What do you expect of students?

classicdame, MSN, EdD · Oct 25, 2007

Better talk to your instructor about this. If this is a precepted clinical you should be a shadow to the primary nurse. If your instructor is on the floor the primary nurse expects the instructor to teach. Better find out for sure so you will know who to go to and what to do so you don't waste time.

RNsRWe, ASN, RN · Oct 25, 2007

I just finished my first week of clinicals in acute care. The nurses flat out ignored us and didn't check on any patient that had a student assigned. There were 8 of us students, some students were paired with a patient and some were one on one with the patient.
I thought that we would be following a nurse and doing anything we knew how to do and observing the things we haven't learned yet.
Obviously I was wrong but what should I expect from the staff? And from my instructor?

You weren't wrong in your expectations, but it sounds like the expectations the staff had of the students might have been off. I would HOPE that the nurses KNEW you guys were only in your first week of clinicals, and therefore should not be "left" with the patients, but perhaps the nurses were led to believe otherwise. I'm giving them the benefit of the doubt; sometimes we're told one thing and it's something else entirely. Students no exception

Remember, too, that because you didn't see that nurse check in on that patient doesn't mean she didn't. I've had a patient complain to me that "not once" did her nurse check on her during the night, and not only did I know for a fact that her nurse DID check on her, assess her, reposition her, but *I* was in there twice myself!

So, ok, what to do now? Make sure that you introduce yourself to the nurse whose patient you're 'taking'. Let her know you'll try to do as much for that patient as you know how to do, but you'll be looking for her if something doesn't look right, or if you're unsure how to proceed. That said, be sure you talk to your INSTRUCTOR about these things, particularly if you're expected to run them past her before finding the nurse.

I love students who ask "how can I help?" I tolerate students who say "I'll let you know when I need something". Remember, that nurse has alot to do, and getting you what you need is not her top priority. Students who are eager to learn are wonderful. Students who appear to be going down a checklist of what they have to do (and not an iota more) are less wonderful.

Hang in there. You're going to meet all kinds of nurses, and within all those kinds are good and bad. There's never one way to do anything (ok, HARDLY ever, lol). Use each clinical as a learning experience, and you'll come out just fine :)

ginger58, ASN, RN · Oct 25, 2007

Sounds like your instructor dropped the ball. Someone needs to be overlooking you. Assuming that your instructor isn't a staff member of the hospital on the floor, then she needed to assign you to a nurse. Maybe the NM failed you not setting you up. The way you thought is what usually happens.

I'm sorry that happened to you. Doesn't sound very legal to me and the behavior of the nursing staff was rude. They could at least said hello and introduced themselves. So sorry but don't let this discourage you. If need be, speak to your instructor and tell him/her that you felt dissatisfied with the way that went and how you felt.

RNGrammie · Oct 25, 2007

actually, our clinicals were just like yours. our first day of clinical, we each were assigned one patient that we were totally responsible for .....except meds. in our second semester, we were assigned 2-3 patients that we cared for. our instructor was on the floor for any questions we may have had and luckily, we had great nurses on the floor who helped if we needed. i've run across a few nurses that would rather not have to deal w/ students, but for the most part they've been great.

i see nothing wrong w/ jumping in.....taking at least one patient and doing what needs to be done on that pt.

Adham Ahmed · Oct 25, 2007

OK

I think that you ought to do what is expected as you are student;

Do all action that you are competent to do, science and practice are not separated, the phase of clinical practice in which you are now,and responsibilities are highly instructor centered,

goood luck

AprilRNhere · Oct 25, 2007

Nurses on the floor never had anything to do with us as students. The extent of our discussions were me letting them know when I went to lunch..as they were then responsible for the pt. I know they went in and assessed the pt at some point during the shift though. Otherwise it was the students..and the instructor. If you felt you needed more guidance..let your instructor know. She's getting paid to help you...the staff nurses are not.

That said...it's really nice when a staff nurse DOES help a student...but I think everyone is often too confused as to what students do..don't do..what they can witness etc. It's easier for them to leave it to the instructor.

ginger58, ASN, RN · Oct 25, 2007

I guess what I'm having trouble understanding after reading the last several postings who is legally responsible for the patient? If the instructor isn't on the hospital staff I don't think she is the one to co-sign the chart with the student. When an instructor pulled the patients' meds an RN on staff had to sign.

The students we've had have always been assigned a staff RN because the instructor couldn't follow 5-6 students around closely enough, especially in their beginning clinicals.

I guess for us it's like having an LVN and having to assess the patient as an RN and co-sign her charting, except for meds.

thyme39 · Oct 25, 2007

In our first clinical (med-surg) our instructor had 7 students. She was always on the floor or in a a patient's room and we only had to ask to receive help. She had access to the get meds as she was an RN. We as students did not. We ONLY gave meds with either her or our nurse (mostly her). We didn't give ANY meds the first 3 days. Then she had half of us give meds one day and the other half give meds the next. She ALWAYS checked any meds we gave. After a while, if it was a PO med and we checked the med, the patient, the exp date, what the med does, side affects, what to watch out for, etc with her then she would let us go give the med to the patient ourselves. Shots , piggybacks, IV push we did only with the nurse or instructor. I did not have a very good day my first day. I followed my nurse around for 10 hrs and ran my legs off and felt totally miserable because i didn't get to do anything. I thought my nurse didn't want students. I talked it over with my instructor and she said to talk to her right away if I feel like that again - so she could do something about it right then. She assigned me to another nurse the next time. A few days later, I got the first nurse again. You know what? I was more forward with my nurse on what I wanted to do. I told her I wanted to learn anything she wanted to teach me. I had this nurse several more times and she came to trust that I knew what I was doing. It ended up that she was really a wonderful nurse. She gave me some great tips, was conscienscious and friendly and i said I would take her as a nurse any day. I think sometimes the nurses don't know what we are supposed to do. Not every clinical instructor tells them and that is why you need to be proactive and let them know. Tell them it is your first day and you would like to just follow them and observe or that you will do total patient care except for meds or that you want to learn anything they will teach you if they have the time. And by the way, don't discount those patient care techs. The best teaching I ever got on how to do a bed bath and change an adult diaper was from a PCT. After we learned a little, we students even helped each other out. I did a tube feeded and then taught another student another day how to do it. Don't give up. Talk to your instructor (nicely - don't blame) or your next nurse and hang in there. I was miserable my first day. Looking back it was one of my better experiences. Good Luck.

Crux1024 · Oct 26, 2007

My clincals are exactly like the Op's. Since Its just 1st semester, We function basically as aides that can give meds under supervision. Today was the FIRST time in 10 weeks (doing once a week clinicals), that the nurse felt it necessary to include me in the patients care plan and etc, and I think that was only because I was translating!!!!

But whatever, Im learning and I am able to independently seek out opportunities to do~learn~see stuff on my own. No one is babysitting me and I kinda appreciate the autonomy given to us to early in the game.

The clinical instructor is fully responsible for us, and she is busy with the other 7 students to spend too much time with just one person.

pagandeva2000, LPN · Oct 26, 2007

I had a semi-hard time in clinical myself, but, basically, I let the nurse know immediately what the professor is allowing me to do. It is best to get instruction from the professor, because if you do anything she has not allowed you to do, HER license is in jeopardy.

To clarify a bit on how the floor nurses are feeling; in my hospital, they never let us know who is coming, and while I understand the student's position (I just became an LPN last year), it DOES slow your day down considerably. And, some students are watching each and every thing the nurse is doing wrong and calling them out on it; usually because this is not what was discussed in class. The real world is filled with short cuts, short staff, high nurse:patient ratios. You really can't get things done if you do it all as taught. There are certain key things that time needs to be taken out such as certain medications. But, if the nurse feels that she has to explain herself or justify her actions to someone that hasn't been out there, yet, it is very frustrating.

Speak to your CI, tell her how you feel. Clinicals go either way; some are very good and others are disasters. Personally, I could have done without them. Others here in the forum may feel differently.

vashtee, RN · Oct 26, 2007

I am a student, and when I go to clinicals, I tell the RN exactly what I will be doing (and what I am not allowed to do) when we take report in the morning. If I am uncertain how to do something, I tell her I hope I can observe when she does it so I will be prepared for next time.