I need some honest opinions from people outside my circle, as all of my fellow students share my same opinion and all the faculty blow sunshine up my you know what, when I even hint that the situation isn't right. So here is the deal...
Me: Adult senior student in BSN program at local university
Preceived problem/issue: Clinical assignments
History:
Fall semester junior year - 10 wks clinical mostly focused on CNA duties w/some assessment
Spring semester junior year- 7 wks med/surg where I passed meds 3 times, then 7 wks mental health where I observed patients (not shadowing nurses) in different settings (eating disorders, adolescence, geriatrics, etc)
Fall semester 2011 -
14 wks med/surg at a nursing home, where I (a BSN student) shadow an LPN whose primary duties is to administer medications to 30-45 patients in their 8 hours shift.
*LPN's, please don't be offended or turn this thread into an arguement of LPN's vs BSN"s. I fully appreciate that I can learn a lot from an LPN and these people bust their A** all day, every day. My issue is that my university placed me in a clinical situation where I am shadowing a nurse who 98 % of the time is handing out PO meds to long term residents, who are primarily stable (because they take 17 meds 3 times a day...OMG).
Community clinical-public health nursing- 7 wks at a local health dept whose budget has been desimated, so we spend our time watching CD's, observing employees in the Lead Poisoning program, or shadowing health inspectors. One was lucky enough to do an at home visit w/an actual nurse meeting w/an at risk mother.
My feelings- I am ANGRY. My primary complaint is that I feel like I am paying a ton of money to learn how to do everyone elses job. My mental health clinical taught me the job of behavioral health specialist (the counselors), my current med/surg clinical is teaching me what it is like to be a full-time CNA (as when I am done assessing and medicating my patient I answer call lights all day, as there are never enough CNA's to help the residents and my community clinical, where I am learning the jobs of health inspector and other misc health dept personnel.
The final thing I will say is I appreciate that all of these people are part of the health care team and I need to have an understanding of what they do, but I have a finite amount of time to learn NURSING, and it feels like I am learning anything but. While I think every student nurse would do well to be exposed to a nursing home setting, I am spending the greatest chunk of my clinical experience there, while my classmates in other clinical groups are one on one w/ICU nurses, in IV clinics, and in hospitals with acute patients, experiencing hospital nursing.
Am I wrong? Should I believe my instructors who give me the party line of "it's a good opportunity to learn____" fill in the blank. I feel like the clinical portion of this nursing program is substandard and I keep getting sunshine in an attempt to deflect the fact that I am in fact right. Please tell me what you think, as I am about to lose it!
It sounds like you are frustrated about the learning experience you received from what you consider subpar clinical placements. I would be VERY upset in your place. My BSN program has us on acute med surg floors for both med surg courses. In Med surg 1 we have to competently do COMPLETE care for 2 patients by halfway through the rotation. We are expected to do 4-5 patients by the end of med surg II.
Just out of curiosity, are you in a for-profit program? Those programs are the ones around me who are sending their BSN students to LTC for med surg II.
What you fail to realize is that another nurses license is on the line when you are in clinicals; therefore, passing meds and shadowing an LPN is what you will do. You need to get what you can get out of every clinical situation and quite complaining about what you are not getting. Too many Nursing Students complain about what is going on in school without taking into account that you are a student. In no profession are you taught everything that you will do on the job, you learn it on the job. Learn what is being taught in the classroom and in clinicals which is to mastered the concept of Critical Thinking for when you actually start working as a Nurse under your own license.
Yeah- that nurse is called the instructor.
This whole mentality of "my license is on the line" is not reality. YOU have to screw up to lose YOUR license. There isn't some random lottery about who has their license yanked
In RN nursing school, this is not the gold standard- at ALL. You are supposed to continuously gain more and more difficult REAL experience on patients after practicing in the lab, and with the instructor along side for the first time; you do not just 'shadow' and give meds exclusively.
YES- students who are paying to LEARN .......Oy vey.
Sounds substadard to me. I do know that many schools are struggling with getting placement in hospitals because of the competition from other school to get in for clinicals. That's why I always hear about "choosing your school wisely"...because for obvious reason, the schools with the best reputations are gonna get first dibs. My very first clinical was Psych and there was no observation. We jumped right in with therapeutic communication, assessment and even ran a group therapy session with a partner. My first med/surg was all hands on, po meds, IV's, IV pushes, along with alot of CNA work. In my junior year now (med/surg II and Maternity) and we are VERY independant...after the first day of course, when our instructor does an assessment with us, then turns us loose for the rest of the rotation. I love it. I don't learn when someone holds my hand, or by watching someone else do their job. I NEED to do it alone so let the skills sink in. I definitely think a conversation with the dean of nursing is in order. Good luck!
It sounds like you are frustrated about the learning experience you received from what you consider subpar clinical placements. I would be VERY upset in your place. My BSN program has us on acute med surg floors for both med surg courses. In Med surg 1 we have to competently do COMPLETE care for 2 patients by halfway through the rotation. We are expected to do 4-5 patients by the end of med surg II.
Just out of curiosity, are you in a for-profit program? Those programs are the ones around me who are sending their BSN students to LTC for med surg II.
My program isn't one of those for-profit schools. I just have a crappy instructor, I think.
Yeah- that nurse is called the instructor.
This whole mentality of "my license is on the line" is not reality. YOU have to screw up to lose YOUR license. There isn't some random lottery about who has their license yanked
In RN nursing school, this is not the gold standard- at ALL. You are supposed to continuously gain more and more difficult REAL experience on patients after practicing in the lab, and with the instructor along side for the first time; you do not just 'shadow' and give meds exclusively.
YES- students who are paying to LEARN .......Oy vey.
Thank you. I am so sick of seeing people on here repeating that like parrots.
Thanks to all of you who have replied. In response to some of the things I read I will say the following....
My school is a private, non-for-profit University.
This year (fall 2011) it increase the size of the junior class by 30%, which I am sure is a factor is being placed in this clinical site. Another senior clinical group was placed at a hospital almost 2 hours away from school. The thing I can't understand is that there are many, many hospitals in the area, so the arguement of lack of clinical sites doesn't seem to hold water. But then again, maybe no one wants us or it's politics...who knows!
To the person who mentioned looking into clinical site placement as part of the research/application process, you make a very valid point. I did not do that as I was basing my decision on the fact that it was a well known university that has been in the community for the past 30+ years. In my case, I don't believe it would have helped, because I would have been told the clinical sites are A, B, C, and D, but would have never been told, by the way, in your senior year we are going to increase junior enrollment by 30% which will have a significant effect on clinical site availability. That being said, I do believe that for furture nursing students, they still should investigate site placement as you suggest.
To the person who suggested I delay my education to get more hands on experience, I wish I could, as that would be ideal. But as I said, I am an adult student who has been out of work for 3 years, so every minute counts. Additionally, I am so far in debt that I can't afford one more minute of nursing school, yet alone another year. Finally, it's not like I can complete my senior year at another school. As I am sure you know, each school mixes up the requirements/line-up of classes, so if I were to delay, I would still be going back to the same school for completion, with the same crapy clinical placements.
To the person who told me I was being snobby about answering call lights, let me clairly. I do not mind at all answering call lights, I am just upset because that is ALL I am getting to do. I do not mind toileting residents or assisting them with any of their needs, but I am greatly concerned that while I am doing this I am missing out on learning nursing duties.
To the person who told me to quit complaining: 1. You need to learn how to give constructive criticism, as "quit complaining" only shuts your listener down and offers no alternative. 2. Considering the fact that I am paying a LARGE sum of money to attend this institution of higher learning, I have the right to question the quality of product of which I am paying for. 3. If you have something negative to say, there is always a nice way to say it. Thank you:p
Again, thank you all for your thoughts, empathy, and suggestions. I am trying to learn wherever I can and I am going to make the best of this bad situation and will overcome. It is just nice to know that there are unbiased people out there who agree with me, so I can stop second guessing myself everytime an instructor tells me how good this is for me. Best to all of you!!!
Another factor in the clinical site placement aside from availability and competition from other schools is whether they have an instructor that is orientated there or willing to work there.
My semester when we were at a sub acute there WAS an acute site available for us and a much closer commute for 7/8 of the students but the instructor only wanted to work close to home.
Sooooo many factors. Instead of shadowing can you ask that nurse you are shadow if you can take over some of their patient load? It's hard to give you advice because for the most part when I was at school we weren't given carte blanche mainly due to instructor's being laize faire
Regarding the instructors license being on the line. I was under the impression that when you are working as a student nurse you are working under the school's "license" ( accreditation or what ever authority allows the school to have nursing students )
Has there ever been a case where a nurse has lost her license because of the actions of a student below him/her? I'd be interested to know either way.
This year (fall 2011) it increase the size of the junior class by 30%, which I am sure is a factor is being placed in this clinical site. Another senior clinical group was placed at a hospital almost 2 hours away from school. The thing I can't understand is that there are many, many hospitals in the area, so the arguement of lack of clinical sites doesn't seem to hold water. But then again, maybe no one wants us or it's politics...who knows!
Exactly. Just b/c there are hospitals doesn't mean they:
1. Accept nursing students.
2. Had good experiences with past students from your school
3. Politics
4. Have the space/time. If there are other NS in the area, you will be competing with them for space.
5. Timing. Maybe your school didn't accept the clinical times made available by the facility.
6. Etc...I'm sure there are more factors into getting a clinical site.
If I get the time I'd love to make a post about the factors that nursing students aren't looking into when choosing a school. Factors that we usually don't even know to consider!
7. Money. When I was in nursing the DON was my clinical instructor ( well before he came the DON but had been DON at another school first) but he made it clear that money was a factor especially for the private for profit schools and donation are made to secure desirable sites. It doesn't really matter how much your school charges but how much they are willing to send.
8. One bad student is enough to lose a clinical site and often they won't send students they know might give them a bad name to a top site. One of my cohort was rude to a lab worker when getting her preclinical drug test done. That worker called the hospital, the hospital turned around and said "Do not send this student to our facility"
And your reality is similar to many nursing students now. Your not going to be the only one with limited experience when you graduate. Just plod on get through, get by.
To the OP, I'm sorry to hear you have had such a poor clinical experience. Have you considered getting a job as a CNA/tech/nurse extern, etc to help boost your exposure to patients and increase your comfort level before graduation? I know that it would not be the same as nursing experience, but it would still help.
Oh, and I went to a hospital based diploma program. By the senior year I had done clinicals on 4 different med-surg floors for 8 weeks each, including passing meds, central line care, dressing changes, IV meds, foleys, etc. I went on in my senior year year to have 8 week rotations in ICU, psych and ob/peds. I also had a final semester where I had to get a couple hundred hours in on a med-surg floor where I was caring for a full pt load of 4-6 pts by the end of the semester. I can honestly say that I feel my RN program prepared me for graduating as well as working as a staff nurse.
What is the hire rate for your school post graduation? Are students having issues getting acute care positions?
As a manager, your clinical experiences sound substandard for my area in California. Your performance once hired, might support that impression.
We currently have 8 or 9 schools of various levels with nursing students in the hospital each semester. The educator responsible for coordinating these schools is ready to pull her hair out because of the increased demand for time.
I will tell you that a few bad experiences with instructor may cause the school to lose clinical privileges at a hospital if they refuse to change the instructor. Poor student performance may impact future decisions to engage a particular school again.
I hope you have the ability to have a final semester clinical practicum where you work with one preceptor on staff for 100+ hours near the end of their program. Try to do it where you want to work post graduation. Be a shining star and get that preceptor to write a letter of recommendation for you describing your clinical experiences and HOW YOU GREW during that time. "Was able to provide primary care for 4 patients by the end of the rotation, developed critical thinking skills" etc as THIS is the letter that means far more to a hiring manager than the canned letters from the instructors that are a cut and paste with a name change. If you are lucky, your abilities will help guide you into a position at that hospital as that reference check with your preceptor is an easy one and a slam dunk.
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SummitRN, BSN, RN
2 Articles; 1,567 Posts
It sounds like you are frustrated about the learning experience you received from what you consider subpar clinical placements. I would be VERY upset in your place. My BSN program has us on acute med surg floors for both med surg courses. In Med surg 1 we have to competently do COMPLETE care for 2 patients by halfway through the rotation. We are expected to do 4-5 patients by the end of med surg II.
Just out of curiosity, are you in a for-profit program? Those programs are the ones around me who are sending their BSN students to LTC for med surg II.