Clinical Nursing Student Needs Advice 5 patients

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Hello All, I am finishing up my ADN with 9 weeks to go. I'm in my mid fifties. In my current rotation we care for as many as 5 patients on a cardiac tele unit. I am overwhelmed to say the least. I have to make it through 5 more of these shifts and should be home free as my last rotation will be less intense. We are expected to do two assessments per patient, IV assessments every two hours,start IVs, all skills, and pass all meds. The med orders change frequently on this unit and there are many unstable patients with codes etc.

I don't mind working very, very hard and forgoing a break but as a student this is a bit much. If we make a mistake depending on the severity we are out of the program :( . My first concern is for my patients I'm just not sure I can do this and am looking for any advice that anyone would kindly share.

Some of the challenges are we do not have immediate access to the med room, have to wait for our instructors for IV pushes and skills, we have not been orientated to the floor...this is tough!!!

Thank YOU!!!

Specializes in LTC/SNF.

The real issue, as few others have pointed out, is that the OP has to wait for the instructor to be present in order to pull/pass meds and perform all skills. This is the same scenario for me during clinicals, and we usually have a group of 8 students to 1 instructor. We can't do ANYTHING but assessments and documentation without our instructor present. We have 2-3 patients assigned and of course we always get ripped a new one for "poor time management". I think I could handle 5 patients just fine if I didn't have to either wait in line or actively seek out my instructor to supervise me every time I need to give a med or perform a procedure. I try to cluster care and catch up on documentation while in line, but this scenario isn't the same as it will be in "the real world".

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Thank You for your comments....I will read and reread them as I finish up this rotation. The nurses on this floor never have more than 5 pts so this is a full pt load.....before you can work in this hospital you are required to go through an orientation that lasts at least 6 weeks so we are handicapped in that way. We were shown nothing absolutely nothing :( didn't know where anything was. We do have to wait for our instructor to do some procedures which slows us down. We also have a shorter shift making it harder to get it all done we have to attend a meeting before the end of shift. The full pt load is new to us this semester last semester we had 2-3 pts but were able to get all our pt info before we hit the floor ......look up drugs, diagnosis's etc. so this is tough. The other night I had late night clinicals and then early morn the next day slept a few hours and by the grace of God only got two pts ,was assigned to charge nurse, otherwise it wouldn't have been pretty. I would have cried uncle before I would have allowed harm to anyone though. I personally think it is too much if I have 3 pts I get to delve in deeper and understand everything better....or 5 but let me get my info ahead of time to compensate for the fact that we have less time to get it all done and far less experience. I do appreciate the comments and will work on memorizing any meds Idk well, improving my organization (although I think it is pretty good), and praying like crazy Let's face it at this age you don't go to school to be a nurse unless you really want it bad and think you'd be darn good at it!!!

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Specializes in Critical Care; Cardiac; Professional Development.

I managed five in my senior practicum. However, I was assigned to a nurse preceptor and my instructor was not even there. My preceptor did meds with me and stood by during skills, but for the most part I was managing these patients. I had a brain sheet and felt pretty proud when all was said and done. It did a lot to alleviate stress when I started on the floor I am on now. I have been out of school 15 months now and things are going well. Doing my practicum that was really did help prepare me for the real world of nursing.

Having that many patients isn't bad at all at the end of nursing school. Not being empowered to manage them with guidance but self directed time management is a shame and weird. Keep your chin up OP, you are almost there!

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If you have clinical rotations in facilities that are in a very upscale area, you will have some serious constraints due to the hospital's fear poor survey/marketing results. Upscale peeps feel they deserve better than "just a student", and often lawsuits are a legitimate concern, as the well-to-do easily have means. Where surveys rule, your student clinical experience WILL SUFFER.

In contrast, lower income areas where people usually take what they get and never fill out surveys or have the means to legally fight poor care ...as a student, you will have the run of the hospital. Your clinical rotation will afford you a chance to practice on just about anybody doing just about anything.

When I was a student, this was very true. Once clinical site was in a very low income area. Students at that site did just about anything and the nurses were grateful just to have another pair of hands on the unit for the day! Students described never wanting anyone they know to ever go to this hospital - but at the same time they all had as many patients as they wanted and nobody cared what the heck they did or didn't do to the patients - pressure was off. In a way that was excellent for the student just to work with out all the games. But, for those patients, they got what ever the student gave. Good or bad.

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Specializes in Med/Surg., Geriatrics, Pediatrics..
And what is your point? In the real world you will work much harder than this. If you think this is too much for you, maybe you should have pursued a different career....and you're not even working nights, weekends, and holidays for 12+ hour shifts yet, as ou will do as an RN. My first job with a BSN was on a cardiac/tele floor, and I had 12-14 patients.

Now that's the spirit of a Nurse Ratched!!

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Sounds intimidating for a student, but you can do it! You've already gotten several really good suggestions like a good "brain" report sheet, prioritizing. A couple other small ideas that might help....... See if there is a way for you to come the day before your rotation to get familiarized with the place, and if that's possible, try to have some of your more important questions ready, and if not, have them ready for the day of & get there as early as you can! Have a game plan before the day you start, and eat a good breakfast. Also, leave room on your report sheets for a "To Do" list or write them on the back of each sheet, so as your getting report & throughout your day, you can quickly jot down things you need to do, such as education, change an INT, supplies they need, dressing change, etc. and mark them off as you complete them.

Best of luck!

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Wow! We never have more than 2 patients! Although we are responsible for all nursing duties and hygiene, vitals, ADLs. Even if we weren't that just seems crazy! I don't see how your instructor can possible supervise more than one student caring for 5 patients each...

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Specializes in Intermediate care.

^AMEN!!! :Whoop:

In my experience, "all business" was not only good, but better for my patients. My competency allowed them to trust me, and they saw me as empathetic.

Like the saying goes: Forewarned is Forearmed!!! Take advantage of the opportunity, OP :)

Yes! Ill be warm and fuzzy if you or your.loved one is dying. But if you just had open heart surgery yup it sucks, and I need to be tough to get them moving to get them better. None of this fuzzy warm crap. That is for when you are better. I feel I'm taken more seriously this way as well. Rather than a push over.

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Specializes in ICU.

It seems that some of the folks who are talking down nursing programs that don't give their students opportunities to take on more realistic patient loads are lacking in scope a bit.

When I was a student, I had 1-2 patients first year and second year I would have 1-6 or 7 depending on when and where my clinical days were.

Some facilities (especially those in rural areas) don't have high enough census to accommodate each student with a full patient load. In the majority of clinical rotations, even small programs of 30 to 50 students could have 5-10 students on a single floor during one clinical shift. If the unit has 25 beds and only half the beds are full, then no single student is going to get a realistic patient load. My program was great in that half of my clinical days were weekends where I had a preceptor and I took on whatever she had been assigned for the day. But not all programs are at liberty to provide such an experience to their students.

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Thanks again for the tips, support, and the confidence you all have in me. I'm on spring break right now so I'm using some of the time to view skill videos and memorize more drugs. I think on the one hand I'm glad my school does all they can to prepare us for the real world of nursing on the other I would hate to fail out just because I don't have as good a time management skills as an already practicing nurse or because I'm handicapped time wise. This floor has been a little different for us on the other floors we just do it all and go find our floor nurse if we have questions regarding their pts. sometimes on this floor the nurses spend the day with us which is fabulous because they have so much to teach us it just depends on the nurse!!! I'm clinging to two things I'll be as prepared as I possibly can be and our instructor did say if you get into trouble use your nurse....I take that to mean have them do some of the pt. care if needed....so that is my plan. Once again, thank you for taking the time to help a nursing student be successful!!!! :)

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At least you are getting that experience now. I just started my first nursing job on a medical floor and they are building me up to 6 patients. I have never had more than 3. I was never given more than 3 in clinicals and my preceptorship was in the ICU where they maxed out at 3 pts

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Wow some of you guys are not nice...that is a lot of work for a student. When I started my first job it was a struggle.

OP, it will be easier once you get into a job where you actually start to know the people, the place, where supplies are, what supplies you have, how to use them, etc.

Exactly. There is a difference between doing this at work when you graduate because you get TIME to learn the unit, policies and procedures and so on. In clinical, it was extremely frustrating being ready to give meds or do a skill on your patient, but the nursing instructor is nowhere to be found (he/she is with another student in a room.) We had 8 students in clinical with 1 instructor. How is that instructor going to make his/herself available to each student for each patient?

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