Dealing with Students in Clinicals: What would you like to see?

[bsf312]

Hello all!

I'm starting in an ADN program Spring 2019. The beautiful and frightening thing about ADN programs (or at least mine) is that you start clinicals the second semester.

I'm 30 years old, an LMT, Licensed Esthetician, and trained electrologist in Texas. I hear all sorts of things from "friends of friends" about how they like older nursing students, etc.

My question to all nurses that work with students during clinicals: what behaviors do you like to see in students? What makes you most willing to extend help? What information that may not be commonly covered early on should I familiarize myself with?

I know a lot about people and my current specialties, but I also know enough to know that I know nothing about the world of nursing. I am interested in all of your thoughts and experiences!

[humerusRN]

I really love teaching newbies. :)

Some tips, from me, for clinical day:

1) The Hover-er. I am very willing to teach you, I enjoy it! But please remember that I have to do actually do a job today as well, outside of teaching you. I have other patients other than the one that you have been "assigned". Please do not hover over my shoulder. Use the time that I am charting to be reading your chart, going through your orders, researching your meds. Do not stare at me and wait to do something. You have plenty to do!

2) Use some initiative. I work in pediatrics. In your "down" time, there is ALWAYS something that can be done to help my day and your patients day. What about playing a card game with the teenager who is alone? Use this time to focus on things that you won't be able to always do every day once you are working... and that is spend some quality time with your patients, get to know them, and just be there for them. That is what I miss most as a "real" nurse... my day is crazy, and those times of quiet bedside care are few and far between. Use these moments. They are invaluable for the future....

3) Want to learn. I love teaching students who truly want to learn.

4) Engage. Don't be on your phone when I'm trying to show you something, teach you something, etc. If this is just "homework" for you, then you'll be eaten alive when it's time to go out on your own.

5) Don't be a know it all. I don't care if you make straight As. You will learn something every day in the hospital. Having the attitude that you have nothing to learn, or that we should be so grateful to have YOU there for clinical.... it will not get you far with me.

6) Be PRESENT. I shouldn't have to make three laps around the unit and ask 6 people where you are when I am about to do something cool that I want to share with you.

Nursing is about so much more than passing meds. Make the most of your clinical experiences!!!

Good luck. :)

[Caprica6]

This might seem like a trivial thing, but I cannot stand when nursing students look disheveled! Make sure your hair is up and off of your collar, wear small, non-dangly earrings, clean shoes, iron your scrubs, and get rid of the damn nail polish!

Grinds my gears...rant over.

[rearviewmirror, BSN, RN]

don't be one of those "I am here to save the world" or bleeding hearts types. Kind of annoying personally, because nursing is not really that anymore.

[SmilingBluEyes]

Here is what I would like: (and sadly you don't control this, but you have the right nonetheless):

To have the instructors actually present, doing the teaching. Yes, mentoring future nurses is so important. But I did not get the memo, nor the bonus, to be that nursing student's instructor during his or her clinical experience on my unit.

It's very unsatisfactory for clinical instructors to be across town at another hospital, or unavailable to be responsible for their student.

I think that would be a game changer to actually expect the clinical instructor to be responsible for the learning experience of the student paying high tuition for just that.

I don't get it; eons ago when I was a student, the instructor was physically on the unit, supervising our learning experiences. They were never far away.

Understand: nurses show up for work, unaware they will be assigned a student for the day until they get report. It changes a nurse's whole day to have a student. Yes, we should be mentoring, but that adds a lot of unplanned work to the day. And some nurses are NOT preceptor/instructor material and really resent being forced to take on students. Some never get a break because the nearby schools are pumping out students like Pez candy.

Here is the most common scenario: A nurse shows up, just hoping to get through the day, and not make any mistakes or have problems. Being assigned a student at the start of the day, unexpected, already sets the tone for some, that it will be a LONG LONG day. Don't take it personally. It's not YOU they are upset at/about. It's about being given zero choice to take on students, no matter how they feel about actually precepting anyone.'

In some cases, their work just got doubled but they get zero compensation for doing this. Understand that is what's bugging them and just do your best to learn when to ask questions and when to stay out of the way. They should tell you what they would like you to do. If they don't just ask. And then just try to do it.

I appreciate your taking the time to ask. That shows initiative on your part and I like that.

[VivaLasViejas, ASN, RN]

I loved precepting students and new nurses. Some were more teachable than others, and my favorites were the ones who were willing to dive in and get their hands dirty. They came prepared for the clinical day with clean scrubs, a drug book so they could look up the meds they were going to give that day (this was before the age of smartphones), and a care plan that we would go over together. They were curious about what was going on with the patient and gave them that 1:1 time that I really couldn't. Sometimes it was sitting with a patient and talking quietly, sometimes it was giving a long, leisurely bed bath and massage. The ideal students also liked getting in there and watching while I was doing a skill they couldn't do yet, listening to a pair of wet lungs or a tympanic abdomen, or doing I & O's at the end of the shift.

Yes, there were a few who I couldn't teach, who were neither ready nor willing to do the hard work of learning. But most of my preceptees were the type I described above, and I feel privileged to have been a part of their formation as nurses.

[Ddestiny, BSN, RN]

There have been some great tips above. Here are a few I'd like to add:

1. Learn when to ask questions and when your talking will just distract the nurse. If the nurse is reading progress notes, in the middle of a procedure where you can tell that he/she is concentrating hard, or -- heaven forbid -- is trying to fix an actively decompensating patient, bookmark your questions mentally and come back to them later. Watch what's happening (or being read) in the moment. It doesn't mean we're trying to be rude, we just need to give our full attention to our patient or the task in that moment.

2. One of my big pet peeves....don't attempt to give a patient a bunch of medications without telling them what they are and why they're taking them. New nurses and students get so focused on the action of scanning and popping pills that they stop thinking about the great responsibility they have in their hands and all of the ways you can change the trajectory of someone's hospital stay (or at least their day) if you give them the wrong meds. I have no desire to "call someone out" in front of a patient, but if you don't know this information then I'm going to inform the patient for you. It's not to be mean, it's because he/she needs to know. If you feel uncomfortable about me doing that, then make sure you research the meds in advance, write them down if needed, and explain them. I find that naming off each med as I scan them and stating their medication action for each med as I scan them is easier than trying to hand someone a big med cup full of pills and trying to recite them by memory. Also it allows you to have a conversation, and if the patient says "oh, I used to take that but I don't anymore" or refuses a medication for whatever reason then you can easily set it to the side in that moment and not have to go get another tab so you can identify it from the 80 pills in the cup and fish it out.

3. I love to teach. If you show enthusiasm and an interest in learning then I'll take you under my wing for the 12 hour shift, self-narrate so you can know the critical thinking behind my decisions and I'll see if any of my colleagues have any interesting procedures we can get you in on. If you act aloof and disinterested then I'm not going to go out of my way for you. I don't tend to see too many of the latter example but they really do drive me nuts. lol Even if you have no interest in my particular specialty there is always something to learn. And, spoiler alert, I had no interest in my current specialty (critical care) when I was in school, either -- but now I love it!

4. Be graceful if we're grumpy in the morning. I always feel bad on those occasions at 0650 when I'm told I have a student and I'm still half asleep. It doesn't happen often but if I didn't sleep well or if it's the 3rd or 4th shift in a row.... I try to make a little joke about needing more time with my caffeine before I'm fully myself. lol Don't take it personally. And the same goes even if your nurse really is just a grump all day, it's probably not about you unless you're one of those know-it-alls mentioned by someone above.

5. If the unit is on fire and everyone is running around like a headless chicken....jump in there and help. Really even if it's just busy-ish or if you're not actively engaged in something at that time, answer some call lights. If you're not sure how to help with a patient's request then report it back to their nurse. Hospitals usually have a white board with the nurse's name and phone number on it. You'll win major brownie points, even if all you end up doing is calling him/her to say "Room 304 is requesting their pain medication" or to ask if the patient can have the requested snack. It's one less call light for us to run off to get.

[hppygr8ful, ASN, RN, EMT-I]

leave your cell phone in the car!

[slauren]

I like having students that are willing to learn by listening and offering to help. I had a student follow me most of her clinical during a semester and she was fabulous. As she got used to the unit she helped answer call lights, offered to bathe patients, ambulated patient's in the hallway, etc (all with nurse permission). One day she wasn't shadowing me but cleaned a patient after a BM when all the staff on the floor were drowning. Some students will go through and tidy up the rooms, restock isolation supplies/gloves as needed. What a lot of nurses don't like is being interrupted or when a student goes behind their back to complain to the charge nurse. What I don't like is when a student says they're shadowing me but I only see them for maybe 2 hours in the 12 hour shift and they're on their cell phone in the break room. Just like with anything else, you can tell when someone truly is wanting to learn and trying their best vs. people that are just annoying.

[theRPN2b]

Thing almost any nurses want to see is willingness to help us out. Even when you're assigned to your own one patient, volunteer to help us with our patients such as do vitals,answer call bells,toilet patients,change incontinent briefs, help us with washes,ambulate patients or help us with transfers requiring 2 people. When we see these kind of students we usually seek them out when there is something interesting for them to see such as blood transfusions,catheters etc and have the students watch or help out.

[bsf312, ADN]

These are all wonderful posts! Thank you for taking your free time to "shop talk" and offer encouragement. I am learning so much and it just makes me more excited. Keep 'em coming! :)

[bsf312, ADN]

Here is what I would like: (and sadly you don't control this, but you have the right nonetheless):

To have the instructors actually present, doing the teaching. Yes, mentoring future nurses is so important. But I did not get the memo, nor the bonus, to be that nursing student's instructor during his or her clinical experience on my unit.

It's very unsatisfactory for clinical instructors to be across town at another hospital, or unavailable to be responsible for their student.

I think that would be a game changer to actually expect the clinical instructor to be responsible for the learning experience of the student paying high tuition for just that.

I don't get it; eons ago when I was a student, the instructor was physically on the unit, supervising our learning experiences. They were never far away.

Understand: nurses show up for work, unaware they will be assigned a student for the day until they get report. It changes a nurse's whole day to have a student. Yes, we should be mentoring, but that adds a lot of unplanned work to the day. And some nurses are NOT preceptor/instructor material and really resent being forced to take on students. Some never get a break because the nearby schools are pumping out students like Pez candy.

Here is the most common scenario: A nurse shows up, just hoping to get through the day, and not make any mistakes or have problems. Being assigned a student at the start of the day, unexpected, already sets the tone for some, that it will be a LONG LONG day. Don't take it personally. It's not YOU they are upset at/about. It's about being given zero choice to take on students, no matter how they feel about actually precepting anyone.'

In some cases, their work just got doubled but they get zero compensation for doing this. Understand that is what's bugging them and just do your best to learn when to ask questions and when to stay out of the way. They should tell you what they would like you to do. If they don't just ask. And then just try to do it.

I appreciate your taking the time to ask. That shows initiative on your part and I like that.

I understand 100%, thank you for your honesty. I don't believe it's fair that you have to shoulder the burden of teaching without consent. It can be just that if you are not inclined to teach, and even if you are, some days it is just more of a hassle. I can only imagine how much more difficult it makes patient care and your day, but I definitely thank you. I do my best not to take things personally; we are all human.

I personally was not aware that this happens, but I'm glad I do now. It will give me a better outlook and while I am generally a very grateful and helpful person, I will do my best in my clinicals to make sure that comes across. :)

[Jules81, BSN, RN]

I'm a second career BSN student and I would LOVE to just have a drug book and leave my cell phone out of the patient room. However, my program REQUIRES the phone to be on us at all times because our apps are on the phone and there is a push to show patients we how "nurses are integrating technology into caring for them". So when we are looking up drugs we are to tell the patient "I'm using my phone to verify your medications are safe to take together and the dosage is calculated correctly to ensure we are preventing medication errors." Most patients still seem rather annoyed and I honestly don't blame them. I find it to be less personal and makes me look distracted but I also don't want to flunk out of my program just because I didn't follow their rule of keeping it on me and using it.