Has your clinical instructor helped you or held you back?

[nowim clean]

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?

[crossfitnurse]

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.[/quote']

Exactly - we do not have passwords to the pixus. A nurse or the instruct must help us get them, then if they have seen us administer or know we are knowledgable to do so on our own, they allow us to. My instructor will even wait by the door of the room sometimes just incase and to "watch" to make sure we are doing everything correctly and timely.

Of course - not without asking us what the med is for, and why we are giving it.

[gummi bear]

We can pull meds from the pixis and gather supplies for skills on our own. But any skills or med administration my be done in the presence of a nurse or instructor. I've had some nurses try to convince me to give meds on my own, but I'm not taking that chance because I can be removed from my program by doing so. I'm assuming that med errors and/or lawsuits are the reasons for doing this.

[Pink Magnolia, BSN, RN]

At one location, we were able to pull the medicine out (we were given a code), but the instructor had to be there when I did all 3 checks and 6 rights.

[AmyRN303, BSN, RN]

It depended on the facility for us regarding pulling meds ahead of time. In the hospitals with Pyxis systems, we did not have access. In other locations, we as students routinely pulled meds....but I wouldn't have dreamed of administering them without the instructor in the room. I don't know if that was a school mandate or that of the facilities, but in no way did it "hold me back".

[christina731]

It really depends on the facility and the nurse in addition to the instructor. I have never had access to meds without a nurse or my instructor so I can't give meds alone since I can't give what they pull without their supervision. Most of the time I am assigned to a nurse and am responsible for every aspect of their patients care within my scope, the nurses stand by to make sure that I am doing ok. My school has a rule across the board that no student can push meds so a nurse has to administer these no matter what. To be honest if I were a patient I would prefer a nurse to be at least over a students shoulder. Sometimes I do wish I had more autonomy but I know it will come with time.

[Jenngirl34RN]

For my program it depends on the clinical instructor and the facility. Mostly, if we get checked off we are allowed to do most things as long as the facility we are in allows it. For example, the last facility I was at did not allow students to insert Foleys even with an instructor or nurse present. One facility (that I have not been to) does not allow students to administer IV push meds under any circumstances. There are also some instructors who are a little more hands on and want to be there when meds are given, or have a nurse there when meds are given. We do have to always get our meds checked off after we have prepped everything and before giving them, but only high alert meds actually have to be given with a nurse or instructor present at all times according to school policy.

[nurseprnRN, 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.

Once again, for those of you who lost your place in the hymnal, you are not working under anybody's license when you practice as a student in clinical. Students work under the auspices of their educational program. They are responsible for not exceeding their training and educational goals as specified in their curricula. They are adults and do not work under anybody's license.

The instructor cannot be watching everyone simultaneously; students have responsibilities too.

[NuGuyNurse2b]

Our instructor then needs to learn that, because we were told by her that it's her license on the line if we make any errors while in clinical...hence, meds/injections/foleys are done with her at our side. I appreciate it first and second semester, but I feel like when you're in your last semester, maybe then they should cut the cord.

[nurseprnRN, BSN, RN]

In fairness, a lot of instructors think it's true, too, so she needs to get the definitive scoop from her dean on that. You can also call the state BoN and ask them for their take, but that's what they'll tell you-- you are an adult and responsible for knowing your school's scope of practice for you as defined between the school and its clinical placement facilities. Your instructor's licensure has nothing to do with your practice.

[akulahawkRN, ADN, RN, EMT-P]

Just to provide some information about the variance in medication administration and skills performance in various schools, my program allows students to give basically any PO medication essentially unsupervised after being checked off in 2nd Semester. During 3rd Semester, students are re-checked off and after that, they're trusted with making good decisions with these medications. However, if the medication route is something other than PO, they must be observed directly by either an instructor or that patient's primary nurse while giving the medication. This includes NGT/PEG med administration, even if all the medications are exactly the same meds the patient receives PO.

I'm at the point now where I'm almost ready to graduate and I'm carrying a full load and medication administration sometimes goes quickly, sometimes it takes a while because of the direct observation requirement. In short, I sometimes have to wait for the patient's primary RN to come over and observe me give some medications, and he or she is doing their own assessments of other patients. I could, at this point, get through my med passes fairly quickly if I were allowed "free reign" to give these meds and it's very tempting to just do this because typically all the meds are available to me. I follow the rules, and at this point, as much as it's irritating, it's also possibly a test to help us students realize that even though we can do something by side-stepping the rules, we still have to follow the rules and stay within the scope of practice we've been told to follow. Truly there are very, very few things I actually can't do even with supervision.

In general, I would say that my current clinical instructor has very much given me a LOT of freedom to learn and experience things that I wouldn't otherwise get. I only truly felt restrained in 1st semester because my own educational background had provided me a whole lot of additional skills and knowledge such that I probably could have started in 2nd semester (out of 4) with little difficulty. I still played the game and followed the rules because adhering to scope of practice is HUGE. In short, I will NOT jeopardize my current license NOR my upcoming RN license before I even get it...

[SopranoKris, MSN, RN, NP]

Our school's policy is absolutely no meds to be given without the instructor present. Certain skills we can do on our own, but anything sterile has to be done in front of them. It gets frustrating when you miss out on doing something because the instructor is tied up with another student.

I can't wait until our last semester when we're responsible for total care and the only time the instructor is there is for meds.