Nursing School Patient Loads

wish_me_luck, BSN, RN · Apr 2, 2013

When I was in nursing school (less than a year ago), we had one patient. The reason we didn't have more is because we needed a nurse (usually supposed to be the instructor) with us--There were five of us students on the floor at a time, so everyone having one made for 5 patients for instructor. It would have been rough on the instructor if we had more. So, we had one patient and if we wanted something else, we did the CNA/PCT work for another. Other times, we went with the floor nurse; but, honestly, quite often they didn't want to have a student (slows them down).

VANurse2010 · Apr 2, 2013

I never had a realistic patient load in nursing school. I took a different track than most by starting in LTC/SNF, but to listen to some nurses on here you'd think one was doomed to failure if you weren't (or couldn't be) given a real patient load by the end of nursing school. Hogwash, I say.

CT Pixie, BSN, RN · Apr 2, 2013

I am in my 2nd class for this semester which is also my last class of the ADN program. For all other clinicals we only had 1 patient, but with this class we are assigned 2 patients. We stay on the same floor for the duration of the class and have clinical days 2 days a week for 8 hrs per day.

I am currently an LPN and work LTC. My patient load is 33 pts w/full census. I don't think I could handle 5 patients at this point in my program and I'm use to having a lot of patients to care for. To expect that student to handle 5 is crazy in my opinion. Even the RN's on our clinical floor have 4 patients max.

Bouncyball · Apr 2, 2013

I am in my last semester of an adn program and we are expected to take a minimum of 4 patients everyday, a maximum of 5. We are allowed to delegate vital signs and ADL's to the CNA. We have 2 8 hour days a week and change floors monthly.

We also have no access to the Pyxis but must give all meds to all patients, do assessments, electronic charting, transcribe new orders, call pharmacy and MD's ect. The not having access to the Pyxis is usually not a problem. Since we take the entire patient load from the RN, they are usually bored and more than happy to get the meds out for us. If the nurse does will not get the meds out, our instructor has to and then your time management is is messed up all day.

We are the only school in the region that has this many patients in clinicals, but we also get jobs over BSN students because our students have a fierce reputation and we hit the ground running. Most schools around us give their students 1-2 pts. It is extremely difficult and I am always stressed, but am thankful it is teaching me time management.

Tait, MSN, RN · Apr 2, 2013

blacksunflower said:
I am in my last semester of an adn program and we are expected to take a minimum of 4 patients everyday, a maximum of 5. We are allowed to delegate vital signs and ADL's to the CNA. We have 2 8 hour days a week and change floors monthly.
We also have no access to the Pyxis but must give all meds to all patients, do assessments, electronic charting, transcribe new orders, call pharmacy and MD's ect. The not having access to the Pyxis is usually not a problem. Since we take the entire patient load from the RN, they are usually bored and more than happy to get the meds out for us. If the nurse does will not get the meds out, our instructor has to and then your time management is is messed up all day.
We are the only school in the region that has this many patients in clinicals, but we also get jobs over BSN students because our students have a fierce reputation and we hit the ground running. Most schools around us give their students 1-2 pts. It is extremely difficult and I am always stressed, but am thankful it is teaching me time management.

Your situation sounds similar to the one we are discussing, though I am not sure how the RN factors into the other students day. Maybe, if you have time, you could pop over to this thread and offer some advice on managing that many patients. ?

cherry_blossom · Apr 2, 2013

There is a discussion going on in the Nurse Educator forum related to clinical expectations. Anyway something that has come out of it is the amount of patients this student is responsible to take on.
In my ADN clinicals back in 2005ish in our last clinical rotation we were expected to have total care over two patients. We were on the same floor for 8 weeks, had two new patients per week with three days of 8 hour clinicals.
The student I am talking to is expected to ramp up to five patients by her last semester, do full care yet not have access to the PIXIS without the primary RN, and has to move to a new floor and learn a new stocking layout about every week.
Does this sound common? I have yet to ask where she goes to school, so this may be an outside of the US situation.
I am just curious as to what your degree is and what clinical expectations they had for you during school.
Tait

I work at a hospital and on a normal day the RN's get 2-3 pts....on a busy day it's 3-4....sometimes 5. So it's better to be over prepared, get as much experience as one can. It will benefit in the long run :-)

vintage_RN, BSN, RN · Apr 2, 2013

I am in my second semester...and i take a 3 patient load every week. We have no aides, so it's full care for all three. My rotation this semester is on a complex care unit (LTAC)..so i have the same patients every week. This makes it easier.

PMFB-RN, RN · Apr 2, 2013

Responsibiliety for 4 or 5 patients was normal in my school's clinical. We had either three 8 hour clinicals, or two 12 hour clinicals a week. This was prior to all hospitals using PIXIS and we could just sign out our meds. We were the the staff nurse for those patients with the RN or our instructor supervising. We had plenty of patients to choose from. Our instructor did not choose our patients, she chose the staff RN we were assinged to and we took that RNs patients. Was great experience. I can remember having a 1 month old and a 100 year old patient on the same day.

sbostonRN · Apr 2, 2013

During my last semester we generally had one patient for total care (including meds on one day). My instructor gave me two in my last semester because he thought I could handle it. I was in an ADN program.

The students in the BSN program that come to my current hospital are senior nursing students and still share a patient (2 students to 1 patient). They also don't pass meds and rarely even help with wound treatments. I'm actually a little worried that they'll be shocked by the reality of nursing when they get licensed in less than 3 months and are faced with 6+ patients. I think a lot of it depends on the instructor.

CodeteamB · Apr 2, 2013

Hey, I have a BScN, which is the entry to practice standard here in Canada. When I was in school we started with one patient and worked our way up to 3. Our instructor said she would like us to take 4 but there were six of us on a 22 bed unit.... So that didn't work out. Of course, preceptorship was a full patient load.

We were also allowed to give all meds unsupervised (some needed dose co-signs) and do most procedures without our instructor. I never did clinical on a floor where students did not have access to the medication cart or Pyxis. We even did our own narc count with our instructor at the end of the day so that we could have a narcotic key available to us.

I think more patients is feasible provided the students have some leeway to act independently. In the city where I am now we would get some students on the floor in their final placement (prior to preceptorship) who took 2 patients but weren't allowed to do very basic things without their instructor. Some of these students would miss out on things with their patients because of the time constraints of the instructor (eg. I am not waiting 15-20 minutes to give a PRN neb for respiratory difficulties, I'll do it myself).

chrisrn24 · Apr 2, 2013

I didn't do a traditional senior clinical but the folks that did I believe ended their senior capstone with 1-2 patients independentlyI'm assuming depending on acuity and under supervision.

For junior clinical which we had 1 time a week, we did 1 patient each (prepared for that patient) but we would be under the watch of the RN except for vitals and easier things. But we would help with other patients (if one patient had a PCA pump and mine didn't I could go see that for example).