Advice For a New Instructor Please!

[New-Instructor]

I am a brand new instructor. My students congregate around the nursing station at times, there are a lot of them and they have one patient each and not many places to go. For the record these students are doing excellent on their clinical paperwork and assessments, and get accolades from patients and family. There is no conference room to go into and they aren't wanted in the break room. The energy is kind of bad on the unit towards the students.

The unit manager's solution is to pair each student with a nurse. My students literally cried about it because they feel so unwelcome already and do not want to be paired with a nurse that rolls their eyes at them all day.

Do y'all have other suggestions for how to get them to congregate less? Should I move forward with pairing them with a nurse? 

This unit manager is also asking for manual blood pressures from the students. And she wants them in the chart. Is that normal? I felt like I should be the one telling them if I want them to do manuals. I know they will be asking me to double check all their manual pressures. They were checked off on those last semester and I would rather move on to higher level skills before they go to the next course. 

TLDR- should I let a unit manager make my nursing students' assignments instead of me? And pair them with a nurse? And demand manual blood pressures?! Help!

[hppygr8ful, ASN, RN, EMT-I]

JBMmom said:

The skill might seem basic, but once they were checked off how many of them really retained proficiency? Repetition is NOT a waste of time. Have them do more in depth assessments related to cardiology and pulmonology. How many nurses finish school and are still not confident on their heart and lung sounds? I know I wasn't. Because we got checked off and moved on, not really incorporating everything into the next set of skills. If one student has a patient with a heart murmur, or rhonchi- get the other students in there to hear it. If the nurses on the floor see some value in having the students there, like they can address small tasks to help the nurses, then they might be willing to look out for things the students might want to see. They have to be very active participants in their clinical learning and while they may have gotten off to a rocky start with the nurses, it's still early in the semester, they can end up great! (Maybe bringing in some cookies as a thank you to the nurses or something will help them thaw a little bit)

This was not my quote you quoted the OP to whom I was responding 

 

[2BS Nurse, BSN]

They don't have a room for you to congregate to discuss with your students??? Dynamaps are short in this day and age?? There is no excuse for either of these situations. ?

Have your students complete 50 NCLEX practice questions while they are idle.

[Hoosier_RN, MSN]

2BS Nurse said:

They don't have a room for you to congregate to discuss with your students??? Dynamaps are short in this day and age?? There is no excuse for either of these situations. ?

Have your students complete 50 NCLEX practice questions while they are idle.

Large teaching hospitals may have these amenities. Small rural hospitals may not. It doesn't make them any "less" as your tone suggests. It means they may have to use their funding differently. Realistically, I'll usually trust manual vitals over a machine anyday. In my experience,  Dynamaps tend to be in the repair area quite frequently 

[Wuzzie]

I'd like to know on what planet a manual BP is a "lower level" skill over slapping on a cuff and pressing a button.

[JBMmom, MSN, NP]

Wuzzie said:

I'd like to know on what planet a manual BP is a "lower level" skill over slapping on a cuff and pressing a button.

Excellent point! I can't even count the number of times I've walked into an ICU room and the patient had the wrong size bp cuff on and sometimes they were on pressors at the time! Familiarity with basic equipment is essential to understanding the whole nursing process. I've been in emergent situations where nurses in a hospital couldn't even take a manual bp reading. Becoming reliant on mechanical devices and interventions is NOT in the best interest of students, nurses or patients. 

[Hoosier_RN, MSN]

JBMmom said:

Excellent point! I can't even count the number of times I've walked into an ICU room and the patient had the wrong size bp cuff on and sometimes they were on pressors at the time!

Or the cuff placed incorrectly

[londonflo]

New-Instructor said:

There is no conference room to go into and they aren't wanted in the break room.

I taught for almost 40 years. The students should not have a place to escape to. If the patient needed to go to the bathroom....where was the student?  We had some trouble with an instructor who who let the students bring in food and soft drinks, play music and work on their paper work in the conference room..all evening.

I have been in a patient's room with a student doing a skill and after I washed and dried my hands..they were already at the nurse's station sitting in a chair.  Here are things I did (but I heard complaints about it from the faculty the students had the next semester) :

1) If you have a med cart , WOW, in room cabinets  or wherever the syringes are stored, have the students stock them. I tstops that recurring question where are the insulin syringes, teaches them the difference in syringe sizes, shows them where the alcohol wipes come from. In the skills lab everything is handed to them  or right in front of them.

2) If the floor has a display of educational materials like brochures on specific health problems, find out how the students can stock them...they will learn about patient teaching materials available, reading level etc.

3) My last two teaching hospital had patient choice menus. Have the student sit down with the menu ( have them actually read it) and figure out choices for recommendations for high protein diet, etc. 

That's all I can think of for now. None of this requires extra paperwork, but dang...when the medcart is empty of syringes, alcohol wipes etc. it sure slows your med pass down. And the student doesn't learn there are no med cart fairies, etc.

[hppygr8ful, ASN, RN, EMT-I]

So there is literally no place for your students to meet up with you singly or as a group to discuss their assignments, ask questions etc Is there not a cafeteria, administrative conference room etc. I can see where having them all hang out at the nursing station could be prblematic for staff. 

[CommunityRNBSN, BSN, RN]

londonflo said:

1) If you have a med cart , WOW, in room cabinets  or wherever the syringes are stored, have the students stock them. I tstops that recurring question where are the insulin syringes, teaches them the difference in syringe sizes, shows them where the alcohol wipes come from. In the skills lab everything is handed to them  or right in front of them.

 

I would so so so much have appreciated this as a student. Syringes but also supplies generally!  I remember that nurses and instructors would go "okay so here's where the fluids are, normal 0.9, ringers, dextrose okay" and then we would be moving off to the next thing. I would internally think, Wait WHAT did she just say?? I would have loved a half hour to just go into the supply room and really look and touch and become familiar with the supplies. 

[londonflo]

JBMmom said:

Can you give each student an additional assignment about assessment/history for their patients? Give them tasks that require they spend more time in the room with their patients? That will help the nurses because they can do things like get the patient a drink or maybe see how the techs help them ambulate to the bathroom.

The students should be helping the patient to the bathroom, if that is their patient. Identifying mobility issues that will need  to addressed before the patient goes home! Urgency, how to get out of bed with walker or not, oxygen issues (pulse ox before, during and after ambulation). This should be incorporated in all clinical assignments. 

• When you look patients for assignments keep the oxygen needs in mind. Write your self a note to ask the student. "Were you looking at pulse ox when they were in the bed or when they were walking." "how will this data contribute to discharge planning?".
• If the patient is being discharged to a nursing home after 6:00 PM, what plans are made to get an evening meal to the patient? Send them back to no meal at assisted living?
• I live in a rural community. If they are going home with a pain RX script, don't tell me, taking a dose before they go home is adequate until tomorrow.  What are they going to be doing until the pharmacy opens? (Many medicare patients want their RX to be filled in one pharmacy. Problem solve this! IS their a 24 hour pharmacy nearby or the hospital outpatient pharmacy and how can they work with those? We even solved this with a family member having the same RX to give that night, until the morning (I know I will get criticized for this, but the patient had pain relief that night).
• Whose going to feed them if their going home? "how many men say when their wife has been there 27/7...my wife will take care of that...as you look at the distress in her eyes!"
• Figure out wound care, drug regimens etc. And stop telling me "the patient is going home so I don't have to do an post 3PM assessment since the 0900 am was okay" "Can I have another patient?"
• If they are going home after surgery, what patient teaching would be done with menu planning the deals with high protein, high vitamin c (NCLEX deals with a lot of nutrition questions -- are you students ready for those?) If they are in ESRD, Discuss with the patient what their regular diet might include (I do understand a Registered Dietician is the best to deal with this). But does the student know the dietary restrictions and allowances? I have had patients on fluid allowances that were never given any fluids despite a schedule outside their door.

Why are we blaming overworked nurses to provide the learning experiences for students when they are already over loaded with a patient load? And the excuse of "nurses eat their young" doesn't help when the students are at the station, talking about their weekend, some students/CNA's describing their feats of daring do....get those students involved in ways that will improve their learning in the RN role. 

BTW I was often criticized when I had students stock the med carts, the brochure stands and learning the diet menu...told "we aren't staff here." Gave me a good picture of the implementation of the RN to come, while they warmed a chair, preventing  actively involved RNs from sitting down to do charting. 

I think we need a revolution on the role students learn, practice, deliver and evolve in nursing education. 

Okay, I know I am going to hell after this post but we have to get students totally involved with everything in patient care before they graduate. BTW I was on a nursing unit when a student from another program announced to the staff "we are just here to delegate!"

[PositiveEnergy, MSN, PhD, RN, APN]

Excellent ideas here.  Because students aren't often directed to do some of these needed task they don't even think about them - especially those things patients need upon discharge to assimilate back into their home life.  Even some seasoned inpatient nurses have a gap in truly understanding what patients need when going home.  If you have ever worked as an RN in both inpatient settings and in home care settings you can appreciate how communication is lacking between the two entities when coordinating home care for patients.  Great idea to get those students nurses thinking about these patient discharge concerns.

How about having some of those students sit at the bedside with their patients and educate them on their disease process.  One would be amazed if they take a pictorial anatomy book in to their patient and show them the part/s of their body involved with the disease process.  Often patients have no idea of their internal anatomy and are very appreciate of learning.  Students too will gain confidence in patient teaching and reinforce their own A&Ps knowledge. 

 

Quote

 

 

[JBMmom, MSN, NP]

I had technical difficulties quoting your post, but you said EXACTLY what I was thinking, but I didn't take the time to spell it all out. All of the things that you mentioned are what SHOULD be happening in clinical rotations, but they're not. Students are not being taught the value of time spent with patients, and then they become new nurses that sit at the computers in the nursing station and say things like "the techs answer the lights" (which is one of my biggest pet peeves). If they're not spending time in the room with patients, how are they going to know when someone has a change in condition? And for the "stable" med-surg floors, that usually take the most students, that's the best place to learn so many aspects of learning. But clinical rotations have become so focused on paperwork- write out the meds, develop a care plan, etc. they don't focus on patient experience. 

You gave some great feedback! (and for what it's worth, two of my instructors had us stock the carts every shift- it's a great way to learn where things are and the nurses appreciate it)