clinicals

Purple_roses · Jul 13, 2015

Okay, now I don't look as stupid

No you don't. But Optimis's response was still kind of adorable. "No, I don't believe so." Hehe.

nurseprnRN, BSN, RN · Jul 13, 2015

When you are a nursing student you are functioning under your clinical instructor's RN/NP license.

Popular myth but not true at all. Every student has a scope of practice-- student. S/he is operating under limits delineated by the agreement between the program and the hospital, is an adult, and is responsible for not exceeding the scope of practice outlined in that agreement. The licensure of the CI or the preceptor has exactly nothing to do with it. I know that sometimes even CIs don't understand this, or if they do, sometimes they intend to scare their students by threatening them with "you're operating under my license" to keep them in line. Still not true.

If the agreement says students may not do X at all, that's that, and even if your preceptor or your CI offers to let you do X under her supervision, you dast not. Your preceptor or CI would be liable for anything that goes wrong if you do, but that's because they let you, not because you're operating under their licenses. You would be screwed too, because you exceeded your scope. NOBODY, ever, even when you're an RN can tell you it's ok to exceed your scope of practice because they'll cover you. What will cover you is the bus they threw you under.

If the agreement says you may do Y under supervision from your CI or preceptor, you'd better not do it without one of them watching you. If you do, it's on you and nobody else, and you are screwed if anything bad happens, and maybe even if nothing bad happens at all, because you have exceeded your scope of practice.

If it says only students at last semester level may do Z independently, then no other student had better do it independently.

Hope that clears that up. AGAIN.

NICUmiiki, DNP, NP · Jul 14, 2015

I experienced all levels of instructorwatcheseverymove-ness...

One instructor pulled all of us to go to lunch with her as a group no matter what we were involved with our patients. Another required we all get our work wrapped up and take lunch at the same time, but not with her and not necessarily together (we usually did). My last med surg instructor told us to take lunch when we were ready. We tried to coordinate with classmates, but sometimes they were busy, and you had to go alone.

We always had lunch. And took breaks as needed.

In my current job, we get 30ish minutes. Apparently, they used to get an hour, but TJC didn't like that (sketchy on the details). Since I work in an intensive care setting, we're expected to eat in the break room. We have an assigned buddy who watches our pts while on breaks, and we can run back if a kidlet (nickname borrowed from someone in the NICU forum) decides to go wonky. Of course, we are not incarcerated and we're allowed to leave the hospital. You must work that out with the charge nurse before leaving, you probably will have to give report, and you have to clock out.

brandiep1982 · Jul 14, 2015

Ok, I just feel a real urge to say something... there are plenty of times I see people get "jumped one" on here... However, the only participant in this thread that I observe being catty is you, OP. Even after you got catty, posters were still patient with you. You come across rude and angry. More than one person has said this... so what is the common denominator here?

I am impressed, actually, with how patient people have been on this thread. I kept reading responses from OP and thinking, whoa... someone's going to jump all over that, and no one did. So I don't understand why OP feels so attacked from the word go.

kalycat, BSN, RN · Jul 14, 2015

Popular myth but not true at all. Every student has a scope of practice-- student. S/he is operating under limits delineated by the agreement between the program and the hospital, is an adult, and is responsible for not exceeding the scope of practice outlined in that agreement. The licensure of the CI or the preceptor has exactly nothing to do with it. I know that sometimes even CIs don't understand this, or if they do, sometimes they intend to scare their students by threatening them with "you're operating under my license" to keep them in line. Still not true.

If the agreement says students may not do X at all, that's that, and even if your preceptor or your CI offers to let you do X under her supervision, you dast not. Your preceptor or CI would be liable for anything that goes wrong if you do, but that's because they let you, not because you're operating under their licenses. You would be screwed too, because you exceeded your scope. NOBODY, ever, even when you're an RN can tell you it's ok to exceed your scope of practice because they'll cover you. What will cover you is the bus they threw you under.

If the agreement says you may do Y under supervision from your CI or preceptor, you'd better not do it without one of them watching you. If you do, it's on you and nobody else, and you are screwed if anything bad happens, and maybe even if nothing bad happens at all, because you have exceeded your scope of practice.

If it says only students at last semester level may do Z independently, then no other student had better do it independently.

Hope that clears that up. AGAIN.

This is how my program (and a few others in the region) could operate under a different model than many of the traditional programs. The students had a set scope of practice, benchmarks they were to attain, and a short list of "never do" tasks. Each semester, we were responsible for knowing this policy, our scope, and maintaining our documentation in hand so that anyone could check and see where we were at in our progress and what we were allowed to do with/without supervision. As I said earlier, the majority of our core skills were signed off first semester, and each following semester started with at least a week's worth (sometimes upwards of 50 hours) of clinical bootcamp where we would refresh skills, practice med math, run simulations, etc.

I'm not knocking more restrictive programs, but I learned a lot and many of the clinical problems I've read about on AN and other sites did not occur. Obviously, no one can learn it all in nursing school and there is still much learning and growing to be done, but I do believe that having a well designed program and clearly defined scope allowed for the development of beginning clinical judgment, professional communication, and time management. Of course, the buck stopped with the nurse preceptor, and if she was not comfortable with your skill set, you were sent for remediation. My program was predominantly traditional students in their early 20s; I was the oldest by 18 years. I personally feel that setting the bar high for professionalism and adult behavior encouraged us to rise and exceed the expectation.

Our nurse preceptors were trained and compensated by our nursing program and also received a differential from the hospital. No one was forced to precept, and the program was laid out so that all students got a fair shot at clinical experiences for most of the rotations. By having clinicals nights, evenings, and weekends and following a preceptor's schedule, it helped avoid having a glut of students on the units who were all looking to put in a foley. Anyway....just wanted to share that as I was the poster who brought up the Epic and Pyxis access. It wasn't that these were skills were considered difficult or necessary to master as a student; the rationale was that by giving the students these responsibilities, they would have a more realistic picture of the time management constraints and start-to-finish duties of an RN managing a full patient load.

As far as breaks, our CIs and preceptors encouraged us to take them, since we were much more effective learners if we had a few moments to eat, hydrate, use the bathroom and even meditate or mentally reset. I know conditions are tough for nurses right now and many don't get breaks, I'm simply trying to illustrate that our instructors of all descriptions set us up for success and took that seriously. No one did anything stupid on their breaks or took advantage of their 30 minute meal time. We had unit phones so we were called back to the unit if needed; many of us ate in the cafeteria or atrium. Oftentimes, the units even preferred that we step away since break room and fridge space was often cramped and as guests, we didn't want to infringe on the staff nurses' comforts.

OP, nursing school is definitely full of mountains to climb. I loved the suggestion from Grn Tea regarding meditation, etc. There is always a take away from any situation, and perhaps this is a great chance for you to develop a new skillset for making peace in the chaos and recharging your batteries. Not the same as the clinical experience you were hoping for, but still valuable. Best wishes!!

futurepsychrn, ADN · Jul 14, 2015

This is how my program (and a few others in the region) could operate under a different model than many of the traditional programs. The students had a set scope of practice, benchmarks they were to attain, and a short list of "never do" tasks. Each semester, we were responsible for knowing this policy, our scope, and maintaining our documentation in hand so that anyone could check and see where we were at in our progress and what we were allowed to do with/without supervision. As I said earlier, the majority of our core skills were signed off first semester, and each following semester started with at least a week's worth (sometimes upwards of 50 hours) of clinical bootcamp where we would refresh skills, practice med math, run simulations, etc.
I'm not knocking more restrictive programs, but I learned a lot and many of the clinical problems I've read about on AN and other sites did not occur. Obviously, no one can learn it all in nursing school and there is still much learning and growing to be done, but I do believe that having a well designed program and clearly defined scope allowed for the development of beginning clinical judgment, professional communication, and time management. Of course, the buck stopped with the nurse preceptor, and if she was not comfortable with your skill set, you were sent for remediation. My program was predominantly traditional students in their early 20s; I was the oldest by 18 years. I personally feel that setting the bar high for professionalism and adult behavior encouraged us to rise and exceed the expectation.
Our nurse preceptors were trained and compensated by our nursing program and also received a differential from the hospital. No one was forced to precept, and the program was laid out so that all students got a fair shot at clinical experiences for most of the rotations. By having clinicals nights, evenings, and weekends and following a preceptor's schedule, it helped avoid having a glut of students on the units who were all looking to put in a foley. Anyway....just wanted to share that as I was the poster who brought up the Epic and Pyxis access. It wasn't that these were skills were considered difficult or necessary to master as a student; the rationale was that by giving the students these responsibilities, they would have a more realistic picture of the time management constraints and start-to-finish duties of an RN managing a full patient load.
As far as breaks, our CIs and preceptors encouraged us to take them, since we were much more effective learners if we had a few moments to eat, hydrate, use the bathroom and even meditate or mentally reset. I know conditions are tough for nurses right now and many don't get breaks, I'm simply trying to illustrate that our instructors of all descriptions set us up for success and took that seriously. No one did anything stupid on their breaks or took advantage of their 30 minute meal time. We had unit phones so we were called back to the unit if needed; many of us ate in the cafeteria or atrium. Oftentimes, the units even preferred that we step away since break room and fridge space was often cramped and as guests, we didn't want to infringe on the staff nurses' comforts.
OP, nursing school is definitely full of mountains to climb. I loved the suggestion from Grn Tea regarding meditation, etc. There is always a take away from any situation, and perhaps this is a great chance for you to develop a new skillset for making peace in the chaos and recharging your batteries. Not the same as the clinical experience you were hoping for, but still valuable. Best wishes!!

We only get 8 hours on Saturdays for clinicals. Normally 6 weeks out of the 8 week module.

blah_blah_blah · Jul 14, 2015

It was up to our instructor for the rotation on how to do lunch. Sometimes we would take lunch in shifts. Half the group would go at one assigned time, the other half after. The instructor would go with either of the 2 groups. Or sometimes we all went at once together.

We also were not allowed to leave the property. We couldn't even leave the floor without our instructor's permission. That didn't even really bother me though. I rarely had to leave the floor for any reason during my shift except for lunch, in which case she would obviously know I was leaving.

The only time I ever had to leave the floor was to take a discharged patient out to the car.

blackribbon · Jul 14, 2015

My program was huge (if you included 1st years and 2nd years, it was probably about 500 students that needed to be placed each rotation) and we had students in almost every teaching hospital around the city each rotation. The lunch policy was set up based on each hospital's student nurse policy AND what shift we were working. There were some places that it wouldn't have been safe to leave the campus on a night clinical. Mostly we opted to sit together because we needed to leave and return at the same time. More often, the instructor did not eat with us because SHE needed time away from US. We had some instructors who used the time for our daily meetings so that we could leave at the end of shifts as we finished our activities and not wait for the student who got tied up in a room with more complicated or time consuming activities. We always had to leave the floor for meals because the instructor could not leave if anyone of us was still on the floor. I can't even imagine having a break long enough to leave the hospital...but all our hospitals are huge campuses.

Honestly, I suspect that your clinicals are only 8 hours long and you can go that long without a break from your classmates or instructor or you will have a lot of difficulty working a 12 hour night shift if you eventually start working in a hospital setting. I am in a huge hospital and the cafeteria is closed at night, the parking structure is too far to walk to and back, and we all hang out in the breakroom because there really is nowhere else to go for "lunch".

noelly10 · Jul 14, 2015

My program was huge (if you included 1st years and 2nd years, it was probably about 500 students that needed to be placed each rotation)

Holy wow!!! That's a lot of bodies!!!!

Janet_RN · Jul 14, 2015

I'm chuckling at this post. I loved my clinical students (& I think they liked me too) but I felt they needed a "break" so I rarely ate lunch with them. ALso it gave me a chance to check in with the floor nurses and make sure all was good (my students took small 2 patient primary care assignments)

However--my students would often approach me and ask me to eat with them. When I explained that they needed time away from their instructor--I got a fair amount of grief :)

I was very lucky: I had group after group of some pretty amazing students!

BTW: I sent them as a group, they had 30 minutes and couldn't leave the site.

nurseprnRN, BSN, RN · Jul 14, 2015

OP, nursing school is definitely full of mountains to climb. I loved the suggestion from Grn Tea regarding meditation, etc. There is always a take away from any situation, and perhaps this is a great chance for you to develop a new skillset for making peace in the chaos and recharging your batteries. Not the same as the clinical experience you were hoping for, but still valuable

i say this all the time to students: Never assume that there's only one learning objective in any assignment, setting, or experience. And not all of them are explicitly stated in the syllabus. Always keep your eyes open to those other opportunities for learning. In this case, there's the opportunity for the OP to learn a lot about the team gestalt and about her own coping skills (and how to develop those).

NYC4738 · Jul 14, 2015

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