Clinical Instructor - PLEASE give me your thoughts/advice!

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Hello everyone,

I'm in a BSN-RN program and I'm in my first clinical rotation. I'm on the Oncology floor now (last 2 weeks) and I had one day on Med/Surg.. This was my 4th week. I took Fundamental last term with lab (to practice skills) and I also have a 10 hour lab this term. I'm just very confused on what I should expect in clinical. Because this is my first clinical experience, I'm not sure if this is normal from a clinical instructor or if I should talk to someone at the school about it.

1. I don't see very much of her. She says to only call if we are passing meds and then she maybe shows up for a few seconds just to "check up" on us.

2. She starts clinical 30 minutes late and usually lets us leave an hour early and our post conference is VERY short. Today, she didn't even know what I actually did during clinical (which is kind of scarey to me!). She asks briefly what a couple of us did and doesn't listen to our entire list... she ALWAYS seems like she's in a hurry to get out of clinical.

3. I have a VERY good nurse that I'm working with and following. However, she's asking me if I want to do a lot and because my teacher said "I only have to be here if you're passing meds" (which she heard today!!) I'm not sure if she's (my instructor) suppose to be there or not. The instructor gets upset at some of the other students if they say, "well I didn't do mcuh but observe because you were with another student on another floor.." Then she says, "you aren't here to just observe, you need to actively participate"... however, she wasn't with this student at all, so what does that mean? The student can do ANYTHING without her as long as the nurse she's with is present???

4. Today I passed meds and did an injection with my instructor in the early AM... during the afternoon my instructor was helping other students with meds and I started a Port-a-cath needle (my nurse made me practice several times on a practice Port-a-cath and walked me through the entire process with the patient - it was VERY safe), I drew up a tube of blood prior to a blood transfusion (from a PICC line, also walked through with the nurse) and irrigated a drain in the pt buttock (also with the nurse). All the other skills I performed were simple and I'm not worried about. The nurse I was with today was VERY helpful and educated me continuously throughout everything (which I feel my instructor should be doing)... Everything was sterile when it was suppose to be or VERY clean and careful when it didn't have to be sterile. I talked about all the steps with the nurse before hand and feel like I did it better with her than it ever could have went with my instructor (but that's not the point if someone else doesn't approve of what I'm doing with my nurse).

OVERALL, I just don't want to get in trouble because my instructor isn't being clear, but I'm not sure if I'm just being worried for no reason. All of us have asked her what we're allowed to do with our nurse and what we have to call her for. She ALWAYS gives us a different anwser.. Today she even told another girl she could pass meds next week with just the nurse and not her. ???? I thought I'm suppose to be learning more from my instructor... the RN I'm with isn't being paid to teach me (THANKFULLY, she really enjoys it).

I'd love your thoughts! I'm a little worried now that I'm back home...

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Specializes in Emergency/Cath Lab.

I rarely saw my instructor the first few semesters at clinical. They relied heavily on the nurses that we were assigned to. That in part was due to the fact that there were 9 other students there with me at the time. I also noticed she would spend more time with those she felt were not as safe, prepared or as confident so maybe take it as a good sign

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OKay - That makes me feel a little better. She spends a lot of time with this one student and mentioned (which I hope she doesn't talk about me with other students) that he makes her nervous because he's so nervous. I just wanted to make sure because I'm doing skills with my nurse instead of her I'm not going to get in trouble (haha.. I sound like a little kid again).

Thank you for your post!

Oh yeah, and there's 7 of us in our clinical group, so I do understand she can't be everywhere at once.

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Specializes in Infusion.

It sounds familiar. I'm just a first year student and I am learning that clinicals are about learning what you want to learn. It is time for you to become comfortable with patients and perform assessments and work on the skills that you have checked off in in your lab. I think we get into such a hurry to try out a bunch of different nursing skills that we forget that so much of what we need to be doing is observing patients, asking them questions and determining what their needs are. I am told that after the first year, you will start feeling more like a RN and doing more and more of the skills you were taught and you will have more opportunities to work on your "practice". We don't see our instructor for most of the day. She observes our med passes and skills until she is comfortable that we are doing those things safely. We tell her and our clinical group about our experiences during the day and we all learn something from that. I consider it a good day when I get to do one or two skills and spend the rest of the time answering call lights and learning a little from one of the RNs. After the first year, we have an opportunity to get some real world nursing experience during t the summer and during term breaks. That's the time to really dig in. You don't want to rush in and perform skills that you haven't received full instruction and given a demonstration in school. You should ask your instructor what you can and cannot do yet. That should be something very clear for everyone. Otherwise, this is one of those experienced where you will need to be self-directed and set your own goals.

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See - that's what I thought. I thought I was suppose to do more assessments and getting to know my way around, but our instructor wants us to do more, but she isn't around to do it with us but my nurse always asks me if I want to do skills. Last week I observed all day and did minimal skills (which I was fine with) but my instructor told me I needed to do more. SO this week I did MORE and did a lot of assessing my patient (I only have one and then I'm allowed to help my nurse with skills on the other patients she has).. I also did a lot of observing too. I'm not worried about getting MORE skills in I just want to make sure I'm okay (allowed) to be doing them with the nurse. I felt comfortable with everything I did today, again I did not feel UNSAFE doing anything. I felt like it went just about as well as it could have. I was slightly nervous but because my nurse explained EVERYTHING (even the reaction -faces, etc the pt would have) I felt very comfortable. And she made me practice before hand.

Also - my lab instructor (whos different than my clinical instructor) told us we might do skills (like starting an IV) with our clinical instructor that we haven't done in lab and that's OK...

Ahhhhh! (that's how I feel right now :p)

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Specializes in Infusion.

It is just the crazy world of being a nursing student. I know we have a clinical instructor or two that gives some very vague "you need to do more" instructions. I've got one of those instructors who says "you're doing fine or great" when I think I need to be doing more.

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I guess maybe I'll just pull the instructor aside and ask her directly 1 on 1 what I am allowed to do.. so hopefully it won't bite me in the butt later... BUT I totally seeing her as the instructor to be like, "I never told them they could do that.." Guess I'm just going to have to be extra extra careful with this instructor. :(

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That wouldn't be okay in my school. We are only allowed to perform skills we have been checked off on. It's our job to know what skills we are allowed to perform unattended. We need our instructors to pass meds and for skills that we haven't performed in lab, we need our instructor to be there the first time.

I am in my second term and our clinicals are focused primarily on assessment. Our second focus is teaching. We have loads of time to learn and perform skills. More important in our program at this point is the assessment and critical thinking - taking the pieces and parts of our assessments with the charts, labs, historical data, etc. and putting them together. We are in OB this term and we are passing meds, IMs, staple removal, caths, and a few others. We have 5 more clinical units to increase our skills.

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Hmm... see, I'm not so sure now. I'm going to go to her office hours and get it figured out completely tomorrow. I do not like feeling unsure. She changes her mind about everything and because this is my first clinical instructor, I'm not sure how things normally run at my school.

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Nursing clinicals are just so poorly designed that it doesn't promote learning. We, for example, and every other school I know of sends students to clinical once each week. We have nine clinical days this semester. We get assigned one patient for a few days and two patients for a few more and the other three days we get elective rotations. Because the clinicals are spread out over a week you aren't given time to grasp the administrative process of the clinical site and allow for patient management to become anything other than a task oriented affair rather than a thoughtful, logical process utilizing that "critical thinking" the faculty harps about as if nursing has some kind of ownership over critical thinking, lol. You're rushed around and told to look busy so you don't get time to absorb or reflect on anything before having to do something else. You're given a patient with a variety of problems many of which you won't have yet covered in didactics, but you've got to go provide physician ordered treatments while washing and feeding them and standing around long enough to talk and socialize with the patient so you're not asked "Have you not spent any time talking to your patient?"

My idea:

Go through all of your lectures and labs, take a comprehensive cognitive and psychomotor exam, and if you pass move into the clnical phase for the last three to four weeks of the semester. Go the same clinical site every day for at least two weeks, before moving on to something else, providing the same role each day then get evaluated on a pass or fail basis.

I just don't like it, obviously.

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Nursing clinicals are just so poorly designed that it doesn't promote learning. We, for example, and every other school I know of sends students to clinical once each week. We have nine clinical days this semester. We get assigned one patient for a few days and two patients for a few more and the other three days we get elective rotations. Because the clinicals are spread out over a week you aren't given time to grasp the administrative process of the clinical site and allow for patient management to become anything other than a task oriented affair rather than a thoughtful, logical process utilizing that "critical thinking" the faculty harps about as if nursing has some kind of ownership over critical thinking, lol. You're rushed around and told to look busy so you don't get time to absorb or reflect on anything before having to do something else. You're given a patient with a variety of problems many of which you won't have yet covered in didactics, but you've got to go provide physician ordered treatments while washing and feeding them and standing around long enough to talk and socialize with the patient so you're not asked "Have you not spent any time talking to your patient?"

My idea:

Go through all of your lectures and labs, take a comprehensive cognitive and psychomotor exam, and if you pass move into the clnical phase for the last three to four weeks of the semester. Go the same clinical site every day for at least two weeks, before moving on to something else, providing the same role each day then get evaluated on a pass or fail basis.

I just don't like it, obviously.

I like your idea!! I just hate how unorganized it is and not knowing what's expected of me, what I'm allowed to do, or how much is tooooo much. They always say to take charge and say you want to do skills... so that's what I did.. but now I'm freaking myself out.. haha.

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Specializes in Critical Care; Cardiac; Professional Development.

I would seek clarification from someone higher than your clinical instructor about what their policy is re: skills being done without an instructor present. Obviously assessment is probably not an issue, but doing things like wound care, starting or discontinuing an IV or Foley etc are more invasive. At my school the instructor has to check you off on those things before you can fly free with a buddy nurse.

Your situation frankly smacks of some of the strange things read here where a student bops along doing as has always been done and then get slammed for not following a policy that had not really been explained or practiced until that student was targeted for some reason.

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