Why are the floor nurses so unwilling to teach?

Editorial Team / Admin · Aug 14, 2015

One thing that students don't seem to realize is that they aren't really there to help. As an experienced nurse, it is much quicker and easier to do something myself than to walk a student through it. Also, patient acuity has increased exponentially as have nurse to patient ratios. This means that nurses continue to be expected to do more with less. They also have routines that are disrupted by having students. There is often no notice that the nurse will be assigned a student- they find out when the student comes on the floor. Nurses also aren't compensated to take on the additional responsibility of students. Additionally, it used to be that educating the students was the responsibility of the clinical instructor. Now, there are so many students scattered throughout that the instructor can't possibly be with all of the students, again, meaning more falls onto the nurse who isn't compensated and likely didn't receive education on how to be a nursing instructor. Additionally, not all nurses are meant to be preceptors, but have the responsibility thrust on them anyway.

All you can do is make the best of the situation, learn what you can, and approach your instructor for assistance if you think you need a new nurse preceptor for the day.

llg, PhD, RN · Aug 14, 2015

When I say 80% of the nurses I've followed have done NOTHING with me I am not exaggerating. Why is this? Last week the nurse I was following wouldn't even let me take vitals, VITALS!! I am in my second semester of nursing school, I think I can handle that.
Any advice? Comments?

1. How much have you paid those nurses to teach you? (I'll bet the answer is "nothing.")

2. How much has your school paid those nurses to teach you? (I'll be the answer is "nothing.")

In an ideal world nurses would have the extra time and energy to take on the extra work of teaching a student dropped on them with little warning and having been given no preparation for the student teaching role. But that's only in the "ideal" world -- not the "real" world. Unfortunately, schools of nursing have not kept pace with what goes on in the real world of bedside nursing and many have unrealistic expectations of what staff nurses are able to do with the minimal resources they are given. That's not your fault -- but it is not the staff nurse's fault, either.

Let's put the blame for this situation where it belongs -- on the hospital administrators who have cut nursing staffs too low -- and on the school administrators & faculty who continue to take students' money and then expect the actual teaching to be done by the staff nurses who get nothing in return for taking on that extra responsibility.

Finally -- You see a staff nurse who won't let you take vital signs: I see a staff nurse needed to assess the patient herself in order to make the judgments she needs to make throughout the shift -- and who doesn't want the patient to be stressed by having to have an extra set of vitals taken by a student who just wants the practice. Neither of you is a bad person. You both have legitimate needs and desires. Let's not make the RN out to be a "bad guy" in this situation.

2bnursebeckky · Aug 14, 2015

1. How much have you paid those nurses to teach you? (I'll bet the answer is "nothing.")
2. How much has your school paid those nurses to teach you? (I'll be the answer is "nothing.")
To address the 'payment' part. I pay a lot of money to attend nursing school and recognize that nurses don't get paid any extra for being "helpful and educating", but really? If these are 'teaching' hospitals then I would gather the nurses working there understand that they may have students under their wing.. call me crazy.

ixchel · Aug 14, 2015

I agree very much with prior posters. I'd like to add that there also may simply not be a culture of welcoming and embracing students there. Not everyone wants to teach, and frankly, even fewer are good at teaching. Hospitals benefit by opening their doors to students only by being able to possibly take the students on as new hires in the future, and claiming to invest in the community by training it's nurses. That doesn't mean the staff within the hospital was ever given a choice to take you on. I know that doesn't sound very nice, but truthfully, taking on a student really is taking on more work.

Put it this way - I absolutely LOVE to work with students. LOVE IT. But if you catch me on a day when I have one more patient than in supposed to (which has been the norm lately), I'm suddenly going to be overwhelmed with the idea that I need to include you. Even without a student, I may be stuck at work charting until 1.5-2 hours after I should have clocked out. With you there, I will definitely be there late, and on top of that, I'll have to be back the next morning. It's rare to get enough sleep as it is between shifts.

I would suggest sharing your thoughts with the coordinator of your clinical section. Maybe there can be a change in floors or facilities to ones that are better accommodating of students. It still won't likely be perfect every shift, but maybe small improvements can be made.

2bnursebeckky · Aug 14, 2015

I understand both of these points of view and appreciate the feedback. It is just really frustrating to be a student paying good money to lean against a wall for six hours. I hope that in the future, when I'm a nurse, I'll be more apt to this teaching roll. I understand that not everyone is equipped to teach, and have been tossed between nurses because of this. I feel that if we are trying to create a better environment for nurses it should start at the bottom- with the students. We are the 'future of nursing' as everyone keeps touting and what better way to equip us than with teaching.

2bnursebeckky · Aug 14, 2015

Maybe a better way to have presented my concern is to ask you (seasoned nurses) how I can better present myself as a helpful unit to you. I want to get the most out of my clinical experience, as you can imagine and hope to bring as much knowledge as I can into my first job.

JustBeachyNurse, LPN · Aug 14, 2015

1. How much have you paid those nurses to teach you? (I'll bet the answer is "nothing.")
2. How much has your school paid those nurses to teach you? (I'll be the answer is "nothing.")
To address the 'payment' part. I pay a lot of money to attend nursing school and recognize that nurses don't get paid any extra for being "helpful and educating", but really? If these are 'teaching' hospitals then I would gather the nurses working there understand that they may have students under their wing.. call me crazy.
Teaching hospitals refers to medical students and medical residents not nursing programs. The faculty attending a are paid a stipend to teach & mentor student and resident physicians.
Nurses at a teaching hospital are not. The teaching & guiding responsibility falls to your clinical instructor not the staff nurses.
This is a common misconception about teaching hospitals.

llg, PhD, RN · Aug 14, 2015

To address the 'payment' part. I pay a lot of money to attend nursing school and recognize that nurses don't get paid any extra for being "helpful and educating", but really? If these are 'teaching' hospitals then I would gather the nurses working there understand that they may have students under their wing.. call me crazy.
You pay a lot of money to the school? Probably so -- so why aren't THEY teaching you? What are they doing with your money other than paying for someone to teach you?
In many hospitals today, nurses are being abused. They are being asked to do more and more while being given fewer and fewer resources. In many places, it is at the breaking point. And no, they don't always have time to add "teaching a student" to their list of tasks for the day. In such cases, the addition of a student to their workload is part of the abuse.
Yes, I am saying that sometimes, the expectation of teaching students is a form of abuse: the student burden is part of the abuse. Many nurses would be far more welcoming to students and be willing to teach them if the students were not shoved at them as part of a package of abuse. You are asking people to smile and be nice and take time and help the students while they themselves are being abused and the schools are contributing to the abuse. That's what many students/faculty/administrators don't grasp.
A lot of nurses just don't have any more to give.

JustBeachyNurse, LPN · Aug 14, 2015

Maybe a better way to have presented my concern is to ask you (seasoned nurses) how I can better present myself as a helpful unit to you. I want to get the most out of my clinical experience, as you can imagine and hope to bring as much knowledge as I can into my first job.

Know what skills you have cleared/checked off on by your clinical instructor to perform without a clinical instructor at your side. Know what the clinical agreement between your school and hospital permit you to do at your current level and under what level of supervision.

ixchel · Aug 14, 2015

Maybe a better way to have presented my concern is to ask you (seasoned nurses) how I can better present myself as a helpful unit to you. I want to get the most out of my clinical experience, as you can imagine and hope to bring as much knowledge as I can into my first job.

I definitely understand and appreciate your frustration. My l&d and peds rotations, literally I had one patient each (plus one newborn and newly delivered mama). That was IT. We spent the remaining 5 weeks for peds and 7 weeks (yes, SEVEN) sitting in a room doing homework and studying for exams. This is just not an area for peds because critical kids are shipped out, and for L&D, it was seriously crappy luck. We paid for the learning experience, but got next to nothing for it.

If the school has an obligation to provide the learning experience, but the hospital ultimately is not, there really isn't much that can be done, especially if clinical sites are lacking. If you're in a rural area like I am, you just have to roll with it.

Now, I agree the clinical faculty should be giving you clinical education and experience. Also, with the blessing (and possibly, the presence) of your instructor, you should be able to gain the skills you need independently of the nurse. For my clinicals (except internship), I did my own assessments and charted them (doesn't hurt to have more than one assessment in the computer), my own vitals, a round of meds (always with the instructor), my own patient education, my own ADLs. If you have proven competence in these areas, you don't need the nurse for them. Obviously, permission from the patient is required, and you need to be mindful of whether the patient just wants to be left alone.

Another thing you can do is observe procedures, whether they be at the bedside or in procedure rooms/the OR. As a student, and in the future as an orientee, these are the only predictable opportunities you will get to observe procedures. Being able to see them gives you the ability to teach about them with real knowledge, not just what you read in the textbook.

Anyway, I'm not sure if any of this will be helpful for you, but I do think it is very important you address this with your instructor and ask what you can do independently, and ask what your instructor would be willing to do with you for skills she feels are not able to be done independently.

llg, PhD, RN · Aug 14, 2015

Maybe a better way to have presented my concern is to ask you (seasoned nurses) how I can better present myself as a helpful unit to you. I want to get the most out of my clinical experience, as you can imagine and hope to bring as much knowledge as I can into my first job.

Maybe start your shift by saying to the nurse, "How can I help you?" If that means doing some stuff you don't want to do -- such a just follow her around while she assessed the patients and don't touch anything -- just do that. Don't interrupt constantly with questions -- but pick your moment carefully and then ask if it is OK to ask a question now. etc. Say things like, "Let me give you a hand with that," if there is something to be carried ... or "Would you like me to go fetch that piece of equipment: I know where it is." etc. Once you have shown that you will do as she asks without complaint (for an hour or two), she may be able to "give" you a little more.

Also, as ixchel, have a list ready of tasks that you have been checked off on. Be prepared to answer the RN's questions about what your goals are for the day, what are you allowed to do without your instructor present, etc. We have a lot of schools in my area that don't allow the students to do much of anything without the instructor present. So the staff gets used to that and is not always prepared for a student who expects to do stuff without her instructor supervising. Remember, the staff may be dealing with lots of different students at different levels from different schools with different rules. You need to be very prepared to quickly communicate what your school expects from you and from this experience. If given the chance to express your learning needs, be prepared to speak up and express an interest as appropriate.

If you have "down time," talk to the patients. You may identify some needs. You could then ask the RN if she'd mind if you took care of it.

Those are just a few thoughts off the top of my head.