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.)
I never remember nursing school like that. I think for the most part nursing students are hard workers, eager to learn everything they can. In my opinion MOST of them work off their ....you know what.
I am a vocational nursing instructor so my experience might be a tad different but I have some rules for my students starting with you are NEVER too good to wipe a butt, empty the trashcan or help the techs take vital signs. If I see students grouped together chatting, I head that way and find out if they need something to do!
Of course, I did walk into the break room one day and found a student reading the newspaper. She certainly lost some clinical points that particular day.
I understand delegation, but when I worked on labor & delivery/postpartum/nursery, we seldom had a tech. We provided total patient care which is why I try to get my students to understand they shouldn't wait for or expect someone to take care of what they are more than capable of doing.
I am an instructor and appreciate your commets and hope you will give feedback to this instructor. This has been a frustration for instructors also. you would think that students who are supposedly adults wouldn't have to be babysat, but this is what happens. I as an instructor have become aware of this and constantly searching for where my students are and what they are doing. I have let them know that there is always something to do and they need to find it. Please everyone let the clinical instructors know your thoughts so we all can prepare better nurses.
I'm not dismissing these student's behavior. Sitting around just chit-chatting isn't acceptable.
Still, as a nursing student, you often don't know what it is you should be doing to maximize your educational experience. If you are refilling water pitchers, stocking supplies, helping make beds, taking patients to the bathroom, etc then you end up almost never seeing the nurses doing their job because you're always in two different places and you may be stuck in a patient room or in a supply closet when an opportunity to insert a foley catheter or the like comes up.
Also, if one hasn't worked as a CNA, the simple task of "getting someone up to the bathroom" can be embarrassingly difficult. Nothing like coming out of a patient room and the nurse or CNA looks disparagingly at you "It took you THAT long to do that? You're never going to make it at that pace!" Little things like what to do with the foley catheter when a patient is ambulating... how to drape and secure the gown so it doesn't slip off when the patient stands up... can be intimidating to a nursing student who when they ask for help from the CNA or nursing tend to get eyerolls and comments like "What are they teaching you in school anyway?" Sometimes, the CNA or nurse pushes your efforts at being helpful aside knowing that they can do it better and faster and don't have the time to accomodate the student nurse's learning needs.
I haven't read all the posts.. but most of them. I am a 3rd term LVN student and the situation that Tulip described wouldn't fly in my program AT ALL! I have 3 patients a day, 3 times a week. We are responsible for AM care, meds if we're passing them that day, ect... The whole point in being in clinicals is to get used to full care, I don't understand why last semester ADN students wouldn't do that? We are learning to delegate, but that doesn't mean we're not responsible for all that happens with the patient.
Most people will do as little as they can get by with - so the preceptor and instructor should have been communicating better. These are type students who will request critical care because they want to monitor the equipment, not the patient. AARRGGGGGGGGGGGG
Reading the OP, I had visions of how a few very lazy peers in the work world might have behaved likewise while in school. But one that I had the displeasure of working around, was savvy enough to talk up a storm to the supervisors. Everyone knew her work habits, but she kept from having to do any work by excelling in politics and lying about her co-workers. Fine people to have to work around every day. Yes, they might have been showing the behaviors while still students.
There are many rotations for us (I'm a 3rd semester student) that we only get one day on a particular unit. Typically the more specialized ones- ie MICU, ER, OR, Peds, Cath Lab, Oncology... I can tell you that when I am in my one day on that unit, especially never having worked in health care before that I would not have the slightest idea what needs to be restocked etc. If I was asked to do it- I would, happily, but I have always been under the impression that different units have different ways of doing things, especially when it comes to stocking rooms. This is not an excuse for the students you had, but maybe something to consider before you decide they were lazy. It also may be different or more obvious at your hospital than the ones we are in.
I know as a student, I try to get involved as much as I can, but many times in our 'offsite' rotations I have no clue what to do, or what I should be or can be doing other than the usual assessment and meds pass. Like I said, we have one day in those more specialized units.
About the CNA responsibilities, we are instructed that we are not CNAs or Techs while we are there. That yes, help out, but we are in the RN capacity while we are at clinical, not CNA, thus the majority or our activities during the day should be centered on learning what the RN does on that unit. For me, I typically follow my nurse around, EVERYWHERE. Even with patients that aren't necessarily ones I'm helping take care of. If my patient or patients are taken care of for the time being, you can bet I'll be your shadow. Its my goal to figure out what I will be doing as a RN, to learn the RN's role on the unit not to busy myself with other tasks that I will not learn about the RN's job from. If my RN is charting at the computer, I will sit down next to her and try to learn about the charting. If thats not possible- that is the time I'll be taking on CNA responsibilities. I understand that part of the RN's job can be doing many of the CNA things, and when the RN I'm following has those jobs to do, I definitley pitch in. I take my cues from the RNs on the unit. I like to help out when I can, but my primary responsibility while I'm at clinical on the unit is to learn how to be a RN. You won't really find me sitting around chit chatting unless I'm out of things to do (which is rare), and don't know what I can be doing. At that point I usually ask. So don't assume your students are lazy. Sometimes we just need direction- particularly on units we've never been on before and there isn't an instructor present.
I totally agree with the OP, this was my experience when I had a student, and I was disgusted with the lot of them. Worst of all was no report when they left, and no discussion with me about who would do what unless I initiated it. The group we had gathered round the nurses station in the way with an open book and gossipped. ARGHHHH!
I remember when the nurses on the floor (let alone the instructor) would pounce on us if we were caught without something to do. We were roped into untold vital sign rounds, rounds for backrubs, and rounds with the snack tray, and all the cleaning up, fetching and carrying that came with those rounds. All with the instructor's blessing. But then if someone got really sick, or there was a cool procedure happening the RN's would give us the heads up. We could also catch them in a free minute and pepper them with questions. Those were my favorite times, we'd dig out some archaic tool no one had seen and ask someone what it was for and how to use it. That was especially fun and bizarre in the OB unit!
Students are missing out on the "life" of a nurse experience if they just sit around. One, because they aren't DOING anything, and two, because they've shut themselves off from the established nursing staff. My fondest memory is the night I burst into tears after being ridiculed by a snotty RN, ran into the utility room and two CNA's and the other RN followed right behind me to give me a hug. Being part of the team is one of the most rewarding experiences in nursing, and it's being lost to our students when they are stuck in sociology class, and not with their peers.
Sometimes my students are standing at the desk because we have run out of things to do. I send them to answer lights etc., and follow patients off the floor for proceures, but the Aides on the floor I have students on are really good. They generally have rooms stocked before my students have their AM care done. Being so early in the program, they can only pass meds with me, not the floor nurses; they are so slow and step by step learning it that I can only do AM meds with 2 a day. I don't let them hang out in the break room to finish paperwork, but I do let them work on their care plans at the desk. I would love to assign them more than one patient, but its a small floor, and I have trouble enough assigning a challenging patient for each of them to begin with.
I just finished up my third semester of nursing (med-surg). I was on an ICU step-down unit and didn't have too much time to slack, but when I found myself standing around at the desk it was because I didn't know what to do. I wish that in the beginning the instructor would have said, "Ok, your first priority is________and when you get finished with that do_____." We were supposed to be providing complete care for our two assigned patients, but I think I would have liked it better if we were assigned to a nurse all day, at least for a couple weeks. I've gotten better at butt-wiping (nothing wrong with that), but do I feel comfortable managing my time and prioritizing care for 4 patients? Yeah, right! I know there's more to patient care than vitals/meds/assessments/hygiene, but it's hard to RN care management role without really getting to see the nurses in action.
cuddlebug
54 Posts
I never remember nursing school like that. I think for the most part nursing students are hard workers, eager to learn everything they can. In my opinion MOST of them work off their ....you know what.