How to deal with slack students - page 2

So, I've started precepting in my ICU. The students I've had thus far have been senior BSN students and new graduate RN's. When I was starting out in nursing, I would read the night before, ask... Read More

  1. by   caliotter3
    When I went to school, precepting in the ICU was considered a privilege that very few students received. I agree that you should tell them at the beginning what the expectations are and perhaps give one, and one only, warning after that. There are students out there who would die to get a chance to work in the ICU and they would not abuse the privilege.
  2. by   daisymae0
    Boy I hope I get preceptors like you guys. From what I've read here it's amazing that anyone has time to text, email, much less go to the restroom during the day.
  3. by   MaverickyMaverick
    Just thought I'd take a break from studying to laugh a little. I have many associates like you are describing. Unbelievable. I think that some will be good nurses and some won't. Some of the jump in folks are going to be bad nurses too, though...they are just kissing up.

    I work super hard. If I sense my preceptor doesn't like me though, I have no choice but to keep my distance. He or She is the seasoned nurse, I don't know what I can and cannot do or say. My way of being respectful and non-confrontational of course.

    I think that the texting is crazy. I WOULD say something to their instructor. They should be given a little talking to by someone if you are not going to do it. AND, you have a chance to evaluate them...this is what they need. What happens when they get in the real world? I say give them the reality before they get out there. Let them cry a little.

    I have cried on every single rotation, for different reasons. Its a very stressful and emotional time.

    I love nursing so far!
    Wish me luck on my big test!
  4. by   Lennonninja
    Quote from BabyLady
    Don't assume that they are all taught the same thing...seniors or not.

    Students are not told at every school who they are going to get the next day in clinical. At our school, we weren't...we found out who our patient was when we showed up for clinical...many times they had a condition and we had not "got to that chapter yet" so I had no idea regarding the management of their care.

    Not my fault..I can't help nor have a choice of who I am assigned to.

    MAP...never covered at my school. I never knew what it was until I started working with patients on vents.

    No nursing school can cover everything.

    Texting or e-mailing is should be able to put a stop to that yourself. careful about "complaining" to the may start out trying to bash the student, but you may end up bashing the program instead.
    I would LOVE to be able to find out who my patient is and what their diagnosis is the day before. At my school, you show up for clinical and get your assignment first thing and hit the ground running.
  5. by   MattiesMama
    Oh wow...I'm a lowly LPN student and as soon as I read your post my first thought was-"MAP=Mean Arterial Pressure, important when dealing with pts. who have head trauma because cerebral perfusion pressure is measured by MAP-ICP, and CPP of at least 70 is necessary for adequate nuerological functioning." Have these people not heard of flash cards??? lol.

    Also, I would give my left arm to have an opportunity to precept in the ICU.Heck I've even gone on my own time to shadow RN's in the ICU and ER just to get the learning experience. I have so much respect for the nurses I work with in clinical and take every opportunity I can to learn from them.

    Next time you catch them slacking off, just say "hey, since you aren't busy right now, [insert name of your most unpleasant, preferably total-care patient here] needs to be [fed/changed/ambulated/showered] today, can you lend a hand?" I'm sure after a few experiences doing the "grunt work" they will find other things to occupy their time
  6. by   cjcsoon2bnp
    Quote from SummerTimeCCRN
    So, I've started precepting in my ICU. The students I've had thus far have been senior BSN students and new graduate RN's. When I was starting out in nursing, I would read the night before, ask "smart" questions, and make every effort to try new task and gain new experiences. I have been so disappointed with the ones who have come in to work with me. I understand that new grads will not know ICU drips and calculations, but not knowing what MAP is or means, not knowing that removing the patients o2 cannula can cause a patients o2 sats to drop, and text-ing at the desk, checking their e-mail, and taking random breaks at their convenience seems a little too much for me. I was never like this at a student. How can I get the new nurses or senior nursing students to take some initiative without "telling" their instructor or director, or making them feel dumb and like they can't hang a critical care unit??
    Please don't give up on us young students. I know it can be tempting because there are a lot of students out there who don't understand what it is to be a working professional but for every slacker student you will meet (regardless of age) you will find a student who is working his/her tail off to be where they are and will try to learn as much as they can from you. Case in point, I am a senior level BSN student and when you posted about MAP the following went through my head.

    1. I know that MAP stands for "Mean Arterial Pressure".
    2. I remember from my Med/Surg. Cardiac Lectures that MAP is related to blood pressure.
    3. I also remember my Med/Surg. professor saying that MAP is routinely measured in patients in critical care settings like ICUs.

    So with that limited knowledge I know that MAP is a cardiac related measurement and is probably pretty important because it is measured in high acuity patients. I'm also thinking that because its related to blood pressure that it probably has something to do with perfusion and blood volume and that's probably why its measured in critical care patients. With that being said, I saw your post and decided that as a prudent nursing student I should do a little research and find out more about MAP. I have found that MAP is defined as the average blood pressure within the arteries and is an important figure to have because it helps to let us know if vital organs are being properly perfused with oxygenated blood. A MAP between 70 - 110mm Hg is preferred for adequate perfusion. MAP is by no means the only number that we should be examining in critical care patients but it remains an important figure.

    "I know I'm still green and have a lot to learn but I'm happy to be here, ready to work and am willing to learn anything you want to teach me if you just give me the chance."

    BTW: I'm 23. A good work ethic and the desire to learn is not exclusive to older nursing students.

  7. by   pawashrn
    welcome to the new world. New students are multi-task oriented, them texting is like you and I watching tv at bedside while titrating drips. Just w/ the flow and encourage attentive behavior by asking pathophis. questions like ( When the O2 is decreased and the Sat's decrease w/ it what is going on inside and how is pt. going to compensate for the drop in O2. SMACK
  8. by   cpl_dvldog
    During my clinicals I noticed several things. One of the things I noticed was the unit I was asigned to normally set the tone of that experience. When the nurses are busy doing their jobs the students tended to stay busy also, but when the nurses wanted to sit at the desk and use the students like rented mules the students soon became disenchanted. In my second semester I did a trauma clinical rotation. When I was finished with my 2 patients I would walk around the unit and see if anything interesting was going on. If so I would ask if I could help, to heck with watching. My second day there I assisted with putting a halo on a woman with a broken neck, helped with removing a chest tube from a gunshot patient. My clinical instructor actually called the school and bragged about how much she enjoyed having me.

    In another setting, L&D, there was not much going on, so some of the nurses thought myself and another student were there to do all their "dirty work". The third day in Labor and Delivery, two of the nurses sent me and another student to change the sheets on every bed in the unit. After the 5th or 6th bed I noticed neither nurse had moved. They were still sitting at the desk shooting the bull. I walked up and told them they could find me something else to do. I was a 4th semester student and I was there to learn, and I think I have changing sheets down pat by now. They thought I was lazy and it was my place to do the crappy jobs. Doing crappy jobs is not why the students are there, they are there to learn something. Not be treated like something that is beneith a nurse.
  9. by   JSlice.
    Thanks for your reply. There are generational gaps between many nurses. While doing a rotation in OB i worked with an old lady nurse who believed she was God of the nursery. During the rotation she railed me with questions, quizzing me and impatiently telling me how to perform tasks. Ridiculing me when answers were answered incorretly. I was later informed that back when she was doing nursing school it was like the army (?) Attitudes of the crusty old ladies on OB sucked and greatly reinforced my decision to not become an OB nurse. I will always remember her poor precepting abilities and never treat a student that way when i become a preceptor myself. ....and I will care for the old "God of the Nursery" in the ER when she falls and breaks a hip
  10. by   REDDOG RN

    I apologize for this response not pertaining to the original poster's question, but the question you had about the pt. with a decreased O2 level and drop in SAT'S and what happens to the body and how the pt. compensates for the decreased O2 intriqued me and was driving me nuts. I love the challenge of a difficult question! So, I like to take a chance at answering it and if you could give me some feedback as to whether or not I'm on the right track. I would so appreciate it!!

    Okay, here goes. If the patient has these low levels I would immediately think of respiratory acidosis. This is due to the fact that more CO2 is binding to the hemoglobin which results in less O2 being available to the tissues. As a result the patient develops hypoxemia and becomes cyanotic. They may have additional symptoms such as dypsnea, tachycardia, tachypnea, sweating, etc. In addition, the patient will develop neuro changes such as confusion, decrease in LOC, etc. The body compensates by increasing the respiratory rate, increasing the heart rate, increasing body temperature, etc. Sorry, can't think of any more additional symptoms off the top of my head.

    Anyhow, so that's my overall summation of the question. Again, any feedback would be welcome and greatly appreciated. I am a newly licensed RN (got my license in June, so I guess that makes me still a new grad?). I'm currently looking for employment (like all the other new grads!). My desire is to be hired in the ICU as a new grad. The reason why is because I love the complexity and detail (and challenge!) of critical care. I enjoy all that pathophysiology and the technology that goes along with it. In additon to how the other aspects (such as intrepretation of labs, blah, blah, etc.) fit into the overall picture. I apologize for blathering on, but I could talk about this stuff forever!! Man, this stuff is so exciting to me.

    Okay, I really need to conclude this as I need to work on my resume that I've been procrastinating on. Thanks again for reading this dissertation that has continued on forever!!

  11. by   wannabeagreatRN
    Can I start by saying that the new grad RN's behaving like this should remember that there are tons of new nurses waiting for their job! I can't fathom behaving like this, my parents taught me better, however if they didn't when I started nursing school my instructors further put the fear of God in me about such behavior lol! I am a new grad with a new position in the ICU and I do like what one poster said about their preceptor that laid everything out from the beginning of the morning, that is very helpful. I am a hardworker and can go 12-13 hrs without sitting down, however it is frustrating as I am being bounced around different preceptors and they all have different styles and give me different levels of autonomy. I also have difficulty because I feel like a stalker and a few of my preceptors seem to like for me to "go away" (in a nice way, but these are the vibes I get). The ICU I am working at has by far the best team work I have ever seen, I was told from day one, when 1 is working, we all work, I don't expect to see you taking a break while someone else is drowning, and they don't! I love it! Now when all is calm, everyone gets a chance to breathe

    As for the student nurses, I believe you should talk to your management. Our school strictly prohibited any unprofessional behavior, and forget your cell phone, you better leave it somewhere! Our area is inudated with schools, and it is very competitive for clinical placement, if students here behaved like this the hospital would inform our school (names included or not) and we would get a very stern talking to as a group that a,b, or c happened and it would not be tolerated, and it worked! Our instructors also would not inform us who/what/where the complaint came from, for all we knew it could have been a family member. I did have a classmate get expelled for cell phone usage. If we had any "down time" which didn't happen so much, we were expected to answer call bells, stock, etc.

    My advice from the other side of the fence is to try asking what their comfort level is/how many days of orientation they have had and laying out your expectations and plan of the day, it really is helpful and breaks the ice. The other thing is having a talk about team work, reiterating how to access protocols and suggest working with those during free time.

    I do have a comment about "smart questions". It is amazing the stupid things that can spurt out of ones mouth when confused or put on the spot. I have been an EMT basic since I was 17, hence, I have known and studied the heart for 10 years now. I had a preceptor that was teaching me about EKG interpretation at a very high level, had me sooo confused that I actually asked him a question about "the superior or inferior ventricle" lol, I have no idea why, and I definitely know there is no such thing~! How big of an idiot does he think I am?