Is it my imagination or do the nurses at clinicals hate us students?

Nursing Students General Students

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Hi:

I'm new here but I thought I would ask this question since so many of the nurses on this site are so helpful and encouraging to students.

I'm in the 3rd semester of a 5 semester program. We have six clinicals per semester. Of them, I've had (I'm serious) 5 clinicals where my patient's primary RN would talk to me. We're supposed to find them (all but impossible when they don't wear name tags) and introduce ourself. When we do, I usually don't get a smile. Lately, actually, I hope for something as nice as this: :stone

I know these are busy floor nurses. At the same time, we students often feel like we're thrown in with little guidance as to what our roles/boundaries are and do little but stand in the way. One clinical, I had an excellent nurse who took me by the arm into every patient's room she entered, and explained what she was doing and why. She did this all day. It was the best clinical I've had, hands down.

Most of the time, though, IV fluid bags are hung, meds are pushed/administered/hung, procedures performed on my patient while I'm off finding clean linens or tracking down the PCA to give her the patient's last vitals (because I'm essentially doing her job: bathing the patient, taking vitals and I&O). I don't mind doing these things of course, and I know I'm low on the totem poll, but being halfway through the program now, it's terribly demoralizing to stand around all day doing nothing, ignored (at best) by the staff--one complained that I had the chart when I'd made clear to the unit secretary where I had it and that I'd happily hand if over if needed. I just had to copy some labs (which, as every nursing student knows, you need to know). Our role on the floor is very unclear. I'm typically a hands-on type of person, but I can't push IV meds, give injections, or even give PO meds without my instructor present, nor do a procedure as simple as d/c'ing an IV. And I don't want to make matters worse with the staff by overstepping my bounds.

Our clinical instructors are pretty good, but mine always seem occupied with another student in my group of 6 or 7. And unfortunately they seem to be under the impression that we're working with great nurses who are student-friendly. I don't know if there's a communication breakdown, if I've been especially unlucky (my classmates have similar stories, though), or if it's just a fact of life that floor nurses cringe when they see a cloud of white student nurse uniforms approaching and therefore refuse to share skills or information. I'm not the crying type, but I want to cry after each clinical because I essentially feel I've wasted 6 hours standing around while real work goes on around me and fear I'll graduate with no experience. :crying2:

Any information or encouragement would be appreciated (I'm not normally so whiny, honest :)).

Specializes in Telemetry & Obs.

I guess I've been lucky...I've always had good clinical experiences. We DO get report from the RNs, then go to a fast pre-conf with our CI where we give report to her and let her know times for meds, treatments, etc. Then we hit the floor running.

I believe a lot of it is in attitude. I respect the nurses I work with, and I deserve their respect. The PATIENT is my first priority, and I'm sure that shows.

Specializes in PACU, PICU, ICU, Peds, Education.
Most of the time, though, IV fluid bags are hung, meds are pushed/administered/hung, procedures performed on my patient while I'm off finding clean linens or tracking down the PCA to give her the patient's last vitals (because I'm essentially doing her job: bathing the patient, taking vitals and I&O).

First, were you supposed to be changing the IV or giving the meds? If not, the staff nurse is not your teacher and isn't obligated to show you anything. If so, different situation.

Second, the total care of the patient IS your job, including vitals and baths.

Sorry. soapbox there. I have had nursing students report off to me that they "didn't have time" to give a bath to one of their two patients that day. (My normal day load was 10-12) with maybe one shared CNA. And it all got done.

Students all manage to lunch together and have the staff nurses cover their assignments.

I have had a student show up for clinicals without a pen and stethoscope when I was precepting her.

When I was a student (15 years ago) we told the floor nurse what we were going to be doing for our patients. When it progressed to total care, those nurses loved seeing us, because they basically had the day off. They didn't see us until we reported to them at 1445.

Our clinical group was 8.

I know it may be more difficult now, with computerized charting and medication access. Believe it or not, I feel a pang of sympathy whenever I see a group of students in the hallway. I used to teach nursing myself, and I love having my externs and management students to precept.

Want a good experience? Make one. Clinical goals not clear. Clarify them with your instructor. Be early. Be friendly. Act interested. And never sit in the last chair!

We arrive at 6:45 for a quick check of labs and new orders, then go to pre-conference, then we begin patient care. Lunches and breaks aren't part of our clinicals (our post-conference starts about 1:00). I'm thankful if I snag a chair at the nurse's desk for some quick charting. I'd never take the last chair in a break/conference room with staff members present.

I'm as friendly as I know how to be when I introduce myself to my primary RN. When I've completed my AM care and I'm caught up on vitals, emptying the foley bag, recording I&O and any other care, I ask around to my classmates to see if they need any help (we often help each other with AM care, especially as it relates to lifting/rolling for linen changes & bathing).

We're supposed to give meds and hang fluids, which we explain to our primary RN when we introduce ourselves. This semester, our instructor wants to be in the room when we do it but with CI's we've had up until now, we've been cleared to do it with only the primary RN in the room (we need either the CI or the primary RN, of course, for pt safety and because we can't get even bathing supplies & lotion unless someone accesses the pyxis for it).

I do seek out chances for new skills. Still, one week I got an unequivocal "no" when I asked my nurse if I could help change my patient's IV tubing (which we'd been trained on). All I can do in these cases is smile, go about my business, and hope for a better experience next week.

I don't know if I came off as a slacker in my original post, but I assure you that's not the case. I stay up as late as necessary preparing my care plan, getting three hours' sleep on a good pre-clinical night. I arrive on the floor well equipped and familiar with my patient's condition, meds, and labs.

I'm not trying to offend any of the RN's here, of course, just get a feel for RN's general feelings about having students on the floor.

Specializes in Acute Care, Rehab, Palliative.

Want a good experience? Make one. Clinical goals not clear. Clarify them with your instructor. Be early. Be friendly. Act interested. And never sit in the last chair!

Well said.

Specializes in Critical Care.

OK. Let me play devil's advocate. This is an edited version of a post I've made on similar threads. For the record, no comments are made about anybody here since this is essentially an old post:

I want you to put your feet into another's shoes for a moment.

First, let me say that all these mean, grouchy nurses aren't your paid clinical instructors. They get no benefit from teaching you and certainly aren't paid more for it. And every question you ask, every interaction that sidetracks them from their 6-7 patients and 15 things that they have prioritized to do - every one of those stolen minutes can be taken as an affront to the time away from their patients; time they already regret not having enough to spend because being a 'light speed soldier' wasn't what they envisioned when they started.

There is somebody there for you during your rotations that is actually paid to teach you.

Every minute spent with you is a minute not spent with a patient that needs their attention; it's a minute not getting Mr. Jones his morphine or making sure Mrs. Smith isn't climbing over the bedrails, again!

You have 2 clinical patients; "your" nurse has at least 3 times that. On a busy floor, every interruption forces "your" nurse to reprioritize her workload. (OK, that took five minutes, now Mr. Smith's morphine is due. I was going to clean Mrs. Jones since she had a BM in the bed, but now I need to go get the morphine first, she'll have to wait.)

In alot of places, the trenches are ugly. It's all nice and well to talk about how they should know where you're coming from and be nice for the welfare of the profession, yada yada yada.

In reality, many nurses just want to get through their shifts. It's great to be an idealist, but there are many things about nursing that can make you jaded over time. Is it right? I'm not saying that it is. If you think it's hard to take care of 2 patients, imagine 6 or 7! Time management skills only serve you so well. Eventually you start cutting corners on all those golden moments you came into nursing to give. That can get to you after over time.

I don't think that it's quite fair to impose your point of view on somebody who's point of view you haven't had the experience to comment upon.

(but as another side point, many - not most - but many students ask questions designed to show how smart they are or how appalled they are that we don't do things 'by the book' in the trenches. --- you want to annoy someone's who attention is already in 30 places by the time you expect them to cater to your learning experience? Just ask questions that don't actually seek knowledge but instead attempt to show what a great student you are.)

I don't share the point of view that students are an annoyance, but I can certainly understand it when you are already completely overburdened just trying to find the glimpses here and there that remind you that you are, in fact, trying to be a so-called 'angel' and not a moral punching bag for others.

You might not be the cause, but when "your" nurse was overwhelmed 4 burdens ago, it's completely reasonable to see the next burden, and the next, and finally you students, yet another burden (and any distraction, however noble, by that point is a burden) as more than can be dealt with.

Yes, you are there to get an education but that doesn't 'entitle' you to command the precious time and empathy from somebody that is already stretched to the limits on both.

I agree that there is no excuse to be rude. But. Nursing doesn't take away somebody's underlying personality. And stress has a way of bringing out the best AND the worst in everybody. The nurse that is inconceivably rude to you in that stress is a totally different person out of work and away from that stress. Well, in most cases.

Some people just aren't teachers and have no idea how to be. And some nurses DO NOT LIKE TO BE OBSERVED. It can be a very self-conscious event. Are you observing me or critiquing me??? You don't think that adds stress instead of diminishing it?

TPTB (standard All Nurses abbrev if you are new here - the powers that be) put all kinds of requirements on nurses without regard to what is already on their plates. It might just not be about you. It doesn't matter how much effort it actually takes to work with you if that nurse feels that you have been pushed on them. It's not about how much effort it takes as much about a rebellion against being required to take on that effort. It's sorta like being asked to shovel the sidewalks DURING the blizzard. Does that make sense?

There are gems out there. And there are people out that aren't good teachers. Learn from the gems. But learn from the others, too. Learn to use other resources. Use your instructor.

Above all else, don't take it personally. It's the old saying: don't let the b******* get you down. Don't. Because, this and many many other threads here should convince you that this is a fairly universal clinical experience. That being the case - it's not about you. Don't make it about you.

Keep the faith. Nursing school is a learning experience. Learn from all of it. If nothing else, learn about what you DON'T want to be as a nurse. That's what I learned the most from the variety of nurses I encountered in clinicals. I learned about the kind of nurse I wanted to be. And the kind I didn't.

~faith,

Timothy.

Sorry. soapbox there. I have had nursing students report off to me that they "didn't have time" to give a bath to one of their two patients that day. (My normal day load was 10-12) with maybe one shared CNA. And it all got done.

Just to give you a nursing student's perspective on that, you've been a nurse for a while. When you're new, you're going to be slower, unfortunately. I am sure when I have a ton of experience I'll be a lot faster, but there's a lot to learn and you can't learn it all in 1 day and be efficient at the same time. We are also quizzed by our clinical instructors to no end on the floor, have to go through every detail in the chart for our care plans, so having 1-2 pts is time consuming when you have to do all that, plus the lack of experience.

Hi:

I'm new here but I thought I would ask this question since so many of the nurses on this site are so helpful and encouraging to students.

I'm in the 3rd semester of a 5 semester program. We have six clinicals per semester. Of them, I've had (I'm serious) 5 clinicals where my patient's primary RN would talk to me. We're supposed to find them (all but impossible when they don't wear name tags) and introduce ourself. When we do, I usually don't get a smile. Lately, actually, I hope for something as nice as this: :stone

I know these are busy floor nurses. At the same time, we students often feel like we're thrown in with little guidance as to what our roles/boundaries are and do little but stand in the way. One clinical, I had an excellent nurse who took me by the arm into every patient's room she entered, and explained what she was doing and why. She did this all day. It was the best clinical I've had, hands down.

Most of the time, though, IV fluid bags are hung, meds are pushed/administered/hung, procedures performed on my patient while I'm off finding clean linens or tracking down the PCA to give her the patient's last vitals (because I'm essentially doing her job: bathing the patient, taking vitals and I&O). I don't mind doing these things of course, and I know I'm low on the totem poll, but being halfway through the program now, it's terribly demoralizing to stand around all day doing nothing, ignored (at best) by the staff--one complained that I had the chart when I'd made clear to the unit secretary where I had it and that I'd happily hand if over if needed. I just had to copy some labs (which, as every nursing student knows, you need to know). Our role on the floor is very unclear. I'm typically a hands-on type of person, but I can't push IV meds, give injections, or even give PO meds without my instructor present, nor do a procedure as simple as d/c'ing an IV. And I don't want to make matters worse with the staff by overstepping my bounds.

Our clinical instructors are pretty good, but mine always seem occupied with another student in my group of 6 or 7. And unfortunately they seem to be under the impression that we're working with great nurses who are student-friendly. I don't know if there's a communication breakdown, if I've been especially unlucky (my classmates have similar stories, though), or if it's just a fact of life that floor nurses cringe when they see a cloud of white student nurse uniforms approaching and therefore refuse to share skills or information. I'm not the crying type, but I want to cry after each clinical because I essentially feel I've wasted 6 hours standing around while real work goes on around me and fear I'll graduate with no experience. :crying2:

Any information or encouragement would be appreciated (I'm not normally so whiny, honest :)).

HI there,

You described my clinical experience to a "t". I am a new RN and I have to tell you that your learning really begins when you are doing your preceptorship and orientation. It is a whole different world than school. You have your own patient load, and you are in charge. It becomes "real world", and unfortunately, clinical isnt. Good luck!

Specializes in Neuro/Med-Surg/Oncology.

As a new grad, I'm on both sides of the fence with this one. I agree that showing initiative is one thing that makes having a student with me better. I remember the great nurses that were willing to help enhace my clinical experiences. Right now, whether or not I want to, I usually can't. I'm carrying a full patient load and still getting a feel for things myself. I don't mind sharing, but if my assignment is really bad, I can't be a lot of help. I'm hardly keeping my own head above water, let alone ready to show someone how to swim. If I'm doing something that would be good for the student to do and things aren't too hectic, I try to grab him or her. (Feeding tube, NG, foley, etc) I also have them check with their instructor in case she/he wants to watch the student do it.

I'll compare and contrast two recent days with two different groups of students that I've had the past two weeks.

Day #1-Student A introduces herself. Tells me her assigned patients, what they will be doing and how long they will be on the floor. Checks the patients, looks up meds, etc while I'm getting report. Gets report from me. Checks pts. Stays on top of care. Makes me and instructor aware of any concerns. Also checks to be sure everything is included in her charting. Gives very thorough nursing care, but realizes that this us not as likely as her patient assignment increases. Later that morning, one of "our" pt's tube feed runs dry. The bag has to be changed. I asked if she had changed a bag before. She had not. Cleared it with instructor and she changed it with me. She did everything on her own with minimal input from me and is confident with tube feeds now. (But she will still ask if she has concerns.)

Day#2-I can't find Students B or C. They get no report from me. One states that she "doesn't need report" b/c she's been in "healthcare" (medical assistant) for xyz years and is biding her time and wants to go right into the ER. The other one is MIA. I found her in the pt's room, introduced myself and updated her on the patient. I see Student B again around noon and she states that "apparently the pt got herself back into bed b/c she was almost falling out." She found her when she got back from lunch. Whaaaaaat?!?!?! First of all, I did not get any report that she was leaving the floor to go to lunch. Secondly, I was not told that patient was in the chair and she left her there. This patient was in a lowboy alarmed bed and on fall precautions! :eek: I said "That's strange. I'm surprised that her bed alarm didn't go off when you got her out of bed." She told me that the bed alarm was "broken." I told her that she needed to tell me or her instructor. Turns out the bed alarm was "off", not broken. Interesting! That patient could have been on the floor unconscious for 45 min and nobody would have known. Now we have Student C. I have Student C check her patient's colostomy pouch with me and it needs changed. She tells me that she has not done one. I told her to check with her instructor and she can to it with her or the student and I can change it together. I showed her where the box was with the new pouches. An hour later I ran into the instructor and she told me that Student C changed pt's pouch. Student C reports off and goes to post conference a little later. I check pt about an hour and a half after she leaves and stool is on his bed,his leg, and abdomen. There was no clamp on the bag and the patient is apologizing to me!:eek: WTF! The poor man is apologizing to me! It's not his fault at all! I understand that the student has never done one before. However . . . when she saw that the bag had a hole in the bottom, she should have asked her instructor or me to take a look at it. She had to realize that if there's a hole at the bottom of a bag that is suppossed to catch feces, something is not right.

Here's the kicker . . . . .

STUDENT'S B AND C GRADUATE IN TEN WEEKS!!!!!!!!!!:eek:

So, needless to say, I have mixed feelings about working with students.

Specializes in Cardiac.

I think we students are aware that nurses are very, very busy. We know that we have to be interested, and that we should go to our clinical instructors when we need help or instruction.

But to completely and totally agree with what the OP said, could you just look my way and not pretend like I'm some communicable disease? Can you stop being so angry that 'some student' is assigned to your patient? Can you just pretend to be a human to another human? Yes, there are people out there that are made to be preceptors, and yes, there are students out there that don't want to do the dirty work or are 'too busy'. But not every nurse is good, and not every student is bad.

Just treat us with a little respect. It's hard to be interested when the nurse rolls her eyes at you when you ask a question that's easy for her, but you just don't know. It's hard to look confident in front of your patients when your nurse ignores you in front of them. It's hard to want to be at clinical when these nurses go out of their way to let you know that you are in their way.

Specializes in Neuro/Med-Surg/Oncology.

Some people just aren't nice. I am in no way condoning their behavior or treatment of other people. But, unfortunately, it's the way the world works sometimes. Not everyone is going to be nice to you everywhere you go. Personally, I would rather have someone a little crabby than someone catty who is your best friend to your face and cutting you to shreds behind your back.

I go out of my way to be nice to everyone. I was very diplomatic when one of the students on my floor told me that my fall risk patient's bed alarm did not work. (After it had been off all morning.) I need to check it if it's broken so that I can notify the specialty bed company and see that it gets fixed. That way the patient stays safe. She gets a working alarm and I can know to keep a closer eye on her until it gets there. I go out of my way to answer questions or at least point someone in the right direction if I'm too busy or I don't know the answer.

Personally, I have had mixed experience with students on my floor. Overall, I like it. It keeps me on my toes. I'm still learning a lot now and having the students take my patients, ask me questions and learn procedures provides reenforcement for me. There's a medical mantra of "See one Do one Teach one" that is so true. It really helps me think a procedure, test or labs through when I'm providing an explaination for someone else or helping them piece together an explaination/rationale for what's going on with a patient. I don't have all the answers and appreciate the input/thought process of another person.

On the other side of the coin, I have had some students do things I would not have dreamed of as a student. Like thinking (and stating aloud) they don't need to get info on their patient b/c they have prevoius medical (non-nursing) experience. Like playing chess on the computer at the clinical site while their one patient has had several episodes of incontinence. (All the way up his back!) Most of them ask for help from us or their instructor when they see something they're not familiar with, but I'm astounded at how many don't!

In my previous post, I was really trying hard not to make generalizations regarding students and noting specific occurances. Just my :twocents: .

There is no reason for these nurses to be so rude to you, they were all once students as well and should recall what they felt like.

Now, I enjoy precepting, though I do mostly EMT students who are really different from nursing students. But there are some days when i simply want to do the work. but, because I am the designated preceptor for these guys on my shift, I just sort of grin and bear it out, and actually make some good friends in the process, usually.

That said, my clinical instructor did a lot of things that made things easier on us.

1. She usually brought the floor nurses some sort of treat at the beginning and end of clinical (dunkin munchkins, pizza etc). Bribery can get you somewhere. They felt appreciated and tended to start to talk with us. I am always amazed at what a simple plate of brownies does for me when I start a new job. I think the nurses would be shocked that anyone in your clinical actually thought of them and showed up with just a little treat.

2. When a certain nurse WAS helpful to us, she suggested that we either write a thank you note personally, or we fill out one of those forms that are on the floors for "patient champion" These things reflect well on the nurse and can affect her performance review, so it was quite an incentive for the nurses to treat us well. And it really changed the attitudes of the nurses who got them. There really is something about acknowledgement.

3. She often scouted out opportunities and offerred to have one of the students "help out" the nurse by placing a foley or IV. Because she offerred, it was different than a student asking, the nurse knew the instructor would get it done, even if the student attempted it and didn't have success.

4. Also, most of our clinical instructors were at sites they had previously worked at, or still worked at PRN, so they had a social network to help get their students in. That was actually planned, in as much as a nurse from one hospital would be assigned definitely to teach in that hospital- on the rationale that they knew the policies well and that decreases the chance of a student violating them by mistake.

I wish you all the best with your clinicals. I honestly had mostly good clinicals, which is probably why I am interested in teaching.

I will just add my two cents. I have not had a problem with RN's. Iam in clinical with some students who have had problems ranging from the RN giving report in Tagalog and refusing to speak English after request from nursing student. I worked with her also, did not have a problem. Not that I was that much more assertive, but I am much older than her. I think that makes a difference. Also, I have taken and dealt with enought BS, I am not into taking it if I don't have it coming, probably shines through. I can tell you, I would have taken her to the mat if need be. I pick and choose my battles nowadays. would not stand for this BS. :rolleyes:

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