Primary Nurse Not Happy Unless You're Drowning?

  1. Clinical is REALLY getting to me this quarter and feel the need to vent a little. I'm at a different hospital that is new to me, but I've finally settled in and am feeling more comfortable.

    The floor on I'm on has a policy of "Students will do everything, their CNA is not allowed to help them...that's part of being a student and learning time management!", I can't tell you how many times I've heard this exact same statement out of all my different primary nurses mouths! While I totally understand and agree, I'm also frustrated because we've been told (by our instructor) as an RN student with a four patient load, we also need to be learning delegation and asking for help getting vitals, baths etc...that CNA's can do. Several students have brought up this issue with our clinical instructor but we've basically been told to do whatever makes our primary nurse happy. Fine. So I had a night the other week where I took care of all my patients, did not need the nurse or CNA for help at all, did total and complete patient care on all of them. At the end of the night, I was finished with my charting about an hour early, which my primary questioned me about and double checked to make sure everything was in. She sat down, read my charting which she seemed very pleased with, and called "very well done". Since I was done, I politley asked if there was anything else I could do, or help her out with. She declined saying there wasn't.

    When I went to leave an hour later, I got my evaluation form back from her and was really quite shocked to see "adequate" for most of the categories. Not well done, not superior, but "adequate". without any supporting comments in the comment section. Some of the categories were things like "Student gave all meds on time and demonstrated the 5 rights" and "Student time manged effectively and completed all charting on time" not to mention several others. We give these forms back to our instructor, which go in our file.

    This left me thinking, would my primary of been happier if I was drowning? Did she think I must of not been doing my job right if I wasn't? If I'd of seen comments in the comment section, it would of given me something to go off of, but now I'm left wondering exactly HOW to be just more than "adequate". what gives??
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  2. 6 Comments

  3. by   Tweety
    If you were drowning you probably would have gotten points off for poor time management. But if you finish too early, one might wonder "did she do everything? is she spending enough time with her patients?". You can't win here.

    "Adequate" is not an insult. it just means you're doing what you are supposed to and that's a good thing.

    Our students evals have a "meets requirements" and that is usually is what I give. That's about the same as adequate. You have to do something above and beyond, not just meet the requirements or even do a good job on the requirements to get an "above standard" out of me.

    I know what you're saying though, seems like she could have been a bit more generous.
    Last edit by Tweety on Oct 25, '05
  4. by   girlfromtx
    How do you manage 4 patients, while having do to bed baths etc? we do vitals, but that takes like 2 seconds. I would definitely be drowning, so my hats off to you .
  5. by   WAstudent
    Quote from Tweety
    "Adequate" is not an insult. it just means you're doing what you are supposed to and that's a good thing.

    Our students evals have a "meets requirements" and that is usually is what I give. That's about the same as adequate. You have to do something above and beyond, not just meet the requirements or even do a good job on the requirements to get an "above standard" out of me.
    Can you give me examples of above and beyond that you give "above standard" for? I'm really trying to understand so I can meet that mark.

    Quote from girlfromtx
    How do you manage 4 patients, while having do to bed baths etc? we do vitals, but that takes like 2 seconds. I would definitely be drowning, so my hats off to you .
    Thanks. Well...it's not easy some days. Especially when you have a patient post op returning to the floor who needs vitals q15, one patient who needs to get up to the commode, the other needs an IV started and hung, and the other who keeps getting out of bed and is a fall risk. Not easy without asking for help, that's for sure!
    Last edit by WAstudent on Oct 25, '05 : Reason: Automerged Doublepost
  6. by   Tweety
    Passing meds on time, doing routine AM care, having good charting and finishing ahead of time is not necessarily above the standard. You're meeting the standard there, you're doing what you're supposed to be doing. Although my hats off to you, four patients is quite a load.

    Getting above standards or excellents requires a little more, but is usally situtational, such as talking down a combative patient, recognizing a critical situation and making a difference, helping out with other nurses patients, or going the extra mile with your patients in teaching, etc.

    I think you should be very proud of yourself that you are meeting the standards of a good nurse, although "adequate" sounds like a put down it really isn't. I applaud you for striving to do better, that's an excellent attitude and I would give you high marks for that.

    I am a generous too. I worked with a BSN student whom I assigned a bath to on her very first clinical. The patient gave me so much praise about her wonderful care, the backrub, etc., I put that in her eval. for the day. Nothing wrong with handing out a few excellents when deserved and to help boost confidence.

    ( I precept students, I'm not an instructor.)
  7. by   caroladybelle
    Quote from girlfromtx
    How do you manage 4 patients, while having do to bed baths etc? we do vitals, but that takes like 2 seconds. I would definitely be drowning, so my hats off to you .
    As I have done that (or more patients) for much of my career, it is manageable and actually expected in many places. And quite a few units have NO CNAs, or have one/two for a floor of 30 patients, hardly adequate for doing all of the vital signs, toileting, bathes, etc.

    Grant you, it will take a while to hone those skills as a student.

    As far as average vs outstanding, there are many people that write that for anything that meets standard. To write "excellent" generally means that you went far and beyond expectations, and is expert in all care...something that is rarely obtainable. As a traveler, I get them for helping to manage difficult cases (not necessarily my primarys) , taking more/ or complicated cases that generally would not come my way, managing the psychologically difficult cancer cases, picking up outpatients without prompting, doing phone follow up, assist other units with information, access Ports on other units, orienting other stffers to new procedures. Generally these are not required of travelers.
  8. by   WAstudent
    Quote from Tweety
    Passing meds on time, doing routine AM care, having good charting and finishing ahead of time is not necessarily above the standard. You're meeting the standard there, you're doing what you're supposed to be doing. Although my hats off to you, four patients is quite a load.

    Getting above standards or excellents requires a little more, but is usally situtational, such as talking down a combative patient, recognizing a critical situation and making a difference, helping out with other nurses patients, or going the extra mile with your patients in teaching, etc.

    I think you should be very proud of yourself that you are meeting the standards of a good nurse, although "adequate" sounds like a put down it really isn't. I applaud you for striving to do better, that's an excellent attitude and I would give you high marks for that.

    I am a generous too. I worked with a BSN student whom I assigned a bath to on her very first clinical. The patient gave me so much praise about her wonderful care, the backrub, etc., I put that in her eval. for the day. Nothing wrong with handing out a few excellents when deserved and to help boost confidence.

    ( I precept students, I'm not an instructor.)
    Thank You for your honesty and insight. I'm going to continue to strive for excellants but will quit being so hard on myself for receiving adequates. You're right, it isn't a put down. It means I'm doing what has been expected, and on the right track.

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