Nurse/Student ratio at clinicals

cgravier · May 16, 2011

yeah thats a pretty crazy set up. Our whole class is only 20 students broken up into 3 clinicals 2 at 1 in the am/pm and 1 at a different hospital We have 4 cohorts (classes about 20-30 students each)that are staggered (1 starts in august, 2 in dec ect) but we have 6-7 clinical hospitals we all go to. No cohorts are at the same hospital at one time. Cohort 1 for example are doing peds at a Childrens Hospial which we wont even see till next year.

Whomever said all nursing programs are the same is clearly wrong.

In my program, there is one clinical instructor for every 10 students. Students are normally spread between 4-5 different areas of the hospital so the instructor travels around as she can to observe/help with skills.
Very often, she will let our primary or charge nurse observe us doing new skills.
The primary nurse(s) for our patients are supposed to review our charting. Some do, some don't. Some of the nurses are wonderful about instructing students and some of them are not. A handful of them shouldn't be allowed to work with students, but we have no control over which primary nurse is assigned to our patient.
Although I feel most people are doing their best to see students have learning opportunities, if the instructor is busy and requests the charge nurse to observe, and she is busy, the student loses the opportunity to perform the skill. It's frustrating as a student to lose a valuable opportunity to experience a new skill.
The program I'm in used to take 40 students each fall semester. Recently, they added an additional class of 40 students each spring. That means in any one week, about 150 students are doing 2 different shifts at a hospital that has about 250 beds. It just feels like the nurses are overwhelmed with all of us. The deeper into the semester we get, the more short-tempered the nurses are. Some are downright hostile.
My classmates are telling me that nursing programs all over the country are set up the same way. I was just curious how other schools have structured the clinical environment.

Seas · May 16, 2011

Oh my...

OP, I feel sorry for the students, and more sorry for the floor nurses who "have to" work with students on top of their patient workload.

My class had 18 people and we had 3 clinical groups. So, 6 students per clinical instructor and floor. The nurses didn't have to work and teach us students unless they were willing/had time to do so.

ggmugsy · May 16, 2011

Thank you all for your input! :)

KimberlyRN89, BSN, RN · May 17, 2011

Our cohort has about 17-18 people. We have two different clinical sites(one at a hospital, the other a nursing home), and has three different groups. My clinical group has 7 students, which is the largest group. We each get one patient, and I think there are three nurses, and one tech on the part of the unit. The nurses give us report, and pretty much leave us alone after that. I don't seem to understand what the issue is with the nurses on the floor? I mean, after they give report, what more do you expect out of them? I'm not trying to be snarky or anything, just wondering...

dandk1997RN, MSN, RN · May 17, 2011

In my program, there is one clinical instructor for every 10 students. Students are normally spread between 4-5 different areas of the hospital so the instructor travels around as she can to observe/help with skills.
Very often, she will let our primary or charge nurse observe us doing new skills.
The primary nurse(s) for our patients are supposed to review our charting......................
My classmates are telling me that nursing programs all over the country are set up the same way. I was just curious how other schools have structured the clinical environment.

My school is definitely not set up this way. We have 180 in our program to start. There is a limit of 8 students per clinical instructor, and usually only two floors per facility (one instructor each) have students from our program at any given time (but there are students from other schools, generally on different floors.) I find it bizarre that your instructor goes from unit to unit to observe- what if you do something you aren't supposed to do when she is elsewhere? We aren't allowed to do anything if our teacher is off the floor we are on. The nurses at the hospital are not responsible for us in any way, shape, or form. Maybe that is why they are more receptive to our being there? Our clinical instructor is responsible for overseeing all our charting, so she goes over it with us before we are allowed to leave the floor for our lunch break (so the sooner we get our shift assessments in, the better.) The nurses from the hospital can show us stuff they are doing, and help us understand the charting if they have time, but they are not at all obligated to (and sadly, the hospital that I have worked for for a decade was terrible in this regard- the nurses were glad we were doing their work, but didn't want to show us anything.)

Imagine this scenario- you've been doing clinicals for weeks at a facility, then show up one day and find a student from another school there...and he is working with your patient...who you were already sharing with a classmate because of the low census. So, 3 students to one patient, and one of them we had never seen before, because he was doing his preceptorship for another school. THAT was a bad situation.

ggmugsy · May 17, 2011

Thank you all so much! Reading your posts has been very eye-opening for me.

In hindsight, I should have asked more questions about how the clinicals were run. This time next year, I'll be studying for my NCLEX and be DONE with this school. I can hardly wait!!!

brillohead, ADN, RN · May 18, 2011

Max of 8 students per clinical instructor, most groups this semester are only 6 students.

And we're all on the same floor (up to 40 beds/floor) with our instructor. The floor nurses don't get more than one student, and our CI is always available to us somewhere on the floor.

shortnorthstudent · May 18, 2011

We have about 80 in our cohort. We have between 7-8 per clinical group and have groups at 6 different hospitals, so we don't have more than 2 groups (from our cohort - althought here may be other clinical groups from other quarters from our school or other groups from other schools) in any one hospital. We are assigned to a specific unit and we are all on the floor with our CI. The nurses assigned to our patients (and the PCA's as well) actually have more time to spend with their other patients because we do everything from am care to meds to other interventions and sometime accompanying our patients to other units for care. I had clinical today and my patient's nurse had 6 patients and one of her other patients also had a student. So, her other 4 patients were able to have extra attention. Ultimately, she is responsible for care of the patients the students are assigned to, so she does her own assessments and checks on them, but we answer call lights, etc. Our CI supervises us and is with us when we pass meds or perform skills that need her presence.

Not all the nurses are excited about having students, but honestly when that happens we all just sort of ignore each other and interact just for report or when pertinent information needs to be passed along.

BacktotheBeach, ADN, BSN, RN · May 18, 2011

Well, in my program and the nursing schools I know of, our clinical instructors were obligated to work with students, not nurses on the floor; except for taking/giving reports, and sharing any significant change in pt condition. No matter if there is 1 or 15 nurses on the floor, it didn't matter for us.
How is it in your school? How do the floor nurses work with students?

In my program, too, we only work with our instructor, not the floor nurses. Is this usual?

~Mi Vida Loca~RN, ASN, RN · May 19, 2011

3 facilities the instructors had 6 students each and were on 12 hr shifts, the other facility is was 8 students per CI for 8 hr shifts. I rarely saw my CI during the shifts, I was with my Co-Nurses for everything. If I needed my CI she would come, and she would make rounds checking on us. She was always available, but my co-nurses were always good and did everything with us. We could do any procedure or pass meds with either our CO-Nurse or CI there. For Senior practicum we don't have a CI. We have someone we report to half way through the practicum and at the end.

BacktotheBeach, ADN, BSN, RN · May 19, 2011

We were told we work under our instructor's license, therefore she/he must be there for most things we do. She has the responsibility if a mistake were to happen. If it is something we have been checked off on and done independently she will let us do it without her.

I don't see how the licensing/responsibility would work if you were working with various floor nurses. They don't know exactly what has been covered in your program at any specific point. Also we must do everything 'by the book', I would think random floor nurses would all do things a little differently.

~Mi Vida Loca~RN, ASN, RN · May 19, 2011

We were told we work under our instructor's license, therefore she/he must be there for most things we do. She has the responsibility if a mistake were to happen. If it is something we have been checked off on and done independently she will let us do it without her.
I don't see how the licensing/responsibility would work if you were working with various floor nurses. They don't know exactly what has been covered in your program at any specific point. Also we must do everything 'by the book', I would think random floor nurses would all do things a little differently.

We have sheets stating what we can do and we are responsible for letting them know. If we do something we aren't allowed to do, we got kicked out of the program. The nurses were always fine with us doing stuff how we learned and some were even thankful to learn the "new way" something was being done. It was never a problem or issue. I can't imagine if only the CI was allowed to be there. She couldn't be there all the time for so many students in various areas of the hospital. I would have had a much more limited experience on things I got to do.