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 Cath Lab/ ICU.
. We (students) need you (experienced nurses) and you need us.

I don't need you. At all. I could go my whole nursing life without a nursing student and me and the pt would be ok. We don't need you. You need us, that's for sure.

It's time you really, really understood that.

Specializes in SICU, MICU, CCU.

"I do try stay out of the way when there is a lot going on. But it's hard sometimes, because this is my education. If I don't learn it in clinicals, I'll end up being a new grad who is vastly under qualified and who can end up seriously harming a patient because I was never shown something."

Relax grasshopper! All new grads are underqualified. That's why hospitals make you complete an orientation before they make you earn your keep by being full staff. All things will be new after graduation and boards. No one has told you that yet? Seriously?

I think you guys also have to realize that hospitals/management forces nurses to work with you guys. It's also tied to promotions and raises for most of us. Also because of staffing needs. Then nurses who KNOW they shouldn't or don't want to teach/orient students or new staff end up getting the nice well meaning student nurse. These may also be the nurses who just want to get started and promptly end their day. They already know their attitude is gonna suck and they aren't interested in putting on the sunshine face and playing nice.

2) You guys are new to nursing. We live it 3, 4 some of us 5 days a week. When your 4 weeks are up, we then get a fresh new batch for another 4 weeks.( some nice/helpful and sweet..some condecending, spoiled, and entitled) You do the math. Depending on where you are doing clinicals, those nurses see 4 to 12 students a month, 48 to 144 per year! Plus families, doctors, new staff, administration, patients etc.. Surely you can see where I'm coming from.

3) It is what it is. Some of my nurses liked, loved and simply disliked me. They ignored me, was rude and condecending to me and I survived it all. You guys will too.

BTW, I personally love to precept and orient new students and new staff.

Specializes in Peds/outpatient FP,derm,allergy/private duty.
Hm...that's an interesting thought. I'm really hoping that's not how I'm coming off to nurses, and I don't think that my peers tend to behave that way. If I ever told ignored my nurse or told her to find a tech and my CI found out, I'm sure I'd be put through a disciplinary hearing at the absolute least. I'm truly sorry if that's coming from personal experiences of your's with students--that type of behavior is beyond unacceptable, and I really hope it's not common.

I probably wrote my post too quickly. You don't come off that way at all. You certainly don't come off that way in your writing, so I am sure you are someone it would be a pleasure to work with.

I'm thinking back over the hundreds of posts about this and pointing out that what students might be interpreting as a blow-off isn't but some veteran nurses could be taken aback by behavior the student feels is merely assertive and proactive, the nurse coming from a very different frame of reference perceives it as overstepping. There is another thread active right now that is the embodiment of the culture clash I'm talking about.

I do try stay out of the way when there is a lot going on. But it's hard sometimes, because this is my education. If I don't learn it in clinicals, I'll end up being a new grad who is vastly under qualified and who can end up seriously harming a patient because I was never shown something. At the end of the day, we literally depend on staff nurses. It might not be fair, but there isn't really a whole lot that the students can do about it.

I totally understand, and I felt the same way, too. Although my first job turned out to be in a pediatric hospital and our peds rotation consisted of a very small unit filled mostly with tonsilectomy patients so I had to start from scratch anyway!

So I guess what I'd like to know is what you'd suggest. If you had a student, what would be the best way for them to benefit from learning from you and gain skills as a nurse, while respecting your duties to your patient? I can't stand that to learn HOW to be a nurse, I have to be a burden to a nurse. Any advice you have on how to make the relationship go as smoothly and mutually beneficial as possible would be greatly appreciated :)

Not going to punt this totally but I will find some links for you with many responses from a variety of people -- but I'd say the most important thing is to be a perceptive observer of your assigned nurse's unique personality and take your cues from that.

Maybe she growls at you but mentions some aspect of the job that she loves to do -- ask more about that. I don't mind being asked questions - such as "what drew you to xx specialty?" He or she will be remembering something positive about the job and may want to share it.

If he or she doesn't snarl at you right away :) go for it - ask lots of questions, offer to do things to save her time, tug on her sleeve and say "can I watch? can I? can I please???" :) Don't do that if you get a look of disgust -- or even a barely audible sigh . . .be perceptive.

In looking through the archives I found this post that nobody responded to at the time she wrote it, but it is excellent. I would've written the same thing, so I requoted the list. Best of luck to you!!!

Clinical advice for nursing studentsAug 04, 2007 10:23 PM written by tulsaL&D | 0 Comments

Reading through some of these posts I see that many of you are in nursing school and I've seen a few posts regarding nurses attitudes toward students. I graduated from RSU claremore. I remember thinking as a nursing student that I would never treat students like I was treated by some nurses. I've been in nursing for a little over five years now and I'd like to give those of you still in school a little advice.

1.) Listen to report.

2.) Review charts of pt's you are assigned to.

3.) Let the nurse you are following know what skills you are allowed to do with/without your instructor and which skill you are most interested in doing.

4.) Do not sit in the breakroom and expect your pt's nurse to come find you for learning opportunities.

The reason for these four tips are this:

Once you've received your pt assignment you need to know as much about that pt as you can. Not to sound hateful, but I don't always have time to tell students everything about a pt. I know that not all nurses have time to teach you skills, but I for one do not mind letting students start IV's, perform straight caths or foleys, take VS, etc...

If your nurse knows #3 ahead of time most will be more than happy to help you get the experience you want.

#4 is the most important of all. My biggest pet peeve is when I have a student assigned to my pt that is never around. I'm not sure if RSU is still this way, but we were expected to be prepared and ready for anything. Sure if there are no pt's around it is no big deal to do homework or work on careplans, but if you have a pt assignment you should be close to the nurse working with that pt. If you are not around I don't feel as though you want the experience you are there for. The only reason you should not be at the nurses station is if your instructor or nurse says otherwise.

I hope this will help those of you in nursing school and clinical rotations. If you have a bad experience with a nurse keep in mind that he/she may be having a bad day, or they may be unaware of how they are acting. Some nurses are just crabby. Your instructor should speak with the charge nurse prior to making pt assignment and hopefully know who you will get the best experience from. If you are doing 1-4 and you still have problems, speak with your instructor. They may be able to assign you to another pt or determine what the problem is. Good luck to all of you.

Specializes in Renal.

DEU= Dedicated Education Unit. It's a system that my school uses that they're trying to get other schools and hospitals to adopt. Nurses from the unit volunteer to work with students. Typically, the nurse gets assigned 2 students and works with them for the entire rotation. This allows a trust relationship, so that students aren't constantly having to prove what they are capable of to several nurses a week.

The pt load is also limited to about 4pts per nurse, so that he/she has the time to help the student one on one. Basically, the student assumes all care of the pt, and the nurse sorta follows up and does quick little checks here and there, based on the level of trust and the student's strengths and weaknesses. We also "prep" the night/morning before...which involves coming in an hourish early, getting your assignments, looking up meds/dx/labs, etc, and forming a care plan to show your nurse. It's essentially a mini preceptorship, with the responsibilities growing as the student grows. At the start of the shift, my nurse would sit with me and go over my plan of care, and then she'd basically just follow me around offering little suggestions here and there. I'm sure there was still stress for her, but she really loved teaching and the unit structured the situation in a way that seemed to help. Plus, I feel like I learned worlds more in one week on a DEU than I have on a non DEU unit.

The nurses also get paid a little more, and they receive some training and benefits from the university. It seems like a pretty great situation. Plus, you really get to know your nurse well, so you end up with a huge advocate come job application time.

Here's some more info on it:

http://nursing.up.edu/default.aspx?cid=7744&pid=2959

Specializes in Renal.
I don't need you. At all. I could go my whole nursing life without a nursing student and me and the pt would be ok. We don't need you. You need us, that's for sure.

It's time you really, really understood that.

I do understand that. You don't need us as students. But you do need coworkers, and I'm sure at one point one of them will be a new grad who was in a situation like this. Students don't stay students forever.

So the DEU is the hospital having to clean up nursing school....an expanded preceptorship. How sad that something like that is needed.

Specializes in SICU, MICU, CCU.

Dedicated Education Unit. The hospital, nurses, affiliated schools etc. all construct an effective learning environment for students. ( In short)

Dedicated Education Unit. The hospital, nurses, affiliated schools etc. all construct an effective learning environment for students. ( In short)

Because nursing school left you hanging. For the history of nursing, this is just now being "needed"..... it's pretty sad. And I understand that the newbies need it- it's just sad that schools are ripping you off.

Specializes in Renal.
So the DEU is the hospital having to clean up nursing school....an expanded preceptorship. How sad that something like that is needed.

I don't really see it that way. It's the same as having normal clinicals, except that you're in a better environment for learning. If anything, I'd say it's an improvement. I've never met a student who didn't have a great relationship with her nurse. It seems like it benefits everyone. We're more prepared for patients, we gain more experience, the nurses who want to teach get to, you form relationships, and it's not simply a student being shuffled. These aren't in addition to "normal clinicals"...for medsurg, these are just considered our clinicals. And it seems to work well for the units I've been on. There seems to be less stress, less ****** off nurses and upset students, and more positive learning experiences occuring.

I don't really see it that way. It's the same as having normal clinicals, except that you're in a better environment for learning. If anything, I'd say it's an improvement. I've never met a student who didn't have a great relationship with her nurse. It seems like it benefits everyone. We're more prepared for patients, we gain more experience, the nurses who want to teach get to, you form relationships, and it's not simply a student being shuffled. These aren't in addition to "normal clinicals"...for medsurg, these are just considered our clinicals. And it seems to work well for the units I've been on. There seems to be less stress, less ****** off nurses and upset students, and more positive learning experiences occuring.

I understand the benefit.....but this is what was included in regular school in the past. Not the 'private' nurse to shadow you- but within the regular clinicals. This should be the last semester of nursing school....not an expense for the hospital. This also contributes to how picky the hospital is- this costs them a LOT- to dedicate staff to new grads, continuing their basic nursing education. I'm sure it's very beneficial for the newbies (and a lot of nurses do like to teach- I loved students). But it's still a HUGE sign of the decline of the nursing education YOU paid for...now the hospital has to pick up the slack. Your employer should not have to provide more clinical experience- that's what school is for.... but I 'get' the need.

It takes care of inadequately trained nurses- but not the cause (the schools themselves). And a NCLEX that accepts 1/8 (one eighth) of the past answers needed to pass. The pencil and paper test had a minimum of 600 questions to get right (out of 1000- and we had to answer them all- no cut off). The "75" question NCLEX RN answers 1/8 of the number that used to mean failing.... that is not good.

It's just a long pattern of skimping on an education that determines how well someone can protect/care for/assess/manage/critically think about patient care. It's scary for us old goats :D

Specializes in Renal.
I understand the benefit.....but this is what was included in regular school in the past. Not the 'private' nurse to shadow you- but within the regular clinicals. This should be the last semester of nursing school....not an expense for the hospital. This also contributes to how picky the hospital is- this costs them a LOT- to dedicate staff to new grads, continuing their basic nursing education. I'm sure it's very beneficial for the newbies (and a lot of nurses do like to teach- I loved students). But it's still a HUGE sign of the decline of the nursing education YOU paid for...now the hospital has to pick up the slack. Your employer should not have to provide more clinical experience- that's what school is for.... but I 'get' the need.

It takes care of inadequately trained nurses- but not the cause (the schools themselves). And a NCLEX that accepts 1/8 (one eighth) of the past answers needed to pass. The pencil and paper test had a minimum of 600 questions to get right (out of 1000- and we had to answer them all- no cut off). The "75" question NCLEX RN answers 1/8 of the number that used to mean failing.... that is not good.

It's just a long pattern of skimping on an education that determines how well someone can protect/care for/assess/manage/critically think about patient care. It's scary for us old goats :D

Ooh, I see what you're saying. One thing is that not all the nurses on the unit are DEU nurses--most of them don't want students. It's more that a unit asks their nurses if they want to work with students. Plus, they work normal shifts the days their students aren't there and they typically take the higher acuity patients since they typically only take 4. And since most new grads in my area get hired by these hospitals, they end up with new grads who have at least some skills...so in that sense, I think that the hospital benefits....in addition to the fact that students have been shown to contribute to better patient outcomes in this setting.

I'm definitely grateful for it--I look at the "regular" clinical setting and I don't know how most grads are getting the skills they need. But I don't think this is entirely the faults of the schools. I mean, the schools can show you on a manequin a hundred times, but unless you've done it on a patient, in clinical....it means nothing. And unfortunately, the shortage of nurse educators mean there aren't enough CIs for students any more. :( And then with so many staff RNs not wanting to work with students, it just creates this messy, broken system.

Specializes in Post Anesthesia.

I know it's hard for you to see it from the staff nurses position, but I'll try. Your instructor gets PAID to supervise and teach student nurses in the clinical area-I don't. I don't mind a student most days but an "interesting patient" from your perspective is a clinical train wreck for me and if I spend my time teaching you what they need to have done, I can't spend that time doing what I should be doing. My patients are placed in jepordy. When you are getting the "cold shoulder" from a staff member, it may be that they have chosen the well being of thier patient over the education of a student. I wish this wasn't the case so often. I would love to have the persons employed to educate student nurses have the time to educate student nurses and the staff being paid to care for the patients can augment that teaching- not take it over. Please hear me when I say, most of the time a like having students. It's just that some days I need to put all my effort into keeping my patient alive.

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