New RN precepting students!

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Wow, this is so wild. I had a couple LPN students following me around last night! It was interesting seeing the other side of the fence.

I was a little irked because the student was assigned to one of my patients and I didn't even know. And she went in and saw the patient before even telling me she was there, and did all the vitals even tho they'd already been done, and then came to me, told me she was assigned to the patient and that she needs to do a mother/baby assessment and so wanted to see me do the next one and then let her do the one on that pt w/ her instructor! I was thinking, was I like that as a student? I always introduced myself to the nurse BEFORE I started working with the patient, in order to touch base and see what was already done so that I wouldn't repeat things unnecessarily. And I asked, never told.

It worked out okay, I got another one of my pts permission to bring her in and her (male) classmate while I did the mother/baby assessment and teach them as I go and the patient was fine with it. That part I loved--the teaching is one of my favorite things about nursing as a whole. I had them do a baby assessment in the nursery with me so they got a real hands-on experience as well.

But the student kept going in to 'her' assigned patient and trying to teach her how to breastfeed, how to change a diaper etc etc. I don't think she ever looked in the chart to see this was the pt's third child. Then of course I had to find out what she was teaching since I had no idea of her knowledge base. She did fine but said "I know all this stuff from when I had my own kids" and that worried me! She needs to know it from her nursing studies.

Anyway, I think I am just blowing off steam. We were ALL students and not too long ago at that. I am SURE that I bothered my share of nurses over the last few years. It was just really annoying that she did a number of things before I even knew she was there.

Today I plan to talk to one of our nurse educators and find out exactly what the role is of the student, and what my role is as the shadowed nurse, and what my responsibilities are regarding the patient.

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ok I am going to add to this thread because the students came back last night and it got worse. I would love input from more seasoned nurses.

I asked what the responsibility is and I found that as long as they have myself or their instructor with them, they are responsible for assessments, vitals, and pretty much all pt care but passing meds.

I found out that 3 out of 4 of my mother/baby couplets had students assigned, the charge nurse took one and traded for one of hers that didn't have a student. So I had four couplets, two of which were to be cared for by students. One was going home in the morning, needed pretty much nothing but pain meds which I gave her. The instructor and student did the assessments, and came to get me--baby had a temp drop. Instructor and student had both taken temp. I get the baby, go down to the nursery and retake the temp--totally fine. grr. So I take the baby back to mom, explain a cheery "false alarm!"

Other pt was pretty high-level---first time parents, 4h post C-section. Lots of stuff to do. Long and short, two students were assigned to that couplet and I explained to students and instructor together that I felt it was necessary to have either the instructor or myself in there when they did their assessments on mother and baby. Instructor said she would be in there the whole time.

Soon the pt calls out, wants students removed asap from them. Want only me, feels students and instructor do not know what they are doing. So I pulled the instructor aside privately and explained that pts requested students be removed, and offered to have them come with me on my three other couplets.

Instructor got pretty defensive, wanted to know why--which is fair, but her whole attitude was very defensive. Finally I just told her. The patients thought it was unprofessional trying to rip her underwear off rather than getting scissors or taking it down around the foley. (I left out the part that they clamped IV and never unclamped it, and did not turn SCD's back on). Instructor was very defensive--'didn't they realize I was trying to make her comfortable and didn't want her to sit there while I got scissors?' I tried therapeutic communication "They are first time parents and not in the medical field. They don't think like nurses, like we do. Some people just aren't good candidates for student nurses" Instructor was just so defensive. She asked me what I would do. I said I'd get scissors or take it down over the foley. She said "Really?" Like she was amazed. :uhoh3:

So now, here I am....a brand new RN, explaining to a nursing instructor that patients were not satisfied with the care they received from her and her students. And this is not about lpn v rn nor is it about students being inept or anything---students are learning, and learning takes place with patient care. But the instructor just was such a pain in the neck about it.

Did I handle it allright? I spoke to the nurse that I am resourcing with, as well as the charge nurse, and they felt I handled it correctly. I can't help it if the census was low (to me that was nice lol) I can't help it if the patients were unsatisfied. I am my patient's advocate first and foremost and I want them to have an enjoyable experience as they get to know their baby.

Am I the only one dealing with this? They won't be there today but they are coming back for their final experience Saturday. I have the night off but I put a big note on the pt's Kardex "NO STUDENT NURSES".

Comments?

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Specializes in SICU.

You did well.

I am not trying to slam clinical instructors so please don't slam me, but I have also seen this happen. Nursing schools have such a hard time finding instructors (bad pay) that not all the instructors are knowledgeble about the area they are being asked to instruct in. In my area of the hospital we have two clinical instructors from different schools. One is great, has worked in pediatrics for years. The other was a home health nurse before becoming the pedicatric clinical instructor and has no to little understanding of this area of nursing. Not slamming home health nurses either.

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Specializes in Case mgmt., rehab, (CRRN), LTC & psych.
Then of course I had to find out what she was teaching since I had no idea of her knowledge base. She did fine but said "I know all this stuff from when I had my own kids" and that worried me! She needs to know it from her nursing studies.
I am an LVN. You've got to realize that many LVN/LPN students do not receive thorough, in-depth classroom education in the areas of antepartum and postpartum care. My class had a grand total of 20 theory days spent on L&D and postpartum. If the LPN student is not being taught what she needs to know in the classroom, she then needs to reflect on her personal experiences with childbirth in order to provide care to postpartum patients.

I asked my OB clinical instructor, "Why do we spend so little time on L&D and postpartum?"

My clinical instructor responded, "It is because very few, if any, of you will land a job working in L&D as LVNs. We strive to teach you students just enough knowledge about L&D to pass the NCLEX."

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Specializes in Telemetry/Med Surg.

You did absolutely the right thing. Sounds like you handled the situation very well indeed. Pts have the right to choose their caregiver including not wanting to have students.

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Specializes in Telemetry & Obs.

Whatever happened to receiving report?!?

I can't imagine not communicating with the nurses during clinicals:o

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Specializes in Med/Surg.

I am a student and I am doing my OB and nursery rotation right now. I agree you handled the situation wonderfully. I often wondered why patients are not asked before hand if they mind having a student or not. We had one a few weeks ago that after an hour with one of my classmates threw her out of the room and demanded that she never come back. She did not mind having students perse just this particular one. It really upset my instructor as she works as a nurse on the floor. She was not upset with the pt but my classmate. I am not sure exactly what happened but have seen this classmate in action so.......but my instructor is wonderful. She has at least 5 of us on the floor every week and we usually have 2 pts each so thats 10 pts and 5 students she has to watch and she always knows everything going on with each pt. she amazes me. Guess I got off track sorry....but yes I think you handled it appropriately.

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It is my understanding that a preceptor is someone who gives practical experience and training to a student. Why would a new graduate RN be used as a preceptor? No offense, but that blows my mind!

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I am an LVN. You've got to realize that many LVN/LPN students do not receive thorough, in-depth classroom education in the areas of antepartum and postpartum care. My class had a grand total of 20 theory days spent on L&D and postpartum. If the LPN student is not being taught what she needs to know in the classroom, she then needs to reflect on her personal experiences with childbirth in order to provide care to postpartum patients.

I asked my OB clinical instructor, "Why do we spend so little time on L&D and postpartum?"

My clinical instructor responded, "It is because very few, if any, of you will land a job working in L&D as LVNs. We strive to teach you students just enough knowledge about L&D to pass the NCLEX."

Yes I know they didn't have a wide, classroom knowledge base--they only have 3 clinical days total on our floor and there are no hospitals in my area that offer positions for LPN's on OB floors. But that was my point...if the students are not taught something in the classroom, they should not be teaching it to patients. This is not a slam against you nor any other person. But its what made me nervous about the whole thing.

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It is my understanding that a preceptor is someone who gives practical experience and training to a student. Why would a new graduate RN be used as a preceptor? No offense, but that blows my mind!

Did I use the word incorrectly? Lol I didn't mean to but anything's likely after the workweek I"ve had :) They were assigned patients that were assigned to me, and I was showing them how to do things.

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I am a student and I am doing my OB and nursery rotation right now. I agree you handled the situation wonderfully. I often wondered why patients are not asked before hand if they mind having a student or not. We had one a few weeks ago that after an hour with one of my classmates threw her out of the room and demanded that she never come back. She did not mind having students perse just this particular one. It really upset my instructor as she works as a nurse on the floor. She was not upset with the pt but my classmate. I am not sure exactly what happened but have seen this classmate in action so.......but my instructor is wonderful. She has at least 5 of us on the floor every week and we usually have 2 pts each so thats 10 pts and 5 students she has to watch and she always knows everything going on with each pt. she amazes me. Guess I got off track sorry....but yes I think you handled it appropriately.

technically, at a teaching hospital, patients get students whether they like it or not. Technically. Me, I warned all my patients first. Plus, a patient can refuse any caregiver any time.

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You did well.

I am not trying to slam clinical instructors so please don't slam me, but I have also seen this happen. Nursing schools have such a hard time finding instructors (bad pay) that not all the instructors are knowledgeble about the area they are being asked to instruct in. In my area of the hospital we have two clinical instructors from different schools. One is great, has worked in pediatrics for years. The other was a home health nurse before becoming the pedicatric clinical instructor and has no to little understanding of this area of nursing. Not slamming home health nurses either.

Thank you. I was telling some others that I work with about it, since the students are coming back tomorrow and I wont be there, and they said that there is one instructor who is absolutely wonderful and then there is this one. My husband always said Someone always has to graduate at the bottom of the class..maybe this instructor wasn't top banana.

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