say to myself, will i know what I need to ?? I am just going to relax though, take in as much as possible, and do the very best I can. I'm not going to slack off. Hopefully the knowlege will come in time. good luck to all of you. We are going to get thru this :kiss
  11. by   RNinRubySlippers
    Hi there. I am a 4th year BSN student and I recall feeling that way here and there. But, I must say, enjoy the extra time you have now to spend with your patients and giving them the conversation and more patient specific care they all love and appreciate. I worked as an UGN (undergraduate nurse) over the summer and will again at CHristmas, and I can tell you this. I learned more in 3 full time months as an UGN that I had in 3 years on school. Meaning, I was able to see real manifestations over time with various pts and appreciate the hectic days the RNs all have. Skills are skills and come with practice, you will have plenty of time for that over the years! I took on 4 pts each day and was responsible for almost everything they needed (not IV starts). Upon reflection, I see that I lost precious time I spend during school clinical with each patient and realize that is a sad reality due to nurse pt ratios and responsibilities.(0700-1400, with a one our postconference to follow) Wooptie doo, 7 hours on the floor in clinical vs 12 hours x 4 days a week days and nights is where ALL mt learning truly began. I feel more confident, was part of the team and learnt from nurses who know I was there full time and was there to help, learn and grow as a nurse. Just be patient, hang in there and do what you can now. Be in the moment and dont think about what you are missing out on. THink about what you are able to do and what you are providing your patients. Your clinical instructor is ther for you as well. Sadly, nurses are run full tilt. This is certainly not to say they dont and wont help. I believe it is the students job to accept that they are SUPER busy and that nurses help as they can, when they have time. Be confident in what you know, and ask your instructor. They can often liase for you if you feel VERY uncomfortable about a situation. Also, be respectful of the RNs situation and remeber, you are a guest on thier unit. Woah-thats a long post! Hope this was somewhat helpful, contact me if you want or have any questions! Cheers! Godd luck in school-enjoy it!
    Last edit by RNinRubySlippers on Oct 29, '05
  12. by   LoraLou
    unfortunately, in my experience at least, i didn't get a real handle on what nursing experience was until my last semester when my school did a practicum where we followed a nurses schedule for a quarter. Before that clinicals were a few skills thrown in here and there.
    Lora
  13. by   Emma123
    Thank you for the great support, advice, and suggestions. I feel better about this now, knowing that my experience is not uncommon (to be feeling like I'm not doing a whole lot), yet to appreciate giving that patient care. It WAS a good feeling to be able to sit with my patient and her spouse, to be able to calm her when she was crying b/c her SO left. (She was confused). I sat with her, held her hand, and talked with her for a while, asked her about her children, etc. It was truly an awesome experience.

    I am glad to know that where I stand is similar to you other students as well. Only for the fact that I feel like I am where I "should be" in this stage of the game.

    Sadly I realized that the RN's don't have the time to really sit with their patients. I am sure they would love to, if given the time. So I will accept that role now, knowing that is part of the learning experience.

    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!

    To my fellow students....Thank you, too, for sharing your experiences. I'm sure we will all make it and be glad we stuck it out. It is nice to know we're not alone, as far as our experiences.

    Thanks again everyone!!!!!!!!!!!!!

    You are sooooooo helpful!!!


    ~ Emma
  14. by   kellyo
    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??

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