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!

[jena5111, ASN, RN]

Same here! My ADN program started in mid-January and we had our first clinical day in the third week of February.

Our "real" first clinical day would have taken place the week prior, but for a "snow day" (pretty absurd in Austin, TX but any trace of ice on the roads here is considered snow).

I was so disappointed!!

[guest940422]

I know the demands on nursing students is different now than it was when I was in school (and that wasn't very long ago). When i was a student, you picked your patient the night or day before and did all the research and paperwork before you got to clinicals. Now I see more and more students showing up the day of with stacks of paperwork they need to fill out on a patient they pick in the morning and be ready to present this by post-conference. So if your teacher is making you spend your clinicals on the computer then I don't know what to tell you.

That situation aside, I feel like clinical experience is sacred and you only have a finite amount of it... don't waste it working on your homework doing care plans or studying for exams.

We are really busy, we don't stop to hunt you down when there is a great learning opportunity. Stay on your nurses heels and you'll get more out of it.

Do the grunt work. Vitals and bed baths may not be what you thought you were signing up for, but support staff is a luxury you may never have. You need to be able to do those things without thinking, they need to be in your muscle memory so you can be simultaneously assessing your patient and noticing trends prioritizing your day and other things that will come later. You don't want to graduate and still be having to think and focus on which way a blood pressure cuff goes.

The only stupid question is the one you don't ask

Never stand when you can sit and if you see a bathroom use it

keep a mini sample size perfume bottle on you and spray it inside your mask for tasks that might make you sick from the smell (12 years in and I still can't handle the smell of puss)

You don't get anything you dont ask for. If your patient is going to the OR for surgery ask if you can go to observe... you may never get another chance and even though your school doesn't get OR rotations they will almost always say yes (just don't touch anything) I work in IR, we don't take students, but if a patient has a student attached to them and the student asks I let them stay and observe. When I was in school I got in to a ton of specialty areas doing this.

If there is a code, don't just watch in the doorway, walk in the room, find a spot out of the way

You will see lots of nurses do things that are not the way you are being taught in school. Some are open minded and would love to learn the latest techniques from you. Most have egos and pride and do not want a student telling them how to do their job. the fastest way to get a nurse to ignore you and not want to teach you is to tell them they are doing something wrong or pull a "well we learned it this way because...."

If you like a unit you are on, ask for a reference from a preceptor and get the manager's card (its usually at the desk) start thinking about job hunting now and make those contacts. This is going on your resume after all.

[Heylove, BSN, RN, EMT-B]

6. Having a student is not "helpful" to the nurses. Some students seem to think it is. Recognize that you represent one more variable the nurses have to balance out in their day. Be cognizant of that, be grateful to them, be kind and definitely don't think you are entitled to time, attention or accommodation. At the end of the day, the responsibility for the patients lies with them, not you. Everything about you being there is a charity to you. Nobody is getting paid extra to have you learning from them. All they get in terms of compensation is your attitude and desire to be a good nurse. For many, that is enough.

7. The break room belongs to the nurses who are at work. Don't take up space at the table for longer than necessary and definitely do not use it to do homework.

8. The nurses need the computers to chart. Don't linger.

I respectfully disagree regarding part of #6. On our adolescent psychiatric unit, I am SO happy to see student nurses. We need all the eyes we can possibly have on all the patients, all of the time. And yes, by being respectful of our time, that means "don't talk to us so much." I don't mind questions about patient-related care or nursing related questions, but I don't want to hear about your aunt and cousin that have been in our facility.

I wholeheartedly agree with #7 and #8.

[JadedCPN, BSN, RN]

This is more so a reminder to yourself - remember that you can and will learn something from every nurse that you encounter, even the mean crabby grumpy ones that obviously don't want a student that day. Sometimes you have to take it upon yourself to determine that learning experience and advocate for yourself in that situation, but if you look for it I guarantee you will realize even the worst of days are learning days.

When I started as a new grad in the PICU a dozen years ago, I thought one of my preceptors was so ridiculously grouchy and mean. After gaining experience and perspective, I can still say she was grouchy but I learned more from her than I did any of the nice preceptors. I didn't need a friend who made me feel happy and included and part of the gang (although that does account for something), I needed someone to teach me. Remember that is what truly matters on your clinical days, and even if you don't get along with a nurse you are assigned to that does not mean you won't have a great educational experience.

[Heylove, BSN, RN, EMT-B]

Oh, and stop bringing us cookies and cupcakes. Ha!

[ColoRena60]

I like to see students put themselves out there and want to learn and offer help even in the menial things. If this is a hospital where you may want a job at later, your preceptor or the nurse who you are assigned to can be your greatest ally. When I was in school, I would volunteer to clean instruments, wash down the beds, clean the delivery rooms, ask the nurses every question I could think of. I tried to pick their brains apart. My fellow students were at the desk, chatting and studying. Before the end of the term, I had a job offer in L&D after I graduated. Never sell yourself short. This could be a working interview of sorts in a clinical area you may want to work one day. A couple of years later, one of the docs, offered me a job in his office where I then worked for several years. Again a launching pad... Now I'm an NP in women's health.

[applewhitern, BSN, RN]

Don't be disrespectful to the nurses. Don't take up their space they need to get report and chart. I've seen students come into the report room and sit in all the chairs, then don't get up to allow the regular nurses to sit down and get report. We take report on ALL the patients, so it can take 30-45 minutes. Don't act superior and assume the nurse knows nothing just because she isn't "fresh out of school where she learned the latest stuff." Sometimes we do things the way we do simply because the hospital we work for wants it that way. I had a student once that was caring for a patient who went to surgery. Upon the patient's return from PACU, student never went into the patient's room. I told her "we get vitals q 15 min for an hour when we get them back from surgery." This student went running to her instructor to complain that I expected HER to do vitals!! No, I expected her to go check on her fresh post-op patient. The instructor told me, "they don't do vitals, they learned that in their first semester." WOW.

[Heylove, BSN, RN, EMT-B]

Don't be disrespectful to the nurses. Don't take up their space they need to get report and chart. I've seen students come into the report room and sit in all the chairs, then don't get up to allow the regular nurses to sit down and get report. We take report on ALL the patients, so it can take 30-45 minutes. Don't act superior and assume the nurse knows nothing just because she isn't "fresh out of school where she learned the latest stuff." Sometimes we do things the way we do simply because the hospital we work for wants it that way. I had a student once that was caring for a patient who went to surgery. Upon the patient's return from PACU, student never went into the patient's room. I told her "we get vitals q 15 min for an hour when we get them back from surgery." This student went running to her instructor to complain that I expected HER to do vitals!! No, I expected her to go check on her fresh post-op patient. The instructor told me, "they don't do vitals, they learned that in their first semester." WOW.

Oh my god. That's unbelievable.

[marable]

The last few years that I worked in an acute care facility I stopped accepting students....They were never on time, I had gotten my report and started assessing my patients and would have to stop to give them a report....Even though the students came in to review their patients charts the day before clinical they were never prepared, most did not know what the medications were for, ie, did not know the difference between a colace or MS Contin.....Their instructors would come in and pile up in the nursing lounge(it was not my job to teach their students clinical)....The students never once helped pass a tray or take a patient a glass of water....Most of the students huddled up in corners (cute girls and handsome male students) flirting and giggling talking about what they were going to do on their next dates....I got to where I could not handle it ....I suggest that a student come in prepared , know what your patients diagnosis is and how to take care of them, look up their medications ....Be ready to answer the staff nurses questions about your patient ....We were told to let the student do procedures like catheterizations yet they had no concept of how to do it ....This is a great story about a student nurse and their instructor I had a male homosexual patient once who had been in a relationship with his lover for nearly 40 years , they had had anal sex for years so this patients orifice was very dilated ....My nurse manager calls me into her office one day and asks me when I was going to call our wound care nurse to look at this man's sacral wound ...I told her that I had been giving that man a complete bed bath and he did not have a bed sore , she said the student and instructor had reported me because I was not providing wound care on this patient .....The next day when the instructor and student came in I took them into that patients room and asked them to show me the decubitus, they searched and searched , low and behold NO DECUBITUS....I then asked them to follow me where I took them into the nurse managers office and had them explain about the so called bed sore that I was not providing wound care for.....Nursing students were exhausting ....I had eight or nine patients that I had to provide total care on each day and then the nursing instructors thought I was going to teach their unprepared students how to be a nurse ....I simply could not do it anymore....Sorry....

[Tenebrae, BSN, RN]

I didn't need to see anything.. but a student wanting to learn. Please try to relax. It is our duty to take you under our wing. Ask any questions you have, if you run into a nurse that will not help you.. notify your instructor.

PM me along the way.. if needed.

Reposted coz she said it way better than I could of.

And ditto on the PMing

[Megan1977, MSN, EdD, RN]

What we want from students and what I tell them when they orient here:

1. You are in scrubs. Therefore, in the eyes of the patients, you are a nurse. They don't differentiate between a student and a "real" nurse.

2. In the eyes of the patients, you are also representing this institution. Your behavior here will reflect on us, your hosts. We aren't obligated to host you and you can indeed wreck it for everyone else by any problems you cause. Behave professionally and if you don't know what that means, find out before hitting the floor. I am happy to help, without judgment.

3. With the above two points in mind, do NOT use your phone in any area where a patient or visitor may observe you doing so. If you need to text, take a call, check an app for lab values or med information, call your instructor or whatever.... step into the break room, the med room, a closet, anything but do NOT pull that phone out on the floor.

4. Clinical time is not the time to do your homework. Care plans and other school work needs to be completed outside of the hospital. You need to be using this time to learn how to care for patients, hands on. It is the only chance you get to do that, so take advantage.

5. Bathing, vital signs, toileting etc are all part of the clinical experience and if you want to make a good impression you will seek out opportunities to do these things.

6. Having a student is not "helpful" to the nurses. Some students seem to think it is. Recognize that you represent one more variable the nurses have to balance out in their day. Be cognizant of that, be grateful to them, be kind and definitely don't think you are entitled to time, attention or accommodation. At the end of the day, the responsibility for the patients lies with them, not you. Everything about you being there is a charity to you. Nobody is getting paid extra to have you learning from them. All they get in terms of compensation is your attitude and desire to be a good nurse. For many, that is enough.

7. The break room belongs to the nurses who are at work. Don't take up space at the table for longer than necessary and definitely do not use it to do homework.

8. The nurses need the computers to chart. Don't linger.

YES, YES, YES!! 100%

[TriciaJ, RN]

The last few years that I worked in an acute care facility I stopped accepting students....They were never on time, I had gotten my report and started assessing my patients and would have to stop to give them a report....Even though the students came in to review their patients charts the day before clinical they were never prepared, most did not know what the medications were for, ie, did not know the difference between a colace or MS Contin.....Their instructors would come in and pile up in the nursing lounge(it was not my job to teach their students clinical)....The students never once helped pass a tray or take a patient a glass of water....Most of the students huddled up in corners (cute girls and handsome male students) flirting and giggling talking about what they were going to do on their next dates....I got to where I could not handle it ....I suggest that a student come in prepared , know what your patients diagnosis is and how to take care of them, look up their medications ....Be ready to answer the staff nurses questions about your patient ....We were told to let the student do procedures like catheterizations yet they had no concept of how to do it ....This is a great story about a student nurse and their instructor I had a male homosexual patient once who had been in a relationship with his lover for nearly 40 years , they had had anal sex for years so this patients orifice was very dilated ....My nurse manager calls me into her office one day and asks me when I was going to call our wound care nurse to look at this man's sacral wound ...I told her that I had been giving that man a complete bed bath and he did not have a bed sore , she said the student and instructor had reported me because I was not providing wound care on this patient .....The next day when the instructor and student came in I took them into that patients room and asked them to show me the decubitus, they searched and searched , low and behold NO DECUBITUS....I then asked them to follow me where I took them into the nurse managers office and had them explain about the so called bed sore that I was not providing wound care for.....Nursing students were exhausting ....I had eight or nine patients that I had to provide total care on each day and then the nursing instructors thought I was going to teach their unprepared students how to be a nurse ....I simply could not do it anymore....Sorry....

This story explains why so many new grads complain about drowning. This school sounds like a diploma mill. Ditto a previous post about "...students don't take vitals."