Clinical without Instructor

What I had during school was basically a helicopter instructor, or at least that is how it was supposed to be. Occasionally we would have an instructor that felt comfortable with you doing skills with the RN on the floor, but mostly they wanted us to not be a burden on the nursing staff. Now that I am a nurse on the floor, I find it highly disturbing that some of the clinical instructors I see are letting the nursing students run wild. I went into another nurse's room only to find 2 nursing students trying to scope out a vein on a patient with no instructor present. When I asked if they had any questions, they asked me how the catheter mechanism worked :/ They reeeallllly should have had an instructor there, but it wasn't like they were trying to do it alone, the instructor just didn't care. They were very grateful for my help.

whoa! That is scary.

I agree - the pendulum has swung waaaay too far. 'Back in the day', CIs kept a watchful eye on their students & had to be physically present for any type of skill/intervention. They were paged (yep - I said a while badk) responded very quickly to accommodate student needs. They reviewed all charting, supervised med administration, etc. They seldom even had an opportunity to sit down.

Then came 'faculty shortage' and hospitals were asked to contribute more to the education of students. At first, preceptors were carefully screened and provided with training by the school before working with a student. Now, it's not unusual for staff nurses to have students plunked in their laps with no warning at all. I've seen CIs lounging in break areas, chatting on the phone, browsing the web, and generally taking it easy while Preceptors do everything.

My organization (prompted by numerous issues) is taking a hard line. We now have a Chief Academic Officer who is responsible for all clinical training arrangements - for all disciplines, including physician training. Our academic agreements now have CI requirements clearly spelled out, along with rights and responsibilities of Preceptors... who must be trained by the school. We're doing 360 evaluations of the whole process & giving feedback on CI performance to their Deans - who are always surprised by any negative comments. But - students are grateful for the increased scrutiny & have commented (in those evaluations) about the improved clinical environment.

Every school is different. There are three ways I have seen clinicals handled.

1. Traditional. One instructor to 7-10 students. Students only do meds and skills with instructor.

2. Same as above, except students are allowed to be under RN supervision as well.

3. Preceptor model. A student is assigned to an RN preceptor and does all skills and meds under RN supervision. There may or may not be an instructor in the building. This preceptor is generally not paid.

I work in model #1 and I wish we had model #2. If the nurses are willing for example, to watch a student put in a foley catheter, while I am giving meds with another student, the students get a much better experience. My state allows 10 students per instructor and that is just too much. I cannot give them everything they need at that ratio. We are told that our "insurance" will not allow this model.

whoa! That is scary.

This situation is not only wrong it has been identified as one of the reasons why a school of nursing was closed down by the BON in Arizona fairly recently.

The above is a link to this school of nursing which was one constituent of a group of schools, soon to be defunct, owned by Education Management Corporation and known collectively as Brown Mackie Colleges.

This corporation is also the owner of South University which many may be familiar with from its advertisements on this site.

EDMC is also the owners of The Art Institutes and Argosy University. (many teaching out)

For any school to say they don't have the resources to properly supervise a student's clinical training and acumen by an onsite representative of the school is a self serving cop-out.

Unless the school wants to give clinical adjuct status to these gratis preceptors, I believe a student refund is in order whether it's the right thing for the preceptors to do or not.

(... and that is to teach for free)