Clinical Paperwork

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Good morning,

I teach in a full time nursing program and two days out of the week, we are in clinical at the local hospital. The students are given 1-2 patients in which they are expected to perform a head-to-toe assessment, complete AM care, and to perform any other needed tasks or skills (foley, NGT, ostomy, etc...). My expectation is that the students will be providing care and attention to their assigned patients for the majority of our time on the floor. However, my issue is clinical paperwork. While we do want to see a written head-to-toe assessment and have the students become familiar with the patient's medications, I struggle with keeping my students engaged with the patients and not so focused on completing their paperwork while at the hospital. Many students will spend entirely too much time on the computers instead of being with their patients. I have made it clear on several occasions that this is not the expectation but it continues to happen. Unfortunately, with 8-10 students on the floor at any given time, I cannot be with or watch each student all day.

Does anyone have any suggestions or ideas? Should I get rid of the paperwork?

Thank you.

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Specializes in Medical-Surgical/Float Pool/Stepdown.

In my ASN program, we showed up to the hospital the night before and chose appropriate patients for the next day and spent all of that time on our clinical paperwork including on care plans and med lists info during that time.

Our expectations were intense and grading was meticulous and the paperwork sometimes would take almost eight hours to finish...but we were prepared, fairly confident in what we had learned about the patient, and spent clinical time hands on with the patients.

FYI/FWIW: We also followed a strict dress code (business casual with a school labeled lab coat over and student badge) and knew we were only allowed to use student specified computers to look our patients up as to not get in staffs way just as we were expected to use during actual clinical. There were Manila envelopes that were pinned up on the wall inside the nurses station for each clinical cohort/school that held a list of patients that were chosen by each student so we each for sure got different patients and staff (usually the charge) would help us pick - first come first serve - between the appropriate patients as in, not going to DC, fresh trach, whipple, trauma, CHF exac, NSTEMI, GI bleed, comfort care, etc.

Hope these run-on sentences are helpful!

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Specializes in Pediatrics.

When you say they are on the computers way too much, do you mean in the chart, or writing out the assignment? Either way, both can be addressed by limiting their time on the computer. If it's the chart they are staring at aimlessly, limit the time, and don't let them on until they have actually been in with their patient. When I taught, it took my way too long to lay the law down on this one. I made them see their patient first (a 'two minute assessment'), then get report from the RN, then report to me. I would give them leading questions based on their first impression and the info they got in report. This way, they had direction when going into the chart.

As far as writing the assessments, do you require that they give it to you before they leave clinical? I would have my students submit whatever the paperwork of the day was by midnight that night. That way they could go home (or back to campus, or Starbucks, lol) and clean up their thoughts and notes, and present something that is a little more substantial.

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When you say they are on the computers way too much, do you mean in the chart, or writing out the assignment? Either way, both can be addressed by limiting their time on the computer. If it's the chart they are staring at aimlessly, limit the time, and don't let them on until they have actually been in with their patient. When I taught, it took my way too long to lay the law down on this one. I made them see their patient first (a 'two minute assessment'), then get report from the RN, then report to me. I would give them leading questions based on their first impression and the info they got in report. This way, they had direction when going into the chart.

As far as writing the assessments, do you require that they give it to you before they leave clinical? I would have my students submit whatever the paperwork of the day was by midnight that night. That way they could go home (or back to campus, or Starbucks, lol) and clean up their thoughts and notes, and present something that is a little more substantial.

Hello, and thanks for your reply. The students are in the chart searching for information to help them complete their paperwork. I have done as you said and "laid down the law" about computer time, but it continues to happen. I have restricted their computer time between certain hours of the day and limited their time to 20 minute intervals to avoid a student sitting at the computer for an hour or more. They turn in their paperwork the next day or even a couple days later, so it isn't like they don't have time to do their work after school/clinical. It is just so frustrating because they give me the impression that they do not fully understand why we are there or what the job of a nurse truly entails. (and they never will if they sit in front of the computer all day.)

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"In my ASN program, we showed up to the hospital the night before and chose appropriate patients for the next day and spent all of that time on our clinical paperwork including on care plans and med lists info during that time."

Unfortunately, this is not an option in my program.

I don't know... maybe I just had a bad batch of students last time around?! :unsure:

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Specializes in ER, ICU.

Ouch, I hate to say it, but the job of a nurse IS to sit in front of the computer. I think you mean the job of a nurse SHOULD'T be to sit in front of a computer. Can you send the JC a note on that please?

I would teach time management as a skill and press them for time. And, teach them ways to bundle their care, speed assessments, and get their tasks completed quickly. Maybe you are already doing that...

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Ouch, I hate to say it, but the job of a nurse IS to sit in front of the computer. I think you mean the job of a nurse SHOULD'T be to sit in front of a computer. Can you send the JC a note on that please?

I would teach time management as a skill and press them for time. And, teach them ways to bundle their care, speed assessments, and get their tasks completed quickly. Maybe you are already doing that...

I feel like I am doing everything! Lol

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Specializes in Nursing Professional Development.
It is just so frustrating because they give me the impression that they do not fully understand why we are there or what the job of a nurse truly entails. (and they never will if they sit in front of the computer all day.)

I am the liaison between my hospital and the many different nursing schools that use the hospital for clinicals. I get lots of complaints about this same issue from the nurses on our units. Students come in and don't seem to know what to do with themselves other than to work on their paperwork.

When I ask the students ... they truly don't know how to fill all that time they have on the unit. Having only 1 patient (or maybe 2 in some cases) simply isn't that busy for them. They do their assessment and AM care ... and then they have an hour to kill before some other task needs done. The patient just wants to rest ... or watch TV ... or play video games (I work in a children's hospital.). In many cases, their mom is there to do the AM care -- and the patient is more comfortable with the mom's help than with a stranger. So ... the students don't always have enough physical tasks to do to fill all the time.

Are you sure the students have enough clinical tasks to do to fill the time? I suspect they do not -- because if they did have plenty to do and weren't doing it, you would know about it. You would know that necessary care was not being delivered.

I recommend that you reconsider the whole clinical experience -- and assess exactly how many hours of physical tasks are actually appropriate for your total clinical time. If there truly are plenty of tasks for them to do to keep them busy, then you should be able to identify which ones are not being done -- and holding them accountable for not doing them should keep them focuses on doing those tasks and away from the computers. However, I suspect that it is harder for the students than you think to find good stuff to do to keep busy -- and you need to re-think how to best use that time.

As I said, I struggle with this issue regularly. Some staff members and faculty don't realize how hard it is for students to keep busy for several hours with just 1 patient. Additional activities need to be planned to fill the time -- and everyone involved (faculty, student, and hospital staff need to be "on the same page" about what those activities may be.

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How familiar are you with the Socratic dialogues and asking revealing questions of your students? Once their assessments are complete and they've begun their assessment documentation, ask them point blank to give you report on their patients. Once they've revealed the essence to you, inquire about patho, what happens when this happens, where do you go to find this info...? From my point of view as a clinical educator, some of us have lost the creative inquiry that enables new nurses to begin that magical thing called critical thinking. I watched new medical and surgical residents grieve sweat and blood under the withering questioning of attendings for years and came to realize that what they were doing to some extent was what Socrates did in ancient Greece. Keeping students uncomfortable to a degree gives you a modicum of control but most importantly readies their brain to think.

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