Need help with my students on rotation

[Midwifemama5]

I'm a nursing clinical instructor (and a midwife) on an ob floor. I am having trouble with the nurses basically ignoring my students when they are assigned their labor rotation. They end up missing the actual delivery, and missing stuff like epidurals, catheters, IV bag changes, etc. I have talked with the nurses and told them it's really more of a shadowing that needs to occur when they are doing labor (on postpartum I am with them and they are actually assigned the care of the couplet). I am thinking of developing a checklist they can go over with their nurse that explains to both the student and the nurse what the goals and objectives are.

Any ideas? How is it done on your floor? Any suggestions for a checklist? The students are having to do extra clinical days at another hospital to get their labor experience in which doesn't seem fair to me. I've talked with management, who has been receptive to my ideas. This is a small hospital, so we can't miss any opportunities.

Midwifemama5

[klone, MSN, RN]

With us, it's definitely more of a "shadowing" than "here you go, you pretend to be the nurse" especially with L&D and nursery, because it's just so different from the med/surg they're trained in. Some nurses will be more hands on than others. If I have a student, I try to let her do as many technical skills that I know she has training in as possible (IV starts, IVPs, foley insertion, etc). But I admit that I don't spend a ton of time with explanations and teaching of OB esoterica unless I know that OB is an area in which they're really interested in going into after graduation. Most of the students treat their OB rotation as something they just need to get through (and sadly, our school's requirement is only two shifts in OB).

Generally, when the students arrive, we ask them what they need to see/do. The students all have to take care of/interview a postpartum mom, they have to do a newborn assessment, and then if possible, they *like* to have them see a birth. So we try to put them with whichever nurse will accomplish what they still need to do. If there is a lady partsl birth imminent and the mother and family are amenable, we will ask all the students if they wish to observe (we generally only have 2-3 at a time).

I'm not sure if any of this was helpful, I just realized I was kind of rambling here. Good luck. I think a checklist would be helpful.

[Work in Progress]

As a student who has completed an OB rotation and am currently doing my senior practicum in OB, I think that our checklist has been very helpful. We also set out personal learning expectations, clinical self assessment and a list of skills we are allowed to do, allowed to observe and absolutely not allowed to do. A copy of this is given to our preceptor at the beginning of the shift. Are your students allowed to be with the triage nurse? I found that I got to do and see so much more in triage than with the L&D nurse on my regular OB rotation.

My instructor also happened to have been a retired nurse from the floor, so she had a good rapport with the staff. Whenever there was an emergency or a precipitous delivery she grabbed a student and jumped in to help. About half of the IV starts I had in OB were in these situations. We took care of that and that allowed the nurse assigned to the patient to coordinate care and do her other duties.

I don't know what your rapport with the staff is, but if you make it clear that you and your students are always available in times of business and stress, that may be helpful.

[debbiernbsn]

I am also a nursing instructor and work on the unit where I have students. If the student is truly shadowing the nurse, following her and watching everything she does, then they should not miss anything. It is frustrating for me to check on my students and see them sitting there while the nurse is in the room doing something for the patient. Some responsibility needs to fall on the student to take every opportunity available to see/do whatever they can in such a short rotation. JMO!

[babyktchr, BSN, RN]

I am also a nursing instructor and work on the unit where I have students. If the student is truly shadowing the nurse, following her and watching everything she does, then they should not miss anything. It is frustrating for me to check on my students and see them sitting there while the nurse is in the room doing something for the patient. Some responsibility needs to fall on the student to take every opportunity available to see/do whatever they can in such a short rotation. JMO!

I couldn't agree more.

[elle_RN]

I agree that the students need to be responsible for tailing the nurse in most situations. In my OB rotation we would "stalk" our nurses by keeping the patient's door in our sight at all times. When the nurse went in, we went in. Most of the nurses would talk to students at the nurses station, while charting, and while getting supplies. But some didn't, so we just observed patient care. Nurses were never expected to find us or even acknowledge us before they did that patient's care. I think a checklist would be helpful for everyone involved, as well as letting the students know that they should be be paying close attention to whoever goes into their patient's room. If one of us had missed a birth while we were still on the floor I think our instructor might have failed us.

[Libitina]

Surely the students are responsible for their own learning?

[cnm in progress]

From my experience as a nurse in L & D... some students were incredible and some shouldn't have been there. I'm a former teacher and regularly oriented new nurses on our unit, so I have no problems teaching. But I refuse to "find" the nursing student so he/she can learn. On our unit, students weren't permitted to give meds in L & D. There wasn't a whole lot they could "do" other than provide labor support, straight cath, etc. I had serious issues with students who sat out at the nurse's station until it was time to push and then expected to come in to "watch" the birth. It's not a spectator sport.

I would suggest providing the students with techniques they can use for labor support and then encourage them to remain at the bedside throughout the labor. Then they won't miss out on anything. If the patient has an epidural and doesn't need as much labor support, then they can spend time developing a rapport with the client.