How do Nursing Instructors deal with this? Clinical site RNs don't want us around

[chicagrl]

Hi

I am a first year student. We have clinical once per week and have just started interacting with patients. Today we gave or helped with bed baths. The problem I see so far is that the nurses are definitely not friendly...in fact none of them seem to want us around. We are mostly in the way. I feel that this is an issue my school should deal with, at least our instructor. She finally admitted today that none of the nurses are very friendly. I am not sure what type of relationship she has with them but it does not seem like much of one.

Has this happened to you and how did you deal with it. We were supposed to sit in on report this morning and got "shooed away" literally. "shoo" We ended up talking with the PCT and eventually gave a bed bath . Our clinical instructor came to check up on us and then later told us all the things we "should" have done etc. It just seems like we need to shadow more but our instructor says we will only learn from "DOING" I agree but i had never even seen a heart monitor or leg compression boots until today ...as i was helping a pt get clean.

Any insight would be great . every one in my group is already counting down the clinical days.....we only go once per week ...until DECEMBER . It is obviously our instructors job to teach us - plus we have a skills check off session each week before clinical. It just seems to be very "incongruent"....

[jjjoy, LPN]

The problem, as a I see it, is that many schools don't have enough structure in starting out clinicals with new students.

I've heard too many similar stories to think that my poor starting clinical experience was an anomaly. We had almost no direction and were pretty clueless. Why not model AM care with a few different real patients before sending the students out alone or in pairs to fumble along with their first patients? Why not pair the students with a CNA to specifically assist with all bedbaths for a day instead of assigning just one patient to one student, where the student isn't quite sure what to do? They drill students on the precise way to hold a washcloth, threatening failure if you deviate in the slightest, and dressing you down if you ask for asking questiongs... and then expect them to not be paralyzed when turned loose on a patient, afraid of doing the wrong thing?

To use an analogy, some schools/instructors seem think if they use any type of 'training wheel' the students will never learn to ride the bike on their own. Of course, by graduation, the students should be self-directed, but why NOT give a bit more direction at first? Most kids who did have training wheels on their bikes, DID learn how to ride and take those training wheels off. And I think nursing students could get off to a better start with more guidance and structure at the beginning AND still build independence and autonomy.

[Jules A, MSN]

I can be a far bigger a-hole than most, when it's called for.

I concur.

Your rant with regard to my post was totally unnecessary and off base.

[psychonaut]

I was fortunate in school to have avoided these issues for the most part.

I think a key part of this were those clinicals where the instructor was in a leadership position in the hospital/unit.

First semester clinicals were led by a CNS for the floor we were on. She was no nonsense to both camps; her nurses were expected to be courteous to the students, and as accomodating to our education as possible. We students were expected to be respectful of the nurses, helpful, involved, and to have a positive attitude. Lazy, timid, or rude students were dealt with *firmly* (this was a tough lady, who I have enormous respect for).

Gero clinicals were taught on an IMC floor, by the head of human resources!

Med-surg was taught by a charge nurse on the floor we were on. He actively sought to find which nurses liked having students, and respected those who didn't want students by not placing us with them.

Critical care clinicals were run by a big-wig CNS at that hospital.

I've had my gripes about my program, but this is one area where they absolutely did things right. Those clinicals where the instructor wasn't an employee/leader in the facility generally had more more "staff vs. student" issues.

Can't be done everywhere, all the time, but seems to be a good thing when it can be.

[WhitePillow]

This happens everywhere and I admit that I have been on both sides of the coin.

When I first started working I was made to feel as if I was always in the way, always asking questions that made me feel "stupid" and I always felt that I couldn't do the job. All I can say is hang in there. Do what you need to do to pick up on the things you are there to learn. The nurses do not OWN the hospital and they are there to teach, if that is what their facility expects from them. Be professional and nice to everyone and remember that the nurses there work hard. It is HARD to take someone under your wing and teach while you are trying to prioritize your day! It takes three times as long to get anything accomplished while nurses are teaching. Have a little patience and help whenever you can.

On the other side of the coin...I have been the one training as well, sometimes as many as 10 people at once. I had the busiest work load of anyone in the company and I had to train as well. Again, this is not an easy task. There were times when I told the trainees to go on a break because I had an emergency that I had to take care of. I was probably a little short with them but when they came back I explained to them the situation and what to do to avoid it (or to learn from it). The worst trainees are the people who just don't get it. It's okay to explain something once or twice but when you have to repeat the same thing over and over again, it gets to a point where I have to tell someone to go look it up in their book, review it overnight and get back to me the next day. I agree with the other poster too...if you are not professional, or together, I wouldn't want to work with you either. Not saying this is you but just in general.

Hope this helps and good luck. Keep a smile on your face and do what you can without help.

[Jump_Nurse]

Good luck dealing with that... Even when you're done with school. I have noticed that nursing, and maybe just healthcare in general, can be an incredibly unfriendly workplace. Nursing staff in particular seem to think everyone else is an idiot and ***** and complain about all of their coworkers. Just sit back, remove yourself from the conversation and listen, it can be quite remarkable just how two-faced and angry nurses can be towards each other.

That said, I experienced the same thing with many preceptors. Some were good, while a majority just didn't want students around. Even the simplest questions seemed to trigger unwarranted hostility.

Good luck, but I don't know that it gets much better.

[FireStarterRN, BSN, RN]

Good luck dealing with that... Even when you're done with school. I have noticed that nursing, and maybe just health care in general, can be an incredibly unfriendly workplace. Nursing staff in particular seem to think everyone else is an idiot and ***** and complain about all of their coworkers. Just sit back, remove yourself from the conversation and listen, it can be quite remarkable just how two-faced and angry nurses can be towards each other.

That said, I experienced the same thing with many preceptors. Some were good, while a majority just didn't want students around. Even the simplest questions seemed to trigger unwarranted hostility.

Good luck, but I don't know that it gets much better.

Allow me to respond...

My first thought is, this has not been my experience personally, and I've been in health care for 17 years. You speak as if you have a great deal of experience in varied fields of work, yet I notice that you are 21 years of age. Can you give specific anecdotal comparisons of working as a nurse relative to other to other lines of work?

I secondly would like to question you to how you are approaching your co-workers and colleagues with these questions that are provoking such hostility. I know there are some units that tend to be toxic, but for the most part I find my fellow workers willing resources of information. So, I ask you to do some self-analysis as to how you are coming across.

[MB37]

I'm a new grad, so I can only offer advice from a student's perspective. I can certainly see both sides, I'm just not out of orientation so I won't be precepting/taking students for quite a while yet. I never had a serious problem with any of the nurses I worked with during my clinicals, although I certainly met some who were having bad days, not in happy bubbly moods, and who didn't trust students. The key is to know how to deal with all of these issues without escalating the problem.

First of all, as others have said, always come in prepared and ready to work. Appearance means something - you don't need to spend an hour on makeup, but make sure you aren't wearing a wrinkled, dirty uniform and you don't look hungover. Our CI had us take a simple notecard every morning and give it to our nurse. On it, we wrote our main goal for the day (i.e. "practice assessments of ABCD systems") as well as procedures we were able and unable to do, and what we needed to practice. We'd say we were expected to take X # of patients (ours weren't pre-assigned) and that we were studying, say, cardiac that week so we'd love to take pts with CV problems. Most of our nurses appreciated the five minutes at most it took to explain where we were in school and what we could do, then we took our patients and gave as much care as we were allowed independently. Many of them would come and let us know if anything on our list was going on with their other patients as well - my first Foley insertions and removals were on pts that weren't assigned to me, for example. If you get your pts the night before, do all of your clinical prep and try to remember some in the morning. If you don't try to look up enough to get a broad understanding of their condition early on in the day. Consult references, the computer, fellow students, and your instructor before bothering your nurse - he/she is busy!

Still, even if you're a model student, you're bound to be assigned to a nurse at least once who is less than pleasant to you - that's OK. Just deal with it professionally. At least once a semester I had a nurse who seemed overwhelmed/irritated by having a student. You can always say, "Hey, I know you're busy - if this is a bad day for you to have a student, just let me know and I'll call my CI and get reassigned." If they're just busy/non-friendly, then don't bother them more than necessary. Most of my nurses who started off unpleasant warmed up to me as the day went on. Smile and offer to help as much as you're able, but also don't be afraid to use your instructor as a resource or backup. Have you learned SBAR reporting in school? It works with nurses too - "Mr. Smith wants pain meds" is too ambiguous. "Mr. Smith in 218 describes his pain as 7/10, he has 1-2 mg of morphine IVP ordered PRN q2h and his last dose was at 0630. I can't give IV push meds, do you mind getting some for him when you get a free second, or would you prefer I ask my instructor? Thank you so much!" works so much better, even if your nurse is swamped and having a day from hell.

Apologize for the length! Just be professional, polite and prepared always, and utilize your CI. He/she can stand up for you if needed, or get you a new situation if you're dealing with someone who really hates students and won't allow you to learn. Always try to work it out with the nurse first though - I found that just offering to call my CI if they were too swamped to deal with me that day usually garnered me both an apology for being short with me and a pleasant nurse to work with that day. Our instructors didn't work on the floor there, so this was never any kind of a threat - just an offer to lighten the load. Hope that was helpful!

[marie-francoise]

I, too, have found the non-structured, unwelcoming atmosphere of clinicals to be just plain ridiculous. My classmates and I count the hours and seconds until clinicals end - and these are 13-hour clinicals...

The current approach to instruction of nurses in a clinical setting seems to be "place them in a clinical setting with a checklist, period". There is absolutely no mentoring; and the attitude of the nurses seems to be JUST this side of tolerance.

So, what I've felt is that we are a herd of nursing students trying to make ourselves non-obtrusive in an unwelcoming, non-education-friendly environment, yet trying to fulfill "checklist requirements" at the same time.

I've felt like quitting nursing school so many times over these clinicals. There must be some way to make them more tolerable. I fear that nursing in reality is intolerable in many workplace settings. Sorry to sound so pessimistic, but I am just coming off of a clinical day and this is my mindset.

[chicagrl]

I'm surprised that the OP only has clinicals once a week. We went twice a week in my program.

I am sure it varies by program :) This first semester we only have clinicals 1x per week, in addition to our skills sessions on campus.

[Bowling Thunder]

I am a first semester student too. I'm sorry, but I do not think we should have to put up with "those" type of nurses. I pay very good money to go to school and learn, not to be harassed or put off by people in the hospital. We are gonna be there, we are gonna learn. I hate to sound harsh towards them but I am there to learn and get a grade. I am not going to get intimidated by some nurse who was once in my shoes.

I agree. I go to my first clinical site Thursday and have already heard the facility is very strict and has a lot of "wealthy" sick people.

[november17, ASN, RN]

A few weeks later, we were told "We no longer will be sending students to ABC Hospital. I sure hope they can continue to meet their staffing needs in the future."

That's really funny, because there is a hospital that is a bike ride away from my house and I refuse to work there because of the terrible experiences I had during nursing school clinicals. Everyone in the hood is always asking me why I don't work there, and I just tell them I'm an anti-union bastard (not true, just an excuse to avoid the topic about why that hospital sucks!!).

I drive 20 mins to work, and it is worth it just to avoid that place.

[Bortaz, MSN, RN]

That's really funny, because there is a hospital that is a bike ride away from my house and I refuse to work there because of the terrible experiences I had during nursing school clinicals. Everyone in the hood is always asking me why I don't work there, and I just tell them I'm an anti-union bastard (not true, just an excuse to avoid the topic about why that hospital sucks!!).

I drive 20 mins to work, and it is worth it just to avoid that place.

Oh yeah, for sure. I'd never even consider working at the hospital I was assigned to for my first clinical.