Clinical Instructors and lecturers with no hospital experience?

Turtle_Dog · Jan 12, 2009

Unfortunately thats where we are in the Phils, stuck between the 2 extremes. I have experienced being under both types of CI's; the new/young grad with little or no experience, and the veteran grand dame, who starts each and every sentence, "In my day, nurses/students were... " and proceeds to berate you or anybody else who has the gall to irritate her with questions. :chuckle

Mind you, I would still prefer the veterans, if they are willing to teach, of course. The new grads, well, I would rather have them go work first. Experience is not something to be taken for granted.

ngg1224 · Jan 20, 2009

You forgot to mention the name of the BP med and the dosage, it is a true fact that these anti hypertensives should not be given when the BP is low, there are parameters to follow, eg. do not give if Systolic BP is below 100, or the pulse is below 60....Some patients take BP medication as a maintenance dose to keep their Blood Pressure at a certain level. If the BP med is Metoprolol, and the patient is on a low dose like 12.5 mg, you can still give it. And like i said, some patients are given the "routine med" as a maintenance dose, stopping or witholding a dose without the Physician's knowledge is DANGEROUS, you are only a nurse, not a doctor to withold a medication, when these BP meds are stopped, some patients will have Hypertension,and the reason?...a Missed BP medication dose. Know the facts before you act is key. Joint Commission will have a fit if they found out that a medication is not given because some smart nurse, without consulting the doctor witheld a medication....ONLY A DOCTOR CAN WITHOLD A MEDICATION...a nurse can suggest what the doctor might do.

ngg1224 · Jan 20, 2009

I would say that Nursing Grads here in the US should not be Clinical Instructors...they just dont have the skills...all they do in their practicum is WRITE, and take vital signs and carry their clip boards and chat..Not in the Philippines, students there will deliver babies, participate in actual surgeries as scrub nurses, insert IV's, apply traction to ortho patients... i have been a preceptor for University Students and North American Students (US and Canada) are not gaining enough "skills", they know their books, that is for sure !

Fiona59 · Jan 20, 2009

I hate to disillusion you but the students both PN and RN in my province all have skills. They work one on one with patients. They do OR and L&D times. They are expected to manage a patient load on a floor during their final placements. Final clinical placements are often in the OR or in the L&D suite. Ortho is a rotation that both grades of nurses work through. IV training is included in the basic education in NA, not achieved through workshops after graduation

Unfortunately, the information we are getting on the current generation of nurses educated in the Phillipines reports 15 students to one patient. How can skills be developed when there are more students than patients? I work with nurses who have come from the Phillipines within the last year, their skills are not the same as nurses who came here a decade ago. And those nurses from the previous generation are even commenting on the difference in the education over the years.

Ginger's Mom, MSN, RN · Jan 21, 2009

I would say that Nursing Grads here in the US should not be Clinical Instructors...they just dont have the skills...all they do in their practicum is WRITE, and take vital signs and carry their clip boards and chat..Not in the Philippines, students there will deliver babies
>
, participate in actual surgeries as scrub nurses
>>
insert IV's
, apply traction to ortho patients...
>
i have been a preceptor for University Students and North American Students (US and Canada) are not gaining enough "skills", they know their books, that is for sure !

US grads can insert foley catheters, do ng tube feedings, administer high risk medications, monitor telemetry, take out staples, place ng tubes and the list goes on and on. Also US nurses pass the NCLEX test the first time ( 85%).

Turtle_Dog · Jan 21, 2009

Hmm student nurses in the phils first assist in delivering babies (in the hospital) and then allowed to handle at least 5 deliveries under the supervision of a clinical instructor and midwife, if it is a home delivery (not allowed anymore as of this writing) or doctors. The premise is that nurses should be able, in a pinch, to actually deliver babies in the absence of doctors or midwives.

Scrubbing in for operations/procedures allows students to better familiarize themselves with instrumentation and the procedure itself; most procedures, without student participation, have the nurses circulating, while aides and interns assist/scrubs with the surgeons.

These are requirements set down by the Professional Regulation Commission (PRC) in order for a nursing graduate to sit to take the exam for a license; they can not be waived and in some cases heavily scrutinized for irregularities.

IV therapy: there is now a law that requires nurses in the phils to have license or certification that states he/she completed an IV therapy course in order to insert IVs and high-risk IV meds. Back then nurses just simply insert when ordered. Students are not allowed to do so now, and therefore are not taught to insert IVs, much less give IV meds. They now have to wait till they have a nurse license, then they finish an IV therapy training course before they can even stick in a needle, and the license/certificate is given after completing an X number of insertions, supervised/witnessed by a doctor or IV therapist. Most hospitals now observe this law; staff nurses are forbidden to insert IV lines until they are certified, and have to call for a doctor or a licensed colleague if they need an IV inserted or re-inserted.

As for the other stuff, like foley catheters and NG tubes, students do that too; however when medical interns are around, like in the teaching hospital where I was doing rotations as a student, some procedures are left to the interns to do so they can practice too. Only in cases such as where an intern passes on a NG tube insertion are student nurses are allowed to do the procedure. The Related Learning Experience (RLE) notebooks, which all students must have, have all the procedures that a nurse should be able to do listed there; students have to either seen/assisted in the procedure being done, or have actually performed the procedure by themselves (with some supervision, of course). The clinical instructor has to countersign each entry in the notebooks and the PRC can demand to examine the RLE notebooks if they see any irregularities in the students records.

As for telemetry, well most hospitals can not afford it. So few students ever get trained. But students will go check everything that is ordered. When doctor's orders require hourly monitoring of vital signs as well as fluid intake and output, a student will go check each hour, even when a nursing aide is around, because that is what is required of them. Telemetry would be spoiling them, in my opinion. :wink2:

To remain on topic: It still depends, on some degree, on clinical instructors if students will be able to do all that I mentioned. And experience clinical instructors have or will find ways for students to learn.

NurseCubanitaRN2b, BSN, RN · Jan 22, 2009

I would say that Nursing Grads here in the US should not be Clinical Instructors...they just dont have the skills...all they do in their practicum is WRITE, and take vital signs and carry their clip boards and chat..Not in the Philippines, students there will deliver babies, participate in actual surgeries as scrub nurses, insert IV's, apply traction to ortho patients... i have been a preceptor for University Students and North American Students (US and Canada) are not gaining enough "skills", they know their books, that is for sure !

In the US it's not standard practice for an RN to deliver babies...that's beyond their scope of practice unless they're also certified midwives.....In the Philippines, does the midwife has to be an RN? I was told no, they don't have to be an RN so why would an RN deliver babies in the Philippines if they have the midwife? Now there are instances where the RN will have to deliver the baby because the doctor didn't make it in time...but it's not standard practice for the RN to deliver a baby, it's not within their scope of practive...but nursing students do go to the OR, and they insert a ton of IV's.....I've spoken to recent grads from the Philippines and they are even saying that they're not getting the quality education that the older generation Filipino nurses once received....But I do believe that there are some schools in the US that probably are producing some incompetent nurses, but those schools are few and far between and that's because here in the US we have regulations and if schools are underperforming then those schools are put on probation, and if they continue to underperform then eventually they are closed :) . Unlike in the Philippines where the nursing schools are sprouting like crazy out of nowhere.

Pediatric Critical Care Columnist · Jan 22, 2009

IV therapy: there is now a law that requires nurses in the phils to have license or certification that states he/she completed an IV therapy course in order to insert IVs and high-risk IV meds. Back then nurses just simply insert when ordered. Students are not allowed to do so now, and therefore are not taught to insert IVs, much less give IV meds. They now have to wait till they have a nurse license, then they finish an IV therapy training course before they can even stick in a needle, and the license/certificate is given after completing an X number of insertions, supervised/witnessed by a doctor or IV therapist. Most hospitals now observe this law; staff nurses are forbidden to insert IV lines until they are certified, and have to call for a doctor or a licensed colleague if they need an IV inserted or re-inserted.

So if I understand this correctly, nursing students in the Philippines do not have anything to do with IV therapy during their training. So how can the new grad planning to emigrate to the West expect to manage multiple IV infusions, high-risk infusions and drugs, central venous catheters, peripherally-inserted central catheters, arterial lines, and so on, never having learned the skills in school nor practiced them afterward?

As for the other stuff, like foley catheters and NG tubes, students do that too; however when medical interns are around, like in the teaching hospital where I was doing rotations as a student, some procedures are left to the interns to do so they can practice too. Only in cases such as where an intern passes on a NG tube insertion are student nurses are allowed to do the procedure.

Here the med students/interns/residents would not be seen doing such tasks. They are considered to be the nurse's responsibility. They will write an order for an NG or foley, but that's as close as they get to the doing. The last time I saw a physician put in an NG, it was coiled in the patient's mouth. The only time a med student/intern/resident would place a foley would be during a urology rotation.

To remain on topic: It still depends, on some degree, on clinical instructors if students will be able to do all that I mentioned. And experience clinical instructors have or will find ways for students to learn.

We practiced on each other. We performed head-to-toe assessments, bed baths, IM and subcutaneous injections and IV placement on each other. For NG and foley practice we used a mannequin but were required to have performed both skills safely and correctly (critical elements) for real patients at least twice under supervision of our clinical instructor before we were allowed to pass. Our clinical instructors never went onto the ward with more than 10 students. No patient had more than one student providing care for them in any one week. Our clinical practicum, the final segment of our training before the CRNE, was eight weeks of full time hands-on nursing under the supervision of a preceptor. We were expected to provide total care for our preceptor's patient load. Even at that we graduated feeling completely unprepared to take on the responsibility for the typical patient assignment. At that stage I couldn't imagine trying to teach any of it to someone else.

Ginger's Mom, MSN, RN · Jan 22, 2009

Scary that telemetry it not done, it is almost routinely done on every patient.

In my state nurses CI are capped at 10 while many hospitals only allow 8. What is the ratio to students to patients.

If you don't have telemetry you probably don't have Smart Infusion pumps,wound vacs, glucometers, insulin pumps, venodyne boots, TPN, bladder scanners, and the list could go on and on. Who do you think is going to teach you when you come over to North America?

Every nursing unit has a defibrillator, do your hospitals have one on each unit and is each nurse trained on it's use. Do you transport critically patients via helicopter? These are all common nursing practices.

I agree we had to team lead our last rotation, you had to supervise the team (under your instructor who only stepped in if you made a mistake) AND I did not feel like I was a fully competent nurse.

suzanne4, RN · Jan 22, 2009

I would say that Nursing Grads here in the US should not be Clinical Instructors...they just dont have the skills...all they do in their practicum is WRITE, and take vital signs and carry their clip boards and chat..Not in the Philippines, students there will deliver babies, participate in actual surgeries as scrub nurses, insert IV's, apply traction to ortho patients... i have been a preceptor for University Students and North American Students (US and Canada) are not gaining enough "skills", they know their books, that is for sure !

Nursing students in the Philippines do not do one thing with IVs. That requires an actual license and then certification by law there.

There is no school in the US that permits a new US grad to be a clinical instructor as well when they have just graduated and have never worked in a school.

And since you brought up the part of the deliveries, in the old days, they had to actually deliver 50 babies before they could even sit for their licensure exam, so many had to be in a hospital and so many were rural.

Now the PRC requires that they were at 5 deliveries, and we are hearing as well as seeing here that there are some that have never even been at the delivery but paid for the information to submit from a nursing office in the hospital. One does not anymore become a scrub nurse by scrubbing in for a procedure in any country, they are doing nothing more than hold a retractor at best and if even that for a day. And what about the number that have come over here in the past couple of years that have never inserted a foley or placed an NG tube or even drawn up meds from a vial that needed to be given IV or IM? I would love to think that it is like the olden days when students trained in the Philippines, but it most certainly is not. And when there are more than 435 RN programs and they are open all over and quite a few have never had even one student pass the local licensing exam, please take the time to do some reading over here about what is actually going on with a large number of programs there.

Add into it the fact that the retrogression has been in place for more than two years and it is expected to take probably closer to seven years for one to be able to get a chance at a green card, what do you expect them to do? Things are most definitely not like they were in the past.

suzanne4, RN · Jan 22, 2009

Procedures of any type normally go first to the medical intern or then the medical student, and this goes for deliveries as well.

Add into it the fact that the majority of nurses in the Philippines are also caring for more than 30 patients at a time so the family member remains at the bedside to do most of the care.

It does not matter what anyone has written or has seen, but I personally have met nurses from there that have never once done anything with foleys, NGs, or even IVs. And they do exist like this over there.

suzanne4, RN · Jan 22, 2009

And then to add this on as an extra thought:

If the training is that wonderful, why do almost all other countries require additional evaluations and assessments of skils for those that have trained in the Philippines now? Australia, NZ, Canada also require additional evaluations before they will issue a license in most cases. And add on the fact the British Columbia is only classifying those that trained for the RN in the Philippines as that of the LPN, until they have been thoroughly assessed and evaluated?

Surely, they have their reasons why they are doing this now.