Low impact student?

[trudeyRN]

Good morning everyone- I am about to start school in a little over a week. One thing I am wondering about is clinical rotations. I have looked up earlier threads on the topic and appreciate everything people have said to give us newbies a clue.

When we go into the sites, I know our presence by necessity has an impact. A "no-impact student" is not getting their learning objectives met. And I'm sure the impact is felt by everyone- the nursing assistant I "help" by dealing with a bed pan could rightly feel that my help is negated if they end up stopping to explain how to position an exceptionally frail or large patient to use the bed pan. So yeah, I know I am asking something of everyone in those sites to use their workplace as my educational opportunity.

Some employees probably deal with it solely based on the idea that their place of employment also happens to be a place nurses are trained in. Nurses particularly seem to be teachers just by how they are made- they may enjoy an opportunity to teach (assuming their other duties are not at the point of overwhelm when all this is supposed to occur). Maybe people have more far reaching thoughts, such as the student they help today could turn out to be the competent coworker they work with later. Or they may never see us again, but realize the time they spent is a contribution to patient care in areas they may never know.

My question is what habits and attitudes can we as students adopt to make our involvement in the training sites smoother? Notice, I didn't say "problem free". Aside from asking the Competence Fairy to sprinkle a little dust (instant competence-powder form), what can we do?

I do realize there are articles and threads devoted to this, and they are great. I just wondered if there are any nurses, aids, clinical instructors or recent students who can give additional insight. Thanks for any ideas you share.

[eyesopen_mouthshut, CNA]

One thing that I've noticed is making yourself available. I guess that kinda goes along with common sense, but still-- I've seen students just flat out avoid the CNA/ PCT on the floor so that didn't have to do something like clean someone up. It makes them look bad, and it makes it that much harder on the CNA/ PCT because there will still be people asking her for help.

Anyway.

The other thing to remember is that sometimes, not always, there will be someone to take advantage of you. So if you're being super helpful and kind and whomever your shadowing isn't being fair/ reasonable/ etc., you have to remember that you're there to learn specific skills. If a specific person is always asking you to take care of nothing but a BM and she's sitting on her but on her phone (yes, it might happen! It's happened to me), remind them that you're there as an ADN student, and you have something you should be doing related to that-- such as helping with meds or assessments. It's okay to say no. Just not every time they ask you for help (it goes both ways).

[trudeyRN]

kskaggs126- so people can smell this (an honest desire to help, and perhaps taking stuff at face value without considering ulterior motives of others) from many, many miles away:unsure:.

You hit the nail on the head with me personally. I have been told that I actually need to take a somewhat more entitled attitude (for lack of a better description) to getting my learning objectives met while contributing to others in those settings. This was said by a person who knows nursing inside and out but only knows me a little.

Yipes, so perhaps my next thread ought to be titled "how to help and not get used as a doormat".

I think shy students will be particularly prone to hiding out (thus not being available). Doing that doesn't help anybody, student or employees.

So be ready to pitch in and keep an eye on why YOU are there (to learn, as a student, who paid money to come do this) are both good to keep in mind.

[bkchick]

Just like the others stated, be ready to help out. Don't avoid the CNAs or PCTs. Even though they're not nurses, it impacts your grades. As an RN, you have to give assignments to them and ensure that they're doing their job properly. What best way to learn than from them how they are supposed to do their jobs?

Another thing one of my clinical instructors told us was to answer call bells especially when we're free even though it's not our own patients. Sometimes the patient just needs something simple and other times, you just need to pass the message on to the appropriate person. In cases like those, sometimes when those nurses sees an opportunity and sees that you're willing to learn and help out, they will include you in to learn something new.

[smf0903]

I think the same things that make you a good employee also make for a good student. Definitely always make yourself available. When I get to the floor I make sure to find the RN and aide who have the patients I am assigned to. I introduce myself and get report from them. I also let them know that I am more than willing to help with anything that comes up with ANY patient. The aides and techs are also a valuable resource, don't overlook them. (I see a lot of people do this, and it's sad because I have learned TONS from the aides and techs!) Keep in mind there is never "nothing" to do. We have had times that were unbelievably slow on the floor (but don't say that out loud!! LOL!), and my patients have what they need (this usually falls at mealtime, when you don't want to be asking a bunch of questions of your patient while they're trying to eat, otherwise slow times I go in and talk to my patients...they all have very interesting backgrounds :)) I will restock accucheck boxes, restock IV kits, you name it. If we've had patients discharged we'll go strip beds, empty wastebaskets, etc., etc. The upside to doing stuff like this is that you get familiar with where things are at on the floor and who you need to contact if it's NOT on your floor (like if there are no available IV pumps on the floor, stuff like that).

Be sure to ask questions, but be smart about it as well. I know this seems like common sense, but I can't tell you how many times I have seen people ask questions of the RNs when they are eyeball-deep in chaos and then get mad when the RN snaps at them. Seriously.

Spend time with your patients...you will be amazed at what they will tell you! Always remember that they aren't there for a party, many are grumpy but just want to be fussed with a bit. Some of the smallest things will win your patients over (combing their hair, little things that some times don't get done but can make a difference!). Treat your patients the way you'd want your family members treated.

Have fun! Challenge yourself by always taking the toughest patient. Be prepared. Spend time on your meds and prep tools (we do prep tools for patients during 2nd and 3rd semesters) and do a good job.

[trudeyRN]

Bkchick-I agree, the only way to supervise anyone would be to actually know how to do what they are doing- which means learning from CNA's and PCT's and assisting them in this phase. Not sure why anyone would enter nursing if they were put off by doing the other tasks patients need in addition to nursing care. Also, any supervisor I ever had that I felt was worth their salt would never ask me to do anything they were unwilling to do. Yes, nurses have to make use of help from assistants to be sure their work gets done. But when the balance is tipped the other way (assistants who have way too much to do), I'd like to believe that nurses pitch in to make it all work. As a nursing student, I agree there is value in learning from everyone in the clinical site, not just nurses.

I'm glad you bring up the idea that we can answer any call bell- and if we can't directly help, go get the person who can. I might have been reluctant, thinking it was not my place to do that or stepping on toes if you hadn't explained it from this perspective.

[trudeyRN]

smf0903- you are right, the "good employee = good student" idea. Many have said these experiences are interviews for jobs we aren't applying for- yet.

The advice to go in and connect with your pt's RN and aide is good to spell out. I wonder how many of us walk in, maybe tell someone who they are and that they are reporting for duty, but fail to seek out the people who need to give you the scoop on what your day is likely to entail. Because I am shy, it is possible I would hang on the periphery, hoping and praying someone would come along and tell me what to do. I see how busy people can not really help anyone who is being passive- we have to jump in there (even if it not in our usual nature to do that). I can imagine myself getting involved quickly because I see this work as being really interesting. Extremely shy types probably need to get over the fear of being in the way and put them selves out there.

Think the timing of questions probably is as important as asking the right questions. I will try to remember that when my enthusiasm for getting something cleared up for me ends up clashing with a person who maybe wasn't showing they are stressed or extremely busy- but they are, and they let me know:sniff:

[NICU Guy, BSN, RN]

My advice is that if you are assigned a patient, know everything about that patient.

1. What is the reason they are in the hospital

2. What other health problems do they have and how do they impact their current health problem

3. What meds are they on, what they are for, what side effects do they cause, which ones are to be given during your clinical.

4. What lab results are a factor with the admitting diagnosis and how does a high or low value effect the patient.

5. Once you know 1-4, go talk to your patient about their health problems. They have been living with them so they are an expert. Patients know you are there to learn and most are willing to teach you about their health problems. The more patients you talk to that have the same health conditions, the quicker you will be able to connect the dots.

Knowing this information will let your nurse know that you are there to learn and not just a "clock watcher" until you get to go home.

[Jenngirl34RN]

I agree with all of the advice above. I would also that you should do everything you can to research the drugs you will be giving or the procedures you may be doing with you patient, do not ever be afraid to ask questions or admit you do not know something. Sometimes RNs will assume you know more than you do, and if you do not speak up you are potentially putting your patient at risk. Two students in my cohort were so afraid of not asking stupid questions or seeming like they didn't know how to do something that they ended up failing for creating a potentially dangerous situation.

One thing I like to do at the beginning of each day is tell the nurse I am assigned exactly what my plan for the day is and if there is anything I am not allowed to do. For example, I will say something like, " I will doing an assessment, charting, giving meds, and doing all of the daily care. I noticed this patient is on Oxy, and since students are not able to give narcotics I will need you to give that one. I will also need you or my instructor present when hanging IVs."

[trudeyRN]

Don1984- funny, one of my attractions to nursing is I can't stand clock watching (or jobs that lend themselves to that). Strikes me that there will always be something to do (probably too many somethings). I like your list because outside of the regular assessments we are supposed to do, what you are suggesting will give me greater insight into how the whole picture fits together, AND give patients a feeling of being listened to. I can certainly do more of that with two patients to keep tabs on, vs. six or eight.

Jenngirl34- that is so true. Whether it's people thinking I have more experience or capabilities than I have, or me taking a little knowledge and running amok with it, it's important to consider the "scope of practice" for students. I guess anyone, nurse or student needs to consider when they are in over their heads and seek assistance for that.