This "us" vs "them" mentality....

Nurses Relations

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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.

Maybe I'm idealistic, but shouldn't we be trying to work as cohesively as possible so that we can combine forces and provide the best care possible for our patients? It seems to me like we're both equally to blame for the issues that seem to be going on. On one hand, it seems like nursing students need to be more willing to contribute and gain some perspective, realizing that while the staff nurse should *try* to teach us, it isn't their main focus. On the other hand, it seems like a lot of staff nurses are going into clinical situations with a negative attitude about working with students, which I really think can only make matters worse.

Can we really care for patients effectively if we're not on the same page and being professional to each other? I personally don't think so. I think that in any customer service business, having issues behind the scenes like this WILL impact the patient. And I'm so tired of all the finger pointing, because both sides are making mistakes. As a student, I am more than willing to admit that I have been less than enthusiastic when asked to perform something I've done a million times. It happens, and when I realize I've done it I try to change my attitude and do better next time.

Instead of all this negativity, why can't we just try to learn from each other, and accept and navigate the limitations of the time together? Students can learn SO much from staff nurses, and (believe it or not) once in a while a staff nurse can learn a new thing from a student. If we can accept that we're all (hopefully) intelligent individuals united in the fact that we chose nursing to help the patients, and see each other as imperfect people who face constrictions based on our role, it seems like everything would go more smoothly.

I know that it's not all nurses and students that are acting this way....it's just incredibly discouraging to see such a lack of teamwork from the members of this community. At the end of the day, all the students of today will be your coworkers soon, staff nurses. And students, soon we'll all have students that stress us out and make more work for us. Can't we accept that and learn from each other?

Sorry for the ranting....I guess my point is this:

Let's meet halfway.

Students: The nurses are stressed out and busy. Try to help. Ask what THEY want you to do. Tell them that you understand they are busy, but that you would appreciate anything they can teach you. SAY THANK YOU. Realize that it's about the patient. If that means that you miss getting to d/c a central line, there is always next time. If it means that you have to help out what with ADLS, I/Os, etc...realize that you WILL learn from that as well. Be grateful for the opportunity to learn anything you can, and always try to be understanding.

Nurses: Realize that a lot of students *do* realize that you don't want us around. We know that it's not your choice to have a student, but realize that we're not there to ruin your day. Realize that most students want to learn from you and value/idolize how much you know. We're sorry that we're often thought of as an annoyance or an extra task, because all we want is to learn from you so that we can care for our pts as well as you do.

Communicate with us. Today, I worked with a nurse who had 2 pts and was getting her 3 admits all at once. All it took was her saying to me "hey, I'm super busy right now. Can you keep an eye on pt 1 and 2 while I admit these new pts? I'll come find you when it calms down or if there is something I think you could really learn from". Seriously, 3 sentences and I was able to feel like I was helping and not simply being ignored. I don't care how busy you are, but communicating with your team (and a student is a part of that team) is such a priority.

Like I said, maybe I'm just idealistic. But from my experience with other jobs and life in general, if we can just take a deep breath and do our best to make the "behind the scenes" dynamics positive, it will help our patients. Because at the end of the day, that's what ALL of us really want, right?

Specializes in ER.
Not saying it's easier- I'm saying that it takes 1/8 of the failing grade from the 'dark ages' to pass.....our students that failed could have 599 right, but fail. Basic patient care needs have to be good enough to at least do SOMETHING on their own.....a PCT can take the vitals, the nurse needs to have the 'real' skills.....they are not trivial :)

We can agree to disagree :D I'll still sleep- and still feel the students' got ripped off.

The real "skills" are minimally invasive procedures that the MDs got bored doing themselves. Historically, it was considered too complicated for an RN to take BPs; now, a tech does it. Most of what we do including foleys and iv starts are not skills and can be learned readily by pretty much anyone so yes, i can consider them trivial activities. I believe these skills are generally performed by an RN because it increases accountability but not because they are difficult.

As for doing it themselves, I will happy supervise and teach but you need to do it to know it and that doesn't require much other than watching a youtube video and having a basic understanding of sterile procedure so no, don't care if you never practiced one in skills lab either. Heck, half of the equipment varies from place to place.

The truly protected activity of a nurse is assessment and development of nursing plan of care that follows.

The real "skills" are minimally invasive procedures that the MDs got bored doing themselves. Historically, it was considered too complicated for an RN to take BPs; now, a tech does it. Most of what we do including foleys and iv starts are not skills and can be learned readily by pretty much anyone so yes, i can consider them trivial activities. I believe these skills are generally performed by an RN because it increases accountability but not because they are difficult.

As for doing it themselves, I will happy supervise and teach but you need to do it to know it and that doesn't require much other than watching a youtube video and having a basic understanding of sterile procedure so no, don't care if you never practiced one in skills lab either. Heck, half of the equipment varies from place to place.

The truly protected activity of a nurse is assessment and development of nursing plan of care that follows.

But YouTube should not be nursing school :) They need to have the "basic" (or trivial if you prefer) skills before they graduate. Yes- they have to hone their skills in their early years in nursing.

Low expectations results in mediocrity at best imo. I don't think that's acceptable. My opinion. :)

I'm not used to the YouTube nursing school, and find it almost criminal that schools are charging students to get a generic computer education- who knows how qualified the video demonstrators are.... Just sad .....

Knowing how to do it is the problem- they don't . On the First Year forum, I asked about what students felt they missed out on in nursing school....nearly all said clinical exposure and skills. This isn't my drummed up idea- I asked. :o

Specializes in Oncology/Haemetology/HIV.
How come you never see the ultrasound, PT, OT and med students being treated the way nursing students are treated...? In regards to the "I don't want you here, **** you" type attitudes?

There needs to be more camaraderie.

In the case of med students, there is a good reason.

They actually do a lot of the work on the floor.

Watch one, do one, teach one.

They aren't one the floor, a few hours, once or twice a week. They don't come in "cold", having to be brought up to speed. They are there before dawn breaks and before their resident shows, already having reviewed the chart, tests and orders.

They also rarely refuse a procedure, just because they have already done it....they know that they need to practice. They do not

consider any work "beneath them". Many even give up seats for the nursing staff, get pts a cup of water, get out their own supplies, clean up after themselves and try to help, and be less than a hindrance. Even change a linen or two when they have soiled it during a procedure.

On the other hand, nursing students:

I have assisted students in a procedure, or gone in after they did a bath just to find dirty linens on the pt's floor. Have a pt that has an order to push fluids, and the pitcher dry as a bone.

I recently had a student, a very nice girl, but dense. I needed to eat lunch, and she was going to "cover" w/another nurse backup for any issues. I'm really glad that I didn't leave the floor.

Call lights went off, the room number was paged repeatedly..... She would "forget " to answer. Monitor alarms would go off.... She was oblivious. Yes, often they were false alarms, but I had explained REPEATEDLY that you must check the rhythm/pt. She would be rattling on with staff, just ignoring the alarms, call bells and pages. It never seemed get through.

If a med student did this, they would be out.

Specializes in ER.
But YouTube should not be nursing school :) They need to have the "basic" (or trivial if you prefer) skills before they graduate. Yes- they have to hone their skills in their early years in nursing.

Low expectations results in mediocrity at best imo. I don't think that's acceptable. My opinion. :)

I'm not used to the YouTube nursing school, and find it almost criminal that schools are charging students to get a generic computer education- who knows how qualified the video demonstrators are.... Just sad .....

Knowing how to do it is the problem- they don't . On the First Year forum, I asked about what students felt they missed out on in nursing school....nearly all said clinical exposure and skills. This isn't my drummed up idea- I asked. :o

I guess that's what it comes down to. I don't think they missed anything. I think they missed out on something that they have defined as nursing: namely, skills. I certainly knew a lot of people who felt like that when I went to school too. Its too easy to call nursing a collection of skills and its too easy to point to it as being what they missed out on. Thank god nursing professors do not spend their time worrying about what a bunch of nursing students think they should be doing. IMHO, its almost narcisstic: this desire to "do" something to the patient. How about PAY attention to the clinical picture instead?

Let me just say to those folks: you won't save a life because you know how to start an IV. There will be plenty of people in the room who can do it instead. You save a life by advocating for a patient that you observed to have a serious situation. (critical thinking and advocacy, not skill sets.)

PS: Your future employer won't care to ask you about how many ivs you started or foleys you did. They will ask, "Now, what would you do in this situation?" to judge your ability to make decisions, act under pressure and think.

Specializes in Peds/outpatient FP,derm,allergy/private duty.
I also think it's completely backwards and asinine to think that an instructor can teach up to 10 students all the ins and outs of skills, patho, and things like that on her own without SOME help from the nurses on the staff.

To you guys that are opposed to having students and teaching, what do you think should be done? Because apparently there's a lot of "I got mines! Good luck" type attitude and that is counterproductive. I mean if you aren't going to try to revamp the nursing education system and change it, then I suggest you just keep quiet about it or try your best to be a good teacher.

I mean, I've never seen other disciplines in the healthcare field act like this.

Med Students: The resident/attending is right there beside them explaining every aspect of the procedure or disease process even if they have to round 40 patients by 10 am.

PT/OT: The student is right there helping get patients out of bed and documenting with the supervision of a licensed PT/OT.

Either way, I don't receive the "I'm not welcomed here" vibe from students of other disciplines. But for nursing students, it's like we have to hide in the closets or something or are looked at as vermin. Umm hello...

I often see nursing compared to med school, PT and pharmacy when many times the only similarity is that they all fall under the umbrella of "healthcare job".

You would have to compare far more than what was said above to make a valid comparison, and if you think an intern isn't left saddled with a whole lot of unexpected things he or she must deal with on the fly with nobody senior to them anywhere near by -- it just isn't true.

Physical therapy programs have the students out working doing simple tasks very early on in their program and my daughter has the equivalent of a full-time unpaid job unsupervised handling sports injuries at local colleges and universities in her last year of her PT program.

If you ever get a chance read blogs written by medical students - many are genuinely hilarious but nursing students who think medical school doesn't have a caste system of sorts will have their eyes opened in a hurry. :)

Sample NCLEX questions.....look pretty basic....JMO :D

http://www.studyguidezone.com/nclexrn_practice1.htm

lol these would be considered "low level passing" questions for NCLEX. If you took the NCLEX and were given nothing but the above questions, you'd fail as you'd be showing minimum competence.

Specializes in Med/Surg, DSU, Ortho, Onc, Psych.

I feel like I'm being told off by a student. And it's not a good feeling as a RN, I must say.

OP, I do agree with the us & them mentality as I mentioned in another post.

You are not a RN yet by the sounds of it (or whatever other nurse you are trying to become).

We RNs/staff nurses DO try to be polite and to teach students as much as possible; we WANT you to learn to become a better nurse. I said in another post that I've probably been lucky - I've pretty much had enthusiastic, proactive students who ask questions and are willing to learn, but perhaps it's because I treat them pretty much like humans. I dunno.....

To me, if a student doesn't want to learn & stands against the wall, I just let them be. The time will come when they are suddenly a RN and they haven't a clue what they should be doing. They WILL drown & probably end up getting sacked, or resign.

But when you have oh so many insanely drunk, psychotic, demanding patients and their families practically screaming at you, & grabbing your shirt as you race down the corridor - in places like the ED/ER - it is very hard some days to focus on teaching and to try not to sound harrassed.

I ask respectfully; have you ever been the charge nurse, and worked in a ED/ER that is NOT on divert - in other words, we take everyone and anyone cos the other major hospitals are ALL FULL. That means that EVERY BED IN THE ENTIRE STATE IS OCCUPIED. Your cubicles are full; your corridors are full; your chairs are all full, triage is full. And these are all patients who still need hourly VS/OBs, who need bed pans, who need comforting, who need medication, who are screaming in pain & want a nurse there RIGHT NOW. There are the drunks yelling out and laughing, there are kids who have been in MVAs who you have to assess along with mum and dad who've just had their car & maybe their lives destroyed - probably by one of the drunk drivers who came in - and who is laughing hysterically at everything going on. There are 92 year old people, patiently waiting in a cold corridor to be seen by the doctor. There are NUMEROUS patients constantly asking the same question: WHEN WILL THE DOCTOR SEE ME? My same answer: the doctor will get to you as soon as he/she is free - there is no time limit I can give you. We don't have enough doctors, nurses or even students to help out. There are labs to check, xrays/scans to be viewed, IVs/narcs to check and give, and people to be moved to xray or wards, there are meals to give out cos catering don't have enough staff (& they don't do that in our ED/ER). There are all the other duties to be done plus other VS such as neurological checks. There's head injuries, bleeding everywhere, there are people we've just discovered have massive lumps they didn't know about and now they are freaking out. There are people suddenly bleeding, seizing, having a psychotic episode, violent people punching nurses then being dragged out by the police (and I do mean DRAGGED OUT) screaming, there are kids wailing, worried parents and grandparent, families who want to speak with you for counselling re their loved ones and who want to tell you all THEIR problems too, phones and bells ringing.....I could go on and on.

And you are telling us RNs that we have to take extra time to be patient and to do teaching?

Unfortunately, until you have a little more experience and you have been THE NURSE IN CHARGE of these crazy work places, I really think your view of the real world and the 'student' world is somewhat fantastical.

Just do the best you can and be proactive. We are not all rude or ignoring you, we are BUSY, sometimes insanely busy. Just don't take it personally, get on with some work and try to mature a little bit. I'm tryint to say nicely, grow up and just get on with it.

Oh and NURSING is completely different from other fields. I've also had 'managers' from other fields tell me: management principles are the same everywhere you go. No, it's not - nursing is a completely different type of management, with time management and trying to find darn beds that don't exist, being the main priority.

Specializes in Cardiology and ER Nursing.

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Knowing how to do it is the problem- they don't . On the First Year forum, I asked about what students felt they missed out on in nursing school....nearly all said clinical exposure and skills. This isn't my drummed up idea- I asked. :o

I once worked with a Nursing Tech who was also a fourth-year nursing student at a prestigious University. She did not know how to place a bedridden patient on a bedpan. :eek:

I'm not kidding.

Specializes in Oncology; medical specialty website.
You know, everything the OP has said here is true. We (students) need you (experienced nurses) and you need us. We will be the ones working along side you after graduation. Do you want us to know a little bit about what we're doing or get annoyed at us because we have no clue? We're not too slow to understand that staff shortages, instructor shortages, crashing patients, and your job in general make it difficult to teach and even delegate sometimes. But....how did YOU learn?

This is the third post this week I have read with a majority outlook of negativity towards students.

I know there will be no tears shed, but I think I'm just about through with the general threads of AN. I think the majority prefers we stay our little happy student selves in the student forum.

And beast master RN, your info says you have all of 2 years experience. Think it's time you got over YOURself.

Did you even read any of the other replies? We learned because we had a clinical instructor there breathing down our necks. We weren't dumped on some hapless staff nurse who already had far too much on her plate. And with customer service being stressed the way it is, it's even more stressful on the floors these days. Then throw in a student who expects you to be constantly available: physically and emotionally. We only have so much of ourselves to go around.

Specializes in Med/Surg, Academics.
So the DEU is the hospital having to clean up nursing school....an expanded preceptorship. How sad that something like that is needed.

I'm only up to this post, so I hope I'm not repeating what others have said.

A DEU sounds similar to a diploma program, but within the constraints of the current healthcare system. I disagree that it's "cleaning up nursing school," just like most diploma graduates of decades ago would probably not look at their education structure as "hospitals cleaning up nursing school."

75 correct answers is not reassuring about the competence of a nurse......sorry- not much will change my mind :)

Keep in mind that it's even worse than that -- 15 questions of every CAT NCLEX are questions that are being validated for inclusion in future exams, and are not counted toward a final score. So, people who passed with 75 questions really only answered 60 questions to get a nursing license ...

(BTW, I completely agree with everything else you've said on this thread, also.)

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