This "us" vs "them" mentality.... - page 10
I've been reading through the posts from the last few days, and I'm completely astonished by the "us" vs "them" mentality that is showing up between the nursing students and the staff nurses. ... Read More
Oct 2, '11Quote from carolmaccas66I have to amiably point out that there's a disconnect here. RNs don't have "just 2 seconds" with a student, and they don't have "just 2 seconds" with a brand new orientee. My CIs in my last clinical rotation were slammed with med pass and really didn't have the time to supervise nursing skills, so we didn't do them, but we would watch the floor nurses do them. You have some nurses who believe that basic skills need to be practiced in school (on whom?!...lab is nothing like a real person), and you have some who believe they will come in time OJT (new grad burden, again!). As a student, to hear both sides equally adamant, can be very anxiety-inducing and frustrating.Sometimes RNs DO NOT have 'JUST 2 SECONDS' to grab you and show you what to do! We get very, very BUSY, sometimes insanely so. I have already detailed on here what some nights in my ED are like.
You are riding on a high-horsed idealistic wind: the real world is so very different from that of a student. Things never just take '2 seconds' sorry, but you are not living in reality! It would be lovely if we always had the time to teach, but when procedures have to be done fast, or people are bleeding out, it's just not possible.
You won't learn everything on EVERY PATIENT either. Give yourself a go! You are jumping the gun and worrying you won't get taught everything - you can still learn some of these skills when u become a RN.
Stop worrying your life away and just learn what you can. You won't ever know everything anyway.
Goodness, stop stressing! Enjoy being a student, stop obsessing over why the RN hasn't grabbed me/taught me this/shown me that etc, and learn all that you can.
Rock meet hard place.
I gained more skills in my final one-on-one practicum than I did in any other rotation. Apparently, the practicum nurses were paid handsomely by our school for their time, and my practicum nurse was very, very good at teaching and providing me opportunities for skills and critical thinking. The area I was in, though, was NOT med-surg, so there were a few bedside skills I see often now that were never presented in my practicum. The handsome payment (in the thousands), I believe is the result of going to a private school where tuition was sky-high, btw.
I agree with your overall sentiment, though, to just go with it. That's really all that we can do It will come in time, with a few bumps along the way. I'm lucky that I now can take my new, permanent preceptor's full load (I'm not yet counted in staffing), and she's right beside me, shadowing me, verbally directing me on the skills. But, early on, it wasn't like that, and I was definitely a burden. Unfortunately, not all new grads get the length of orientation that I'm getting where I can build trust with my preceptor and gain the necessary hands-on experience as my own competence with time management grows.
Oct 2, '11I don't leave my Midwife (I'm at the end of my midwifery placement and then have 1 more semester in Nursing). Unless she gives me a job to do, so I've been doing a lot of my prac in birth suite and I usually get 'given' a lady in labour who I stay with the whole time, doing obs, etc... If I think its time for a V.E or if I get the 'feeling' we are going to do an amniotomy I go get my preceptor and she will come in with me and watch me do it when she is ready. But I kind of take the initiative and get everything ready beforehand. I'm sort of running after her a lot rather than her running after me. When she is with me she will fire off a heap of questions, its learning time, and she's checking that I'm competent and going to be safe... so I get 'whats your plan of care now', or 'whats the indication'... I have to think quick because she has about 2 other women in labour and she doesn't have time to stand around. Then I hit the buzzer when the lady starts pushing, I catch the baby and she is there for the mum. She directs me on everything I need, but I've done a few births with her now so she doesn't need to say much to me anymore. I then do all the documentation and get her to check it. You really must take as much initiative and just sort of push in.
Also I act like I'm part of the team, while still being in my role and scope of practice as a student (I know my limitations and so do the people I work with). If my preceptor is telling me that a lady is having synto (pitocin) put up, I'll ask her if she would like me to get the IV ready and put up some fluids, prime it all so its ready to go, grab the medication, just do as much as I can. I don't feel like I'm helping her when I do this, I just feel like I'm a small part of the team. You really have to have some initiative. BUT I understand its hard when you get nurses that just plain ignore you. Its down putting and depressing. I don't put up with rolling eyes though or any disrespect like that. That is wrong and I will address it right there with her. Like I said before there is no need for anyone to be rude. If my midwife turned around and told me tomorrow when I turn up for prac that I was not part of any team, I was in the way, pesky, then I would lose all confidence and just want to stand in the corner so I didn't get in the road.
Oct 2, '11The way I see this is that yes, if there has to be a choice, it's far more important for a brand new nurse to be able to recognise when something is about to go badly wrong than it is for that same brand new nurse to be an expert at the tasks. I don't think that's the ideal way though. If you're new and scared and don't know much, the stress of not being able to do those tasks with relative ease is enough to put most new nurses into a state of panic when the patient is deteriorating in front of them. It's just not true that there's always going to be someone nearby who can step in and take over at a moment's notice so the new nurse may well find himself/herself in a situation where they've recognised that something is wrong, informed the doctor that there's a problem and gotten orders but are then stuck watching and waiting until someone can come and help them with the next step. It might only be 10 minutes, or it might be a lot longer than that, but either way it's not good for the patient, and it's not good for the new nurse's confidence. Sometimes it might be disastrous.
Like it or not, a good part of nursing IS skills. I agree that the skills are actually the easy part and doesn't it make sense to learn the easy part first? There is much to be gleaned when washing, turning, moving, toileting, talking to and listening to a patient, and often it's when you're helping the patient with those very things that you'll spot the first sign of something going wrong. I cannot understand students who have done one bed bath and then think they don't ever need to do another one.
Getting back to the OP, I think students should be assigned to an RN for a complete shift, rather than be assigned to one or two patients for a part of the shift. If a student is with me for a whole shift, they see reality. They learn a hell of a lot more by sticking to me everywhere I go, watching how I organise my day and what I actually do all shift and seeing how the plan usually goes to pieces in the first hour. I like having students and I enjoy teaching and watching students grow and gain confidence. Despite all that, even the best student doesn't make my day any easier and I don't know how we as RNs can convey that to students without making them feel they're in the wrong for being there.
Far too often lately I get the feeling that students think the hospital is there for them to learn in and the patients are there for them to practise on because 'how else are we expected to learn?' Another thing, and this one is probably going to outrage students everywhere, is that some students (and I think even the OP said something like this) truly believe that they know best about a lot of things, that their knowledge is more up-to-date and that we the floor nurses could learn some things from them. Well, some of that may be true at times, but the fact is that I have to follow the policies and procedures laid down by my employer and if the student tells me that all the evidence shows that green sheets are better than blue sheets it doesn't matter a bit, because my hospital only has blue sheets. If my hospital DID have green sheets, I still wouldn't take a student's word for it that the green ones are superior. I'd want to do my own research before ditching the blue sheets, yet I've had students act as though I'm unsafe when I don't change the way I do things based on what they're told me.
Oct 2, '11Quote from All4SeasonsThat was not judgemental?That's a low brow response from you,isn't it, Linear Thinker? I thought you prided yourself on your intellect. Perhaps you didn't understand the question
In any regard,I am through with AN. To read so much caustic,sarcastic,bombastic drivel....well,it's just not fun.This is my 31 st year of active practice and the end's not in sight; I have spent the past 26 years in various ICUs on both sides of the country; I've have worked with hundreds of nurses and thousands of patients and their families; had some really tough situations,horrid shifts,worked with some,let's just say,less than charitable colleagues and many more wonderful ones.
But,here's the kicker -I haven't developed the hard-edged,aggressive,judgmental 'tudes that I routinely read here (interestingly enough,only in the General Nursing discussion). I'm generally kind and respectful to my peers,I seek advice when I'm unsure,I believe one can learn from others - including students. And I don't come in through the hospital's front door dragging a chip on my shoulder the size of Manhattan like so many of you. I've read many fine posts here,written by fine nurses, but the bitterness here is just not palatable,so...
I'm off to save some lives.... Ba-bye!
Oct 2, '11Quote from All4SeasonsBuh-bye now!! (said with inflection used by David Spade in the immortal flight attendant SNL sketch.). . . . . .I'm off to save some lives.... Ba-bye!
There's an old saying.. (I know, gag me) . . you are neither as wonderful nor others as terrible as you believe. Thanks for letting us know your plans, though.
.That's a low brow response from you,isn't it, Linear Thinker? I thought you prided yourself on your intellect. Perhaps you didn't understand the question
Oct 2, '11Quote from linear thinkerI agree wholeheartedly.....but I think the elite has to do with standards of admission and curriculum and not necessarily the degree.I think nursing needs to do a better job of weeding people out. Let's start with requiring some SAT scores comparable to the other professional, which means no more of this community college for RNs stuff. It's nonsense. Professionals have college degrees (don't bother with the "I know a BSN who is a terrible nurse" crap- you will not convince me). The NCLEX needs to be much harder, and much more expensive. CEU requirements need to be more stringent, as in more rigorous, and more of them. In addition, RNs should have to reboard every 5 years, just like physicians.
I honestly think if you weed out the lowest common denominator you will attract a higher caliber of professional, and then the money and respect will follow. I have said it before, and it isn't popular. The reason nursing isn't respected is because it is populated by people who simply aren't going to gain respect from other professionals. We need to get rid of them. Raise the bar, weed them out. I don't want girls who look and act like they belong on the pole representing nursing. I don't want Gomer Pyle representing nursing. I don't want idiots representing nursing. I don't want Jerry Springer guest material representing nursing. Raise the bar. Let's get rid of them.
You want nursing to be elite, start only accepting elite into the ranks.
Argue too strenuously with this, and I'm going to assume you fall into one of the Gomer Pyle or Springer categories.
When I went to school the diploma schools were closing all across the US and "New" Associate of Science and Nursing degree's were developed. When I applied to my Associate degree program at Purdue University the accepted 60 applicants. Period. The best of the best. They had an arduous curriculum. If you didn't like it.....leave. Someone else was waiting to take your place. They had a waiting list a mile long. My program was headed by Dr. Joyce Ellis (rip) one of the very first Phd prepared nurses in the country. Strangely enough I never took my SAT's or SAT in the beginning, I was in a gifted program at my high school. Dr. Ellis thought I was "bright" and she "liked" me....she thought I would make a good nurse because I kept good grades while being very active at school........is how I got in.
We respected our elders and those with more experience knowing that experience was an important factor in the care of patients and our education. I did nothing without my instructors permission. Mrs. Givens was her name and she might have been tough.....but she was fair and she made me what she knew I could be. We started clinical at 0530 to be able to prep all the pre-ops and inset all the foleys, NGT, and anything else to prep the patient for the day on a rotational basis (people were admitted for testing in those days..LOL) Then we went to pre conference to start clinical with our patients care. After clinical ended at 2 pm we returned to campus for lecture or other required courses like pharmacology, microbiology, A&P and advance A&P.....to name a few.
It was required by the program to have to have a GPA 3.0 to be a candidate to sit for boards. Boards was 3 days long. We took SEVEN tests the seventh being test questions. Each test had a minimum of 250 questions (I really think it was 300 but my memory is hazy). You had to pass ALL SIX tests to pass the boards. If you failed by even one point on one test you had to wait 6 months, when the test was offered again. If you failed twice you had to return to school and repeat those subjects that you failed to enable you to take the tests again. You mention that The NCLEX needs to be much harder, and much more expensive. I am curious what does the expense of the NCLEX have to do with the quality of the exam and how paying more money will improve the quality of the nurses education taking it.
Lastly....as long as we all bicker amongst ourselves like those people on Jerry Springer maybe deserve to be treated as such.....and at least Gomer Pyle had a good heart. Peace.
Oct 2, '11Quote from linearthinkerI'm sorry......I'd rather jump off the brooklyn bridge than re-board. BUt my experence ia vastly different than that of the younger generation..... I think the certification process would suffice for this purpose as in. the CEN CCRN PCCN ect.I really do think a really good place to start would be to start requiring nurses to reboard every 5 years. We could lose a lot of ballast that way immediately. Let's face, a great many people who presently hold RN licenses should not. We should purge the ranks.
Basic literacy would also be good criteria.
Oct 2, '11Esme: I don't want to reboard, I just think we ought to. It is the right thing to do. It's the professional thing to do. I don't want to have to renew my driver's license every four years either, going to the DMV is a total PITA. But I get that it is important to try to ascertain drivers' competency and safety. I think at least as much care ought to apply to nurses.
Re: expense of NCLEX. The cost should approximate comparable professional board exams.
And I didn't even read the whole post by All4Seasons initially, but caught part of it in the replay referring to some of us as being sarcastic. I am only speaking for myself, but I would just like to go on record as making sure that all readers know that I am NEVER sarcastic. I simply cannot stand sarcasm. It is truly the lowest form of wit. I never use it. Ever. It is intolerable, and the very definition of "low-brow" in my opinion. In fact, and the is the god's honest truth (from an atheist) I don't permit sarcasm in my home. I don't allow my children to use it, we don't watch TV programs that utilize it as "humor" and I do not socialize with people whom speak sarcastically. Therefore, if you are reading a reply from me and are unsure if I am being sarcastic, now you know. Most definitely not.
That said, I reserve the right to be satirical if it amuses me.
Oct 2, '11Quote from carolmaccas66I'm not saying it would take 2 seconds to show me what to do....I'm saying it would take 2 seconds to tell me to grab my clinical faculty and go do it. The nurse wouldn't have to be there, because my clinical faculty would be. And, in this case, it would save her the time of having to do it because my clinical faculty, registered nurse (who, like I said, works at the hospital on her free time as well) would be there with me. I understand thoroughly why my nurse wouldn't show me-she's busy. But she easily could have let my CI show me (especially since my CI is ALWAYS on the floor).OK your illogic is getting to me now, I must say. Please read this statement carefully:
Sometimes RNs DO NOT have 'JUST 2 SECONDS' to grab you and show you what to do! We get very, very BUSY, sometimes insanely so. I have already detailed on here what some nights in my ED are like.
Oct 2, '11Quote from linearthinkerI think even if we re-board it will not bring the respect the profession deserves. I think maintaining certification like the CEN CCRN goes further in proving competence. When I renew my drivers license I don't have to take drivers ED and pass a test until I'm 75. I can renew on-line and only have to appear for picture taking every 8 years and then they only do a visual acuity. Getting my drivers license renewed doesn't show that I know how to drive. Do you have to take another drivers test in your state to re-new your license? Going to the DMV for a picture doesn't ensure competency. I hear what you are saying and I get it, I just feel it's more linked to what you said earlier...the QUALITY of the education and the standards they are held to that will elevate not how much we pay to get our license.Esme: I don't want to reboard, I just think we ought to. It is the right thing to do. It's the professional thing to do. I don't want to have to renew my driver's license every four years either, going to the DMV is a total PITA. But I get that it is important to try to ascertain drivers' competency and safety. I think at least as much care ought to apply to nurses.
Re: expense of NCLEX. The cost should approximate comparable professional board exams.
That said, I reserve the right to be satirical if it amuses me.
Oct 4, '11I've been thinking about this thread for awhile now and want to add something that hasn't been discussed.
The OP talked about the teamwork that goes into patient care. The concept of teamwork is much deeper than just showing up for clinical/for work. It takes time to build an effective team and it takes time for a new person to be fully integrated into the team. The existing members have to be able to gauge the new person's strengths and weaknesses, and must be able to trust that person to do what they need to do. This only comes with time. I'm speaking from experience here. I'm a new grad; I've been working for 3 months now. While my coworkers have been friendly, I've noticed a change in the last couple of weeks--I am starting to be fully integrated into our night shift team. I expected that it would take awhile; they didn't know me and my work ethic and knowledge base.
The deeper part of teamwork is what makes being a nursing student in clinical so difficult. You do so many rotations at many different floors or facilities (I was at 5 different acute care facilities and one nursing home through the course of my LPN then ASN programs). It's wonderful to get to see how different places operate, but at the same time it seems that about the time you're getting comfortable and the nurses and CNAs are getting to know you, it's time to move on. Nurses may not be asking you if you want to do/observe procedures because they're jerks but because you're not even on their radar, since you're not part of the team they work with everyday.
Nov 13, '11OH BOY ! I dont think this is anywhere near solved...but I appreciated hearing all opinions! I can tell you things I have agreed with while reading all these posts.
Students really are not very helpful and honestly no matter how much I like them which I like them (I do like most of them) they are always one more thing to factor into my day. (if you follow and keep up and just help out as needed thats great we truely do not need another opinion in most cases and will ask you when we do) I do not mean any of this to be rude.
I honestly have to say that nurses have been students but students are nt nurses and do not understand the issues yet. THIS plays a huge part in the arguement. It is not my job to be nice to you or let you do things, the drama that comes with a scared or opinionated student is just ridiculous to me in the big scheme of things, do not get me wrong I will not knowingly be rude or mean, I do understand that we all start somewhere and that you are human too. I obviously chose to work with people so I do not wish to get away from you, I don't mind teaching anyone along the way....BUT I do not KNOW you or your skill set, I CANNOT concern myself with your individual needs for skills or emotional support when I have a full assignment and am sometimes working short it is in my job description someplace to delegate.
If you are with me this would be an acceptable situation maybe ideal in my opinion. You are with me for longer than a few hours, you listen to report with me from start to finish, writing things down so you can ask questions when there is time, come to the patients bedside with me I know it is uncomfortable to some extent let me introduce you, or you introduce yourself briefly then step back watch how i work, take mental note of what you like about my approach and what you dont etc *this too is expirience.
Some of you are with instructors and will pass meds etc with them, please make known what is expected of you from them, I will tell you what I can and cannot do to accomadate you. usually at this time if you have heard of a certain procedure that needs to be performed we will have some small op to discuss if you are able to do it with instructor or if you willasssist me as I have the time to do it. If I have time I can teach you in the steps you would like things done in but I am betting on you having to run room to room with me to keep up and when I am ready to do something you will need to be present or you will miss out...I do not have time to wait for you to read a book or look up each individual med, nor do i have time to explain each one. I dont mind explaining procedures and I believe I can do so in a way that both you and the patient can understand and be comfortable with so please do not pry into why I did something a certain way in front of the patient. Or worse yet try and be a know it all and correct me or the patient at this time, please be curteous.
This will be repeated over and over all day long its like plan A, plan B, PLan A, maybe plan C nursing is changing every minute prioritizing for the good of all of the patients you take care of for the day. If you are responsible for only two of my patients then you are getting only a little part of the picture. You are not seeing a nurse organize thier day. You are getting a very narrow view.
Ideally you would be with one nurse even longer than a day. You would be there the whole shift. You would have time to organize your time and talk about EVERYTHING and chart with the nurse and learn many many skills and perform them in the order and frequenct required by your school....but this is the real world, patients are very ill, staffing may be poor, someone may code, someone may die, oh good grief anything can happen and thats what its all about...UNDERSTANDING. You have to roll with the punches, give people the benefit of the doubt, help out as much as you can, take notice of whats going on around you and try and learn something new, maybe even a skill. I would say alot of emphasis is placed on tasks and skills when so much more is gained from knowing how to read people, knowing when to pay attention, and being willing to help. Is it going to do you any good not help out? be a complete pain in the butt and demand things from people who owe you nothing? I am much more willing to ask the same student (even if we have 4 on the floor at once) to help me out again if they had a good attitude even if their skill level left some tobe desired than to try and track down someone with a bad attitude who gets good grades and needs to check this off thier list....again this is a long rant from an expirienced nurse who is hitting on just a small part of a heated issue.
Nov 13, '11Quote from DL-SNUPThat right there is the problem with "these days".You know, I do see what you're saying...but sometimes it can't be helped. For example, I've never inserted an NG tube. Most of my classmates have, but I've never had a patient who has needed one. I know the theory behind how to do one, and I've performed it on a dummy....but I know it's not the same as doing it on a patient. Is there anything my school can do about that? Not really, unless an instructor wants to let me do it on them. And it does get frustrating as a student when you miss these opportunities. For example, last week I had a patient who needed one, but the nurse inserted it without thinking about it. It would have taken two seconds for her to grab me and my clinical faculty and have us do it (my clinical faculty is also employed by the hospital as an RN, so it's definitely within her scope to do). She simply didn't think about it. And while I'm not mad and definitely understand what it's like to get in the grove of it, that opportunity might not present itself again before I graduate. So on one hand, I do see what you're saying. It has to be frustrating to be an experienced nurse having to do an NG tube type of thing with a student. But on the other hand...sometimes it can't be helped, especially with things that students can't practice on each other (ie....IVs, blood draws, so forth)....
Many of us who graduated from degreed programs (not diploma programs) didn't get to graduate unless we demonstrated proficiency in doing the nursing tasks that students get by with knowing how to do "in theory" or on a dummy. Before we graduated we darn well better be able to look at an order, gather the materials, explain it to the patient and perform the task. If we couldn't demonstrate proficiency at sinking a tube, starting an IV, inserting a foley, etc we got remediated until we could do it.
New grads got maybe 4 weeks of orientation in med-surg, because they already knew how to do nursing tasks and to think like nurses, they knew how to spot a patient going down the tubes.
I honestly don't know what nursing are teaching these days but it sure looks to me like many of them aren't teaching nursing.
And I'm galled by stories of people taking the NCLEX five, TEN times? Unheard of. Fail it twice and you had to return to school. Fail it four times and you were done. To be honest, I don't want some who can't answer 75 questions after 4 tries as my nurse or coworker.Last edit by kids on Nov 13, '11