This "us" vs "them" mentality.... - page 12

by DL-SNUP

10,715 Unique Views | 134 Comments

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... Read More


  1. 3
    Quote from snazzy-jazzy
    Just want to say to the OP, oh well at least you tried.

    Over my last 4 years as a student I have been made to feel like the dirt under someones nursing shoe about 3 times. I have had a lot more great experiences with both Nurses and Midwives, that have made me feel a part of their team. That have said thankyou to me, when I have thanked them for sharing their shift with me. And I never have an instructor come to the floor and do skills with me, all my skills are done with the nurse or midwife.

    I really can't get over how high and mighty some people on this thread think they are. Yes I get that you hate pesky students, but is there any need to be so rude about it. After reading this thread, I think its important for other students who may be reading this to remember that the nurses bagging out having students only represent a small minority of nurses and not all nurses.
    Thanks! At the end of the day, the message that I was trying to get across is that "This is how it is". Whether or it is or isn't fair, nurses have to work with students. That's real life nursing. But it's not fair to punish each other for something that neither party can help....and being constantly negative, angry, and bitter will not facilitate patient care. Because I don't care what anyone says---when you're in a bad mood, it's going to come off to your patient. If you're busy being annoyed that you have a student/the RN your working with isn't 'nice', you're taking time that could be spent a) learning something and b)helping your patient.

    I'm not asking for nurses to become the teachers of students, or to be excited about having one. I'm simply asking for some understanding that poor attitudes are a waste of time and energy, and don't benefit anyone. Sure, sometimes you can't help and you'll be annoyed. I get that. But getting an attitude adjustment will go along way (on both sides).

    Students need to realize they aren't the center of the universe, that the patient is. And the nurses need to stop taking their frustrations with the system out on the students. At the end of the day, I'm hoping that most of us, registered or not, are semi-intelligent people who deserve respect. Treat people how you would want your mother/father or daughter/son to be treated in their situation.

    Seriously...we're all adults, and we should all act like it. That goes for nurses and students across the board--there is NO excuse for cruelty.
    ProfRN4, SeeTheMoon, and xtxrn like this.
  2. 5
    Quote from vicedrn
    so...here is the reality of my job. the real, grown up reality. i have five patients at any given time, most of them fairly critical because this is the regional trauma center in a large urban center. there is one tech for 30 patients and the phleb covers closer to 100 patients. the phleb might draw labs on one of my patients at some point during my shift. the tech changes out dirty linens carts and hides somewhere deep in the hospital for the rest of the shift. (unless it happens to be a nursing student who hangs about doing nothing related to actual tech stuff.)


    otherwise, i must do all of your precious skills for every single one of the countless patients i see. draw labs, start ivs, foleys, ngs. unless of course one of the unlicensed unsupervised med students does it...

    while i do it, (and speaking of reality) i consider the fact that the hospital probably employs $10/hr phlebs and techs to draw labs and do other unlicensed skills because they don't want to pay me $23/hr to do so and i wonder how long until they bump the patient load up for me and start demanding that the tech show up to do the tasks. the reality is that it makes no business sense to pay me to do the work.

    as for what other states protect, i am aware that plenty of states protect plenty of activities for nurses. i feel comfortable that sooner or later that will end or the decent salary that is associated with the same will erode as healthcare and really nursing advances past a lot of skills that really don't require a nurse to do them.

    do i mind doing the tasks? no. its mindless work. it is similar to untangling my phone cord or unraveling string. i do "bedside nurse" in the er and i do get "it." i just don't agree with it. that's the part you have dead right. the new grads don't need skills and i assume they start with none and caution them outloud in person (because i am a real person) not to get all hung up on what they can and can't do. it'll come in time but they need to be sure and holler if someone starts, you know, crumping.

    to the poster who states er needs the floor for throughput: as for where the patients go after they leave the er, most return out the front door. i really don't care whether or not you accept report from me or "hold" your beds. i will just do what any professional does: document and calmly contact my supervisor. its not my problem if you choose to interfere with the throughput in the er and sensible calm people resolve these issues without judgment or reservation.

    what you don't seem to get is that your reality isn't the only one out there.....the floors have a very different reality that relies on assessment and technical skills. i never worked in a facility where someone did the ngs, ivs, foleys, chest tube maintenance, cvc maintenance, etc....it's the bedside nurse that does it.

    great....you have "underlings" to do the 'mindless' work....have a ball.....but why so ballistic about what is fact for a lot more floors than eds.... ???? why can't you understand that the floors don't work the same way eds do? and the nurses there need to know what to do with the actual skills .... this is such old information.... and maybe that's the issue- you don't know how it's done on the floors because you've never worked them? idk- but it sure sounds like you're not understanding what nurses on the floors actually do. ed bedside isn't the same as the floor at all....you have a much different set of stressors and demands. but that doesn't mean that the floor nurses who need new nurses to not be lacking in the basics are not living in "reality"....

    they aren't "my" skills.....they're basic "get-out-of-school" and be useful skills - the bottom of the barrel skills that many aren't getting. they are the ones who say so....not my battle anymore.

    the volume of patients you see is way different than the floors- of course you need ancillary staff, and have different priorities. duh. that doesn't change the floor nurse load a bit. yep- most ed folks go home. and some times you get slammed and are waiting on the floors to empty out and rearrange things so you can free up beds- i understand that. but don't knock what you don't work.

    getting bored with the superiority....
  3. 2
    Quote from xtxrn
    [B][I][SIZE="3"]

    They aren't "my" skills.....they're basic "get-out-of-school" and be useful skills - the bottom of the barrel skills that many aren't getting. THEY are the ones who say so....not my battle anymore.
    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)....
    SeeTheMoon and xtxrn like this.
  4. 0
    Quote from DL-SNUP
    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)....
    I understand that - and that's my beef with the education you guys got- NOT you personally. You needed to get that stuff (as much as possible- I get that patients don't just appear w/stuff you need to do ). I was GLAD to help a newbie do stuff- but it was very helpful if they had the basic info re: equipment needed, measuring the tube, etc.... Being new isn't the issue....it's the long list of things SO many here have said they don't get to do (or even get much exposure to) AND they don't know how to walk through it verbally- at least partially (I expect some stuff to be missing simply from not having done them). I don't blame the students- they're doing what the CI tells them to....you're stuck.

    It's just really new to the older folks that this stuff is taking a back seat when bedside care of some sort is where most folks end up, at least initially.
  5. 1
    Quote from xtxrn
    .

    great....you have "underlings" to do the 'mindless' work....have a ball.....but why so ballistic about what is fact for a lot more floors than eds.... ???? why can't you understand that the floors don't work the same way eds do? and the nurses there need to know what to do with the actual skills .... this is such old information.... and maybe that's the issue- you don't know how it's done on the floors because you've never worked them? idk- but it sure sounds like you're not understanding what nurses on the floors actually do. ed bedside isn't the same as the floor at all....you have a much different set of stressors and demands. but that doesn't mean that the floor nurses who need new nurses to not be lacking in the basics are not living in "reality"....

    i don't have underlings to do mindless skills, do i? i basically told you that in the last post. i do them myself. for the record, the phlebs draw labs on the floor here too and i know a fair number of rns that have never started an iv because several of the big local hospitals insist that you call iv team! plenty of resources at lots of places, perhaps just not at yours!

    for the record, i spent 6 months on a floor at the end of nursing school in a preceptorship (my preceptor read a book while i did her job) and i have tons of friends that work on floors and i try very hard to follow their stories too! it is different but i sure hope the floor folks know their pharm before they worry about their skills.

    i guess if they lack skills, they can come slow their roll with me. i don't mind and i think they can pick it up quick. after all, i graduated nursing school without dropping an ng into a patient and i survived my very first ng on a patient ok!

    i will repeat again: i don't really care what they think about getting their skills in. its an easy frustration. the students want to be a nurse and they don't really understand that doesn't mean skills!
    xtxrn likes this.
  6. 0
    Peace


    But I guarantee it's not just the places I've worked
    Last edit by xtxrn on Oct 2, '11
  7. 6
    Quote from DL-SNUP
    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)....
    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.
    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.
    kelll, wooh, Mrs. SnowStormRN, and 3 others like this.
  8. 2
    Quote from carolmaccas66
    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.
    I 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.

    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.
    hiddencatRN and xtxrn like this.
  9. 2
    I 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.
    CompleteUnknown and xtxrn like this.
  10. 7
    The 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.
    Orange Tree, elkpark, ChristaRN, and 4 others like this.


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