Published Apr 8, 2014
I at times am amazed at how clinicals are run where I work. In 2010 when I finished my degree things were so different, my instructor cut the apron strings and told us to go be nurses. We all carried a full load , whatever are nurse had we had 5-6 each day. My second semester we were giving po meds unsupervised, and the last semester we were doing ivpb,iv fluids, iv pushes starting ivs ect. Once we did the skill in front of the instructor we were good to go on our own. The same school I went to, different instructor insists that even po meds be given in front of her. These students have 4 clinical days left and they sit for boards, but they are not allowed to do anything by themselves. I feel these students are at an extreme disadvantage compared to what I had. What is your clinical instructor like? Do they let you go and assisted if needed or do they make you come to them to pass an aspirin?
ChristineN, BSN, RN
I have noticed a similar phenomenon. I graduated in 2008 and, once checked off by an instructor, was giving PO meds unsupervised early on in my program. I eventually carried a load of 5 med-surg pts before graduating, and was responsible for every aspect of their care.
However, now, when I see new nurses start orientation on the floor, they do not seem comfortable with skills/meds nor do most of them seem like they knew what to expect. Our schools are not preparing the students for clinical practice, and it is the students that suffer in the long run
HouTx, BSN, MSN, EdD
You have to wonder what prompted this change. Maybe some safety or quality issues?? Concerns about lack of student supervision? These changes have had a negative effect. We are also seeing more problems with graduates who have only done skills in a Sim lab - not on real people. Huge problems that discourage employers from hiring new grads.
THELIVINGWORST, ASN, RN
Not all schools or instructors are like this.
We are not allowed to give any meds without our instructor present. Period. Doing so will lead to removal from the program. I have never given any med, PO or otherwise, without an instructor by my side. I don't even pull meds without supervision. I have one more semester before preceptorship. Wish me luck.
Edit: I should add here that my current clinical instructor will sometimes let us give a subcutaneous injection that is not HA if the nurse is present and supervising us while doing it.
I've had wonderful clinical instructors, for the most part, and all of them have let us work pretty autonomously once we've earned their trust. Some of my classmates needed a little more of their time, but I had a lot of freedom, and my instructors were great with me.
I've always had the "do it once with me and go" type of professor, and even then, they'd rather us do a skill with the nurse if they aren't available that miss that opportunity (except with meds.)
We can never push high risk drugs without an instructor.
I did have one instructor in my 3rd semester that insisted on giving meds with us every clinical day. It was extremely annoying and it annoyed the nurses as well. You can't pass meds with 6 students and be on time.
Other than that, I've pretty much been left alone. Too much, in un opinion. Relying on the nurses to teach us everything we should know is a mistake, since their attitudes vary, and most have zero teaching experience.
llg, PhD, RN
I don't understand how a student could give meds without supervision. In my view, that would be illegal. The same goes for a lot of activities that by law, require an RN.
Perhaps that is the reason for the change.
I don't understand how a student could give meds without supervision. In my view, that would be illegal. The same goes for a lot of activities that by law, require an RN. Perhaps that is the reason for the change.
It depends on what you mean by "without supervision." A nurse might not physically be in the room with me when I give meds, but I can't pull anything out of the pixus and anything out of the ordinary has always been somewhat directed by the nurse.
mzrainydayz, BSN, RN
My school policy is that for med passes and skills you have to do in front of your instructor or a primary nurse. I have never done anything alone but documenting which they have to go in and approve your notes. I was just asking myself that question today why can't I just do some things on my own rather than my instructor breathing down my neck, but then again we are working under their license. So for that reason I totally understand.
We actually get in trouble if we are not being "our own nurse." My current instructor can be harsh, but once she sees us do something and it's done correctly she wants us to go be an RN. Now - of course with exceptions, we aren't allowed to do certain things due to safety reasons, and there are still plenty of things id rather do with someone there just incase (more invasive things) but wow - I've gained some major confidence this semester.
I really hope not all schools are hand holding, I'd feel super lost of that were the case at my school, especially since this is my second to last semester!
Now that I see what all I am actually able to do on my own I appreciate the attitude of "now go fly" my clinical instructor has. If you aren't ready to do so though - she will let you know it :-/
Our clinical instructor has no choice, school policy is no med, not even po aspirin, can be given without instructor or RN present. As far as skills go, it is up to the instructor. The med policy is due to a student at a nearby school who made a med error her last week of school that resulted in a death of a patient who was about to be discharged.
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