Is it normal to be asked to perform skills in clinical before testing off?

Twinmom06, ASN, APN · Oct 7, 2011

if the CI is there and helping, I chalk it up to a learning experience - as in today myself and 2 other students did a foley insertion - haven't done it in lab yet, but the CI (who is an RN herself) stood there and guided us right through it - we've already done sterile fields and gloving, and she walked us right through it...I've pulled heplocks, hung IV bags, and changed dressings - we also chart and stuff...

as for the CI that is refusing to understand that the pt didn't want a student well then yes that is the CI's issue to deal with - everything else I just learn from...whether we've done it in lab or not...

LolaVenice · Oct 7, 2011

I wish I felt like the CI's in my school were helpful. I guess it wouldn't scare me as much if I felt like our teachers had a supportive attitude. I'm not usually nervous about doing things I've never done before, so it might just be the atmosphere and intimidating attitude I'm reacting to.

My issue is that these teachers who are asking students to perform stuff are not being very supportive of the fact that it's skills we haven't learned yet and they are handing out clinical deficiencies to people for not performing skills right.

But, that puts it in perspective. I haven't been asked to do things outside of the scope of my knowledge yet, but if I am asked, I will just be assertive about making sure the CI is helping me.

CaptScrubs13 · Oct 7, 2011

No you are not overreacting. Patients ABSOLUTELY have the right to refuse a student nurse, and it is not the student's job to try to convince the pt otherwise. The CI should be finding a new patient for the student, or doing the convincing herself if she feels so strongly.

Some things I would say are ok to do w/o check offs IF the CI is very helpful and genuine. Some of those tricky evil CI may be trying to test you though (you'd think people really aren't that evil and don't want anyone to fail, but there are crazies who will trip up students just to give them the F). And I would not be volunteering to do any skill I was uncomfortable with if I hadn't been checked off in lab. Just my 2 cents though :)

GOOD LUCK!

Clovery · Oct 7, 2011

It doesn't sound right to me...

From what I understand, (at least for my school) it's the assigned nurse's and your clinical instructor's license at stake if a student effs up under their watch. So it'd be in their best interest to make sure you know what you're doing when you perform any treatments on patients. There are some things that you will not formally learn in lab and have a practical exam for, but if you have never done something before, your instructor should be there walking you though it or having you observe while she does it. If a student says "I have never done this before, I haven't received any training on it, and I don't feel comfortable with it" the instructor should NEVER pressure the student to go do it on her own. At the start of the semester, our clinical instructor told us not to do ANYTHING without her knowing first. Even if it is just changing a baby's diaper.

There have been some things I've been encouraged to do, without receiving proper clearance first. But nothing invasive. Just things like "go assess the patient's lungs." And I've said "we haven't covered that in lab yet." But the instructor or nurse has said "that's okay, just go listen and tell me what you hear." It's a good experience and builds confidence and there's no harm to the patient, as long as they are willing to work with a student. Will the nurse chart my assessment? No way. She's going to do her own assessment. If you're being pressured to perform procedures independently, that you have not received training for, and can potentially harm the patient, don't do it. tell your instructor you'd be more comfortable observing her do it first, since you're not familiar with it. If she is pushing you to do things that seem wrong, you should talk to the course leader or dean, imo.

Where are the facility nurses who are in charge of these patients that the instructor is pressuring students to treat? If they're not aware of this, I'm sure they'd like to be!

LolaVenice · Oct 7, 2011

"Some things I would say are ok to do w/o check offs IF the CI is very helpful and genuine. Some of those tricky evil CI may be trying to test you though (you'd think people really aren't that evil and don't want anyone to fail, but there are crazies who will trip up students just to give them the F)."

Thanks for saying that Courtney. That's how it's making me feel and I didn't know if I was being paranoid. I don't understand why some of these people decided to become teachers because I do feel like some of them are not interested in teaching at all and they just are on some power trip!

I will refuse to do things that I'm not comfortable with, because I know if something goes wrong, it's going to be on my head. Not the school's or the teacher's!

Twinmom06, ASN, APN · Oct 7, 2011

It doesn't sound right to me...
Where are the facility nurses who are in charge of these patients that the instructor is pressuring students to treat? If they're not aware of this, I'm sure they'd like to be!

honestly in the hospital I'm in now if the students have a pt the only thing the co-assign does is pass meds - we're responsible for bathing, toileting, assessments, feedings and anything else our CI wants us to do that week...if there is something alarming we report it to the co-assign immediately but we pretty much "take care" of the patient.

LolaVenice · Oct 7, 2011

Clovery, thank you for your supportive words! I'm pretty sure, though, that if something went wrong, the teacher and the facility would have no problem throwing some first year nursing student under a bus! I highly doubt they would take responsiblity for it.

Thank you everyone for your comments on this. I've been feeling SO uneasy and I'm glad that there are others who agree with me that it doesn't seem right :uhoh21:

If I'm asked to do anything I'm uncomfortable with and haven't learned yet, I will be sure to tell the teacher that I haven't gone over it/tested off on it, but would like to learn as long as they talk me through it.

Thanks for all your perspectives!

Clovery · Oct 7, 2011

honestly in the hospital I'm in now if the students have a pt the only thing the co-assign does is pass meds - we're responsible for bathing, toileting, assessments, feedings and anything else our CI wants us to do that week...if there is something alarming we report it to the co-assign immediately but we pretty much "take care" of the patient.

Interesting how it's different! In the hospital I'm in, we students do all of the meds (unless they are IV, which we haven't tested on yet), vitals, feeding and personal care. We also practice assessment on the patients who are willing. But the facility nurses always do their own assessments - they don't want us charting that for them. And they always check on their patients even if there are two students and a clinical instructor taking care of their every need. Sometimes the nurses are comfortable with us doing other treatments that we have been cleared for - like catheters, but usually they want our instructor present if we're doing something like that. Otherwise they'd prefer to do it themselves since it's their patient and responsibility that it's done right. Occasionally there will be a nurse who has the time and trust to walk us through things herself. But I've never experienced a nurse who has had an attitude like "he's your patient now, go do whatever is necessary". They are always very much concerned about what the students are doing with their patients.

theantichick · Oct 7, 2011

That certainly sounds fishy and concerning to me. As someone else said, there are skills that won't be covered/tested in lab, but even with the skills that were, my CI's have had a "see one, do one" approach with us. If we'd tested off on something in lab and were confident, she was ok with us doing it, but was also ok if we preferred to see one done on a live patient before trying it ourselves. And certainly for anything we hadn't covered in lab, we usually assisted or watched it being done by the tech/RN/CI the first time, and then got to try it on our own supervised.

If I were an RN with a student on my pt, I'd be furious if they were expected to perform skills they hadn't a clue about.

mangopeach · Oct 7, 2011

We do things in clinicals that we don't check off in lab. HOWEVER, our CI will assist and walk us through it. We are not told to just go in there and do it on our own. Why on earth would a CI want that under their watch?

If a patient does not want a student nurse then the CI needs to find another patient for that student. I don't complain about too many things in nursing school, but if I got chastised because the patient did not want a student, that would be something I would be complaining about to the powers that be. That being said, I had a patient that did not want me to touch her, she was really upset - more to the story but anyhoo, I went and told my CI but I knew there was an underlying issue so I had to practice my therapeutic communication to get to what was really bothering her. She eventually calmed down.

IMO, part of the CI's job is to teach so I don't see anything wrong with doing skills in clinicals that you have not checked off in lab. (Unless your school policy explicitly forbids it) - But like I said, the student should not be expected to just go in there and do things on their own and I can't imagine an instructor in their right mind that would want to do that.

JROregon, ASN, BSN, RN · Oct 7, 2011

No way in heck at my school would that take place. Our clinical sites want us to take it as slowly and carefully as possible. A patient has every right to decline a student and you have no reason to question. If I was a patient, I would be tweaked if a student kept hassling me. When I say no, I mean NO. Now, that being said, I think a CI could talk you through a colostomy bag change. This is a CNA task in my state so I would likely do a "talk through" the skill with my CI outside the room and then go in and do it. I wouldn't be pulling out a feeding tube and then placing it back in without some knowledge of what type of tube it is and whether it needs to be placed with a sterile procedure. We haven't been "hanging" IV bags and I assume, disconnecting and connecting tubing until this, my second year of nursing school. This all has to do with what is acceptable at the clinical sites.