How do you teach students on the floor?

[darcicat]

This month I have had to add a new process to my nursing - working with students on the unit. I am wondering if anyone has any advice on the best way to do this? My first time with a student was lovely, she was on top of things, her charting was great, and though I assessed our patients myself and checked in on them, all I really had to do was co-sign her charting, pull out her meds, and find cool stuff for her to do with my other patients. It was fun and I loved it.

Tonight however, I had two students who each had 2 of my patients. They were both super different personalities. I ended up staying a half an hour over waiting for the first to finish her charting so I could review it. Her patients seemed to be happy with with her, but her assessments were a little off, so I modified them. Overall, she got all the patient care priorities done though. Generally speaking, I would have gone through her assessments with her to teach her and had her modify them herself, but it go so late I just felt like I had to fix everything myself so I didn't have too much overtime. I sort of felt like I didn't do right by her education though because we just didn't have time to review everything together. I sorta feel like this was my fault, and maybe I should have directed her more earlier? Specifically found times for her to sit down and chart? Taken over her meds if she was falling behind on the charting piece? I'm not sure here.

My other student had been an LVN, and acted like he knew everything. But when it came down to it he had missed meds, he didn't know all the forms to chart, he was significantly late with his blood sugars and all his evening meds, and every time I told him to do something he'd be somewhere else. Eventually, I just went through and caught him up by doing it all myself. I had to repeat things a hundred times, I even made him a list of things he needed to chart and he lost it, it was frustrating to say the least. PLUS he's already taking shortcuts that I don't even take. And some of them were patient safety related - like he wanted to pull out everyone's meds from the omnicell at once. Maybe I am too "by the book", but I do meds one patient at a time. It is hospital policy, and a JCHAO standard. I think that when you are just beginning, that is how you SHOULD be doing it. And he says to me "well, I think you are the only one who does it that way." ARG.

First of all, for my own sanity and my own liability, should I just chart everything myself and not wait to cosign at the end of the night if I feel like the students are falling behind? We have computer charting, so it would be easy to do my own documentation, but I don't think that is really how it is supposed to work. I know that if I do things for them, they won't learn, but what do I do if they are seriously missing the priorities? I mean, patient safety comes first, right? So do I just give the meds and tell them I gave them? Do I prioritize for them and say, okay this is what we are doing right now? And with my guy who is totally slacking, is it my place to tell him this isn't cutting it? Or do I talk to his teacher after the shift is over?

I'm at the tail end of my first year of nursing, so I know the "right way" the "ivory tower" way, and for the most part I adhere. What do I do if a student is too far away from the ideal too soon? I know that I am a good teacher when it comes to tasks and patho, and all of that, and I am good at getting them to critically think, but I just don't know how to time manage them, how to make sure that every thing gets done on time, correctly, and without us all having to stay an hour over the shift. Any advice?

[tyvin, BSN, RN]

I hear you. My thing is when I had students I would make sure the "teacher" was on sight and involved. It's been awhile since I've trained anyone but don't their instructors come with them and don't the students work under the instructor RN license? That's how it was the last time I had students. I know the instructors were very involved.

It's scary when you get students because even with the best intentions you don't want that little mistake to happen on your shift with your patients. As far as charting I was expected to chart even though the students did (the instructor co-signed their charting not me). Sounds like things have changed or perhaps it's a state or school issue.

[NoviceRN10]

Is there no clinical instructor on the unit with these students? I can't see how a first year nurse would be expected to totally cover these students with instruction and charting audits.

[Penelope_Pitstop, BSN, RN]

I work 7P-7A so rarely work with students. In my limited experience with students on the floor, I do find the instructor and ask what the student is to be doing and what he or she would like my role to be. Remember, the student isn't working under your license, but under the instructor's!

It is a bit different if you are precepting a student one on one. If you're a newer nurse, though, I doubt you will experience this for a while. In this case, it is essential to meet with the clinical instructor and your own nurse educator beforehand.

[casi, ASN, RN]

You shouldn't have to stay late to sign off a student's charting. Their instructor should be doing that. I would chart my own assessment.

[sistasoul]

The instructor is respomsible for the student. Nurses do not have time for that. I love having students but I do not feel responsible for them. I get involved as much as I can and answer questions. When I was a student I was told to not bother the staff but go to the instructor as the staff nurses were so busy.

[healthstar, BSN, RN]

My instructor tells informs the nurse that the students are going to do everything for that day. We never administer meds alone ( instructor has to be with us), the student signs the meds off (by fingerprint), we constantly let the nurse know what is going on with the patient. If the assessment was done by a student, the student is the one who charts everything and the instructor reviews the chart and signs it.

[BluegrassRN]

Definitely chart your own assessments. While you can review the students' assessments (and if you can, you should do it in real time, with them, so that they can learn from you), ultimately it is the responsibility of the instructor to review and cosign their assessments.

When I taught clinicals, the students had to have either me or their nurse with them when giving meds. I had 10 students scattered across 3 units in the hospital; I was not always available to do it. My students were all LPNs already, though, for what that's worth.

I think there is not enough time devoted to what the precepting nurse's responsibilities are with the students. I myself am unaware of what I'm supposed to do when I have a student (which is rare, working nights), because in each program, each semester the students are at different levels. I would appreciate a class/CEU/workshop on what my organization expects from me, and what responsibilities it expects from the instructors.

[gonzo1, ASN, RN]

In my opinion having 3 students at the same time is too much, esp if it is your first time with them and you do not know their knowledge or skill level. To let them do all these things on their own without you with them is not teaching them anything.

You should be with them, giving them tips on how to do things, prioritize care etc. Also agree with checking with their instructor first to see what they need to learn/accomplish while with you.

The "know it all" student should not be left alone with pts now that you know how he is. And his attitude and cutting corners needs to be addressed with his teacher.

[noahsmama]

I would not stay late waiting for a student to finish charting -- either they finish it in a timely fashion, before the end of the shift, or you let them know that you will be doing it, not them. Talk to the student about this at the beginning of the shift.

Likewise with meds -- either they give them (with their instructor or you present) within the time limits established by your facility (most places have rules that meds need to be given within a certain time plus or minus of the scheduled time -- usually either 1 hour or half an hour), or you will do it. Communication is key -- obviously you want it to be clear who is giving the meds when -- you don't want the pt to get a double dose or miss a dose.

Even with a very competent student who is totally on top of things, it's important to double check their work throughout the shift, not just at the end. Although it may be true that the students are working under the instructor's license, the patient is still your patient and you are still responsible for making sure that all of the required patient care is done and charted (at least that's my understanding).

[dudette10, MSN, RN]

FWIW, I don't think the OP is talking about clinicals with a group of students and an instructor on site. Sounds like the OP is precepting for a role transition course, so the students are all just *this* far away from graduating and taking the NCLEX. An instructor is not always on site for role transition.

[darcicat]

Thank you all for the advice. With my first student I did check in with her for everything, the relationship seemed very natural. She had 3 patients but only one of them was my patient - however, she was always present, always around, always asking me questions, tagging along behind me. It was easy. She got her charting done on time, so I had PLENTY of time to go over everything with her. She came to me to get meds like 30 minutes before they were due, she already had her accuchecks done for the insulin. I am realizing that she was just a good student, going to make a great nurse.

All of these students are in the 4th semester, doing their last clinical on our unit. The students are spread out across 3 floors, so while the instructor is on site, she isn't always present.

I asked my clinical coordinator the first time how I was supposed to handle students and just got some brief directions. I've asked my peers, and I've asked the students themselves. The answers all seem to vary. I think I need to actually sit down with my CC and make her tell me exactly what I am expected to do.

My thought is that I am going to do my own charting so that I am not waiting to go over their charting at the end of the night. If they get it done in a timely manner, I'll go over it with them. If not, I will just say "you can review mine for the correct assessment."

I like the idea of saying "meds are given up to an hour before to 30 minutes after they are due. If they are not done by 15 after I will give them myself."

Students like working with me, even these students did, because I am youngish, I'm friendly, and I'm pretty laid back, and I'm great at explaining patho, and I drill them on their interventions. One of them even asked me to precept her (I said no because I feel that I am still too new at this game.) However, I think that I need to be a little more assertive at the beginning with my expectations. I also think that I need to be more assertive throughout the shift... Asking for status updates and what their plan/priorities are every 30 minutes or something. Just to make sure that they are on the right track.

I like all of your ideas, thank you.