Clinical supervision by instructors

Ausculapius · Jun 12, 2008

I'd say a good number of my clinical instructors were very hands off. About 50/50 as well. It honestly did not bother me at all if the instructor had a hands off approach. To be quite honest, I found the clinical experience was better w/o the nursing instructor there. I found 9 times out of 10 the staff nurses were better able to answer my questions regarding the specialty.

al7139, ASN, RN · Jun 12, 2008

In school, I had some instructors that were hard to find, and some that were there and available, but not right over me all the time.

I saw that alot of times it depended on if the instructor had a good relationship with the nurses working on the unit, and if she trusted them to supervise us with certain things. Lots of times our clinical instructor also worked at the hospital we were at, so she knew the nurses and trusted them to help us out, and assist her in supervising 8 or 10 students to give meds, and do certain procedures.

As students (as I am sure you know), we had competencies that had to be signed off on by our instructor. If we were doing it for the first time in a hospital (e.g. giving IV meds, foleys, IV catheters, dressings, etc.), usually our instructor would first have us talk it out to her step by step, then go with us to do the procedure to observe our technique and skill level. If she felt we could safely do something on our own, she would sign off on it, and we would just let her know that we were going to do this and what nurse would be there ,since we always had to have a licensed nurse present for invasive procedures.

In my first semester of school, I was so nervous, I had to go to my instructor for everything...I was so scared of making a mistake! After a while, I was not so nervous, and was generally very confident in my basic skills (esp assessments, and pt education). I still needed to get with my instructor to discuss what I found, signs/symptoms, and questions I had no idea how to answer. Often, these things were topics in our group conference at the end of the day.

I never really had a teacher who I thought was "hovering" I guess from my first semester, the instructor was very adamantabout she had to be there when we gave meds (since we had never done it), but generally was there to help us. In my last semester, the instructor would really sit on the sidelines, and let us work with the nurses who would teach us the culture, and the reality of nursing as well as giving us the opportunity to do "cool stuff" but would still be very available to help us if we needed her.

I hope you are like this.

Any instructor who is MIA is not an instructor in my opinion...How do you learn?

Amy

shock-me-sane · Jun 12, 2008

For me I wouldn't say it was the norm. I had a bad clinical instructor first year who would hide in the conference room and grade papers. Other than that I don't have many complaints about clinical instructors. As I progressed in the program I haven't needed them as much (other than checking my meds). I think the first year is the most important to have a hovering CI, after that they need to be available via phone call.

That is just my .02 but i tend to hate people hovering over me and work well independently.

pinkiepie_RN · Jun 12, 2008

I just finished up my first year of nursing school and have had amazing clinical instructors both semesters. First semester for Fundamentals I had an ED nurse teaching us and she always wanted to be there if we had issues. We weren't doing much aside from bed baths and patient histories/head-to-toe assessment but she was around if we needed her. This past semester for Med-Surg, my clinical instructor was most pivotal to my success. We started passing meds and taking report and preparing care-plans the night before. In pre-conference, she always asked questions that were helpful and made me think. She was there for med passes and she was always right there if we had questions. There was no such thing as a dumb question for her and she made it her duty to know that we were comfortable in our skills and with our patients. Hope this helps!

caliotter3 · Jun 12, 2008

During the clinical placement that I had during the summer term our clinical instructor was there for a meeting at the beginning and then spent the entire summer on her vacation at a spa where she could presumably be reached by our preceptors, but not by us. She showed up again at the end to tie up the loose ends. That was what we paid extra money to take a summer course for.

Trauma Columnist · Jun 12, 2008

I worked in a large (750 bed) hospital for 10 years and we had students from four nursing schools, a couple of rad tech schools, OR tech school students not to mention the resident physicians. What usually happened is that the nursing students were spread out over the hospital - so yes, the instructors weren't always on the same floor. Could that be the case?

NoviceRN10 · Jun 12, 2008

I've only had one so far. She definately did not hover. If we couldn't find her she was always in a pt's room helping a classmate with a peg tube, trach, or something a little complicated. I do wish I had been more accountable to her for the status of my pts. I mean, I wish she had asked me about my pts or given me some tough/good questions or something! A standard assessment form to fill out would have been good (not the specialized ones we did as class assignments). I guess a little more guidance? I felt like nobody was making sure I wasn't harming anyone (and by that I mean because of my inexperience). The actual nurses for my pts seemed to think I had things under control (or maybe they were popping in the room to check the pts when I didn't see them?). I felt like a lost puppy, one that was responsible for someone's life. For a first clinical rotation that wasn't really a good feeling.

MB37 · Jun 12, 2008

Our clinicals are "preceptored" from the beginning, so we're assigned to a nurse each day rather than a patient. We aren't all on the same floor, and it's also a huge teaching hospital. Our preceptor signs off on our skills and teaches us what we need to know, and our instructor is always just a quick page away. We can (and are expected to) call for help if we feel like we could use instruction in doing a skill for the first time out of lab, if we're having problems with our preceptor, or if we need assistance making a decision on a patient. I think it's worked really well, and our preceptors have to evaluate us each day so you have to be on the ball the whole time. Our instructors do make rounds on us, but at least with me they only seem to stop and say hi and make sure I'm fine - other instructors may do more quizzing, or maybe they're harder on other students if they lack confidence in them - I only see how my day goes. Sometimes I wish we had a little more supervision/instruction, but it does get us used to being on our own from the beginning.

vashtee, RN · Jun 12, 2008

I think this is a bigger problem with newer students, but less so for ones further on in their programs. My first semester clinical instructor was pretty absent. She had students spread on 3 different floors, and students on each floor said she was never around. I don't know what she was doing all the time, and unfortunately, we didn't have enough skills or autonomy to allow for her being gone so much. This is probably why the nurses in that rotation were so nasty with some of the students.

My next clinical instructor was so scary, we were happy NOT to have her around, because even if she wasn't terrorizing YOU, she was terrorizing one of your classmates. :)

During last semester, I was okay with my instructor not being at my beck and call; we were pretty autonomous except for IV push medications. If we knew they were scheduled, we let her know before clinicals started, and she would arrange to meet us +/- 30 minutes of when medication was due. Otherwise we would page her and wait for her to get back to us. If PRN IV push meds were being given, I usually asked the RN to give them so the patient wouldn't have to wait too long.

AOx1 · Jun 12, 2008

TraumaRUs, this is definitely the case for me. We have students in 3-5 areas, depending on the clinical rotation. I wish I could be more present!

Alternator81 · Jun 12, 2008

They can't hover over, there are 9 students! What we usually do is look at our MARs and try to schedule meds or procedures with her.

She will also tell you to come down and observe if another student has an interesting procedure to do on a patient.

Things always come up, so if you need her, she puts a magnetic sign in the door hinge that sticks out, so you can see what room she is when looking down a hallway.

She is never on breaks. She worked her butt off this semester!