No hands on skill labs?

londonflo · Nov 5, 2020

On 10/24/2020 at 4:16 PM, TheDudeWithTheBigDog said:

For tons of us, clinical was being a free glorified CNA. And if you actually had experience, you'd knock out your shower, bath, assessment, and linen change within the first hour and then have an entire day of being at the mercy of if you're allowed to follow your nurse or not.

When you did your bath did you perform a thorough skin assessment? Perform massage over boney prominences and talk to the patient about repositioning? What about foot assessment in the diabetic? Additional teaching for foot care? Adding the additional skills of a professional nurse to a routine task by a CNA that wants to "knock the task out" is the difference between the RN and the CNA and is so individual but does reflect on the student's initiative.

TheDudeWithTheBigDog, ADN, RN · Nov 16, 2020

I educated when it was appropriate to educate. Full assessments were done with baths, just like what most CNAs do while they give a bath. They don't auscultate or document, but any decent CNA is going to notice a wound or a change in the skin way before the nurse even will. But a confused patient that's telling me that he's in a hotel in Miami, there's only so much you can do. You can correct him, but then when he's starting to say he has to go outside to meet his kids, what are you going to educate?

It's not about initiative. It's about the fact that nursing students are abused as free labor provided to the hospitals to keep up a school's positive image with them. Using the students as free aides rather than taking advantage of the tons of learning opportunities and having the instructor actually do their job and teach the students.

londonflo · Nov 17, 2020

2 hours ago, TheDudeWithTheBigDog said:

, just like what most CNAs do while they give a bath. They don't auscultate or document, but any decent CNA is going to notice a wound or a change in the skin way before the nurse even will.

I was speaking of your assessment skills and hopefully they were at a higher level than a "decent CNA". Yes CNAs are very good at observation and need to bring those things to the RNs attention. But the RN Nurse Practice Act speaks to an expert role in assessment that the nurse brings to the situation and it is more than skin or wound care. Perhaps you didn't have a specific assessment course but I hope the content was atleast integrated into a systems approach. The CNA job description does point out that importance of reporting patient physical and psychosocial observations to the RN/LPN.

2 hours ago, TheDudeWithTheBigDog said:

But a confused patient that's telling me that he's in a hotel in Miami, there's only so much you can do. You can correct him, but then when he's starting to say he has to go outside to meet his kids, what are you going to educate?

I never mentioned educating confused patients, so I don't follow you here.

2 hours ago, TheDudeWithTheBigDog said:

Using the students as free aides rather than taking advantage of the tons of learning opportunities and having the instructor actually do their job and teach the students.

I am very sorry that your nursing school experience was such a disappointment to you and causing such reactional anger. Hopefully in your current and future RN experiences with nursing students you will have a positive impact on their education. When I was a nursing student, I too, had some disappointment with the instruction received and when I was a staff nurse and instructor I remembered those and employed ways to help rather than hinder effective learning.

On 10/25/2020 at 6:52 AM, FiremedicMike said:

I assume you had a clinical instructor on site employed by your program? Were they the ones holding you back on your experience or was it the floor nurses?

FiremedicMike touched on some of the reasons students may have to wait for an instructor to do a skill or even pass up the opportunity altogether. One hospital required an instructor and only an instructor teach/supervise skill performance (including medication passes). Maximum ratio is dictated in state nursing acts and regulations. While all faculty request a low ratio it is not going to happen. Nursing programs are the most costly to run of all college programs and no one wants to increase costs.

50 years ago I worked with a ratio of 1:12. With the increase in more acutely ill patients on general units and actually more intense and timefulfilling skills, the ratio in most states is now 1:10. Below I have quoted what is allowed in Florida:

Quote

The number of program faculty members equals at least one faculty member directly supervising every 12 students unless the written agreement between the program and the agency, facility, or organization providing clinical training sites allows more students, not to exceed 18 students, to be directly supervised by one program faculty member.

I want to add that clinical instruction involves much more than skill development and performance. An instructor also is to assist students with chart review, clinical correlation of symptoms, past medical history and how it may be impacting the patient's health now. Students can work on some independent activities such as helping a patient pick out nutritious menu items (for example high protein and vitamin C) and anticipate discharge planning. Will they need any help at home or any assistive devices? From personal experience I can say I do wish someone had suggested a toilet seat riser for my home after I broke my hip. I had no help with planning for ADLs at home that first night, screaming when I had to get up from the toilet and unable to sleep in my bed because I could not climb into it. The next day I made a list and my husband had to go to 3 places for preparing my home for rehab. (PS it was 2 days before Christmas) BTW this is just a tidbit I learned: a big box store has a bigger choice than any medical supply store-- footstool for bed, shower chair, attachment to change shower head etc.)

With regard to the OPs post:

On 10/10/2020 at 6:30 PM, olaswaisi said:

I need to say this because my mind is going to explode from stress.

On 10/10/2020 at 10:44 PM, olaswaisi said:

I forgot to tell is that lots of us when they wanted to schedule the 1-hour training, they told them that there are no free spots available! that means they might go to the check-off without even practicing the skill. Is the whole thing legal?

I hope you will let us know if things have gotten any better for you. Is signing up for skill practice for all skills available at the start of the semester? I knew some students who did that. They made sure they had an appointment for each test and avoided the rush of students who want to make appointments right before the skill test.

Please let us know how things are going!

TheDudeWithTheBigDog, ADN, RN · Nov 18, 2020

On 11/16/2020 at 8:39 PM, londonflo said:

I was speaking of your assessment skills and hopefully they were at a higher level than a "decent CNA". Yes CNAs are very good at observation and need to bring those things to the RNs attention. But the RN Nurse Practice Act speaks to an expert role in assessment that the nurse brings to the situation and it is more than skin or wound care. Perhaps you didn't have a specific assessment course but I hope the content was atleast integrated into a systems approach. The CNA job description does point out that importance of reporting patient physical and psychosocial observations to the RN/LPN.

I never mentioned educating confused patients, so I don't follow you here.

I am very sorry that your nursing school experience was such a disappointment to you and causing such reactional anger. Hopefully in your current and future RN experiences with nursing students you will have a positive impact on their education. When I was a nursing student, I too, had some disappointment with the instruction received and when I was a staff nurse and instructor I remembered those and employed ways to help rather than hinder effective learning.

FiremedicMike touched on some of the reasons students may have to wait for an instructor to do a skill or even pass up the opportunity altogether. One hospital required an instructor and only an instructor teach/supervise skill performance (including medication passes). Maximum ratio is dictated in state nursing acts and regulations. While all faculty request a low ratio it is not going to happen. Nursing programs are the most costly to run of all college programs and no one wants to increase costs.

50 years ago I worked with a ratio of 1:12. With the increase in more acutely ill patients on general units and actually more intense and timefulfilling skills, the ratio in most states is now 1:10. Below I have quoted what is allowed in Florida:

I want to add that clinical instruction involves much more than skill development and performance. An instructor also is to assist students with chart review, clinical correlation of symptoms, past medical history and how it may be impacting the patient's health now. Students can work on some independent activities such as helping a patient pick out nutritious menu items (for example high protein and vitamin C) and anticipate discharge planning. Will they need any help at home or any assistive devices? From personal experience I can say I do wish someone had suggested a toilet seat riser for my home after I broke my hip. I had no help with planning for ADLs at home that first night, screaming when I had to get up from the toilet and unable to sleep in my bed because I could not climb into it. The next day I made a list and my husband had to go to 3 places for preparing my home for rehab. (PS it was 2 days before Christmas) BTW this is just a tidbit I learned: a big box store has a bigger choice than any medical supply store-- footstool for bed, shower chair, attachment to change shower head etc.)

With regard to the OPs post:

I hope you will let us know if things have gotten any better for you. Is signing up for skill practice for all skills available at the start of the semester? I knew some students who did that. They made sure they had an appointment for each test and avoided the rush of students who want to make appointments right before the skill test.

Please let us know how things are going!

So basically, the instructor is there to teach the student how to be and think like a nurse? Good thing they're on top of that and hospitals all over the country didn't start year-long training programs specifically to address a major shortfall of schools not teaching right.

And on the assessment skills: If you can't look at a person and identify a wound, and be able to describe it, and think to investigate where it came from, and figure out how to prevent it from getting worse, while knowing that maybe you should let the doctor know... As any healthcare worker, you shouldn't even be leaving the house because you probably lack the common sense to even figure out how to open your front door. There's nothing profoundly different about the assessment an RN gives and the assessment a CNA gives. The only difference is that our license makes it our responsibility, and a CNA's assessment is not legally CALLED an assessment. The CNA doesn't actually measure the exact length of a wound, but they compare the size and they're usually the first ones to notice that it's getting bigger or smaller. ANY CNA that has any clue what they're doing is doing a full body skin assessment on every patient they bathe or dress. They're assessing their ability to move independently and if they can do their ADLs on their own or not. They're not deaf, so they hear when their patient starts wheezing or is getting short of breath. If your CNAs aren't doing all of this, either you have bad coworkers, or you just have a bad relationship with your aides. We chart the assessment, but everybody (including the CNAs, lab techs, RTs, PT/PTAs, OT/OTAs, xray techs, transporters, even the volunteer giving them the newspaper in the morning) who touches or interacts with that patient assesses that patient.

Great, I know the names of the lung sounds, and own a stethoscope to find which part of the lung it's coming from, so that it can be addressed... But the aide already heard the very audible wheezing, noticed that it's when the patient breathes out, letting me know exactly what to expect, which can be a normal thing that there's already an order for, and already has the patient sitting up in bed, made sure their NC isn't out of their nose, and the better ones even already checked their spO2.

A head to toe assessment is nothing special. A focused assessment can get a little more complex, but it's still the same thing. If you're working on a neuro floor, your aides are going to identify those problems, because they know what they should be looking for. Because as the RN, you did your job and made sure that they knew that when these certain things are happening on a stroke patient, it's kind of an emergency and they need to let a nurse know NOW!

THAT is why just dumping complete ADL care on a nursing student is a waste of their time. Maybe your first semester there's a lot to learn, so you'll have your instructor go back and check on your assessment... But after that, a bed bath, linen change, all the morning ADL care, and a head to toe assessment should maybe take you an hour if you really focus on that assessment. So why isn't your instructor teaching you during the rest of that day?

londonflo · Nov 19, 2020

51 minutes ago, TheDudeWithTheBigDog said:

There's nothing profoundly different about the assessment an RN gives and the assessment a CNA gives. The only difference is that our license makes it our responsibility, and a CNA's assessment is not legally CALLED an assessment.

If I was your employer, I would say you just talked youself out of a job.

51 minutes ago, TheDudeWithTheBigDog said:

ANY CNA that has any clue what they're doing is doing a full body skin assessment on every patient they bathe or dress. They're assessing their ability to move independently and if they can do their ADLs on their own or not. They're not deaf, so they hear when their patient starts wheezing or is getting short of breath.

51 minutes ago, TheDudeWithTheBigDog said:

We chart the assessment, but everybody (including the CNAs, lab techs, RTs, PT/PTAs, OT/OTAs, xray techs, transporters, even the volunteer giving them the newspaper in the morning) who touches or interacts with that patient assesses that patient.

51 minutes ago, TheDudeWithTheBigDog said:

A head to toe assessment is nothing special. A focused assessment can get a little more complex, but it's still the same thing. If you're working on a neuro floor, your aides are going to identify those problems, because they know what they should be looking for.

Quote

Quote

“Practice of professional nursing from Florida Nurse Practice Act

” means the performance of those acts requiring substantial specialized knowledge, judgment, and nursing skill based upon applied principles of psychological, biological, physical, and social sciences which shall include, but not be limited to:

(a) The observation, assessment, nursing diagnosis, planning, intervention, and evaluation of care; health teaching and counseling of the ill, injured, or infirm; and the promotion of wellness, maintenance of health, and prevention of illness of others.

Quote

“Practice of a certified nursing assistant” (also from Florida BON) means providing care and assisting persons with tasks relating to the activities of daily living. Such tasks are those associated with personal care, maintaining mobility, nutrition and hydration, toileting and elimination, assistive devices, safety and cleanliness, data gathering, reporting abnormal signs and symptoms, postmortem care, patient socialization and reality orientation, end-of-life care, cardiopulmonary resuscitation and emergency care, residents’ or patients’ rights, documentation of nursing-assistant services, and other tasks that a certified nurse assistant may perform after training beyond that required for initial certification and upon validation of competence in that skill by a registered nurse

.If you think you are training them beyond the initial certification to do your job, how and where are you validating their competence and documenting this, you know, in case something goes wrong, things were missed, harm came to the patient and you were trusting that the CNA did it all?

FiremedicMike, RN, EMT-P · Nov 19, 2020

2 hours ago, TheDudeWithTheBigDog said:

So basically, the instructor is there to teach the student how to be and think like a nurse? Good thing they're on top of that and hospitals all over the country didn't start year-long training programs specifically to address a major shortfall of schools not teaching right.

And on the assessment skills: If you can't look at a person and identify a wound, and be able to describe it, and think to investigate where it came from, and figure out how to prevent it from getting worse, while knowing that maybe you should let the doctor know... As any healthcare worker, you shouldn't even be leaving the house because you probably lack the common sense to even figure out how to open your front door. There's nothing profoundly different about the assessment an RN gives and the assessment a CNA gives. The only difference is that our license makes it our responsibility, and a CNA's assessment is not legally CALLED an assessment. The CNA doesn't actually measure the exact length of a wound, but they compare the size and they're usually the first ones to notice that it's getting bigger or smaller. ANY CNA that has any clue what they're doing is doing a full body skin assessment on every patient they bathe or dress. They're assessing their ability to move independently and if they can do their ADLs on their own or not. They're not deaf, so they hear when their patient starts wheezing or is getting short of breath. If your CNAs aren't doing all of this, either you have bad coworkers, or you just have a bad relationship with your aides. We chart the assessment, but everybody (including the CNAs, lab techs, RTs, PT/PTAs, OT/OTAs, xray techs, transporters, even the volunteer giving them the newspaper in the morning) who touches or interacts with that patient assesses that patient.

Great, I know the names of the lung sounds, and own a stethoscope to find which part of the lung it's coming from, so that it can be addressed... But the aide already heard the very audible wheezing, noticed that it's when the patient breathes out, letting me know exactly what to expect, which can be a normal thing that there's already an order for, and already has the patient sitting up in bed, made sure their NC isn't out of their nose, and the better ones even already checked their spO2.

A head to toe assessment is nothing special. A focused assessment can get a little more complex, but it's still the same thing. If you're working on a neuro floor, your aides are going to identify those problems, because they know what they should be looking for. Because as the RN, you did your job and made sure that they knew that when these certain things are happening on a stroke patient, it's kind of an emergency and they need to let a nurse know NOW!

THAT is why just dumping complete ADL care on a nursing student is a waste of their time. Maybe your first semester there's a lot to learn, so you'll have your instructor go back and check on your assessment... But after that, a bed bath, linen change, all the morning ADL care, and a head to toe assessment should maybe take you an hour if you really focus on that assessment. So why isn't your instructor teaching you during the rest of that day?

I’m going to go out on a limb and say that there were likely several learning opportunities you missed out on due to your attitude..

Did I change diapers and help give bed baths during med surg? Yep. But I jumped at every opportunity to help the floor nurses and didn’t complain. Because I was always visible and unobtrusively ready to help with whatever, they grabbed me when fun stuff was going on, skills needed performed, or interesting assessments were available.

Personally, I had an excellent experience on med surg, and it wasn’t solely because of my instructor or assigned floor. Folks in my own clinical group had an entirely different experience due to their affect and/or demeanor.

TheDudeWithTheBigDog, ADN, RN · Nov 19, 2020

3 hours ago, londonflo said:

If I was your employer, I would say you just talked youself out of a job.

I'm guessing you're a big hit with the aides and other nurses on your floor.

Why don't you educate us: Why don't you tell us what's magically different between my skin assessment and my CNA looking completely over the patient's skin while giving a bath and coming to me and saying "This wound looks bigger than yesterday?"

And while you're at it, why don't you post it in the CNA forums. Explain to them how much better your RN title makes you at noticing differences in your patient than them, the people who take on the majority of the actual patient contact.

If you are identifying something wrong with your patient before your aides do, they're not doing their job. But what looks like a MASSIVE ego about your RN title, I can't blame them if they just act oblivious. When I was an aide, I'd dread having to report anything to nurses that act like that

Oh, and right from your explanation of a CNAs role: reporting abnormal signs and symptoms. You want to explain how they identify that those abnormal signs and symptoms exist? Aides assess. LPNs assess. The EVS worker assesses. An assessment is not a word owned by the medical industry. As nurses, we take responsibility, confirm, and follow through. When your CNA respects you, they caught that your patient was short of breath, they adjusted them in bed to sitting up which is 100% within the scope of a CNA. They checked vitals, which is a very common job given to CNAs, and yes, they all know that if a patient is short of breath, you check their oxygen. If the patient was on O2, they confirmed that it was connected and working and that the patient was wearing it. And then they judge, do they start yelling for help, or is that patient stable enough to come get me. Anybody can tell the difference. You don't have to be licensed as an RN to have common sense. This is what every single competent aide is going to do in that situation, and it's all 100% within their scope of care. A CNA can't be tasked with an assessment, but to say that they don't assess every time they give a bath shows that you know absolutely nothing about what the people around you even do for a job.

So more than likely, if you were my employer, I would have already quit. I'm not going to work somewhere where my patients can suffer over an egotistic opinion that my aides shouldn't be checking every inch of that patient's skin during a bath, or hear the patient wheezing (since most lung sounds are easily heard externally), or know how to react to make sure that the patient isn't about die before leaving the room to calmly come get me rather than yelling for help because the patient is in very bad shape. Me and my CNAs are team. We have different responsibilities, but we BOTH stay aware of what's going on with our patients. I trust them. As a result, my patients are always turned on schedule, vitals are always done, the patients are being watched for incontinence or brought to the bathroom before they ask. Knowing that I have to do assessments, they'll plan their morning with me to help me with turning and moving the patient so that I can do everything that I have to do. When something goes wrong that wasn't my fault, they have my back when I get blamed because of just being the nurse that was on the floor. Knowing that I need a larger size glove than everyone else on the floor, they make sure the rooms are always stocked for me.

I'm not saying you're a bad nurse. Experience brings a ton of knowledge. But I am going to assume that you're a bad coworker. Instead of putting down the role that your CNAs actually play in patient care, try working together with them. We're all equally nobody to our upper management. These aides aren't stupid. They know when something is wrong with the patient, and they have the awareness to be able to identify what's wrong and to make sure the patient isn't in any immediate risk before leaving the room. Your skin assessment is not profoundly different than theirs, you just chart it and take measurements, and then make decisions based on it.

olaswaisi · Nov 19, 2020

On 10/24/2020 at 4:43 PM, londonflo said:

I am basing my comments on the understanding you are 7 weeks into your program.

Have you had some content and practice on clinical roles, assessment, communication, handwashing and PPE? You will need that content before you can be active with patient care. Yes, clinicals in any setting begin with researching your patient's health care needs and history. Does your clinical schedule show more time as you learn more for application? Do you have a clinical topic assigned for each clinical that coordinates with what is going on in class?

I can understand your frustration but you have to have some useful skills under your belt before you can be useful in the clinical setting. Please don't take this the wrong way, but without any assessment and basic patient care skills you are just getting in the way. Sure you can shadow the nurse a shift or two but usually a staff nurse does not have a lot of time to provide clinical instruction.

Since the semester almost is done and I'm sorry for not being here so I can answer so I hope you accept my apology.

I will summarize the school thing and you can judge it because I really need advice.

1-lets start with the clinical,continued as it is, go read the patient files , then write a report about the disease and the used meds. when it was the time for the health assessment check off, the instructor signed the documents (pass) without doing this actually!

About the other things you asked me : clinical roles, communication, handwashing and PPE. we were thought the PPE and the AIDET. no clinical roles were explained nor handwashing. guess what we don't study fundementals !

2- let me tell a story about a professor who is teaching us on of the most important classes. reading from the slides, well, many professors are doing this.

But when it comes to the fact that she doesn't know how to pronounce the names of the meds, that her boyfriend jumbes to the zoom meetings from time to time, the fact that we are given the exam and the answers under the name " review" , the reality that one day we found that the answers with rationales in one of the tests! I couldn't believe it ! this is a nightmare and it couldn't be true!! when we asked her she said that this is an early Christmas gift take it and run!!!

What is the result ? students now will not study it! they wait the review !!

3-Skills lab : We didn't see this one at all or enter it the whole semester, they are claiming COVID is the reason. well, every school in the country created a policy to allow thier students to practice while keeping social distancing.

when the check off came, they asked us to schedule time for practice, not . we went to schedule to surprisingly find no slots available !! many of us went to medication administration, Foley's catheter, and wound care check offs without any practice!

4-Now lets come to the Crème de la Crème in all of this:

We don't have ATI ! Yes! they shifted this year to an educational model called "NurseThink". which is not compared to ATI or HESI. We are the pilot school for this things which is mainly about Med-Surg and that is it ! it is only a fraction from what is the ATI presenting. I asked them why we switched from a program 88% of the US nursing schools for something totally, untested, and not execlusive. No answer!

The problem here is we don't have have any way to practice test questions ! they ask us to go to quizlet ! seriously ? since when Quizlet becomes a trusted source ??

After all of this, what do you think @londonflo . Do you think this is all right and prepare students to success and become skilled nurses?
I'm tired and anxious and thinking seriously to transfer to another school.

londonflo · Nov 19, 2020

With respect to what I wrote and your interpretation: 1) Your physical assessment class should have assisted you with acquiring additional assessment skills like a focused neuro check, neck vein distention, etc. Every patient should have a comprehensive assessment performed so a baseline is established. 2) The majority of your actual patient contact may depend on the setting of your employment. I suspect you have minimal time with a lot of patients except for medication administration. Perhaps you can clarify your setting and what it is you do the majority of your time at work, as it is true, team roles are different when patients are more stable and not acutely ill.

With respect to my interactions with co-workers and team members, you know nothing about me, except for my strong belief in education and clinical expertise (competency) and my belief that nursing practice is driven and evaluated by nurse practice acts.

londonflo · Nov 19, 2020

4 hours ago, TheDudeWithTheBigDog said:

Why don't you tell us what's magically different between my skin assessment and my CNA looking completely over the patient's skin while giving a bath and coming to me and saying "This wound looks bigger than yesterday?"

With respect to what I wrote and your interpretation: 1) Your physical assessment class should have assisted you with acquiring additional assessment skills like a focused neuro check, neck vein distention, etc. Every patient should have a comprehensive assessment performed so a baseline is established. 2) The majority of your actual patient contact may depend on the setting of your employment. I suspect you have minimal time with a lot of patients except for medication administration. Perhaps you can clarify your setting and what it is you do the majority of your time at work, as it is true, team roles are different when patients are more stable and not acutely ill.

Quote

If you are identifying something wrong with your patient before your aides do, they're not doing their job.

So you are just called in when a second opinion is needed?

With respect to my interactions with co-workers and team members, you know nothing about me, except for my strong belief in education and clinical expertise (competency) and my belief that nursing practice is driven and evaluated by nurse practice acts.

FiremedicMike, RN, EMT-P · Nov 19, 2020

6 hours ago, TheDudeWithTheBigDog said:

I'm guessing you're a big hit with the aides and other nurses on your floor.

Why don't you educate us: Why don't you tell us what's magically different between my skin assessment and my CNA looking completely over the patient's skin while giving a bath and coming to me and saying "This wound looks bigger than yesterday?"

And while you're at it, why don't you post it in the CNA forums. Explain to them how much better your RN title makes you at noticing differences in your patient than them, the people who take on the majority of the actual patient contact.

If you are identifying something wrong with your patient before your aides do, they're not doing their job. But what looks like a MASSIVE ego about your RN title, I can't blame them if they just act oblivious. When I was an aide, I'd dread having to report anything to nurses that act like that

Oh, and right from your explanation of a CNAs role: reporting abnormal signs and symptoms. You want to explain how they identify that those abnormal signs and symptoms exist? Aides assess. LPNs assess. The EVS worker assesses. An assessment is not a word owned by the medical industry. As nurses, we take responsibility, confirm, and follow through. When your CNA respects you, they caught that your patient was short of breath, they adjusted them in bed to sitting up which is 100% within the scope of a CNA. They checked vitals, which is a very common job given to CNAs, and yes, they all know that if a patient is short of breath, you check their oxygen. If the patient was on O2, they confirmed that it was connected and working and that the patient was wearing it. And then they judge, do they start yelling for help, or is that patient stable enough to come get me. Anybody can tell the difference. You don't have to be licensed as an RN to have common sense. This is what every single competent aide is going to do in that situation, and it's all 100% within their scope of care. A CNA can't be tasked with an assessment, but to say that they don't assess every time they give a bath shows that you know absolutely nothing about what the people around you even do for a job.

So more than likely, if you were my employer, I would have already quit. I'm not going to work somewhere where my patients can suffer over an egotistic opinion that my aides shouldn't be checking every inch of that patient's skin during a bath, or hear the patient wheezing (since most lung sounds are easily heard externally), or know how to react to make sure that the patient isn't about die before leaving the room to calmly come get me rather than yelling for help because the patient is in very bad shape. Me and my CNAs are team. We have different responsibilities, but we BOTH stay aware of what's going on with our patients. I trust them. As a result, my patients are always turned on schedule, vitals are always done, the patients are being watched for incontinence or brought to the bathroom before they ask. Knowing that I have to do assessments, they'll plan their morning with me to help me with turning and moving the patient so that I can do everything that I have to do. When something goes wrong that wasn't my fault, they have my back when I get blamed because of just being the nurse that was on the floor. Knowing that I need a larger size glove than everyone else on the floor, they make sure the rooms are always stocked for me.

I'm not saying you're a bad nurse. Experience brings a ton of knowledge. But I am going to assume that you're a bad coworker. Instead of putting down the role that your CNAs actually play in patient care, try working together with them. We're all equally nobody to our upper management. These aides aren't stupid. They know when something is wrong with the patient, and they have the awareness to be able to identify what's wrong and to make sure the patient isn't in any immediate risk before leaving the room. Your skin assessment is not profoundly different than theirs, you just chart it and take measurements, and then make decisions based on it.

You are AGGRESSIVELY missing the forest to argue over the trees. The point made to you has nothing to do with comparing nursing assessment to CNA assessment, the point was that if you are truly spending your entire clinical shift doing CNA stuff, then use those opportunities to practice RN assessment.

If you honestly are getting zero input from your clinical instructor, and the floor nurses refuse to help you, then make note of the patient's diagnosis, and once you get done doing whatever CNA skill you are doing for the patient, do your own history and physicial. Write down your findings, take them out to the clinical instructor and share with them, get input on good things and bad things. If your clinical instructor won't participate, Google the disease process and see if your assessment findings hit or missed anything major.

Or, I guess you can continue running around with this giant chip on your shoulder and continue to gain absolutely nothing of value from nursing school.

londonflo · Nov 19, 2020

7 hours ago, olaswaisi said:

I'm tired and anxious and thinking seriously to transfer to another school.

You are certainly having a very rough semester. Here are some of my thoughts:

Your clinical practicums are following a usual method of the case study method of learning which has been used for medical and nursing education for atleast a hundred years. It always starts with a review of the patient's presenting health problem and any other additional concerns. While researching the pathophysiology and usual symptoms you are aquiring the basic knowledge to understand the disease process and what you should look for. Additionally, you can learn what medications are being used since this seems to be the primary initial treatment in Western medicine. I think you are also taking a pharmacology course concurrently, is this right?

The lack of validation of your assessment skills concerns me. While an instructor may not observe every student assessment, there should atleast be some time for this. Is it possible to ask for help with something you seem unsure about...like pedal pulses, return of bowel sounds, lung sounds? Are you able to participate when your RN performs theirs?

The lack of skills lab is also a concern. How are skills presented to you? (video or actual demonstration). Can you practice on your own in the skills lab with PPE? When you are doing 'check-offs' are you using actual supplies and mannequins? What do your classmates think about this? Are there some make-do arrangements such as atleast letting you handle the equipment? Actual application of the principles of skills in clinical is different but at least you can learn how to handle the equipment. I thought I saw that you are taking an actual skills class this first semester, what is taking up that time?

I have heard of "Nurse Think: by Nurse Tim. Nurse Tim has been around quite a while. I used to watch his videos on Youtube and 'steal' his ideas for helping students retain information. It looks like his program is concept-based which is the currently promoted educational approach.

Practice questions have not been part of a curriculum but are always requested by students. Some students use resources like Saunders or other NCLEX books. Are there any students in semesters ahead of you to ask for recommendations?

If you choose to transfer I doubt you will be able to use the credits you are earning this semester. Your program has excellent pass rates for the last 5 years.