Hands on Training in school?

Wuzzie · Oct 15, 2019

“Totally responsible” is probably not a good description. Back in the day clinical groups were small, maybe 4 students, so assuming a large part of the care for the patients assigned to us (usually 4) was entirely possible with the assistance of the RN also assigned. We were observed by our instructors and deemed okay to perform nursing tasks independently/with the assigned RN on a progressive basis. It started with the basics (VS, baths). Assessments were always done in tandem with the RN, documented by us and co-signed. First set of vitals we did but the remainder were done by the NA’s unless we were struggling with the skill. We would frequently team up with another student to complete “am care” which we could knock out pretty quickly. Complicated treatments (dressing changes, etc) were done with the RN or the instructor depending on what else was going on on the unit. Simple dressings, wound care, etc we could do. Once approved we could independently hang fluids, time tape the bag, draw labs, administer PO meds, and insert Foley’s, etc. Woe be to the student who didn’t do their I’s & O’s though. We were in clinical for 3 eight hour days/wk followed by 3 hours of class. The other two days were class days usually 8 hours long. We went year round with a one week break between terms. Still, even with all that we could do I wouldn’t call us completely responsible and the RNs would bail us out if we got in the weeds. In my three decades plus of nursing and precepting students I have never seen any student be entirely responsible for a full patient load. I think students who feel that they were capable of handling such loads as we have today may be suffering from “you don’t know what you don’t know” syndrome. But God bless their enthusiasm.

Oldmahubbard · Oct 15, 2019

No where near anything to that degree. Our clinicals were mostly 4 hours a week.

Meet up for an hour.

Two hour to assess the pt and do a little care.

Meet up to discuss the care for an hour.

I guess I am crazy

Wuzzie · Oct 15, 2019

Naaaaah. Not crazy, just a little unfortunate to have such a limited clinical foundation. I hope those kind of programs are few and far between but you seem to have done okay! ?

Hoosier_RN, MSN · Oct 16, 2019

2 hours ago, Wuzzie said:
“Totally responsible” is probably not a good description. Back in the day clinical groups were small, maybe 4 students, so assuming a large part of the care for the patients assigned to us (usually 4) was entirely possible with the assistance of the RN also assigned. We were observed by our instructors and deemed okay to perform nursing tasks independently/with the assigned RN on a progressive basis. It started with the basics (VS, baths). Assessments were always done in tandem with the RN, documented by us and co-signed. First set of vitals we did but the remainder were done by the NA’s unless we were struggling with the skill. We would frequently team up with another student to complete “am care” which we could knock out pretty quickly. Complicated treatments (dressing changes, etc) were done with the RN or the instructor depending on what else was going on on the unit. Simple dressings, wound care, etc we could do. Once approved we could independently hang fluids, time tape the bag, draw labs, administer PO meds, and insert Foley’s, etc. Woe be to the student who didn’t do their I’s & O’s though. We were in clinical for 3 eight hour days/wk followed by 3 hours of class. The other two days were class days usually 8 hours long. We went year round with a one week break between terms. Still, even with all that we could do I wouldn’t call us completely responsible and the RNs would bail us out if we got in the weeds. In my three decades plus of nursing and precepting students I have never seen any student be entirely responsible for a full patient load. I think students who feel that they were capable of handling such loads as we have today may be suffering from “you don’t know what you don’t know” syndrome. But God bless their enthusiasm.

This was how my nursing education was as well. I hated it at the time, but so thankful for that when I hear how programs are nowadays. Maybe that's why long orientation periods where not as common then as they are now

Wuzzie · Oct 16, 2019

Probably, although a friend of mine went to the BSN program in the same city at the same time and her clinical experience was pitiful so I guess this really isn’t new. For example, we had 8 weeks in our critical care rotation (3 MICU, 3 CVICU, 2 PACU) they had 2 weeks of rounding with the RTs giving IPPBs. I’m seriously not exaggerating this. We both started in the NICU as new grads and she was terrified because she had literally never seen a vent. She was also one of the funniest people on earth and made that hell hole tolerable. Thanks Kathleen!

Here.I.Stand, BSN, RN · Oct 16, 2019

In my program we worked up to caring for a full assignment— during our final practicum, at which point we were with a preceptor. I even called the physicians with my preceptor listening in.

MunoRN, RN · Oct 16, 2019

There are programs where it's not the instructor directly teaching you during clinicals, each student is paired with a nurse and the instructor 'oversees' typically 8 students. The nurse the student is paired with gets basically a report on the student; what they can do independently, what they can do with direct supervision by the nurse, what they can do only with the instructor and what they can't do at all. The student takes part of the nurse's assignment with the nurse acting as preceptor or if it's their final preceptorship then they'll often take the nurse's entire patient load.

RNperdiem, RN · Oct 16, 2019

When I worked full time, my manager announced that I would have a student for the next 12 weeks. The students were paired with nurses in the ICU and could do certain things under our supervision. The nursing instructor was nowhere in sight. I never saw any nursing instructor. In many ways I was the nursing instructor even though I only had one year of ICU experience and taking on a student added to my burdens. Don't get me wrong, the students were top-notch brilliant people who went on to have sucessful careers, but as an introvert it was like having a houseguest in my personal space every working day for twelve weeks.

For the manager, it was a way to test the nurse and see if the nurse taking the student would make a good preceptor for new nurses.

Jedrnurse, BSN, RN · Oct 16, 2019

19 minutes ago, RNperdiem said:
When I worked full time, my manager announced that I would have a student for the next 12 weeks. The students were paired with nurses in the ICU and could do certain things under our supervision. The nursing instructor was nowhere in sight. I never saw any nursing instructor. In many ways I was the nursing instructor even though I only had one year of ICU experience and taking on a student added to my burdens. Don't get me wrong, the students were top-notch brilliant people who went on to have sucessful careers, but as an introvert it was like having a houseguest in my personal space every working day for twelve weeks.
For the manager, it was a way to test the nurse and see if the nurse taking the student would make a good preceptor for new nurses.

Sounds like you were in effect being forced to be adjunct faculty for the student's college. How much did they pay you? (sarcasm definitely intended...?)

Oldmahubbard · Oct 16, 2019

Where I went, the nurses had zero to do with us. They were busy people and we were not there to reduce their load. That idea would have been hilarious.

We were closely observed by the instructor to do absolutely everything, and since there were 8 of us, we did virtually nothing.

It was all theory, and understanding the disease and drugs.

I never even gave a simple injection until I had RN after my name.

Rionoir, ADN, RN · Oct 16, 2019

I'm just starting my final clinical and we are up to three patients and do just about everything the hospital will allow us. Oral meds and SQ injections we can do alone in the room (we go over them with someone in the med room usually so they know that we know what the meds are, but it's a pretty quick process at this point) - anything else (IV, IM, etc.) someone has to watch (hospital policy), so we'll usually get it all scanned in and they'll pop in for the administration portion. But 90% of our meds are oral or SQ so we are pretty independent at this point. We are also starting to do OFTs (where you meet with the social worker, etc. to discuss the patients plan).

Our clinical groups are usually about 6 people, and one instructor who is responsible for all of us and always on the floor. The first couple of semesters we were watched very closely and couldn't give any meds alone obviously, but they kept adding layers of responsibility until we reached the point we are at now. Most of us also have externships at hospitals already, where we do another clinical-type day on another unit and are able to act even more independently than we can in clinicals (externs can hang IVs alone, do IM, etc. as long as their preceptor feels comfortable with it).

I attend a community college program, btw. I've heard from people at the local state university that they get hardly any decent clinical experiences or practice. Needless to say a lot of people leave the BSN program to go to the CC program.