For those in ADN programs -- how many patients do you have in clinical?

Pia Mater · Feb 25, 2012

I am in my second semester, we only get one patient, if that.

kh321 · Feb 25, 2012

I am in my fourth semester and we get 3. The decision is up to the instructor.

KatieJ91 · Feb 25, 2012

I am second semester and we started with one and are now to 2. Next quarter 2 then possibly 3. It is up to the clinical teachers discretion and not everyone gains a patient at the same time. Also, when we have 3 patients we cannot delegate to a CNA, but when we have 4 we can delegate things like AM care and such.

brillohead, ADN, RN · Feb 25, 2012

It depends on the rotation.

When I was in Med-Surg I, I would have up to three patients, but I was really only doing things like a CNA would do, plus I would do one head-to-toe assessment.

When I was in L&D it was one, because the unit is a 1-on-1 assignment for regular nurses -- the goal is to be totally focused on your laboring mother, always available when needed.

When I was in Mother-Baby, it was 1-3 couplets, depending on acuity and census (when I had a fresh c-section PIH mom still on Mag-Sulfate, I only had one couplet b/c I had 15-minute vitals, etc.; when I had second-day uncomplicated NSVD moms, I had three couplets).

I'm currently in Med-Surg II, and we are only assigned one patient because we are dealing with higher acuity situations (IVP meds, full-assists, etc.), but we also help out the floor nurses whenever they need a hand with other patients. We have time to really look over our patient's medical history, lab values, meds, etc., and discuss their condition with our precepting RN and our clinical instructor.

Honestly, from what I see of the OP's program, they're not interested in you LEARNING as much as they are interested in having free manual laborers. The med-surg floor nurses in my area typically only have 4-5 patients, and a new-hire RN on orientation would only have 2 or possibly 3 (towards the end of orientation). I'm a straight-A student who is very comfortable in clinicals, and I know that I could not learn and give competent care to four patients at once unless it was four rehab or LTC residents rather than hospital patients.

SunshineDaisy, ASN, RN · Feb 25, 2012

I am in 2nd semester also. In med-surge we have 1 pt we do a full head to toe and everything on and do our care plans on. But we help where needed with the other patients. We also do things we have been signed off on (dressing changes, we can do catheters, start and hang IVs, we'll be able to do trach suctioning next week!).

RN/Mom · Feb 25, 2012

Honestly, from what I see of the OP's program, they're not interested in you LEARNING as much as they are interested in having free manual laborers. The med-surg floor nurses in my area typically only have 4-5 patients, and a new-hire RN on orientation would only have 2 or possibly 3 (towards the end of orientation). I'm a straight-A student who is very comfortable in clinicals, and I know that I could not learn and give competent care to four patients at once unless it was four rehab or LTC residents rather than hospital patients.

Thank you, these are my feelings, exactly! My school requires 4th semester students to do EVERYTHING the staff nurses do for four patients for the end of our med-surg rotation (we have 3 patients the first 3-4 weeks, too). Students that struggle the most with this are written up and/or failed for poor time management/incompetence. I think this is pretty unreasonable, and now that I'm hearing other programs don't do this to students, I really wonder what is up with the program I am in! They seem to really want to weed students out (the funny thing is, some of the best clinical students are the worst students academically and vice versa, so it can't be about raising NCLEX pass rates).

We still have to do morning v/s for 4 patients, too. We can, however, delegate noon vitals and ADL's to the CNA's. The staff nurses on the floor only take four patients (rarely 5) and DON'T have to do any vitals! Plus, they have free access to the supplies and Pyxis, and we don't (which slows us down a lot because we have to find staff to pull meds and supplies for us). It is challenging to juggle all of this and NOT make a mistake -- which is an unfortunate position to put both students and patients in (in my opinion anyways).

I am also a straight-A student (except at this school, because nobody earns an A), and I work med-surg as an LVN. I am very comfortable caring for 6 patients at work and have never struggled like I struggle here. Our instructors like to brag how our school's clinicals are far superior than other ADN programs in the area because of the high expectations that are put on students, but I can't help but feel that the 4-5 patient assignment is really a safety issue!

blue4thebeach · Feb 25, 2012

OP,You must be at County! I just graduated in December. While the clinical program IS difficult to manage, it teaches you time management, prioritization and how to be a floor nurse. County grads are loved at hospitals because not only do we pass nclex first try, but we are more competent as new grads on the floor. Other schools... They might not get to insert a foley on a "real" patient. Some don't even get to give injections or start IVs while in school. I am guessing that you were an LVN previously... Those of us that started in 1st semester were pushed to the limit from day one, both clinically and academically. The exams are harder than you'll have ever seen. Comps (written test at end of clinical) are even more so. Clinicals are tough and a lot is expected of you. But I would do it again in a heartbeat. I start my first job in a week (less than 3 months after graduation). I was hired when they heard I was successfully caring for 4 pts during 4th semester, had inserted IVs, foleys and NG tubes. Not to mention all meds, assessments on all 4 pts, and full charting. Yes, they'll probably start me with 2 pts during orientation... But I KNOW I can handle 4-5 pts. County taught me very well. The instructors are there as your resource and to guide you. After graduation you will be expected to be an RN, not a student. County grads do well in that transition... Others have a steeper learning curve.You might have to work harder as a County student... But you'll be thankful when you land your first job and don't drown the first night.Good luck!! Go County! ;-)

Scarlettz, BSN, RN · Feb 25, 2012

1st semester- We had 1 patient all semester (though our teacher gave us 2 patients the last week.)

2nd semester- Started off with 1 patient for about a week then 2 the rest of the semester

3rd semester- 2 patients

4th semester- I believe it's still 2 on medsurg. However, we have a LTC rotation where we get 5 patients (but we work in teams.) I could not imagine having 5 patients each week by myself - especially if you are doing all their care and meds! I guess it gets easier and you will be well prepared for the future if you can handle it.

njmomstudent · Feb 25, 2012

I'm in NJ in an ADN program in my last semester and yes, we have a minimum of 3 patients. If we have 3 we have to do everything (vitals, linens, etc.). We are on a med/surg floor. If we have 4 or more we can delegate the vitals and such. I have to say, it will better prepare you when you are done as blue for the beach said. Seriously, I have seen new nurses in thier last week of orientation (BSN's mind you) that haven't had more than 1 or 2 patients during clinical and they are losing thier minds because they can't keep up.

MN-Nurse, ASN, RN · Feb 25, 2012

At my school, it coincides with the semester you're in. So, first semester gets 1 patient, second semester gets 2 patients, third semester gets 3 patients and fourth semester gets 4 patients. These numbers are only the minimum number we are required to care for, however, so some instructors may require third semester students to take 4 patients and fourth semester students to take 5.

There is no way any student could ever take 3 or 4 patients on my floor during a regular clinical day. It would be a useless learning exercise for the student and frustrating for the nurse. I just finished a 90-hour preceptorship with a student and by the end of it she was handling two patients "OK" at best.

Unless you have the equivalent of a complete orientation on that floor, (which they used to have in diploma programs) I don't see how this is feasible.

QuarterLife88, MSN, RN, NP · Feb 25, 2012

1st semester - started out with one, but my instructor mid-way through gave us two if she felt we were good at time management. Basic PCT/CNA skills.

2nd semester - I've had psych so far and we had two. Not hard when psych is just talking to people. For the second half of this semester I will be in med-surg, and I will be paired with a 5th semester student. They have four patients, and me and my clinical mates with be helping them with theirs.