Clinical Instructor - PLEASE give me your thoughts/advice!

[NICURN2013]

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...

[~Mi Vida Loca~RN, ASN, RN]

In our program we have ti either have our instructor or a co nurse present to do our stuff. I didn't often see my clinical instructor. But it doesn't seem right that she is always sending you all home early. Cutting conference short and starting late. Seems lazy to me, we have an instructor like that. All the lazy students love her. They get to get out hrs early. They don't have to do their paper work cause she doesn't check. She tries way to hard to be their friends and have people like her. She doesn't teach. Her lectures are terrible and so are her tests. She writes the most absurd questions. Me personally, I think she has no place teaching, or in the classroom. But those that get her for clinical will always defend her cuse they get to half orifice their way through clinical. It will only hurt them in the end and I don't think they get that.

[NICURN2013]

Thankfully... I talked with my instructor today and told her exactly what my concerns were and she said I was doing nothing wrong. She also said she was very glad I was trying new skills and getting involved as much as possible. She said no matter what either herself or the RN I was assigned to HAD to be present when I was doing any sort of skill and she wanted to be present if we were giving meds.

So. I'm going to see how things go and see what my other classmates are doing. As of right now, it doesn't sound like I'm doing anything I shouldn't be. I'm going to try to focus on more assessment/care plan stuff this week because I have a couple due.

Thank you all for your thoughts! I was a nervous wreck last night!! Hopefully she'll keep us there the full amount of time next week.. otherwise I might have to talk to someone about that. I just don't feel its fair when we're only there for 7 1/2 hours anyway once a week.

[BeenThereDoneThat74, MSN, RN]

As a clinical instructor, I see some things that I am nodding my head in agreement about, and things I am shaking my head (saying (Oh no!!) about.

-With student ratios being what they are, there is no way you're going to get a lot of one on one time with your instructor. Just as a floor nurse needs to prioritize their patients, we have to prioritize which students need us more. It may be due to the students ability (or lack) or it may be the complexity of that patient. Even my stellar student will get more attention if her patient demands it.

-As an instructor, I am not there to take the student by the hand to do everything. Mine are 2nd semester. By no means are they experts, but they should be able to go in and communicat and assess their patients. If they encounter something they are unfamiliar with, they should come and seek me. If I am not available, they should go to their primary nurse (if it is an urgent matter). The floor nurses are not there to teach the students; some love to, and some stay as far away as possible.

-New procedures (especially ones that they have not been checked off on) are off limits alone. Accessing a port?? wow, I'd have a problem with that (we don't even teach that in our program). It may be acceptable in your neck of the woods tho. Anything invasive, I need to know about (and this thread will remind me to remind them about that ). Even fingersticks: I just want to know about them (they are not teated on that skill until their 3rd semester in my program). As the instructor, I am always worried about the liability. The last thing I want is some administrator coming up to me asking me if I allowed to my stuednt to do the procedure. Last week my student was doing CPR on a patient (who obviously needed it). I was sweating for a bit, until I justified to myself that there is a REASON we have them BLS certified!!

-Meds: absolutely, positively need to be done with an instructor. Every year I get someone who gives a med without me (I swear to God, it happens every year). So now, who's signing off on that med? Who verified the med? Who ID'd the ptient? Not an RN, yet my name has to stand behind that student. It is something I take very seriously, and it takes up the majority of the clinical day. If we didn't have to do meds, you'd get a lot more of my attention.

It is a challenge to insure that those not giving meds are being productive. I always know which ones I have to look out for. Many students are like you and feel they are not sure of what they should be doing. Often times the ones who have HC experience find themselves not knowing what to do. Students who are not giving meds will sometimes say they 'didn't do anything for the patient'. Our job is not just to give meds. But the instructor needs to steer you in the right direction to remind you of that, and to show you what else there is to do.

Post conferences: I don't hear everyone's story. It's hard to hear what everyone has to say, especially when their stories are a bit too wordy . I try to steer the direction of the conference, rather than let them say "I assesses my patients, I did their vitals" (yeah, I hope you did!!). I tryo to focus on the situations that make for good group conversation. Your creplans are what lets me know about how and what you did with your patients.

AND... leaving early, her not being on the floor with you? That's just not good. Speak up NOW. Take my advice. While no one else in your group may have a problem with it, it's going to catch up with you next semester, when your instructor wants to know why you never did certain things. Your peers will then speak up and say "we never stayed the whole day". Then it will be too late. Go in to your coordinator (or lecturer, whomever oversees the clinical instructors), anonymously, if you have to. They need to (and prbably want to) know. ou are paying money (and she is getting paid money) to be there.

[Student KMW]

In my current clinical, my instructor likes to be with us as we perform skills for the first time, but we are expected to act independently (of our instructor and the nurses).

We are not allowed, by hospital policy, to pass meds on our own, therefore the instructor has to be with us when we pass meds.

I think one of the things we are "graded" on is our initiative.

If you are not comfortable, ask for clarification from your instructor, or our Dean has an open door policy for any issues that we may encounter, if you feel comfortable going above your instructor's head.