Student supervision

[1Tulip]

Yesterday I was "shadowing" a staff nurse on our neuroscience service. She was great, the whole staff was great. I'm going to take a job there. But here is my question:

There was a student on the unit from our local ADN program. She was wearing her student uniform with the school patch. She had responsibility for the care of one fairly stable patient and was being well supervised by the staff nurse. However, I never saw an instructor come by. I didn't see any education happening at all. No care plan, no med discussion (the staff nurse gave the meds), no Q and A from anyone on patho-processes, assessment, or evaluation... Nothing.

Now, I've been out of direct patient care for well over a decade. Maybe things have changed. But don't nursing schools still put a gaggle of nurslings on one unit (or maybe two geographically close units) with their instructor who closely watches them and endeavors to further their clinical education?

What is going on? (I was technically a visitor and didn't want to ask potentially rude questions.)

[VickyRN, MSN, DNP, RN]

Perhaps this was a senior nursing student in some sort of internship program with preceptor? These are becoming very popular: http://www.ncbon.com/Education-preceptor.asp

[1Tulip]

Possibly. But she was doing really basic stuff. I find it unlikely that she was a senior.

But, I wonder... forgive me if this is a bone-headed question: For regular clinical instruction, is it still the practice to group the students in close proximity such that an instructor can closely watch over them for safety and instructional purposes?

I have seen at least one situation where the instructor's students were sprinkled all over the hospital because (the school said) there was a shortage of clinical sites. They gave the instructor a pager so students could call for her if they got their fannies in a crack. It was arranged like this over the objections of the instructor, I should add.

[suzanne4, RN]

Unfortunately, I ran across the same thing the other day. I had a student taking care of one of my patients, no instructor for hours on the unit, and the student was quite "green" in what she knew.

Not the way that I went to school, and definitely not the way that I would teach. The instructor had students on multiple different units, and could not know what was going on with her students. This is unacceptable to me, and they had just started med-surg.

[purplemania, BSN, RN]

Believe me, there IS a shortage of clinical sites. We have 4 nursing schools wanting sites in our 150 bed hospital and, of course, they all want the same days. The Instructor must be on site, but does not have to be with the student if an RN is present. This way I can place them in OR, ER, Wound Care, etc. and not all on the Med-Surg floor at once. Texas law requires one MSN for each 10 nurses, but allows an assistant for up to 15. However, if the student is being precepted one-on-one the Instructor does not have to be present. As a former clinical instructor I shuddered at having to leave a student then go to another floor to check on someone. Too much liability for me. But the schools just don't have enough staff and we don't have enough beds.

[NurseJimAZ]

many clinical sites restrict the number of students per unit, forcing the instuctor to be in multiple locations. i have had students in up to 6 different locations in the hospital. unfortunately, you end up spending more time with the "bad" ones (because they are not trustworthy) and less time developing the stars. the good news is the "stars" are usually bright enough to self-train.

[1Tulip]

I don't know. It's been 15 years since I was a clinical instructor. But it just seems to me that even if I had to put 2 students on one patient in order to keep them all geographically together, I could provide better instruction in a safer environment. Obviously, it wouldn't help them learn to organize their time and set priorities, but that's a later-down-the-road proficiency than basic care, meds, IV's, etc.

Of course, if the hospital has a policy that restricted the number of students on a unit, the instructor's hands are tied. I wonder, however if the administration could be made to see that by spreading the instructor so thin, they are putting greater burdens on their staff nurses. Oh, that's right... we're talking about hospital administrators, here. Can't tell them anything they don't want to hear. What was I thinking?!!

[Mymimi]

I am also from Texas, and we are limited in the number of clinical sites, with a 30-40 student increase from last year! The Texas BNE does limit the number of students per instructor as mentioned above. I have had first year nursing students this semester, the nurses were wonderful, and I had students on one floor only. It was great! For the seniors next semester, I will have them in several different areas. It seems every area in nursing has a shortage, including clinical areas. Our hospital restricted the number of students on the floor at one time, also.

[luvmy2angels]

We have some areas of clinical in the hospital where it is just us students, no instructor. These are basically observational like cath lab, endo lab, and the OR. Whenever we are doing patient care like giving meds, treatments etc, there is always an instructor there to help and guide us. There are also places we go outside of the hospital that we go on our own for instance child care centers, we went to our local prison, we spent an evening with a visiting nurse etc.