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!
let clarify something when rn's in clinical rotation are put to work with lpn's it not so that the rn could learn from the lpn but for the rn to get comfortable in her new supervising position observing the lpn verifying that she does things correctly. you may not like spending your days and hrs shadowing a lower level nurse but it is what it is and it is part of your learning process into your new duty role. i don't even know why i am explaining this because clearly if doing so was not part of the curriculum why would your instructors assigned you to that in the first place??? i know one rn bsn who worked as cna at a ltc , she worked her way up to lpn , than rn and got her bsn . she will come back for her clinical at the same facility . she told me every time it was different because with her new knowledge her thinking ability was also upgraded , she was watching the nurses not as to learn from them but this time to verify and test her own knowledge vs what the lower level nurse was doing while training herself to teach and supervise base on whatever mistakes or lacks she would observed during her assignment period. so you don't need to be unhappy about it when or if it happens, just know your objectives going in there and you will have fun.[/quote']
i'm sure that happens all the time, i don't see your point.
it seems you are assuming that every bsn is going to be in a supervisory position. in my clinicals and in my classes, there has been no mention of preparing us for our "new supervising positions". if i was in clinical and i was with an lpn, never would i assume i was there to "get used to supervising him/her". what? your view of this is simply bizarre.
Let clarify something when RN's in clinical rotation are put to work with LPN's it not so that the RN could learn from the LPN but for the RN to get comfortable in her new supervising position observing the LPN verifying that she does things correctly. You may not like spending your days and hrs shadowing a lower level nurse but it is what it is and it is part of your learning process into your new duty role. I don't even know why i am explaining this because clearly if doing so was not part of the curriculum why would your instructors assigned you to that in the first place??? I know one RN BSN who worked as Cna at a LTC , she worked her way up to LPN , than RN and got her BSN . She will come back for her clinical at the same facility . She told me every time it was different because with her new knowledge her thinking ability was also upgraded , she was watching the nurses not as to learn from them but this time to verify and test her own knowledge vs what the lower level nurse was doing while training herself to teach and supervise base on whatever mistakes or lacks she would observed during her assignment period. So you don't need to be unhappy about it when or if it happens, just know your objectives going in there and you will have fun.[/quote']
No, the clinicals aren't for the student to supervise the LPN. They are not qualified to do that. It isn't in the student's scope of practice to observe the LPN to verify she is doing things correctly. The LPN should let the student pass the meds, and quiz the student on their action/SE, etc, as the clinical instructor should be doing. Like I said before, I, as an LPN and a BSN student, I don't know anymore now after completing my MS clinicals than I did when I started clinicals. Doing VS, giving showers, making beds.....I already know how to do that. WE ALREADY KNOW HOW TO DO THAT. We are PAYING money to LEARN, not do CNA work just to get our REQUIRED clinical hours in. I can tell you right now, if my clinicals continue like this I won't learn ANYTHING! And neither will the OP. I don't know about you, but I would like to learn to be a BSN and pass my boards on the first try. Failure isn't an option. The school has a duty to TEACH and the students have a responsibility to LEARN. If you pay money for a good or service, do you not expect it to be what you paid for? Because the school's accredidation is based on NCLEX pass rates. And if student's don't pass, guess who's out of business?
Whoa, wait a minute. We don't know if the OP is already an LPN. A BSN student has no authority to "discuss that with the LPN, help her understand and learn what you know...." I am an LPN and a BSN student and I don't know anymore now as a student than I do as an LPN, except for having a broader knowledge of assessment skills! LTC is no place for med/surg clinicals. If the OP is already an LPN, she doesn't need to spend clinical time doing the whole floor's VS like my class was. She doesn't need to spend her clinicals wiping butts. No where in her posts did I see that she felt she was "more than" other nurses. I will say it again....LTC is no place for M/S clinicals. I work in LTC, 16 hour shifts. I give meds to 28 patients, and do a whole lot more than just that. You can't teach med surg in LTC. You can't learn med surg in LTC. You can't be a supervisor or teacher when you are doing VS. In LTC you can't spend time with your patient just talking to them, or giving a backrub, or whatever. (Nursing 101?) You have a state mandated time frame in which to get meds out to those 20-40 patients. BSN classes are preparing the student for the RN supervisory role. We don't need to re-learn VS, we need to learn RN skills. We need to learn how to prioritize critical patients, how to do a fast thorough assessment. We need to learn delegation skills. How do we learn that by shadowing an LPN who is passing meds?
I guess I am confused by your post but I don't read her post as complaining, after all, she IS paying for the BSN and demands to LEARN and expand her KNOWLEDGE, not do VS for a clinical rotation. That teaches us nothing. We already know how to spot inaccurate VS. Too bad some of the CNA's don't! What is wrong with that? A BSN is very expensive. If we wanted to do VS and pass meds and wipe butts for 8 hours with satisfaction, we'd stay a CNA or an LPN. Getting the BSN is no cakewalk! Wanting to learn and having the courage to go back to school takes a lot of time and dedication.
YEs she did you can tell in her quote " I BSN student " and her other quote " 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). " NOw you tell me what she implied ?????? how do you interpret that " I BSN student" "OMG" " 98% of time handing out Po meds"????? You mean to tell me at this point she was not thinking too much of herself ? come on ....... Did read her update? , she is confirming this but only now she has an understanding of what LPN's deal with on the floor and appreciate it in her own words "Thank you all so much for your kind words of encouragement, support, and advice. And to all of the LPN's out there who do their best to care for their 30-45 patients during a shift, I respect the Hell out of you and wish you well! "
when she may have had a point being frustrated , i felt she was focused on her BSN title making the mistake of looking down on other health care workers and that what i responded to. all is good i am thinking she has a new mind now about her other fellow nurses who haven't got working on their BSN Yet! a caring nurse will never allow herself to get caught up in title
The OP didn't say if she was already doing a LPN-BSN or a full 4 year BSN but you older RN's need to understand.......if we are LPN's doing a BSN program, we have to be working as a LPN to be in the program. That means: we do VS, we do toilet people, we do answer call lights. THAT is what we are frustrated about!! We are adult learners doing an ADULT BSN program. We are already working as LPN's and we don't need to do VS, toilet people, give showers, and just answer call lights during a clinical rotation. We need to be with the RN so we can LEARN. I can do a med pass to your 4-6 people with my eyes closed. A 4-6-8 person med pass is NOTHING to us if we work in LTC and do it EVERY DAY!! Yes, we know there is a certain time frame in which to give meds. Can you give meds to 28-30 people in 2 hours??? I can, because I DO.
I had 2 patients at the end of my med/surg rotation. I had my ADL's AND assessments done and charted before the RN even completed her first one! Trust me when I say having 4-8 patients to me is nothing. I think my time management/prioritization skills are so strong that they may hinder me in the future, because I don't feel like I am learning how to prioritize care to 2-4 critically sick patients. Sure, I can read that in the book, but to help me understand it better, I need to see it being done. How can we learn that if we are doing VS and showers, and answering call lights?
On the job training is the answer . Just as you did with passing meds . you trained yourself and got better and better .Don't get me wrong it sad to not have enough training &practicing toward your next level of duty but you and all of us know how things work , on the job training is the answer .
No, the clinicals aren't for the student to supervise the LPN. They are not qualified to do that. It isn't in the student's scope of practice to observe the LPN to verify she is doing things correctly. The LPN should let the student pass the meds, and quiz the student on their action/SE, etc, as the clinical instructor should be doing. Like I said before, I, as an LPN and a BSN student, I don't know anymore now after completing my MS clinicals than I did when I started clinicals. Doing VS, giving showers, making beds.....I already know how to do that. WE ALREADY KNOW HOW TO DO THAT. We are PAYING money to LEARN, not do CNA work just to get our REQUIRED clinical hours in. I can tell you right now, if my clinicals continue like this I won't learn ANYTHING! And neither will the OP. I don't know about you, but I would like to learn to be a BSN and pass my boards on the first try. Failure isn't an option. The school has a duty to TEACH and the students have a responsibility to LEARN. If you pay money for a good or service, do you not expect it to be what you paid for? Because the school's accredidation is based on NCLEX pass rates. And if student's don't pass, guess who's out of business?
The nurse BSN duty if working in a LTC is more supervision and little hand on , i am talking of a full licensed one . . Therefore in my message i am saying that the BSN student could use this time to get comfortable and learn a this role so that if she ever worked in such facility will benefit her. I worked in a NH at one point and the BSN student who come for clinical this is what they did along with their instructor or another employee BSN on duty helping them showing them duty in their scope of practice .Have you tried to ask these questions to your instructors they have an answer for you i am sure of it!
Its been my experience that med surg nurses do pass meds and answer call lights all day. That's med surg and is the nature of the beast. What did you think you'd be doing? Multidisciplinary meetings, developing care plans and education materials? What you discover in nursing is that EVERYTHING is your job (regardless if it actually is or not). It's frustrating, but in the end beneficial to experience the jobs of others. Depending on how many nursing programs are in the area, clinical placements can be ridiculously competitive. I agree with a previous poster: learn what you can, pass NCLEX.
Side note: nursing jobs were incredibly scarce when I graduated, and my first job was in a nursing home. An LPN trained me (thanks again, Arriyn!) and I did the exact job she did for eight months before I got my current job. The positive side of being a BSN is that others assume you can do anything.
I understand your frustrations with your clinical experiences. I am from the "old school" diploma program through a hospital. We worked full 8 hour shifts in each clinical setting and not just day shift lol And I had a 6 week orientation program in my first job. I understand this is no longer the case.
It might seem like following a med pass is not a good learning experience, but...did you know that this med pass needs to be completed within a certain time frame? Did you know certain drugs have parameters, like taking a pulse with Dig, checking an INR with Coumadin, what is the blood level for the pt on Phenobarb? While you are following this nurse, ask questions..like why is the patient receiving this med, have you noted any side effects, what are the state regs regarding a med pass in this setting?
Bring a list of questions with you each day. Be curious.
Look up the meds you see being passed-a great opportunity to learn what type of meds geriatric patients receive. Do you see any potential issues? SNFs also have pharmacist reviewers who review patient files to ensure there are no interactions or problems. See if you are able to review this report for the unit you are on-a great learning tool. When I worked in LTC, I learned a great deal from my pharmacist reviewer. With her help, we were able to reduce doses or eliminate completely for many of our residents because as we know livers do not detoxify the body as well as we age.
Review the care plan for the patient-see if you can help identify any problems that are not addressed or whether any of the goals are being met. Then you can discuss this with your instructior and brainstorm how to improve the patient outcomes.
You can practicing assessing patients also..review your findings with the RN to see if you are on target.
One thing I learned through the years, is that complaining did not achieve much, except the person complaining was ignored. Remember to come with a solution when you see a problem.
Good luck to you and your fellow students. Don't give up :-)
Well explained . All i saw in her post was complaint . This will help not just her but everyone who will come across your post.Kudo:yeah:
Oh, this response makes me very, very sad. Look, the OP is going to be a nurse in what, 6 months? Maybe 7, she said she's a senior. Is it even rational to throw a person with absolutely NO experience into a hospital or LTC facility and expect them to be a good nurse? Or heck, even a safe nurse? Theory is not going to cut it. You don't walk into a patient's room and get 4 multiple choice questions on their chest for how to proceed. None of us want to know everything or experience everything. But before many of us went to nursing school we completed required courses comparable to CNA work. We can wipe butts. We can give baths. We can do it. And we will routinely prove that in nursing school, and be thrown to the wolves when we leave because we've never had any chance to do any real skills or get any experiences. My clinical experiences haven't been quite so dull, but close. It's horrible. I'm scared for when I leave school. I need a skill set that I absolutely cannot obtain. I'm told it didn't used to be like that. I'm told that through the hospital based diploma programs and some of the older modeled ADN/BSN programs they actually got nurses ready to work the floor when they left. This makes me want to puke. Which I will get the opportunity to show you I can clean up. But push some Zofran to help you? Nope.
That why it may be best at time to consider starting from bottom up by the time you learn a little bit of everything from being Cna, Lpn, Rn , working you knowlege and skills up. Some ppl choose going straight to the 4 yr program and those are mostly the one who complaint because all they got is theory .
I'm sure that happens all the time, I don't see your point.
It seems you are assuming that every BSN is going to be in a supervisory position. In my clinicals and in my classes, there has been no mention of preparing us for our "new supervising positions". If I was in clinical and I was with an LPN, never would I assume I was there to "get used to supervising him/her". What? Your view of this is simply bizarre.
I am only speaking from my experience and what the BSN did when i worked few years ago in a NH. Yes They did more in service , working along with Dr's, social worker , Physical therapist i mean everything you can think of on a multidisciplinary level with regard to resident and their care. But when the LPN was concerned it all come down to Supervision. Now you know , you couldn't have assumed but i have been there and it was done the way i am am explaining .why not verify this with your instructor and ask about my simply bizarre view to find out for yourself.
Again supervising is only one among many duty and responsibility that comes along i know that . I was suggesting this because when placed to shadow an LPN there is nothing else to be done but supervise why? b/c you are a step higher in education .
The nurse BSN duty if working in a LTC is more supervision and little hand on i am talking of a full licensed one . . Therefore in my message i am saying that the BSN student could use this time to get comfortable and learn a this role so that if she ever worked in such facility will benefit her. I worked in a NH at one point and the BSN student who come for clinical this is what they did along with their instructor or another employee BSN on duty helping them showing them duty in their scope of practice .Have you tried to ask these questions to your instructors they have an answer for you i am sure of it![/quote']
The BSN's in my facility aside from the DON and ADON work on the floor, doing hands on care. In order for a hospital to have Magnet status, they must have a certain % of RN's on the floor, with a BSN. So, a BSN is not just a supervisory role. Yes, I have asked my instructors. I am also on a student panel on how to improve education at my University. Clinical sites are hard to get into with competition from other schools. However, I don't appreciate, as a student, being told to do everyone's VS's on the floor for the next shift when I should be with my nurse on the floor learning from her, not doing the hospital CNA's work so they can spend time on their cell phone. None of my BSN clinicals are done in a NH. All is done in the hospital. So, like a good girl, I keep my mouth shut, do what I am told, learn very little, do a whole floor's VS and give a bath because the nurse is required to give one bath....and pay a LARGE sum of money. AND miss out on learning opportunities. I need to improve my IV skills, and foley insertion skills. How can I do that when I am doing VS and baths? My clinical instructor (who is employed by the hospital to precept the students) was not interested in reading my goals for the rotation, nor was she interested in reading what I thought I needed to improve on. And since I can chose where I do clinicals at, I won't be going back to that hospital. I learned nothing.
Anyway, we are beating a dead horse. Clinicals are going to be what they are. Some will be good, some, not so much. I will go on, pass my boards, and continue on to my MSN, which is my short term goal. My long term goal is to go on and get my DNP. Only 4 more clinical rotations and the whole program is done.
So, to the OP, I empathize, truly I do. You are almost done. Soon it will all be over and you can wear your title proudly. We will be in the same boat paying off those student loans!
I am only speaking from my experience and what the BSN did when i worked few years ago in a NH. Yes They did more in service , working along with Dr's, social worker , Physical therapist i mean everything you can think of on a multidisciplinary level with regard to resident and their care. But when the LPN was concerned it all come down to Supervision. Now you know , you couldn't have assumed but i have been there and it was done the way i am am explaining .why not verify this with your instructor and ask about my simply bizarre view to find out for yourself.
Again supervising is only one among many duty and responsibility that comes along i know that . I was suggesting this because when placed to shadow an LPN there is nothing else to be done but supervise why? b/c you are a step higher in education .
No, a BSN student is not higher in education, because we haven't obtained that degree yet. A student BSN can not call herself a BSN, that is illegal. Just like an LPN who is a student RN can not call herself a RN. And in LTC as a BSN on the floor you aren't supervising the LPN. The LPN has her own job to do. A student can not be put into the role as supervisor. That is what the instructor is for. Cuz, let me tell you, LOL if you came to me as a BSN student (I am an LPN AND a BSN student) and tried to "supervise" me, you will do none of my work, I can guarantee you that. Because, ultimately, since I am the nurse and you are the student, I am responsible for what you do because you are caring for my patients, and if I don't think you are safe to do so, that is my obligation and my right.
"Anyway, we are beating a dead horse. Clinicals are going to be what they are. Some will be good, some, not so much. I will go on, pass my boards, and continue on to my MSN, which is my short term goal. My long term goal is to go on and get my DNP. Only 4 more clinical rotations and the whole program is done."
how do you interpret that " I BSN student" "OMG" " 98% of time handing out Po meds"????? You mean to tell me at this point she was not thinking too much of herself ? come on ....... Did read her update? , she is confirming this but only now she has an understanding of what LPN's deal with on the floor and appreciate it in her own words "Thank you all so much for your kind words of encouragement, support, and advice. And to all of the LPN's out there who do their best to care for their 30-45 patients during a shift, I respect the Hell out of you and wish you well! "
CrazierThanYou
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