Not getting any patients assigned at end of preceptorship

[Presto]

I am writing this because I am concerned about my performance during my preceptorship in an emergency department.

I am a nursing student finishing up my last semester at a nursing school. I have done about 12, 12 hour shifts and I am at the end of a preceptorship program. I am concerned because I haven't been assigned to have a single patient on my own.

I understand that at the hospital where I precept, we, as nursing students don't have any access to patient chart, so we have no way of knowing patient information, documentation, and lab results unless we ask our preceptor to access patient info, so we can view it.

My preceptor not assigning me any patient load, even at the end of preceptorship reflect my ability and skills as a nurse? Or is it because ED is such a different place from other unit, where it is hectic and always so busy, it is harder to assign nursing students their own patients?

Can anyone give me a feedback on this?

Thank you...

[gigglestarsRN]

Hi~ I'm sorry this has been your experience. My understanding, and personal experience, was that this is the time to gear up to a full load in preparation for graduation and a realistic patient care experience. I find it curious you cannot access charts and patient information. Have you ever been able to while in school clinicals? This is fundamental to reviewing information, following orders, determining a course of action and setting priorities. Every clinical experience, including my preceptorship (nicu) allowed me full access. I was hired as a new grad into an ER and a few of my classmates were as well, and some of them had precepted there at the end of our schooling, and they had full access. I'm not sure what to say other than if you haven't asked for your own patients, give it a shot, ask your clinical instructor too. It does seem you are missing something very valuable, especially 12 shifts in. You are right, the Ed is VERY busy, it is hard as a new grad, but if you want o get hired there, they should really give you a shot at your own patient load. Maybe the nurse you are working with can print the orders and labs out for you to work off of? Can you even hand out meds or do treatments and patient care or perform any charting?

Good luck, I think your concerns are valid :)

[Presto]

Hi GigglestarRN,

Thank you for responding to my message.

It is really unfortunate that the site I am at allow no access to patient charts for nursing students. My preceptor, however, does print out the labs and orders and allow me to pass out meds, start IV, do blood draws...etc.

Maybe I am taking patient load, but not aware of it?? When I go in, this is what happens.. patients come in, I do the assessment, start IV, do blood draw/blood culture, on my own, wait for my preceptor to hand me a print out of order, and take care of all of the order on my own, if not, have some help from my preceptor, and usually discharge patient on my own. Is this consider having my own patients??

But when it gets busy, we just help each other get tasks done. And in most cases, it gets so busy that my preceptor just likes to do everything together, since that is easier for her.

I am just concerned that if my skills are not adequate enough for her to trust me to have my own patient even during busy times, or it is just her style of teaching to not let me have my own patients...

What are your thoughts?

Thank you so much again for responding to my message. It is really nice to have opinion from outside view on this matter.

Looking forward to hearing your thoughts...

Thank you.

[BVFD 333]

Usually, a nurse needs experiences in med-surge or other area before starting to work in the ED. Than they have months of training and orientation. Or if they are a New Grad one does usually a one year internship :)

So, do not worry...does that help?

You should ask for feedback from your preceptor how your doing and progressing :)

[CrunchRN, ADN, RN]

You have gotten about a million times more skill development than i ever got in clinical. I would call it good.

[NurseOnAMotorcycle, ASN, RN]

I agree with CrunchRN. It sounds like you are doing the whole thing except computer charting. You can't be totally on your own in the E.D. without ACLS and maybe PALS, and I don't know what the policy is on students having computer access. Other than that, it sounds like you are being supervised but not much more. Congrats!

[Altra, BSN, RN]

The lack of access to the electronic documentation system / tracking board is a major limitation, but there's nothing that can be done about that in the short term. Without that access, you cannot independently "see" the big picture of your team of patients as well as what else is going on in the department.

But it does sound as though you are getting sound experience with assessment and various skills. Remember, this is not orientation for a newly hired nurse: this is still student experience and as such requires close supervision.

What do you feel you are lacking, and have you specifically asked your preceptor if you can take on more responsibility in those areas?

[DC Collins, ASN]

Yes, it sounds to me like you are getting as much of a full patient load as you can, without access to the chart (which I don't understand). DC :-)

[ecerrn]

it sounds more like a legal/confidentiality issue. if your a student precepting, and not already hired preception, theres huge issue with you tip toeing around in the charts. likely your not covered to have access to those things.

[Sun0408, ASN, RN]

You are still a student, therefore you can't have your "own" pt load. You need supervision to do the things you are doing because you are not 1. licensed 2. an employee. I don't understand why your don't have access to the pts charts tho. Even as a student, I had access to the computers with my own log in as well as the charts.

If you are doing assessments, IV, labs, giving meds etc it sounds as tho you are doing everything you can as a student.

[hiddencatRN, BSN, RN]

Usually, a nurse needs experiences in med-surge or other area before starting to work in the ED. Than they have months of training and orientation. Or if they are a New Grad one does usually a one year internship :)So, do not worry...does that help? You should ask for feedback from your preceptor how your doing and progressing :)

"Usually"? From my experience and from talking to others the "usual" you present is one variation on the "possible" roads to becoming an ER nurse. I didn't have (nor did I feel like I needed) a year long internship as a new grad in the ER. I DID however, have a much longer orientation than 12 shifts. But based on what the OP describes, it sounds like they're actually managing to do quite a bit during the preceptorship.

[Perpetual Student]

A student has no business taking an independent patient load in an ED nor any other sort of critical care area. While it's incredibly stupid that the facility does not provide access to the EMR to students, that shouldn't be the determinant of whether you take an independent patient load. It sounds like you're collaborating with your preceptor to pretty much do the entire job, which is what you should be doing as a student. Anything else would be doing you, and the patients, a disservice.

It sounds like your preceptor respects you and is giving you a wonderful learning experience, which is what you're supposed to have. Would you really want to go to an ED and not have an RN be actively involved in your care, even if it's just to say behind the scenes "good work, I agree with your assessment and plan" to the student?