Clinical experience- difficulty w/ primary nurse

SunnyAndrsn · Sep 20, 2008

The best thing you can do is be upfront. I always go up to my primary nurse and start with:

"Hi, I'm Sunny and I'll be working with the pt. in room ___ today until 9pm, I will give you my report before we leave. We also take our dinner break at 6pm as a group, I'll be sure to update you before we go to dinner as well. Can you give me report (if she has already cleared it from the phone), or is it okay if I go with you to get report?"

I clarify the cares we can provide, in this clincal we can't do blood products, and we can't do IV push meds. The facility also won't let us start IVs as this is a pediatric rotation. Finally, I ask if there is anything they are not comfortable with me doing for the pt. that day. You can get a feel for how the nurse feels about the student this way, and if I get bad vibes, I just go to my instructor with any questions. Of course, anything pertinent still must be reported to the staff nurse.

For example, last week my pt. needed IV IG, and the primary was not comfortable with me and my instructor hanging the infusion, despite the fact that my instructor was also an employee of that hospital. Fine by me, I ended up doing vitals for her qhr, and two assessments at 4 and 8pm.

As it turned out, this was a nurse who was not so hot on students, and she told our instructor that me and another student did not do our cares (my pt. needed to have her gown changed, but we couldn't because she had a gown without snaps for her MRI, and she wouldn't let me unhook her IV to get her changed.) She also stated we didn't report off to her at the end of the shift. I almost got put on remediation for that, but I asked to speak to her to clarify what she felt happened, and opps, all of a sudden she remembers me telling her about the gown issue and that I DID report off...hmmm...if she didn't want students she should have just said so!

As a result of last week, I decided that this week I'd also ask the staff nurse to initial my sheet before I turned it into my instructor, that way there is no questioning if I reported off or not.

I've only had one other poor experience with a staff nurse, back in my OB rotation. She was so rude it was unbelievable, I felt sorry for her pts! My instructor told me to just back off and help my classmates instead and to do my assessments after that nurse had left the room. I just asked the pt. if it was okay if I re-assessed her so I could report to my instructor and she was fine with it. Of course it helped that I admired her newborn too.

If I should end up with a primary nurse during a clinical rotation that has no interest in helping students (or is having a bad day, or is just an unfriendly nurse), what should I do? I haven't experienced this yet, but I have heard of others who have had this happen to them. Obviously we, as nursing students, need and want to learn and that is why we do clinicals, but that becomes more difficult if the person who is teaching us doesn't want to help. Just wondering if anyone has experienced this and how they handled it. Or, if you are one of those primary nurses who isn't wild about having students, what can I do to earn your trust and respect so that I can learn and have a productive clinical experience? Thanks!

Jules A, MSN · Sep 20, 2008

I played it by ear and took my cue from their personality. If they were busy or unfriendly I would just go about my business and try to stay out of their way unless I really needed something that my instructor couldn't answer. For someone that really didn't want to or wasn't able to help me get the most from my day I just chalked it up as the way things go sometimes. It really wasn't their responsibility to make my student experience valuable although it would have been nice. I always tried to be gracious because despite what some students think they really are extra work for the nurses on the unit. Kudos to you for considering this and I hope you only have wonderful nurses.

86toronado, BSN, RN · Sep 20, 2008

I try and remember that they are not teachers, and in general, don't request to have a student work with them, it's just something that's pushed off on them. If they don't want to show me anything that day, I take it for what it is and move on. What I do have a problem with is the ones who won't even give you report - they say "go look in the chart" that is not safe patient care. :banghead: