Need tips for working with student RNs!

Nurses General Nursing

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Today I had a student RN in year two. I myself only graduated in March last yr and have only been on this floor for two months. Its a mostly surgical floor, some medical. She took two pts., but was not allowed to hang IV meds, give po meds or do any nursing activity unsupervised by me. Her slip stated if she could not give the med because of time constraints, she was to observe me instead.

OMG! When I was a student our instructor would not let us go with a nurse and take two pts unless SHE had checked us off giving PO and IV meds. The instructor had to observe them, not the nurses. It took so much time to wait for her to look up meds, prepare them and administer them. I got out an hour late because of my own sick pts and not being able to chart on time.

Anyone got any tips? I know they will be back.... :uhoh3:

PS, I am NOT dissing students, I love students, I just never had to time manage with a student yet...my co worker had the same problem...

Specializes in Going to Peds!.

In my community college's clinical groups, we had one instructor per 8 students. The instructor was required to sign off on our meds. It was her license, not the staff nurse's.

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Have them look all meds up on assigned pt.'s ahead of time- maybe while your doing assessments...sounds like med administration is new to them and that's what they're learning. Then be upfront w/ the student (in a nice way, of course)- they will understand. Let them know you are a new grad and need to manage your time so they don't feel like it's personal...ask about their confidence level. If they are very new at this- they probably would prefer to just observe, anyway. However, some students have practiced their hearts out or really feel competent and can probably do the skill fairly quickly. (I think of one student who was an LPN-RN with lots of experience and could probably do tings faster than many new grad RN's) If it's a brand new student who's scared and going to repetitively recite the five rights to you and meds will be late...just ask them to observe for now-

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Specializes in Psych, Extended Care, Med/Surg.

Our instructors in the medical hospital did the same. They assigned the patients, they checked the meds and they watched the administration of the meds. That is what they get paid for and they are responsible under their licensure. I would talk to your risk management to see who would be responsible if something happened to the patients under your care and get it documented.

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Specializes in Hospital Education Coordinator.

This is a dangerous situation for you and your license and is not the best learning situation for the student. I would tell my supervisor (Director) and contact the clinical liasion nurse, or Educator, who schedules these students. You are describing a precepted situation and that should only be done with last semester students. I would try to get out of the assignment. Really.

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In general I just don't need another job. Besides, The students don't get, the supervision they need. They need to be asked spacific questions and be able to cooralate many aspects of care to DX etc..! If the school wants nurses to pair up with students, then they should offer spacific training for those nurses and the nurse should get extra pay. (payed by the school not the hospital) After all if the school needs more instructors thats their problem. We need extra nurses, they don't care about our needs. Nurses pay a lot of money for their education....They sould get what they payed for !:studyowl:

I agree with you.

As a staff nurse, they seem to be expecting you to take on additional responsibilities (you already have enough work, and this seems to be something that the school is expecting).

What is the instructor doing?

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I want to clarify, students do not work under another persons license, but under the presumption of theirs. It is your responbility as an RN to check their work, and to document work that you have completed, not their work. You should not be signing their MAR (or any other documentation) if they gave meds, but you should look over it at the end of the shift to make sure meds were correctly given- if something is missed after the student left, its you're responbility.

We were able to give meds by ourselves in the 2nd semester, but that all depended on how confident the instructor felt of you. She would also go over the medication prior to administration with you.

We were also allowed to give meds/do procedures with an RN as long as they didn't have a problem with it. There were a few situations that we were told the instructor had to be present at (ie., your first central line dressing). For any subsequent ones, we had to let the instructor know and she would either allow us to do it ourselves, with another classmate, or with the RN.

If anything it seems like the student is now looking for you to primarily teach them. That's all well and good if you're up to it, but ultimatly not your responsibility. I would bring it up to the clinical instructor and NM/charge nurse.

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Specializes in Med-Surg, Wound Care.

I love having students on my floor, but there is NO WAY that I'm going to take the responsibility of them giving meds. Clinical instructors are Masters level for a reason. That is was is required to teach nursing students. My patients come first.

I want to clarify, students do not work under another persons license, but under the presumption of theirs. It is your responbility as an RN to check their work, and to document work that you have completed, not their work.

Hmmm, we were told that we were only able to do ANYTHING in clinical IF our instructor was on the floor and supervising.

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I am a student, and that is SO not okay...if that student is taking too long...honestly, SHE should be the one to point on she is taking too long and do whatever it takes to get you home on time!!! She needs to learn that it is important to work with others, and respect your co-workers. I love my RN's I work with, and honestly, being aware of their schedules is important to me because I would never want to make someone late. I would DEFINITELY talk to the instructor. That's just rude, and unprofessional...you're not getting paid to be an instructor are you? LOL!

Being a student RN I wanted lots of hands on and clinical experience, so I work as a CNA so I can see and learn more....maybe this student needs more hands on or shadowing experience...I would suggest that to her instructor.

You don't sound rude....but that student needs to act like this is a job and be aware of you as a co-worker...don't feel bad....you wanna get home!

Claire

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Not to dis your experience but I thought that it was a required for an instructor to have 5 years experience. It is wonderful that you are trying to do it all but instructors are paid and have extra that you do not. Do what you safely and sanely can but do not jepordize yourself.

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As a student, in our first clinical rotation, our instructors checked off that we were okay to give PO, Sub Q, and topical meds. After that we were good to go for the rest of our rotations. They observed us the first few times, but then we were on our own for those types of meds--as long as we demonstrated that we knew what those meds were for, when they should be held, etc. We were quizzed relentlessly on meds before every clinical day.

We had to have an instructor (preferably) or the nurse (if we were in a time constraint) for anything that was IV. Fluids, Piggybacks, Pushes, it didn't matter. It was that way throughout all our clinical rotations. Up to and including our final one where students took responsibility for a full load of patients. During our internship, however, where we were working 1/1 with a nurse preceptor, we could do everything our preceptors were comfortable with letting us do. They didn't have to watch us hang IV meds then, if they were comfortable with our skills.

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I'm sure it is different everywhere, but where I am (Australia) there is no instructor to assist students on a daily basis. Students are assigned to an RN who plans their shift. Students work under your license, so the RN is the one who decides what a student is able to do. Of course, there are still rules they must follow about what they are allowed to do etc, and it is their job to let you know what those rules are.

I actually really like having students with me. They are all different in capability though, and I have found the trick is to ascertain their level of confidence and ability as early as possible, and plan your shift accordingly. I've had first year students who can run rings around third years in ability, confidence, knowledge, time management etc. I try to work out where they are at, and then as I plan my shift I will try to work out what will be a challenge for them, or new for them...and try to make it possible for them. So, for example, if I have a patient going for ECT and I know the student has never been, I will allocate them this patient and give them a rundown on what they should be expecting to do from start to finish. I'll always let them know that they can come to me at any time if they get stuck, but for the most part I trust them.

I will try to ask their opinion on things...I'm in psych, so it is perhaps a little easier to do this. But I might ask them, "what do you think of this patient? Do you think he is agitated? Anxious? Paranoid? Why do you think this? Do you think he needs some PRN medication? If so, what type do you think he needs? Or do you think you need to go and talk with him?" I will generally let the student make his/her own call and own mistakes. If they make the wrong call, they soon figure it out in psych! lol I try to get them to problem-solve, which IMHO is the key to nursing...I do this by conveniently disappearing (while keeping my ear to the ground) when a problem crops up...and letting the student "work it out". Whether it be a query with pharmacy or pathology, a curly question by phone or a teary family member...it is all good experience.

Very rarely will I get a student who I would not feel confident giving that degree of independence. When I get one, I am prepared to stand with them for the extra half hour as they prepare meds etc. If I am running short of time I have them help with stuff that is easy but time-consuming. Taking vitals, making beds, doing rounds, writing progress notes etc. I always thank them profusely and let them know how I appreciate their help. And I really mean it! There is nothing nicer than having someone willing to help you out on a really busy shift.

OH, and my final tip to get the unmotivated motivated...let them know that when "such and such" is done, you get to go home. Most students are doing it tough. They have kids at home, they have another job, they have study to do....and an earlymark is like gold! This has the added benefit of giving me a bit of time student-free to catch up on stuff I'm behind in :-)

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thank you for the post, I've just had my first student Rn, everyone I've trained was an RN after an extensive critical care program. She said she was afraid so many times I could have pulled my hair out! the deep breath on my part, I see a trached vent as a cake walk, she was freaking.... we stopped, set realistic goals for the night.... assessment and any basic skills she could get. so we assessed 4 ICU pt. went through each chart for h&P, looked at meds for the diagnosis, plan of care. Well she stated she was bored and wanted to learn about the equipment, and focus on skills.

I'd stated that I can train a monkey to draw blood, shoot hemodnamics... but her roll was to understand what the information meant; re-review everything based on our numbers and change our plan of care... ie drips and what not. Deer in the headlights look, then "when can I draw blood":lol2:

My response; you signed up for an ICU experience, lets focus on that and leave basic skills for another more appropriate clinical setting.

and then I hear from my student..."If I'm not going to get to do everything why am I here?"..... Um, I responded critical care nurses spend more time researching, looking, measuring... trying to invent a problem and a solution and the skills are done between, again, these skills are for a floor practicum. Well I gave in we spent the last three hours drawing blood, she felt fabulous and I fell short.

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