clinicals

futurepsychrn, ADN · Jul 13, 2015

Well unless you have a long lunch break, a good portion of people don't even have enough time to leave the work place to go grab the lunch, eat the lunch and make it back to work on time. If you find the working condition of nurses bad, then why are you pursuing a nursing career?

We have an hour!

futurepsychrn, ADN · Jul 13, 2015

We have an hour!

I'm not the one who finds the conditions bad. How could I find the conditions bad if I am not even working as a nurse yet? I just read the posts on here and wonder why you all put up with some of the things you do!

futurepsychrn, ADN · Jul 13, 2015

How is it a race if there are 7 nursing students (+ 2-3 precepting students) & 15 patients? Unless I'm missing something. There should be no race. There are plenty of patients to go around. If need be for nurses, they just have to take on an extra student or two. But I don't see a problem.

Count! That's a total of 21 staff members for 15 patients. Also it's a specially designed quiet floor. Which means, the call lights don't come on. The nurses and PAs carry phones and when the patient pushes the call light the phone rings, they answer and go and see to the patient's needs. So we walk the halls glancing in rooms to see if someone looks like they need something.

futurepsychrn, ADN · Jul 13, 2015

To the op, during clinicals, you are representing the school, what if you leave the clinical site during the lunch break and something happens to you? Please note that as a nurse you may not have opportunities to leave the site to take lunch breaks or even have a lunch break.

I understand that I am representing the school, however I am an adult and if I chose to leave the clinical site and something happened to me that would be my responsibility not theirs. In other words, how in the world could they be held liable for a decision I made as an adult ?

akulahawkRN, ADN, RN, EMT-P · Jul 13, 2015

When I was a student, we weren't allowed to leave the premises of a clinical site for lunch. We could get food from the cafeteria or bring our own lunches. Our lunch breaks were also scheduled, which was nice. We could basically eat anywhere except in patient rooms or nursing stations. Most of us usually ate in the cafeteria. Big deal. We did have to report off when leaving the floor for any reason though.

My first semester was a bit hectic but manageable. It was also the last time I would ever have a 1:1 ratio normally. We weren't allowed to pass meds back then without our instructors but that would change as the semesters progressed. Second semester saw us allowed to pass oral medication without direct instructor supervision but the RN we worked with had to be aware of what we were doing but IV stuff had to be directly supervised. This was also true during third semester as well. During fourth semester, we could do IV push if we were signed off and directly supervised and we could also do IV starts.

That was our progression for certain things, just using med admin as an example. The same was true of other skills. In the beginning, it was incredibly restrictive because we were only authorized to do certain things and most we weren't. This was to ensure patient safety because we hadn't received the required education from the school. There were many things I already knew how to do competently due to prior training/education. Didn't matter - it wasn't nursing and wasn't from that school.

Now I'm an ED nurse, able to manage 3-4 patients and I do things all the time for which I would have been thrown out of school had I done them in first semester clinical. Now that I'm working, if I'm on lunch, I can leave the premises to get food, but most of the time I don't because I only have 30 minutes and leaving the premises means I have less time to eat. Of course I have to report off and just let someone know I'm off campus so they know to call me instead of page me overhead if I'm needed.

kalycat, BSN, RN · Jul 13, 2015

Wow, that escalated quickly. Eek.

Akulahawk, my program progressed in a similar fashion. Each rotation was formatted as a preceptorship, so we were expected to have a full patient load with our preceptor, work her schedule, chart, have Pyxis access, etc. We did hand off report to whoever our "buddy" nurse was and took breaks at the same time as our preceptor, but we didn't have to eat *with* them or anything. We were also encouraged not to be out on the town or at the bar in our school uniform lol But, there was never any talk of liability or anything like that or concerns when we were driving to or from clinical sites, or on breaks off the unit. Because we worked 12s with our preceptors, we didn't have a faculty on site at all hours. Usually just meetings weekly and sometimes a spot check for skills, etc. The vast majority of our skills were signed off first semester so we only needed our preceptor's supervision for later rotations. Our post conference was a weekly class session where we presented our patients, did grand rounds with care plans, etc. Our instructors were always available by phone if there was an emergency. I did most of my clinicals on evenings and nights, which was great.

As far as conditions now go, I work in the OR, which means I wear hospital provided scrubs and shoes that never leave the hospital, and we aren't supposed to wear the scrubs outside without a cover jacket. That said, we do have plenty of patios, atriums, etc so if we need a mental break or fresh air, we can go there during breaks. We get 30 mins for lunch and pretty much everyone eats in the cafeteria or outside; we have nurses who come in to active cases to relieve us just like anyplace else, so no abandonment or anything. I don't feel like the conditions are bad at all, even when there are days that you can't get a lunch or regular breaks because you're in the middle of an intense case. I like being at the hospital, so I don't mind staying on site for lunch - it's just part of the gig. I just wouldn't like having to eat lunch with my boss every day. That would get annoying. :)

futurepsychrn, ADN · Jul 13, 2015

Wow, that escalated quickly. Eek.
Akulahawk, my program progressed in a similar fashion. Each rotation was formatted as a preceptorship, so we were expected to have a full patient load with our preceptor, work her schedule, chart, have Pyxis access, etc. We did hand off report to whoever our "buddy" nurse was and took breaks at the same time as our preceptor, but we didn't have to eat *with* them or anything. We were also encouraged not to be out on the town or at the bar in our school uniform lol But, there was never any talk of liability or anything like that or concerns when we were driving to or from clinical sites, or on breaks off the unit. Because we worked 12s with our preceptors, we didn't have a faculty on site at all hours. Usually just meetings weekly and sometimes a spot check for skills, etc. The vast majority of our skills were signed off first semester so we only needed our preceptor's supervision for later rotations. Our post conference was a weekly class session where we presented our patients, did grand rounds with care plans, etc. Our instructors were always available by phone if there was an emergency. I did most of my clinicals on evenings and nights, which was great.
As far as conditions now go, I work in the OR, which means I wear hospital provided scrubs and shoes that never leave the hospital, and we aren't supposed to wear the scrubs outside without a cover jacket. That said, we do have plenty of patios, atriums, etc so if we need a mental break or fresh air, we can go there during breaks. We get 30 mins for lunch and pretty much everyone eats in the cafeteria or outside; we have nurses who come in to active cases to relieve us just like anyplace else, so no abandonment or anything. I don't feel like the conditions are bad at all, even when there are days that you can't get a lunch or regular breaks because you're in the middle of an intense case. I like being at the hospital, so I don't mind staying on site for lunch - it's just part of the gig. I just wouldn't like having to eat lunch with my boss every day. That would get annoying. :)

Sadly we don't get a preceptorship until 2 months before we graduate. We aren't allowed into any computer system and God Forbid we go anywhere near the Pyxis. We can't pull meds, chart, administer any meds without our instructor being in the same room (we get to administer meds only every 2 weeks as our instructor says she can't handle us all passing meds) and handing us the meds, do dressings, wraps, IV care of any kind etc.... This is our 2nd semester, 3rd clinical rotation. I know learning to be a nurse takes time and I want to make sure that when I do something I am doing it the right way so that I don't harm anyone, however at this point I'm basically being trained as a PA. How can I learn to do things if no one ever gives me the opportunity or teaches me how? I would love to just be able to work with the nurses on the floor, they're wonderful!

Here's a good example, I had a patient that had not urinated since 9:00 p.m. the night before. After repeatedly asking and trying to coax her to at least try, I went to my instructor (around 10:00 a.m.), at around 1:00 p.m. I started getting really concerned and the patient started getting really annoyed with me for asking if she had to go or would just try lol. One of the problems she was admitted for was edema. I finally went to her RN and she said lets do a bladder scan. I had to get permission! I could not find the instructor for about 1/2 an hour and by the time I did we were leaving the floor and she told me no because she hadn't signed me off on it. It was a bladder scan! How much harm could I have done with a noninvasive procedure and a licensed RN right there? Sorry didn't mean to rant. Just very frustrated.

mrsboots87 · Jul 13, 2015

I understand that I am representing the school, however I am an adult and if I chose to leave the clinical site and something happened to me that would be my responsibility not theirs. In other words, how in the world could they be held liable for a decision I made as an adult ?

I think the biggest thing you are missing is this is considered class time. Yes, the school is responsible for you during class time.

I do understand the frustration of being required to stay and have to sit with your instructor. It sounds like you have a terrible clinical set up. Not just the sitting with the instructor for lunch, but that there are so many staff to so few patients and so many nursing students trying to learn. Are you attending a private school or in a rural area? That environment is not conducive to learning and is absurd to think a reputable school would allow clinical in such a way. I have never been to a clinical where there were more than a handful of students to a floor of 25 patients. Its how we get opportunities to practice skills while still learning how to manage patient care.

For our clinicals we can not leave the facility. This is both a school and facility policy for students. It does not make me feel like a child. I am there to learn and abide by the rules. I understand I am a guest at the hospital. However, we are not required to sit as a group with our instructor. We go to lunch whenever our assigned nurse goes or says its ok for us to go. We don't always get to go together. We can bring lunch or purchase from the cafeteria. We get 30-60 minutes. Time depends on how busy the floor i we are assigned to and how long the nurse says lunch is.

Even though this frustrates you, keep in mind that you are merely a student. You must follow the rules in order to get that golden ticket known as the ATT for NCLEX at the end of the road. Once you are a nurse, you can take your lunch (if you get one) all by yourself, or with friends, or whatever you like. Just make it through your 2 years and move on.

vanilla bean · Jul 13, 2015

Nursing school is a means to an end. My philosophy was suck it up, play the game, keep my head down, do the work (regardless of when or how often I thought it was simply busy work or ridiculous), take what I could from it and let the rest roll off my back. Just get it done. What is the point of fixating on the policies that you have no ability to control or change during your very temporary time in nursing school?

By the way, since I have started working as a nurse, I have not stepped foot off my home unit once while working unless it was to carry out a job related duty. Not to go to the cafeteria, or to find some quiet time, or to (god forbid) leave the facility. The docs that I work with don't leave the facility while on duty either (although I don't know how that's relevant to your gripe about not having personal/alone time while at clinical as a student).

Also, I feel compelled to add, as a "futurepsychrn," you may want to dial the angry fist waving down a notch. Getting so riled up about what, IMO, is such a trivial matter may not be conducive to portraying the cool, calm, collected, controlled demeanor that I've seen presented by some of the very talented psych nurses I know. Just sayin'.

Samantha Harris · Jul 13, 2015

Students don't have the same freedoms as RNs do, that's just the nature of the game.

It is often an expectation that students remain on hospital or school property during clinical and lab time. This is for liability reasons for the respective facilities. It has nothing to do with your status as an adult.

Although, as an adult, you would be expected to face the consequences of you leaving the premises for lunch. Namely, corrective disciplinary action up to and including expulsion. That seems kind of a silly reason to risk getting kicked out of your program.

Also, each school and each clinical instructor has a certain set of rules that they must follow to meet state licensing requirements. Nursing students generally are only allowed to perform tasks once they have proved competence, whether it's invasive or not. Manual blood pressures aren't invasive, but you have to be checked off on these, also. There can be big consequences for basing interventions on faulty info from a student, including losing the clinical site, aside from possible harm to the patient. The school and the instructor will rarely risk that.

As a student on the floor, it is your responsibility to report clinically concerning findings to your instructor and the primary nurse for your patient. As much as you want to help the patient and are itching to perform interventions on your own, you are not clinically safe to do so until you have been evaluated.

The big things to take away here are that you are a student, and you must follow the policies and procedures of your school and the clinical facility if you wish to remain a student long enough to graduate. Please be safe and stop trying to circumvent the instructor.

If you were my student and you displayed the same kind of kind of attitude in front of me that you have displayed here, we would be meeting with the head of the program and discussing remediation.

johsonmichelle · Jul 13, 2015

I think the original poster does not understand clinical time. Certain amount of clinical hours are required by the school and state in order to complete nursing school. Clinical hours should be treated as class time, therefore you need to stay with you clinical instructor and group during clinical. If you don't have enough work to do then find some, ask the other techs or nurses if they need help. If there is truly no work to do then you can use that time to do some school work if permitted by the instructor. There is also a liability risk during clinical, if you get injured or your patients gets injured from your care then the school may be held liable. From your posts, it seems like you have hard time following simple rules, that may end up being a problem if you become a nurse. Clinical sites are hard to get these days that why you must respect and follow both school policy and hospitals policy regarding clinical.

CT Pixie, BSN, RN · Jul 13, 2015

We were able to break away from the group. However, we HAD to be back in 30 minutes. Depending on our instructor, sometimes the whole group went to break or just half went then the other half.

Many of us would eat together in the caf but we weren't required to in any of my clinical groups.