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

[DL-SNUP]

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?

[SeeTheMoon]

Esme, you read me wrong. Believe me, I do not have a sense of entitlement, at least I do not intend to come across that way. The only thing I am entitled to is a good education that I am busting my fanny for and paying mostly out of pocket for.

No, it is NOT the staff nurses responsibility to teach the students. You are paid to do your job. But what the OP is addressing, (or at least it seemed to me) is that there does seem to be an air of animosity towards students. In the hospital setting and even on AN sometimes. And I agree with her. As I said, I have seen several posts this week by students that it just seemed they were getting slammed.

I agree with another poster that it is not too easy for me or any student to make an asumption on what it's like to be a nurse. You are the only ones that have done both: been a nurse and a student.

But I don't think it is fair that as students we are given very little support in the way of making our own. Is life fair? Nope. Do we need to get over it and put our big girl and big boy britches on? Yep. But this is supposed to be a place to vent, even for us sometimes.

Try to remember all students do not have this "give me, give me" mentality and, "what can you do for me??". Trust me, we don't. We know you are over worked and under paid and appreciated, and we will be right there with you in a few years, even a few months for some of us. And that's all we ask is to remember that. We will be right there with you.

[OCNRN63, RN]

Esme, you read me wrong. Believe me, I do not have a sense of entitlement, at least I do not intend to come across that way. The only thing I am entitled to is a good education that I am busting my fanny for and paying mostly out of pocket for.

No, it is NOT the staff nurses responsibility to teach the students. You are paid to do your job. But what the OP is addressing, (or at least it seemed to me) is that there does seem to be an air of animosity towards students. In the hospital setting and even on AN sometimes. And I agree with her. As I said, I have seen several posts this week by students that it just seemed they were getting slammed.

I agree with another poster that it is not too easy for me or any student to make an asumption on what it's like to be a nurse. You are the only ones that have done both: been a nurse and a student.

But I don't think it is fair that as students we are given very little support in the way of making our own. Is life fair? Nope. Do we need to get over it and put our big girl and big boy britches on? Yep. But this is supposed to be a place to vent, even for us sometimes.

Try to remember all students do not have this "give me, give me" mentality and, "what can you do for me??". Trust me, we don't. We know you are over worked and under paid and appreciated, and we will be right there with you in a few years, even a few months for some of us. And that's all we ask is to remember that. We will be right there with you.

There are times students bring it upon themselves. The "Do my homework for me" threads. The "I'm just a student, but I would never do blah, blah, blah" posts. The "I may only be a student but I wouldn't want you taking care of my father/mother/sister/parakeet" posts. The "My preceptor hates me...she didn't say 'Hello' this morning" threads.

We know how hard it is for students. Who would "get it" better than someone who already walked that walk?

[xtxrn, ASN, RN]

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.

But getting out of nursing school does imply that someone is competent to sink an NG, put an IV in, a Foley, check NG placement for meds, do accucheks when conditions change on a diabetic, etc.....the SKILLS are very basic- and not CNA-level. Yes- they also need the critical thinking- but if they can't get past cramming food into a lethargic, diaphoretic diabetic, how can they be trusted with anything else?

Nursing involves skills and thinking/planning. How many students "drop off" their homework here ,and don't even participate in the discussion? No thought involved at all- just the ability to make two fingers flutter around a keyboard (gotta give credit to the ones who at least don't "text" message- LOL

Yes- in a code situation an IV could save a life....and NO not all places have someone else to do that job (that is a HUGE myth). Why have the attitude that someone else can do it? They have the same RN license- why is someone else picking up the slack for someone else's ineptitude??? Why is that even remotely ok?

Now, there are units in hospitals to deal with that- which should not be the hospital's problem. They are the clean-up team for lousy nursing schools. It's pathetic. AND unfair- to the students, and the nurses who do not want to teach. I enjoyed it. But my patients were my first priority- NOT the student who has a clinical instructor who isn't doing her (his?) job. THAT instructor probably scraped by with a whole lot of "mediocre" and was accepted into the teaching end of things because of not being able to do the job herself (not ALL--- I know there are some good ones being identified- but the MIAs can't be considered as competent when they're nowhere to be seen.

JMO..... :) And it's not likely to change - but I do feel badly for both sides of the issue. The staff nurses are out of school...this is not their battle to fight. The students need to demand decent education- by not going to schools that don't emphasize clinical skills; theory can be learned later (even us "trailer park" ADNs can think with the "gated community" BSNs- and have the clinical chops to earn our keep-- the housing issue is just a metaphor- don't anybody go getting all twisted up over that- the battles don't stop with student vs staff nurse....the distaste and condescension continues w/some major superiority attitudes towards more than that).

[BeenThereDoneThat74, MSN, RN]

I think it's funny how this thread turned into an "Instructor Bashing" thread (I only got through page 3 or so). And yeah, I'm being sarcastic.

It seems that we are dealing with a lot of different methods of teaching and learning in programs throughout the country. We're dealing of schools of different calibers, different standards/guidelines.

I'm not sure what upsets me more here: the seasoned nurses who are blaming the schools/instructors for the disconnect between student and graduate, or the number of people who state that the instructors are not teaching while in clinical. I am not naive by any means. I only know what I do (and the rest of my colleagues in my school and neighboring schools, as reported by my RN friends/colleagues), so yeah, I feel the need to defend myself, as well as enlighten some of you on how some schools run their clinical days.

I NEVER leave the floor while my students are caring for patients. I'm afraid to even go to the bathroom . Am I with every student with every patiient contact? No, I can't clone myself x8. But I am there to assist, answer questions, question them, go over things that are relevant, and there to administer every single medication with them (since it's my signature on the MAR). BTW, do you have any idea how long it takes to get 4 students ready to give meds? This is what the majority of my clinical day is spent doing.

Where I work, we don't have check-offs in clinical. Anything that they need to be signed off on is done in lab, and we (the instructor) checks them off. And if we did had clinical check-offs, I'd be the one signing them off. That's not the nurses job.

I am very grateful for the nurses who help me out in any way they can. A select few on my unit are awesome: they love having students, and they utilize them in a way that I cannot possible oversee. They'll ask them to check on one of their other patients, maybe do a set of vitals, empty a foley, whatever. The students are learning, keeping busy and learning to communicate with staff.

At the very least, I expect these things from the floor nurses:

- A brief report for the student (I want the students to hear what they feel is important to know)

- Any serious/pertinent updates during the shift

- The common courtesy of communication (it goes both ways, and my students know this)

Anything they choose to do above that is gravy. It's my job to teach my students.

In return, my expectations from my students:

-communication toward the staff nurse (don't just walk into pts room, let the RN know you are caring for THEIR patient)

-updates on pts condition that they may discover

-sign off at our day's end

I learned this early in my teaching career: the students need to know which questions come to me, and which go to the RN. I got balled out for a student asking the RN a stupid question (don't even rememeber what it was, a long time ago). When in doubt, they ask me, and I'll let them know that this is a question/issue for the primary RN.

So, in short: while I feel that many said it in a rather kurt way here, I do agree: it is not the RN's job to teach the students. Unless they signed up for precepting, or are on a DEU (which I think is a great idea). I've never thought as a teaching hosptial in a nursing sense. We utilize clincial sites that are not teaching hospitals.

[xtxrn, ASN, RN]

Then you aren't one of the problems :)

[linearthinker, DNP, RN]

The reason I won't teach nursing students (besides the obvious facts that I am not nursing faculty, am not adequately educated in pedagogy and am not being paid to teach) is that I get all of the responsibility and no power. IMNSHO, the bar is set way too low for today's NS. I'd throw half of them out for being a) lazy and b) stupid. My cousin is in a RN program, and that girl is dumber than a sack of hair. I read posts here all the time from people that I desperately hope are not really nurses, b/c they sound dumb as he//. Half the nurses I know are an embarrassment to the profession and given the opportunity there is no way I'd ever have let them pass. So if you wont give me pass/fail authority, don't ask me to teach them anything more than where the bathroom is. I hope they already know how to flush the toilet and wash their own hands, but I know better than to count on it.

[VICEDRN, BSN, RN]

But getting out of nursing school does imply that someone is competent to sink an NG, put an IV in, a Foley, check NG placement for meds, do accucheks when conditions change on a diabetic, etc.....the SKILLS are very basic- and not CNA-level. Yes- they also need the critical thinking- but if they can't get past cramming food into a lethargic, diaphoretic diabetic, how can they be trusted with anything else?

Nursing involves skills and thinking/planning. How many students "drop off" their homework here ,and don't even participate in the discussion? No thought involved at all- just the ability to make two fingers flutter around a keyboard (gotta give credit to the ones who at least don't "text" message- LOL

Yes- in a code situation an IV could save a life....and NO not all places have someone else to do that job (that is a HUGE myth). Why have the attitude that someone else can do it? They have the same RN license- why is someone else picking up the slack for someone else's ineptitude??? Why is that even remotely ok?

Now, there are units in hospitals to deal with that- which should not be the hospital's problem. They are the clean-up team for lousy nursing schools. It's pathetic. AND unfair- to the students, and the nurses who do not want to teach. I enjoyed it. But my patients were my first priority- NOT the student who has a clinical instructor who isn't doing her (his?) job. THAT instructor probably scraped by with a whole lot of "mediocre" and was accepted into the teaching end of things because of not being able to do the job herself (not ALL--- I know there are some good ones being identified- but the MIAs can't be considered as competent when they're nowhere to be seen.

JMO..... :) And it's not likely to change - but I do feel badly for both sides of the issue. The staff nurses are out of school...this is not their battle to fight. The students need to demand decent education- by not going to schools that don't emphasize clinical skills; theory can be learned later (even us "trailer park" ADNs can think with the "gated community" BSNs- and have the clinical chops to earn our keep-- the housing issue is just a metaphor- don't anybody go getting all twisted up over that- the battles don't stop with student vs staff nurse....the distaste and condescension continues w/some major superiority attitudes towards more than that).

The skills you refer to are absolutely suitable to a CNA/tech and I have seen a tech do every ONE of the skills you just mentioned. IV starts, foleys, even drop an NG (was a nursing student but unlicensed all the same). In homes and schools everywhere, people are receiving all kinds of meds and feedings through all kinds of accesses and they are being administered by NON RNs and the patients are surviving.

The logic that you need to have basic manual skills to grasp concepts of patient assessment is flawed at best. You do not need to "earn" the respect of other nurses by "proving" you can start an IV before being exposed to actual patient care. In fact, its bullying and its very common in nursing and its one of the ugly unprofessional sides of nursing that make me often embarrassed to be counted among us.

Imagine the pressure. You are weak at a skill or just never got exposed to it in nursing school and now, some undereducated bully is judging your entire ability to provide safe effective care because you just never dropped an NG before. So sad for the little newbies.

Unless you plan to code the patient yourself, there will always be another person in the room besides an RN. For example, an MD will likely attend and while I have no idea how many codes you have attended for patients that have no access but its a common issue and even the best sticks in the house may still not get it. Don't know how many times I have had to stick another nurse's patient because she just wasn't getting it and I don't make some big stink about it like its a reflection of her skills and neither does the MD when they drill the IO or start the central line.

I have no idea why anyone would call that a "myth" and I certainly can not entertain justifying that starting an IV is more important than identifying a coding patient but hey, that's just me. Don't know how many times I see nurses minimize or undervalue a tanking patient. I would trade any of their "skills" in to rewind back a few hours and have them identify and intervene when it would be more effective.

As for the educational units described in this thread, I am not remotely impressed by the argument that hospitals now have to "make up" for nursing schools' failure and that this is somehow costly to the hospital. Most of us came out of school to expensive, time consuming contracts that ensure the hospital gets all of its training money back (though I have to see a single RN get all of the training as promised) AND most of what they "teach" you when you start in a hospital is a requirement of regulatory bodies that require hospitals to show that each member of the team has received appropriate training in their field.

For example, every hospital will require you to check off on the accucheck machine and while you can sit here and fuss about how nursing students just "SHOULD ABSOLUTELY KNOW" that, they will soon be wearing their fancy RN scrubs with a fresh RN name badge....aaaaand...wait for it...sitting through some two hour class and check off on the glucometer. And the next job you take or I take? Yup, we are gonna be checking off on it too. JCAHO requirement after all.

The real issue here is a philosophical one. Which direct is nursing moving? Will it be a skills based job? (Gosh, I hope not! We are overpaid and overtrained for it if so) Or will it be assessment based? (Hope so!) The tension you describe in your last paragraph is real and palpable to me too but I suspect we sit on different sides of the aisle.

[xtxrn, ASN, RN]

The ED is not the same as the floor....whatever- we're both firm in our positions.

We still have lousy new grads out there with no skills. All the theory in the world will not get the job done without the ability to actually DO something.

Have a ball in your padded-staff situation...pray you never hit the floors as a staff nurse there. :)

Techs aren't allowed to do all of that in every state...you want those patients sent to your lovely little Nirvana of so many unlicensed staff???

If you did bedside nursing, you'd probably get it- aside from just wanting to let someone else do the job....?????

And skills being required for assessment skills wasn't my issue- of course they're different. They need BOTH.

[Esme12, ASN, BSN, RN]

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 narcissistic: 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 foley's 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.

I beg to differ....without IV access the patient wil die while everyone else is discussing the clinical picture to advocate for the patient for someone to start that IV. I have been asked on many occasions....How good are you at IV's as the resource person. Without that IV access.....the patient will die. If not the nurse then who starts them where you work? Not all hospitals have IV teams (which by the way are RN', in my experience). And not all ED's have resident/fellows and Medics.

For me I believe that the lack of the skill set is what is damaging bedside nursing which is just as important as any other speciality in nursing itself and without us at the bedside....who cares for the patient while we are analyzing the clinical picture. When I went to school I got the best of both worlds.....diploma Is placed on the college campus and professors for the academics. I had the clinical of the diploma grads and had to fit college in between.

I have no narcissistic desire to help but I do enjoy "nursing" and being a nurse.Isn't it and example of the "us versus them" in the post? I believe that we have swung to an extreme away from being nurses and will educate ourselves away from the bedside. I have always been very proud to be a bedside nurse, just a bedside grunt, taking satisfaction from a job well done. I have always wondered at the look of disdain when I've been asked about furthering my education and saying I'm very happy

being the best bedside nurse I can be.....just a bedside grunt that has no ambition for any higher education.

I hope the pendulum swings back the other way and being a bedside nurse is OK and having a good set of skill sets is an asset and not a lack of education looking at the clinical picture long enough to hold someone's hand.

It's just my opinion and you know wha tthey say about opinions....they're like.....umm....noses..... and everybody has one that's different. :redpinkhe

[xtxrn, ASN, RN]

Without beside grunts, that ED would get pretty backed up, eh?

[Esme12, ASN, BSN, RN]

Without beside grunts, that ED would get pretty backed up, eh?

:lol2:Yes it would...

[OCNRN63, RN]

The reason I won't teach nursing students (besides the obvious facts that I am not nursing faculty, am not adequately educated in pedagogy and am not being paid to teach) is that I get all of the responsibility and no power. IMNSHO, the bar is set way too low for today's NS. I'd throw half of them out for being a) lazy and b) stupid. My cousin is in a RN program, and that girl is dumber than a sack of hair. I read posts here all the time from people that I desperately hope are not really nurses, b/c they sound dumb as he//. Half the nurses I know are an embarrassment to the profession and given the opportunity there is no way I'd ever have let them pass. So if you wont give me pass/fail authority, don't ask me to teach them anything more than where the bathroom is. I hope they already know how to flush the toilet and wash their own hands, but I know better than to count on it.

I know what you mean. I just read a post on another thread that left me wondering if the writer was stroking out/heavily medicated/just plain illiterate. I certainly hope she communicates IRL better than she does on a MB.

The post from "nurse educate" referring to clinical sign-offs made me think of that little procedure book we had to carry around on clinical. It had all of the required procedures you had to do to progress to the next level. If people think "Survivor" gets dirty, they should have seen how it got when you had a bunch of people vying for the chance to do the more uncommon procedures.

I get impatient with myself; I really don't have the temperament to take on a student. Students require more nurturing than I can provide while trying to get my job done.