Not impressed with clinical group and instructor

tulip928 · Mar 29, 2007

Hello Tulip,

Love your name :)

Were these students with you for just 1 week? Did you have 1 student assigned to you each day they were in your unit?

Your experience sounds different than when I was in my ADN program just about 5 years ago. We would have been in the same unit for a few weeks.

1Tulip · Mar 30, 2007

Hello Tulip,
Love your name :)
Were these students with you for just 1 week? Did you have 1 student assigned to you each day they were in your unit?
Your experience sounds different than when I was in my ADN program just about 5 years ago. We would have been in the same unit for a few weeks.

They were on the unit the whole semester, but only (I think) two... at the most three days per week. Since I work 3 12's, and since we didn't always share patients, I probably only worked with them twice. To their credit, I did see them there the night before studying their pt's charts. And I think they were clear on the meds and why the pt was getting them.

I think what upset me most was the fact that the CNA did all the AM care. It wouldn't have happened when I was a student and if it did, if I let it happen, I would have faced serious grade consequences.

AnnieOaklyRN, BSN, RN, EMT-P · Mar 30, 2007

I am a last semester student and we have a max of two patients and we are suppose to try and do most of the care; however since we are last semester students the instructors do want us to learn appropriate delegation so in some isntances we are to delegate certain things to the CNAs, but on the same note it is meant for times when we are too busy getting medications or doing other things for the patient to do those things.

Swtooth

tulip928 · Mar 30, 2007

I am a last semester student and we have a max of two patients and we are suppose to try and do most of the care; however since we are last semester students the instructors do want us to learn appropriate delegation so in some isntances we are to delegate certain things to the CNAs, but on the same note it is meant for times when we are too busy getting medications or doing other things for the patient to do those things.
Swtooth

That's what I remember, too - learning to delegate some care. I had 4 pts. my last sememster, so to do AM care, plus morning meds (which had to be passed by the instructor prior to giving), would have been crazy. I remember doing morning vitals myself, though.

jen7393 · Mar 30, 2007

I didn't read all of the responses here. I totally agree with you. I am in second semester of a BSN program. I use every minute I am in clinical to learn something! I want the opportunity to practice as a student so when I am on my own, I have some experience. When I have a patient, I do everything I can for them. I would never expect to have someone else clean them or anything else that I am capable of doing. If I have the chance, I even help with other patients. The more I can practice, the more confidence I receive. It is a shame that some students let learning opportunities pass right by them.

I work on a neuro floor. It is a GREAT learning environment for nursing students. Now, I know clinical education has changed since I was a student (Dr. Kildare taught us materia medica and I graduated with Cherry Ames...) but still, I don't think the gals who worked with us last week got nearly enough from their time on the unit.
These are final semester ADN students. One example: a student had a pt. who is severely brain injured, has a tracheostomy, a PEG, is hemiplegic, a compelling list of family and emotional needs and so forth.
In general, the student took the pt's vital signs, and gave him his AM meds via his PEG. She let me show her how to deep suction with sterile technique (which I was pleased to do... and she did a credible job.) But otherwise, they let the CNA's clean him, change his bed, turn him, position him, etc. They hung in the Nursing station and dithered with the computer and chit chatted with each other. That is my main gripe. But also, they didn't report off to me or let me know where they were leaving off his meds (he gets something almost hourly). I found later where they had updated his chart or not.
None of the students were really pushing themselves, either intellectually or in terms of hands-on care. (Here is where I sound like a real anti-deluvian...) When I was a student, I would have been worried about the instructor seeing me sitting down, let alone chit-chatting with my fellow students. Not unless my patient was in pristine shape, the room was tidy, restocked with suction catheters, new irrigant and piston syringe for the PEG, foley bag emptied, I and O calculated for the time I was there, all conceivable charting completed, and unless/until I'd offered to help my fellow students and other unit staff members. In short, there would have been no stopping until every opportunity to learn had been wrung from the few hours we had at the bedside.
I suppose this is a generational thing, nevertheless... what did the students really learn yesterday? They just scratched the surface, did the minimum. And that seemed fine with the instructor (though, obviously I don't know what the learning objectives were nor what she was trying to accomplish.)
It was sort of disappointing.

jill48, ASN, RN · Mar 30, 2007

The problem is that is seems to be allowed for them to just sit around at the nurses station and do nothing. I couldn't imagine doing that as a student. Even if everything was completed, I would still do other things to keep busy, like catching up on supplies or cleaning the room. And why doesn't anyone take the time to sit at the bedside and get to know the patient if there are a few minutes to spare? How sad that they are allowed to get away with this behavior. It will catch up to them when their CNA's don't respect them. Your nothing without good CNA's. :uhoh21:

1Tulip · Mar 30, 2007

The problem is that is seems to be allowed for them to just sit around at the nurses station and do nothing. I couldn't imagine doing that as a student. Even if everything was completed, I would still do other things to keep busy, like catching up on supplies or cleaning the room. And why doesn't anyone take the time to sit at the bedside and get to know the patient if there are a few minutes to spare? How sad that they are allowed to get away with this behavior. It will catch up to them when their CNA's don't respect them. Your nothing without good CNA's. :uhoh21:

exACTly! There was SO much to learn. The room needed their attention, (after they left, I ran in to suction him and there were no catheters...) the patient could have used the interaction (and couldn't they have learned a lot about cognitive deficits in brain injured patients) and they could have done some things that we almost never have time to do (at least not as they should be done...) like range of motion, or MOUTH care.

And believe me... I heard about it from the CNAs after they left.

Is this an instructor problem, do you think?

Ariesbsn · Mar 30, 2007

I graduated from a BSN program in December of 2004. Our clinicals were a joke, much like what 1Tulip described. I was lucky, I had worked as a CNA so I know how to give a bed bath and make an occupied bed. I didn't pass meds after my first semester of clinicals, never changed a dressing, inserted a foley, or even fed a patient. I got lucky and started 1 IV. I let my patient sleep until 0800 and by 0900 they were bathed and clean, and my charting was done. I never had more than one patient, no matter how much I begged and pleaded. By the end of my junior year, many of my clinical group couldn't get that done by noon. The ones that could, were often found, sitting in the nurses station, working on the copious amts of clinical paperwork.

Our fundamentals class was a joke too. They had us checking off on how to manually set a gtt rate without a pump (counting the gtts), but not on how to make an occupied bed or transfer someone from a chair to a wheel chair. When I asked my instructor, she said it wasn't necessary for us to do that, the CNAs would do it. The funny part about that was that 2 weeks before graduation, I overheard a group of my classmates discussing the fact that they didn't remember how to make an occupied bed, but they weren't worried, they would have CNAs to do it for them.

As far as my ICU rotation, it was in summer. I had 2 days in neuro (not back to back), 1 in MICU, and 2 in SICU. I had a day of observation in both bone marrow and rehab. For our ICU rotation, the faculty was different every week and 1 faculty member was spread across 4 floors. My first day in neuro ICU, I was assigned to an agency nurse.

My mother was a diploma nurse and I heard horror stories about nursing school. However, at the end of her diploma program, Ma was a functional nurse. I have nothing against humanities or foreign languages, however I think nursing students would benefit from more clinical time and less BS.

cuddlebug · Apr 7, 2007

When I was in my 4th semester of nursing school I was so exausted both physically/mentally. However, when it came to clinical you bet I had my booty in the room with the patients. Sometimes I had 3 to 4 patients. My instructor wanted us to take as many as we could handle. Sitting at computer, not communicating with the NURSE, with free time?! :nono: I never experienced such a thing as nursing student. With free time it would've been appropriate to give that patient a bed bath.

cuddlebug · Apr 7, 2007

I should say though that in the 4th semester my instructor influenced delegation. If you had 3-4 patients as a nursing student believe me it kept you busy. If you couldn't handle it then we were told to let the CNA's do the direct care. But if you had time, then participate. Just because your a 4th semester nursing student doesn't mean your excluded from CNA work. Gives you a good opportunity to assess skin integrity.

Kim O'Therapy, BSN, RN · Apr 7, 2007

exACTly! There was SO much to learn. The room needed their attention, (after they left, I ran in to suction him and there were no catheters...) the patient could have used the interaction (and couldn't they have learned a lot about cognitive deficits in brain injured patients) and they could have done some things that we almost never have time to do (at least not as they should be done...) like range of motion, or MOUTH care.
And believe me... I heard about it from the CNAs after they left.
Is this an instructor problem, do you think?

Yes! I've had instructors who had better not see you standing still. Now, I have one that kind of lets the students do their own thing. Sometimes, I'm running my a## off looking after ALL aspects of my patient's care and others are in the hall, leaning on the wall, talking on their cell phones! Can't get over it. Of course, I'm also an "older" student and have been a CNA for years, so I think I have a different kind of work ethic.