Nursing school Clinicals

Zippy83 · May 6, 2019

Unlike a teaching hospital, where everyone who works there understands that it is a teaching hospital and generally might have an open attitude towards that, long-term care centers don’t really operate that way, so the nurses working at these facilities usually had no choice in the matter, and likely did not even know that the facility accepts students for clinicals throughout the year when they took the job.

In my experience most of the places that we did clinicals, the nurses felt that we were in their way and hated when we were there. We did try to stay out of their way as much as possible. They would even complain to our instructors if we were taking up too much space at the nurses station when looking at charts, looking at the chart too long, etc.

I actually enjoy training nurses, and often have a new nurses shadow me when they come to our company, but I’m in home health and hospice which is very different than the environment in an LTC. At the time I thought those nurses were mean but now I understand that they were probably already overly stressed and burdened before we even got there, and then we made it even worse.

On the one hand it sounds like your instructor is a bit of a hothead, but you also have to consider that there is a lot of competition for clinical settings, and they can get stressed out if they fear that any of their students are putting them at risk for a facility deciding they don’t want to deal with that school anymore. It probably would’ve been smart for them to tell you upfront to stay out of the way of the nurses as much as possible. But at the same time, you are not a nurse coming on shift asking for endorsement on the patient, you should definitely be doing your own assessment and looking at the chart to build your care plan.

Now you know!

Nickc58 · May 6, 2019

I am frankly upset that so many experienced nurses are responding to this post the way they are. Students shouldn’t ask questions? ARE YOU SERIOUS? I am still a student. I finished my last clinical week this week. For our last week we pair with an RN at the hospital associated with our facility (not and instructor) and work with them for 36 hours (a full true week of nursing). In this time I took care of 14 patients, and not ONCE was I asked to write a care plan. Instead, I was asked to hang IV fluids, administer medications, perform assessments, and perform proper documentation doing this time. I also participated in rounds and gave report to incoming nurses. How are you supposed to do ANY of these things if you are DISCOURAGED from communicating with the team? And honestly oh well if the original poster was asking questions that helped formulate her care plan. She is a freshman who needs to learn. I personally need someone to specifically show me how to do something, then I can do it myself. And then on top of this all the clinical instructor is showing such immature behavior! Aside from taking her actual care plan to the nurse and asking the nurse to answer questions down a list, she should be encouraged to ask questions! My gosh the replies in the post have me infuriated. To the original poster keep your head up. I am sorry that you have had to deal with a clinical instructor like this. If the other faculty in your school support behavior like this, I would consider choosing a different school.

Zippy83 · May 6, 2019

Quote
For our last week we pair with an RN at the hospital associated with our facility (not and instructor) and work with them for 36 hours (a full true week of nursing). In this time I took care of 14 patients, and not ONCE was I asked to write a careplan. Instead, I was asked to hang IVfluids, administer medications, perform assessments, and performproper documentation doing this time. I also participated in rounds and gave report to incoming nurses.

What you are describing there is a preceptor, which is completely different. In that case, that nurse is assigned to work with you and teach you and answer your questions. That is usually done in the hospital setting.

What the OP is describing is a clinical round in an LTC where the nurses on staff have nothing to do with the school or the training, and her assignment was to create a care plan on a specific patient.

That’s an apples to oranges comparison. If she was working in a hospital with a preceptor and was yelled at for asking questions, that would be insane.

JKL33 · May 6, 2019

31 minutes ago, Nickc58 said:
I am frankly upset that so many experienced nurses are responding to this post the way they are. Students shouldn’t ask questions? ARE YOU SERIOUS?

Hello Nick,

A few of us have very specifically described that the specific question asked (as reported here) may have been broad enough that it was perceived in a way other than what the OP intended. I'm not going back detail by detail to see if someone in fact did say "students shouldn't ask questions," but I can assure you that hasn't generally been the spirit of the responses to this OP. It's almost like you didn't even read what we did say.

31 minutes ago, Nickc58 said:
For our last week we pair with an RN at the hospital associated with our facility (not and instructor) and work with them for 36 hours (a full true week of nursing). In this time I took care of 14 patients, and not ONCE was I asked to write a care plan. Instead, I was asked to hang IV fluids, administer medications, perform assessments, and perform proper documentation doing this time.

That sounds great, although that has nothing to do with what we're discussing here.

31 minutes ago, Nickc58 said:
How are you supposed to do ANY of these things if you are DISCOURAGED from communicating with the team?

Students are not as a rule discouraged from communicating with the team... whatsoever.

31 minutes ago, Nickc58 said:
And honestly oh well if the original poster was asking questions that helped formulate her care plan. She is a freshman who needs to learn. I personally need someone to specifically show me how to do something, then I can do it myself.

And there are plenty of things that staff nurses are happy to show you and talk about and teach about, provided they can take a minute or two to do so.

Creating a care plan is generally not one of those things. That is the instructor's realm, although I personally am happy to help with specific questions I may be asked.

Of course, question #1 should be: "Do you have a minute for a care plan question about the patient I'm caring for today?" [or whatever] but not: "Anything I need to know here?"

31 minutes ago, Nickc58 said:
My gosh the replies in the post have me infuriated.

Okay. I'll entertain this. Which ones?

Oldmahubbard · May 6, 2019

I did clinical back in medieval times, but we didn't bother the nurses if we could possibly help it. We understood we were to work very hard to answer our own questions, and make the material our own. It was evident from their body language and facial expressions that our presence was a nuisance, because they were already stretched to the absolute max.

Should it be this way? Probably not. It would be a better world if hospitals and LTC facilities were well staffed, everyone is cheerful and relaxed, but don't expect it in your lifetime.

I completely agree that if the student had said " do you have a minute for a quick question?" they probably would have been fine. But not "what should I include on the care plan?"

And I do think we sometimes clobber students over the head too hard for these types of minor faux pas.

Live and learn. As my mother used to say, I hope that's the worst thing that ever happens.

LubbDubb77, BSN, RN · May 8, 2019

On 5/1/2019 at 5:46 PM, Trinity33 said:
I've been taking classes toward an RN degree and started my first semester of Nursing school. I am in my clinicals at a long term care facility where we were each assigned a patient. Our job was to create a care plan for them. In order to aquire more information about mine, I asked the nurse on staff that cares for her some questions. Apparently she told my instructor I had asked questions and he blew up at me after class. I am guessing she was annoyed by the questions.
My instuctor is now very upset with me, as I could tell he would no longer make eye contact with me, verbally began saying I don't know anything, and now failed my care plan. I noticed today that my classmates were discussing how he left them many notes but had not taken off points.
I am already under a lot of stress with a full courseload, and also work outside of school. My instructor has been very difficult to approach and responds to questions with questions. I feel as though I am now being subject to his emotions.
Does anyone have any suggestions for me? Was I wrong to ask the nurse? I was not advised not to talk to anyone.
(Another student had missed some work and was going to be sent home and mentioned too he would not look at her, so this is a behavior trend when he is upset).
I fear telling anyone will cause for problems but also very upset over this. I am an A-B student and do not beleive this is an issue of my not doing the work or knowing how to do it. I now face failing my very first clinical and not sure what that would mean going forward if I wanted to switch schools or how it might affect my standing.

In my program, we were specifically instructed to not bombard the nurse with questions because they already have enough on their plate. If we have questions, to ask the instructor.

In my opinion I would talk to the instructor and apologize. Just explain that you didn't know and won't do it again. Just show a sincere interest in correcting whatever you did wrong and ask for help.