My role in student nurse clinicals

  1. Instructor, where art thou?
    I've looked high and low
    Your student nurse is looking lost and
    is not sure where to go.

    I'm really very busy with the job
    I'm paid to do
    Instructor, dear instructor,
    I can't do your job too.

    Back in the day, during my clinicals, I was assigned to one or two patients and was responsible for vs, bathing, toileting and meds. I had to have the patients' meds written out on index cards and had to know how these meds were related to their diagnosis or PMH and why they were taking them. I was literally ignored by the regular staff and, if I needed help, was told to find my instructor.

    I know it's a different world from my days in nursing school, but the nursing students that we get on my unit are assigned to a nurse, not a patient, and are told to "shadow" that nurse for their clinical time. The SN can do assessments and give meds "with me". Most times, I end up explaining the med and coaching the student through the administration process. How did this happen?

    I'm not saying nursing students should be ignored like when I was in school and I don't mind answering questions or sharing information about the patient with the student, but it completely throws me off my day to have to stop and explain everything I'm doing to the student. There must be a middle ground somewhere. I feel like student supervision should ultimately be the instructor's responsibility, not mine.

    Can anyone else relate to this?
    Last edit by serenity now on Nov 14, '17 : Reason: Wasn't finished post
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    About serenity now

    Joined: Dec '16; Posts: 7; Likes: 25

    14 Comments

  3. by   Atl-Murse
    Might be SN from fundamental of nursing
  4. by   JBMmom
    Maybe that school/program is doing something different. The students on my current floor are also assigned to patients and have a PCT/nurse role with the instructor. The do vitals, care, and meds with the instructor. Maybe you should talk with your management and have them clarify with the school the goals of their program to balance that the responsibilities of the floor nurses. Certainly we can all take some time to help students since we were once there are well, but if it's interfering with the care that you can provide then it's not in the best interest of the patient, or your hospital.
  5. by   registerednutrn
    I am a clinical instructor in a LVN program I take a group to a nursing home. My role is somewhat limited due to the facility's rules not ours. So for my student to give meds the nurse has to log on for and watch us prepare and give the meds so we only get to give meds once other wise I do any skills that come up such as foley changes or placements with the students Now I also work on a busy medsurg floor and I will usually have a management level student from either of the 2 RN programs assigned to me so they follow me everywhere the only way they get to do anything with me is to show me that they are competent. If they are not I communicate that to the instructors. It can be overwhelming at times but is what the schools and hospital agreed on I can refuse to have a student if I want. Please forgive any crazy misspelling as I am typing on my phone e and it autocorrects really crazy
  6. by   canoehead
    I got caught once with a student and no instructor. I don't mind if a student follows me around, but the instructor needs to be on the floor, and responsible for them. If I'm responsible for someone else, not related to the job I signed up for, they can give me their instructor pay, or do it themselves.
  7. by   elkpark
    I was a student nurse back in the day, when our instructor did all the teaching and supervising, and we worked alongside the staff nurses but they were in no way expected to provide any of our education. In fact, they were not allowed to supervise us giving meds or doing anything that we needed to be supervised doing. I've been a clinical instructor since then, in med-surg and in psych, and I've used the same model. I've also had the experience of showing up for work and discovering that I have a student for the day, no instructor around, the student can't tell me anything about what the specific clinical objectives are for the rotation or what the student is or isn't allowed to do, and, somehow, I'm supposed to create a productive clinical day for the student.

    I don't understand how so many schools get away with dumping their teaching responsibilities on staff nurses. I don't understand why the hospitals put up with it, and don't just refuse to allow those schools to return for future clinicals. I think it's a disgrace.
  8. by   CCRN2BE
    I can completely relate......

    I don't know when this shift to the following happened, but I know I, nor my fellow coworkers, appreciate it.

    Dump your student on my floor and tell them they're assigned to "me".

    Recently had a student "assigned" to me whose clinical instructor was not even present on the unit/floor. Did not see said CI at all throughout entire shift. Student shows up with no stethoscope, no books, no paper, not even so much as a pen and tells me they'll just be "following me around."

    For one, I cannot stand to be followed around (anywhere!) and don't appreciate when I can't even sneak away to the break room to shove some food in or to the bathroom without a student trailing me.

    The student gains no educational benefit from chasing around a nurse who just wants to get her own work done without being interrupted 5 million times with questions. I want to say, "go look it up!" or "where is your instructor?!?". If they'd put just a tiny bit of effort into thinking or attempting to learn, I might not be so irritated by it. But a student who shows up completely unprepared and then grills me with questions about every action I take or do not take and expects me to regurgitate the what, why and how of everything is just wasting both our time.

    I know I sound harsh, but this method leads to a poor experience for the student and the nurse both. I wish they'd realize they are not doing their students any favors by structuring clincials this way.

    With the exception of a few great students, we've had a rash of unmotivated and unprepared students with MIA clinical instructors from programs like this lately and it's caused a lot of frustration for all.
  9. by   JBMmom
    Quote from CCRN2BE
    I can completely relate......

    I don't know when this shift to the following happened, but I know I, nor my fellow coworkers, appreciate it.

    Dump your student on my floor and tell them they're assigned to "me".

    Recently had a student "assigned" to me whose clinical instructor was not even present on the unit/floor. Did not see said CI at all throughout entire shift. Student shows up with no stethoscope, no books, no paper, not even so much as a pen and tells me they'll just be "following me around."

    For one, I cannot stand to be followed around (anywhere!) and don't appreciate when I can't even sneak away to the break room to shove some food in or to the bathroom without a student trailing me.

    The student gains no educational benefit from chasing around a nurse who just wants to get her own work done without being interrupted 5 million times with questions. I want to say, "go look it up!" or "where is your instructor?!?". If they'd put just a tiny bit of effort into thinking or attempting to learn, I might not be so irritated by it. But a student who shows up completely unprepared and then grills me with questions about every action I take or do not take and expects me to regurgitate the what, why and how of everything is just wasting both our time.

    I know I sound harsh, but this method leads to a poor experience for the student and the nurse both. I wish they'd realize they are not doing their students any favors by structuring clincials this way.

    With the exception of a few great students, we've had a rash of unmotivated and unprepared students with MIA clinical instructors from programs like this lately and it's caused a lot of frustration for all.
    That's awful! I know one thing I miss out on being on third shift is that we obviously don't get any students. I would love to have the opportunity to payback for the awesome nurses I had in my hospital during my clinicals. We had to pass meds with our CI, and other than that we were expected to answer the lights for our patients and do more of the PCT stuff. But the nurses I had were awesome about involving me with other aspects of care, like inserting Foleys, dropping NG tubes, sending me to learn from the monitor techs for the tele patients. We did our best to stay out of the way so they could work, but we were there if they were willing to spend the time with us. Thanks to all of you that are helping the students, and I hope these programs wake up about appropriate use of clinical time!
  10. by   NurseKatie08
    Quote from serenity now
    Instructor, where art thou?
    I've looked high and low
    Your student nurse is looking lost and
    is not sure where to go.

    I'm really very busy with the job
    I'm paid to do
    Instructor, dear instructor,
    I can't do your job too.

    Back in the day, during my clinicals, I was assigned to one or two patients and was responsible for vs, bathing, toileting and meds. I had to have the patients' meds written out on index cards and had to know how these meds were related to their diagnosis or PMH and why they were taking them. I was literally ignored by the regular staff and, if I needed help, was told to find my instructor.

    I know it's a different world from my days in nursing school, but the nursing students that we get on my unit are assigned to a nurse, not a patient, and are told to "shadow" that nurse for their clinical time. The SN can do assessments and give meds "with me". Most times, I end up explaining the med and coaching the student through the administration process. How did this happen?

    I'm not saying nursing students should be ignored like when I was in school and I don't mind answering questions or sharing information about the patient with the student, but it completely throws me off my day to have to stop and explain everything I'm doing to the student. There must be a middle ground somewhere. I feel like student supervision should ultimately be the instructor's responsibility, not mine.

    Can anyone else relate to this?
    I am a clinical instructor part-time (as well as a full time staff nurse). It frustrates me to no end when I see/hear of other instructors that just dump their students on the floor staff. That is not your job! I teach med surg, and my students are each assigned to a patient (or two as they get more proficient) and they are responsible for that patient--they are NOT assigned to a nurse! They take vital signs, help the patient with ADLs/ambulation, do an assessment and any other treatments as I see fit--WITH ME! I happen to teach clinical on the floor I work on as a staff nurse, and my colleagues are very receptive to pulling my students in and showing/teaching them things, but I think this is because of the environment I create--I do NOT expect the staff to teach them anything--that is my job! Often times I do pair a single student up with a nurse for one day in the semester, just so they can observe and learn about prioritization & delegation and what having a full assignment is like, but I make the expectations of that day very clear, and I ASK the nurse ahead of time if they would be willing--I don't just assign the student to them with no warning. I have heard of clinical instructors that have students give meds with the staff nurse's supervision...no no no!
    I could go on for days!
  11. by   Nature_walker
    My unit is an "extra observation" day for students. They come down during their clinical day just to observe what my unit is/what we do in emergency psych. They are there only to observe. I've never seen hide or hair of any of their clinical instructors. I walk into my shift and am told, Student X is going to following you for part of the day. I don't mind so much unless our milieu gets busy or people are amping up. I tell the students "first rule, if I say go back to the nursing station, you follow that command as it can become dangerous for you." They are not trained in how to handle our population and it can become unsafe for them. I've only had one that I emailed the instructor as they wanted to try to "help" when I told them they needed to go back into the nursing station. I had to remove myself with the student in tow as the situation was not going well. Other than that, it has been fine since they are only supposed to be observing.
  12. by   Lulu Belle
    I am a BSN student and I just finished my first clinical experience at a SNF. I was shocked at how the whole thing went down. I went in expecting to do all the "CNA stuff" for my patient, assist with/observe dressing changes, and maybe pass some meds under supervision of my instructor.

    Instead, our instructor threw us at the poor, unsuspecting nurses and aides and expected them to teach us everything. I was told that I was not allowed to give any care by myself (not even toileting or a bed bath) because I "wasn't familiar with the patient." I even got a stern talking to for passing breakfast trays!

    The reason for all of this was facility policy, but I felt that it was a disservice to us, to the nurses, and by extension to the residents. How am I supposed to be anywhere near competent when i graduate if I'm not even allowed to give a bed bath?

    Thank for listening to my rant from the student perspective!
  13. by   gemmi999
    In the ER I work in, we actually get quite a few students from both LVN and RN programs. A lot of times the LVN students get dropped off and they float around, trying to get skills in. They can't pass meds without their instructor but they help out with CNA duties and if the RN has a procedure AND time, such as foley, NG tube, etc, they have the student do it with them. RN students tend to get paired with an RN and shadow the RN, assisting when appropriate but typically shadowing more because our ER can get pretty busy. We do ensure they know basic things at the start of the day--how to label urine specimens, where the lab is, how to place a pt. on the monitor correctly, how to clean a room, etc. These are skills that they can be independent on during the day that can greatly assist our ER.

    A lot of times I end up with three nursing students because I'm typically a resource or float RN, and can take the time to explain what I'm doing and have the students help because I don't also have a full patient load. Instead, I end up teaching about the flow of the ER, the ESI system, helping them link why we order specific labs with specific complaints, etc.

    I *never* see the instructors once the students get dropped off. Sometimes, if they are RN students, they can give non-narcotics with the primary RN if the primary RN feels it is safe. If they are LVN students they can not give medications without an instructor. The biggest hurdle is we get *lots* of IV starts in the ER, but students are told by the instructor they can't start an IV without the instructor there. The student's text the instructor but the instructor never turns up and the student doesn't get to do the IV start. *sigh*

    This is a good thread! I want to go into clinical teaching, I'm just waiting until I have more experience (I only have 3 years and the school's I've looked at applying to tend to want at least 5).
  14. by   MyAimIsTrue
    Our school cherishes the relationships they have with our clinical sites and have basically told all of us students, "Don't mess this up!" Our instructor is always there and we are not allowed to pass meds without him/her. Usually (but not always) our first day at a new site we are assigned a nurse to shadow. The nurse doesn't volunteer for this--it's thrust upon him/her when they show up for their shift, but they've been welcoming so far. I will say I've had some excellent teaching from staff nurses and I always appreciate it and let them know.

    Our school contracts with 12-15 hospitals (not including for preceptorships) and is competing with lots of other schools for those rotations, so they really do care about the impact that student nurses have on staff nurses. Our clinical instructors are very gracious to the staff as well.

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