So this past week I precepted a 2 year ADN student nurse in her last 2 days of clinical before her internship. So I ask "what are your expectations today" as I had not worked with this SN before. So she said I'll take care of 3 pts. Okay, good, I was standing back, giving advice when asked and oversaw documentation, skills etc.
She did great with patient care when she did it but I had to prompt her to do everything! Okay, you should give those 0900 meds since you're here assessing. Okay, you should be checking the vitals before you give all those cardiac meds.Okay, those vitals were taken at 0600 and now it's 0930, yes, YOU need to take a new set of vitals. Okay, make sure the tele gets taken off soon since it was D/C'd. Okay, it's 3 hours later so I took the tele off the pt it was D/C'd from.
Didn't have ANY clue how to set up a bag of maintenance IV fluids with a piggyback nor put a pt on tele.What the heck have these students been doing during their 'lab' time?
Then to top it off, she stated she wanted to work on this unit. I politely reminded her of the over abundance of nurses and how she needed to really go above and beyond to get noticed and make an impression.
You don't get a second chance to make a first impression.
I know, I know, not all NS's are this way. I was just so frustrated I wanted to scream, take some initiative and take responsibility for your education!
Students who currently attend the programme I attended are expected to manage a full patient load by the end of their med-surg rotation. That's five with the buddy nurse on standby.
The student was clearly in over her head and had no business taking care of three, even three low acuity patients. Employees on my unit can't even do that without a few weeks of orientation and a week on the floor. I would have (and have) cut her back to one patient when it was clear early on she was doing everything via prompting.
This group of students had been on the unit for 6 weeks and a total of 12 shifts. Plus they weren't new students, she also knew how to do pt care she'd been a CNA previously, she just wanted to sit around and chat. Yeah that'd be nice but there's no time to sit and chat on day shift.
Oh, god, I was a horrible student nurse. I could go into it but don't want to hijack your thread.
I will say that the best thing my capstone/practicum instructor ever did for me was force me to push myself. I was a very, very hesitant student which I think could have been perceived as lazy but my instructor realized that I was just super, super uncomfortable going out of my comfort zone and that she really had to just put her foot down, MAKE me do it the first time. I loved her for that.
Seems like your student is in cruisin' mode. Hey, she graduates in a few months. Senioritis or whatever. Honestly, she might have also learned her laziness from previous clinicals. Poor clinicals might also help to explain her lack of skills in some areas. (Seeing something done or even just doing it once or twice is much different from doing it repeatedly. Esp. if it has to be done alone. I find my best retention rate for skills is when I'm alone and HAVE to process through things without relying on having someone near by.)
I can't judge the situation, I wasn't there, and please know I am not judging your reaction, I am just telling of my experience on both sides of the line.
AS THE TERRIFIED, SHY, SLEEP DEPRIVED, BROKE, AND PEOPLE PLEASING NERVE-STUDENT
I had a Lamb meets Wolf Preceptor experience, and we are close now until this day. She brought me out of my shell. Its a crazy situation to have FULL RESPONSIBILITY for the students patients, and LET GO and let the student work. That said, I feel like the student is often counting down the minutes until they can crawl out of the spotlight hotseat and breath again. I have noticed that compared to what I felt. I will admit that clinicals are for learning, and that competence should be present during this time. My preceptor could alway "get me" on some little thing I forgot to do, like "did you check his bandage?" I did during assessment, "ANYTHING CAN CHANGE," I learned assertiveness, sharp awareness (the developed nurses' 6th sense), and Advocation for my patience. Just saying, It takes a special person in a path to make the difference of a competent nurse, or one hell of an awesome nurse. I APPLAUD AND AM GRATEFUL FOR EVERY RN THAT WILL STILL TAKE A STUDENT UNDER THEIR WING EVEN THE STUDENT ISN'T "WORTHY!"
There are many nurses that WILL NOT take students, or precepts. I understand that too.
AS THE PARANOID, UNDERPAID, OVERWHELMED, OVERWORKED, SORE-FOOTED PRECEPTOR
You saying that you "asked what their expectations were," I think was really neat. I do the same. I do push them, but try to be understanding. When a mistake is made (correctable ones), we discuss what can change it or prevent it from re-occurence. I DO NOT ALLOW CNA ASSISTANCE BEYOND LIFT HELP, at our local schools the 3-5 patients are total care. I REMIND THEM THAT THIS IS THEIR BEST LAST CHANCE TO BECOME A COMPETENT, DEPENDABLE, SAFE, AND ALERT NURSE. If I don't see INTIATIVE, I investigate. I THINK THAT IT IS OBSENE THAT STUDENT NURSES GRADUATE WITHOUT HAVING PLACED AN IV SUCCESSFULLY, STARTED A FOLEY CATHETER ON THEIR SAME SEX PATIENT AT LEAST, AND A TRUE STERILE DRESSING!!!!
I quiz them during downtime, and patient specific on our load for the day, the "what-if's," according to safety, education, priority, d/c teaching, assessment, and the nursing process. IF YOU CAN CRACK THAT SHELL AND GET THE TURTLE OUT, THEY WILL NEVER GO BACK IN, AND YOU HAVE MADE A CATERPILLAR INTO A BUTTERFLY, AND WITNESSING THAT CHANGE OVER THEIR 40 HOUR STENT IS INCREDIBLE.
However if, and you will get the lazy one with no initiative and no baseline of comfort in sharing your patients with them, I FEEL IT IS OUR DUTY TO STAND UP AND SAY, "THIS STUDENT IS NOT WHERE HE/SHE SHOULD BE AT THIS LEVEL, SOMETHING IS WRONG!!!!!!! THE ODDs ARE IN YOUR FAVOR FOR SAVING A LIFE!!!!
Dirtyhippiegirl, I'm so glad I'm not the only one. My first clinical experience at the hospital was terrible and it was all my fault. I was so uncertain. The best criticism I ever got in school was my instructor, in front of the whole group, telling me I'm too timid. It really made all the difference. Thankfully things got better from there and I'm now a semi decent first year nurse.
Only one patient? How did you ever learn to take a full load?
Orientation. In clinicals we only ever got 1-2 patients. My clinicals weren't all that great for learning skills; you never know how crappy the nursing student's experience has been up to the point when they're with you.
Only one patient? How did you ever learn to take a full load?
Taking on 1 pt is good, in the beginning, so students can really really focus on assessment and skills without the stress of trying to do 100 different things at once.
But throughout the entire program?
Not realistic and where did they learn to do it then?
Of course, on the floor in their first job.
Oy.
Back on topic, I see 2 possible things with OP's student:
It could be performance anxiety. I know I sometimes was pretty sure of what I needed to do, but I was afraid of doing it without approval or verbal validation that I was right.
I know that sounds dumb because I always learned by "just doing it" and if it's wrong, someone will let me know.
Well... that might be okay for learning how to set up a window display or running the cash register, but I didn't really think that method was altogether wise for learning IV starts or setting an IV pump... or pushing meds... or cleaning a wound...etc, etc.
I got over it, but it wasn't easy.
I'm positive I caused many many eyeballs to roll.
It could be sheer lack of common sense. Not everyone is good at thinking things through. That's bad and I don't think there's much to be done.
Can common sense be taught? Can it be learned over time?
Heck, if I know.
If it's laziness... then that's bogus waste of time for everyone and I would be frustrated, too.
I went to school with many people who are clueless. I have no idea how they'll manage in real nursing, since the things you describe and worse are very common. It's frightening how little initiative some people have. How do they manage with a critical situation? The problem is, those types of new grads ruin it for the new grads who are worthy of having on staff.
And when I was a student, we were expected to manage a full patient load, including the charting and flow sheets. I had 4 to 5 heavy patients. We were told, "if you can't manage a full load by mid semester of your last rotation, you'll be here next year." End of story.
You know I really like working with students. I don't try and put any undue stress on them but I won't sugarcoat anything either. We got along great and had lots in common but just disappointed. I had an awesome student the week before who took off each morning upon my suggestion to get assessments and chart as you go unless something with higher priority happens. Only one time did student X ask for help with a pt's morning med pass. No problem, I'd rather help than a student acting like everything's covered when it's apparently not. Than student X asked for suggestions on what could be done better next time to get it done more efficiently. It felt nice to help a new nurse realize what it takes.
Fiona59
8,343 Posts
Students who currently attend the programme I attended are expected to manage a full patient load by the end of their med-surg rotation. That's five with the buddy nurse on standby.
Three would be a luxury.