Is it my imagination or do the nurses at clinicals hate us students?

  1. Hi:

    I'm new here but I thought I would ask this question since so many of the nurses on this site are so helpful and encouraging to students.

    I'm in the 3rd semester of a 5 semester program. We have six clinicals per semester. Of them, I've had (I'm serious) 5 clinicals where my patient's primary RN would talk to me. We're supposed to find them (all but impossible when they don't wear name tags) and introduce ourself. When we do, I usually don't get a smile. Lately, actually, I hope for something as nice as this: :stone

    I know these are busy floor nurses. At the same time, we students often feel like we're thrown in with little guidance as to what our roles/boundaries are and do little but stand in the way. One clinical, I had an excellent nurse who took me by the arm into every patient's room she entered, and explained what she was doing and why. She did this all day. It was the best clinical I've had, hands down.

    Most of the time, though, IV fluid bags are hung, meds are pushed/administered/hung, procedures performed on my patient while I'm off finding clean linens or tracking down the PCA to give her the patient's last vitals (because I'm essentially doing her job: bathing the patient, taking vitals and I&O). I don't mind doing these things of course, and I know I'm low on the totem poll, but being halfway through the program now, it's terribly demoralizing to stand around all day doing nothing, ignored (at best) by the staff--one complained that I had the chart when I'd made clear to the unit secretary where I had it and that I'd happily hand if over if needed. I just had to copy some labs (which, as every nursing student knows, you need to know). Our role on the floor is very unclear. I'm typically a hands-on type of person, but I can't push IV meds, give injections, or even give PO meds without my instructor present, nor do a procedure as simple as d/c'ing an IV. And I don't want to make matters worse with the staff by overstepping my bounds.

    Our clinical instructors are pretty good, but mine always seem occupied with another student in my group of 6 or 7. And unfortunately they seem to be under the impression that we're working with great nurses who are student-friendly. I don't know if there's a communication breakdown, if I've been especially unlucky (my classmates have similar stories, though), or if it's just a fact of life that floor nurses cringe when they see a cloud of white student nurse uniforms approaching and therefore refuse to share skills or information. I'm not the crying type, but I want to cry after each clinical because I essentially feel I've wasted 6 hours standing around while real work goes on around me and fear I'll graduate with no experience.

    Any information or encouragement would be appreciated (I'm not normally so whiny, honest ).
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  2. 36 Comments

  3. by   sparkplug
    Well Michele I don,t know how old you are or where you go to school but let me tell you how I view nursing students. First I remeber what it was like because I just graduated 10 years ago at the age of 42. I had been an lpn before and the staff nurses most of who were much younger then me treated all students like dirt.
    What I find now is that if a nursing student shows me a little initative I am happy to take her under my wing so to speak and make sure she gets experience. I have had students who are not assigned to my patients ask me questions about labs or meds and these are the students I seek out when I know a chest tube is about to being inserted or if a patient needs and NG tube. Itry to offer them the experience because they have not been sitting or hiding in the clean utility room.
    Accountability is key to staff nurses if a student says they are going to do something I don,t want to find out 5 minutes before you leave the floor that it was not done. Personally I do not think baths and beds are high on the priority list for students, you need to learn so many other things that these are low. The use of dinamaps by students should be banned, you need to refine your skills by taking manul Bp and apical rates. All in all I think if you show an interest some nurse will appreciate that and help you out.
  4. by   suzanne4
    I love having students with me, but I expect them to show some initiative about learning new things...........as stated above, there are some that will go and hide, and then complain at the end of the day that they didn't get to see or do anything.........and then there are others, that learned so much because they were there and you did not have to hunt for them.

    If there are students around, I will make sure that they get to see everything that is being done or anything unusual if even with another patient or nurse, just so that they get the experience..........But it is a two way street.....don't have time to go looking for them.
  5. by   MicheleSN
    "I have had students who are not assigned to my patients ask me questions about labs or meds and these are the students I seek out when I know a chest tube is about to being inserted or if a patient needs and NG tube."

    Thanks for telling me that, Sparkplug. I'm usually timid about approaching RN's I'm not "assigned to," although these have often been the more friendly ones (as I said, maybe I've had bad luck with my assignments).

    I'm in my mid-30's. Many of the nurses I've worked with have been about my age or just a few years older. I assure you I'm not hiding, but I am sometimes nervous about approaching the nurses with questions. As I said, I realize they're busy, and I'm unsure about my role. Anyway, in a week I'm moving to an ICU environment. Maybe things will go differently there (it was in an ICU stepdown where I had an excellent clinical experience before). Fortunately, this semester, our clinical instructors have begun to suggest that am care isn't our top priority, but our written guidelines for the course still say it's our responsbility (once again, a little vagueness about roles & responsibilities from our instructors).

    Thanks to both of you for your advice.
  6. by   stressgal
    I'm in quarter 5 of 7 and have found the nurses on the floor to be wonderful. But I do rely on my clinical Instructor to set the parameters. If you are not sure what you are to be doing for the day, ask your Instructor during report. It usually only takes once to know what they are looking for. I tend to be one of those that keeps my ears open to things going on around me and try to experience as much as possible. Our time at clinical is limited so I think it is up to us to ensure we get as much out of it as possible. Even if it is simply observing. Last quarter we even got to administer TB tests on a floor, not a common thing in our clinical settings.
  7. by   kellyo
    I think it depend a lot on the facility, the floor and how well they get along with your clinical instructor. I think emplyee morale has a lot to do with it...
  8. by   mariedoreen
    When we're assigned a patient, we're responsibile for the care that patient requires for the shift within our scope. We go to report, do AM care, take care of meds, and do their treatments. Anything that requires our instructor to be present we call and let them know that we need them and when. Anything outside of our scope we observe on. When I'm not in my patient's room I'm at the nurse's station looking something up in the chart (the labs you mentioned, new dr's orders etc...) I try to stay right in the hub of activity (but of course as out of the way as possible...) and have picked up some procedures this way. For example, an RN (not my patient's) gets off the phone one night, turns to me and says 'I have a Phenergan IM do you want to do it?' Most of the time I've had patients that have kept me completely occupied throughout the shift. The one time I did not I approached my patient's RN and asked if there was anything I could assist her with or if I could simply observe her with her other patients. She looked at me and said, "I just have some beds I have to make and rooms to get ready right now. We're getting admits and we're low on techs." I said "Great." and helped her out. After that she seemed happy to let me tag along the rest of the day.

    To combat the "You're a pain in my ..." attitude I start in report where I do not take a seat until I've been told there are enough for everyone or until everyone's shown up and I can see there's one left for the student. I note who my patient's RN is so I know who to go to with questions and then once report's over I'm off. I'll stop and talk with my RN if they indicate they want this (some don't want to acknowledge I exist) but if they don't I head straight for my patient's room to do an assessment. I touch base with my RN periodically if they don't seek me out to give them the FYI with their patient or to ask any questions I may have. Otherwise I leave them alone. I see them more as a co-worker than as my caretaker and try to be self sufficient whenever possible. If the RN assigned to my patient is really into students I obviously get a lot of opportunities, information, advice etc... If they're not I interact as needed for the care of our patient, it just usually goes no further than that and that's ok. I've never had an RN be rude or mean to me, some are cold but that's okay, I can deal with that. And I've never had a cold RN that didn't thaw at least a little by the time the shift was over.

    It is very frustrating when things are not clearly defined and you're unsure of what your boundaries are. I understand, I was there early on. I would suggest you attempt to clarify some of this at post conference or even privately with your CI. Once you've clarified your duties you'll find that you'll be so busy that you won't have time to care about the RN's lack of enthusiasm at your presence. Good luck!
  9. by   purplemania
    It is not your imagination, it is their frustration. The nurse is still responsible for the patient even though you might be providing care. The nurse does not have much control over what you are doing and there may be a breakdown in communications, which can lead to mistakes. Plus, there is increased chatter, fewer places to sit, the charts are not in place, etc. HOWEVER, if you ask appropriate questions, communicate frequently with the primary nurse and give good care you will be appreciated!! ASK if you don't know. ASK for a better way to do things. ASK for the rationale on decisions. Make mental notes of what they are doing "wrong" so you will not perpetuate the problem when you are licensed.
  10. by   DutchgirlRN
    I enjoy precepting and I enjoy having students around. I remember what it was like to be a student, all be it 30 years ago. I know on my floor we are so busy that we don't even have time to talk to each other and that may be preceived as not wanting to be bothered with a student. On our floor that's not the case were just really busy all the time. Good Luck.
  11. by   MicheleSN
    Thanks again for all your perspectives.

    MarieDoreen: You said

    "To combat the 'You're a pain in my ...' attitude I start in report where I do not take a seat until I've been told there are enough for everyone or until everyone's shown up and I can see there's one left for the student. I note who my patient's RN is so I know who to go to with questions and then once report's over I'm off."
    So, at your clinicals, students sit in on the staff's shift change reports/conferences? At mine, we students get together with our CI after shift changes (after reports from RN-to-RN have taken place). We have what we call a 'pre-conference' for about an hour, where our CI "grills" us (no, it's really not bad) about our patient, their meds, their pathos, their labs, etc. Anyway, by the time we hit the floor, the nurses are an hour or so into their shift. I think it would be great to hear the RN-to-RN report; it would also be a good way to identify my primary RN and hit the ground running along with her/him.
  12. by   loriangel14
    It seems to me that some schools organize their clinicals very poorly.I am in the middle of one at a long term care facility and we have a supervisor there that is employed by the college.It is her job to make sure we get an opportunity to observe and practice as many skills as possible.When we are not busy taking care of our assigned residents we are with her doing things such as dressing changes,meds, injections, eye drops, nebulizer treatments, computer charting on our respective residents, etc.There is no chance to be doing nothing or hiding out.She just finds out from the staff what needs to be done and then we do it for them. She lets us do everything and observes and notes who has had a chance to do what things. If there is a dressing change to be done and someone in the group hasn't done one yet then it is your turn.We are not allowed to perform any skill without staff or our supervisor present until we have done it safely for our supervisor( except for personal care, feeding or toileting).We are responsible for charting evrything we do as well but our supervisor oversees this as well.We don't need to bother staff because the supervisor can explain anything and answer questions.
  13. by   sunnysideup09
    I love having clinical students, but I also love teaching others. I have some expectations of the students thought: be willing to seek out learning opportunities while at clinical, be prepared, and ask questions. I have had some students where they just want to sit and talk with the nurse. Our clinical students listen to report, but most want help with their paperwork. I'm fine with telling them where to find the information, but sticking their head into a chart the entire morning versus learning about what NICU nurses do is what I get upset about. With a heavy assignment, it's not possible to sit and give them the answers to every question. Forget about the paperwork...I have gone to instructors and asked them to forego the student's paperwork if she/he got some good experiences and there wasn't the time to do it. The clinical experience is not about getting the paperwork done.

    Christine, RNC, BSN

    Quote from MicheleSN
    Hi:

    I'm new here but I thought I would ask this question since so many of the nurses on this site are so helpful and encouraging to students.

    I'm in the 3rd semester of a 5 semester program. We have six clinicals per semester. Of them, I've had (I'm serious) 5 clinicals where my patient's primary RN would talk to me. We're supposed to find them (all but impossible when they don't wear name tags) and introduce ourself. When we do, I usually don't get a smile. Lately, actually, I hope for something as nice as this: :stone

    I know these are busy floor nurses. At the same time, we students often feel like we're thrown in with little guidance as to what our roles/boundaries are and do little but stand in the way. One clinical, I had an excellent nurse who took me by the arm into every patient's room she entered, and explained what she was doing and why. She did this all day. It was the best clinical I've had, hands down.

    Most of the time, though, IV fluid bags are hung, meds are pushed/administered/hung, procedures performed on my patient while I'm off finding clean linens or tracking down the PCA to give her the patient's last vitals (because I'm essentially doing her job: bathing the patient, taking vitals and I&O). I don't mind doing these things of course, and I know I'm low on the totem poll, but being halfway through the program now, it's terribly demoralizing to stand around all day doing nothing, ignored (at best) by the staff--one complained that I had the chart when I'd made clear to the unit secretary where I had it and that I'd happily hand if over if needed. I just had to copy some labs (which, as every nursing student knows, you need to know). Our role on the floor is very unclear. I'm typically a hands-on type of person, but I can't push IV meds, give injections, or even give PO meds without my instructor present, nor do a procedure as simple as d/c'ing an IV. And I don't want to make matters worse with the staff by overstepping my bounds.

    Our clinical instructors are pretty good, but mine always seem occupied with another student in my group of 6 or 7. And unfortunately they seem to be under the impression that we're working with great nurses who are student-friendly. I don't know if there's a communication breakdown, if I've been especially unlucky (my classmates have similar stories, though), or if it's just a fact of life that floor nurses cringe when they see a cloud of white student nurse uniforms approaching and therefore refuse to share skills or information. I'm not the crying type, but I want to cry after each clinical because I essentially feel I've wasted 6 hours standing around while real work goes on around me and fear I'll graduate with no experience.

    Any information or encouragement would be appreciated (I'm not normally so whiny, honest ).
  14. by   truern
    I guess I've been lucky...I've always had good clinical experiences. We DO get report from the RNs, then go to a fast pre-conf with our CI where we give report to her and let her know times for meds, treatments, etc. Then we hit the floor running.

    I believe a lot of it is in attitude. I respect the nurses I work with, and I deserve their respect. The PATIENT is my first priority, and I'm sure that shows.

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