No time to review patient charts

Altra, BSN, RN · Mar 20, 2004

I found this thread very curious, because my school takes a different approach ...

During the last 8 weeks of our program, which is a nursing trends/leadership course, our clinical experiences will consist of shadowing an RN and working with him/her on whatever number of patients they have without the benefit of preparing the night before. By that time we're expected to be knowledgeable enough to do this safely just from the info we get in report.

Until then, however, it's all about proving you have the knowledge base to safely care for the patient(s), so we have to prep the night before.

To specifically address the OP's situation -- I'd get a PDA and appropriate software, or at least a drug book and pocket-size RN-Notes or one of those laminated reference sheets you can attach to your clipboard with normal lab values & that kind of stuff on it. First thing in the morning I'd take vitals & chart them, and get the patient set up for a bath, or let them know I'll be back very shortly if they need extensive assistance w/bathing, and then go read the chart - at least the Kardex & the previous day's nursing assessments & progress notes - as quickly as possible.

I'm just kinda flabbergasted at some of these posts, because at my school we've had drummed into our heads that you will not go anywhere near a patient that you're not totally prepared to care for. Very different approach ...

newgrad2004 · Mar 20, 2004

the floor about an hour after report has been given. The nurses on the floor resent having to give the students a second report.

DO they also resent having some help with those pt's? Seriously, how hard is it to give report and have a student meet most or all of the pts needs....

Puuuuuuuuuulllllllllleeeeeeeese

newgrad2004 · Mar 20, 2004

I found this thread very curious, because my school takes a different approach ...
During the last 8 weeks of our program, which is a nursing trends/leadership course, our clinical experiences will consist of shadowing an RN and working with him/her on whatever number of patients they have without the benefit of preparing the night before. By that time we're expected to be knowledgeable enough to do this safely just from the info we get in report.
Until then, however, it's all about proving you have the knowledge base to safely care for the patient(s), so we have to prep the night before.

Shadowing? In my last semster we TAKE 1-2 pt's first week, then 3-4 second week. One day or 2 we can follow a team leader. But those other days we are out there just as other nurses doing everything fo up to 4 pts, altho we dont get the 5-6 they might have. Seems your class might set you up for shell shock when you do hit the floor the first day. No RN goes up night before and get assignments. I understand about the need when doing papers but its not realistic in the real world.

Altra, BSN, RN · Mar 20, 2004

DO they also resent having some help with those pt's? Seriously, how hard is it to give report and have a stufent meet most or all of the pts needs....
Puuuuuuuuuulllllllllleeeeeeeese

Not to hijack the thread, but I'd be curious to get some input from RNs on this issue. The nurses on the units where I've had clinicals so far have been very helpful answering questions during report, but once report is done ... everyone is off and running. Since we're there during report, the nurses often clarify with us - what will you be doing today? can you do IVs yet? etc. Obviously other systems work for some, but I just can't quite imagine coming in after report and disrupting the work flow.

newgrad2004 · Mar 20, 2004

but I just can't quite imagine coming in after report and disrupting the work flow.

Well I as a student nurse, have had some nurses not be all that helpful, but for th emost part they are extremely happy to see me. Some are nervous of having a student. But others know we will have our instructor there with us for the harder proceedures and are happy for the break.

As far as interuptions, it is full of them in nursing..

Phone calls, family, physicians, unexpected proceedures, etc., but to give a student some instruction to get some relief and help with your pts?

Humm let me think if I was a Rn with a student, I would certainly take the time...No question.

Altra, BSN, RN · Mar 20, 2004

Well I as a student nurse, have had some nurses not be all that helpful, but for th emost part they are extremely happy to see me. Some are nervous of having a student. But others know we will have our instructor there with us for the harder proceedures and are happy for the break.
As far as interuptions, it is full of them in nursing..
Phone calls, family, physicians, unexpected proceedures, etc., but to give a student some instruction to get some relief and help with your pts?
Humm let me think if I was a Rn with a student, I would certainly take the time...No question.

When I say disrupting the work flow, I guess I'm just drawing from my own experience ... If you come in after report - do the nurses know which patients will have students? At the hospitals where I've had clinicals so far, by about 7:10 if there isn't a student assigned to a patient, the PCT/CNA is already checking vitals, getting the patient set up for a bath, linen changes, etc. RNs start doing their assessments right after report. 7:00am gluc checks are usually done a little before 7:00 by the night PCT, but if the student is there, then he/she can do it. What about meds at 7:30 that are to be given on an empty stomach? Or insulin that should be given within 15-30 min. of when the breakfast trays will arrive? I'm just curious ...

newgrad2004 · Mar 20, 2004

Most of the nurses should be aware students are coming and if your instructor didnt assisgn you pt's then they assign you an RN who will give you pt's. So yes most of the time they will know someone is coming. And depending on which semester your in, first usually they make you do everything but by 2-3 semester it isnt such a big deal if an aid has done your vitals, this happens normally on a unit, if they have time. In my first semesters I told the cna's I was there or my instrutor did and they were happy to leave me my own vitals/bedbaths/linens to change etc. But futher along the program, you dont have to DO EVERYTHING. Sometimes you assist with the ADL's, sometimes you assit other students, a nurse, or an aid with them What goes around comes around, and if your not there to do the vitals or the bs because they were already done, dont sweat it. If they really wanted you to do them they would have left them for you and told you to do them first.

jenrninmi, MSN, RN · Mar 20, 2004

Well I as a student nurse, have had some nurses not be all that helpful, but for th emost part they are extremely happy to see me. Some are nervous of having a student. But others know we will have our instructor there with us for the harder proceedures and are happy for the break.
As far as interuptions, it is full of them in nursing..
Phone calls, family, physicians, unexpected proceedures, etc., but to give a student some instruction to get some relief and help with your pts?
Humm let me think if I was a Rn with a student, I would certainly take the time...No question.

For my clinicals the nurses also seem really happy to have us. It takes a patient off their work load. I specifically remember one nurse in the room where we were at report actually upset that she DIDN'T have a student because she was so busy. So far, I've felt very welcomed.

Hellllllo Nurse, BSN, RN · Mar 20, 2004

This is actually great preparation for real-life nursing, where you have about 15 minutes to gather all your info on your six patients for the shift. :)
When I was in school, however, we didn't get thrown to the wolves like this until our last term, by which time we were all so sick of writing care plans for pts who inevitably had been discharged the night before clinical, that we relished jumping in there without 3 hours of prep work. Now sometimes I wish I had the luxury of reading over an entire chart and making notes before trying to care for someone with multiple medical/psychosocial issues...........

I agree!

But, you could get 8 or 9 pts, instead of 6.

newgrad2004 · Mar 20, 2004

not in california any more. 4:1 step down units. And soon going to 5 on regular units.

Did I mention MANDATORY :)

wonderbee, BSN, RN · Mar 20, 2004

Actually, I think it depends on where you're at in your program as concerning the attitudes of nurses on the floor. As a first semester student, my tasks consist of beds, baths, vital signs and grooming... PCT tasks, not RN tasks. I can't even chart yet! If anything, I make more work for the RNs if I find something not right in my assessment but they're grateful in such a case. I see the looks on the faces of the RN's when my reply to their "what can you do?" is beds and baths. But hey, we gotta start somewhere. I don't mean to imply that the nurses aren't pleasant to us. It depends on which nurse and which student.

RNinRubySlippers, BSN, RN · Mar 20, 2004

I think that is kinda crazy...we are given the Dx and the Meds. We have that to prep with the night before and the rest we have to do at the beg. of shift before report. we usually come 15 min early to check lab values and all that. I was wondering what kind of floor you are on. On surgical, we also got our pts. when we arived. It's a bit easier than a medical floor tho. Well I know this is nerve wracking and nauseating...but it gets better! I am in 4th semester adn it is so much better now! Hang in there! We are here for ya!