Nursing student asks nurses the question..

elkpark · Jun 25, 2016

Elkpark: Not sure how that is supposed to look. 1 clinical instructor, 10 students parading around a unit taking care of a patient...? Have you seen that where you work? Our good clinical instructors did teach, but they can only be one place at a time and the hospital spread the students across several units. The good instructors would round on us students, spend time with us and our patients and observe us/help us get signed off on skills. The bad instructors sat in the cafeteria working on their own assignments for their MSN program, and utilized the time for their own benefit. So elkpark, describe your clinical experience? Did you have a 1:1 clinical instructor all to yourself for 12 hours that would follow you while you followed a nurse? Your response is illogical.

As a nursing student, I was a member of clinical groups that were supervised by a clinical instructor who supervised us providing care to our assigned clients. It was never a case of "1 clinical instructor, 10 students parading around a unit taking care of a patient..." We certainly did not "tour the hospital while the instructor teaches," and following a staff nurse around is not "the only way to have patient contact and get a small feel of what nursing is." We graduated with a v. clear and realistic sense of what nursing practice was, much more so than students do now. In our clinicals, we had two, three, or four assigned clients each (heavier client loads as we progressed through the program, of course), and our instructors were active on the floor, supervising each of us individually giving meds and doing any kind of invasive procedure. For the basic nursing care, we didn't need to be supervised, and there was never any expectation (or need) that we would be supervised 1:1 by an instructor for an entire shift. We provided all the direct nursing care the clients needed (except for, in our earlier clinical rotations, the few advanced skills we weren't allowed to do yet). By the time we were close to graduation, we did everything the staff nurses did, and were basically functioning independently (although we still had an instructor present and available). There were staff nurses assigned to our clients, of course, and we communicated with them and interacted with them during the shift, but they were never expected to do any teaching, and weren't allowed to officially supervise us doing any skills or tasks (and they all knew that). The "dumping the students on the staff nurses" is a relatively new model of nursing "education." As a faculty member in ADN and BSN programs over the years, I've taught med-surg, pediatric, and (mostly) psychiatric clinicals, and I have never paired off students with staff nurses and expected the staff nurses to do the teaching (nor have the other faculty in the programs in which I've taught). The staff nurses are there to do their jobs providing nursing care to the facility's clients. The nursing instructors are there to supervise and teach the nursing students. I understand that is a different model than you've experienced, but I don't understand how that makes it "illogical."

Tenebrae, BSN, RN · Jun 25, 2016

....
Some nurses are very disrespectful to students, they see us as extra work.....

You are extra work that I dont get paid for.

Sorry if that hurts your feelings. There is no gentle way to say it. Some students are great to have on the ward. Others who hang out in groups, barge into situations they have no comprehension of and generally create more work are just a PITA

Tenebrae, BSN, RN · Jun 25, 2016

Nurses eating their young on social media sites.

Statement of fact

JVLims · Jun 25, 2016

Elkpark, your program sounds a lot like my ADN program. We were responsible to go to the clinical site a day before to research our patient and had to be prepared to address whatever disease process was affecting them. Pre and post conference were held in a meeting room, not in an area that proved inconvenient to staff or HIPAA-imploding...we ended the program as team leaders with an assignment. All med passes and new clinical skills were under the direct supervision of the CI. We never expected this of the staff nurses, agree with your observation that many I see have a rather loose, boundary free relationship with their students that I find troubling. Recently I observed one CI disappearing for a goodly portion of time when students were still on the unit. I can't understand that.

hillbillienurse · Jun 25, 2016

First of all I suggest you do a search of this site. This question has been asked many times before and there are some particularly good threads with very comprehensive answers to you question. Secondly, I suggest you re-read your post and find the extremely inflammatory and rude sentence that is going to get you burned to a crisp when more people respond. Or get your flame-proof undies on because it's going to get real for you very fast.

No cause for that reply. It was arrogant and rude. She wants help, not more snob.

bekabsn · Jun 25, 2016

As a nursing student, I was a member of clinical groups that were supervised by a clinical instructor who supervised us providing care to our assigned clients. It was never a case of "1 clinical instructor, 10 students parading around a unit taking care of a patient..." We certainly did not "tour the hospital while the instructor teaches," and following a staff nurse around is not "the only way to have patient contact and get a small feel of what nursing is." We graduated with a v. clear and realistic sense of what nursing practice was, much more so than students do now. In our clinicals, we had two, three, or four assigned clients each (heavier client loads as we progressed through the program, of course), and our instructors were active on the floor, supervising each of us individually giving meds and doing any kind of invasive procedure. For the basic nursing care, we didn't need to be supervised, and there was never any expectation (or need) that we would be supervised 1:1 by an instructor for an entire shift. We provided all the direct nursing care the clients needed (except for, in our earlier clinical rotations, the few advanced skills we weren't allowed to do yet). By the time we were close to graduation, we did everything the staff nurses did, and were basically functioning independently (although we still had an instructor present and available). There were staff nurses assigned to our clients, of course, and we communicated with them and interacted with them during the shift, but they were never expected to do any teaching, and weren't allowed to officially supervise us doing any skills or tasks (and they all knew that). The "dumping the students on the staff nurses" is a relatively new model of nursing "education." As a faculty member in ADN and BSN programs over the years, I've taught med-surg, pediatric, and (mostly) psychiatric clinicals, and I have never paired off students with staff nurses and expected the staff nurses to do the teaching (nor have the other faculty in the programs in which I've taught). The staff nurses are there to do their jobs providing nursing care to the facility's clients. The nursing instructors are there to supervise and teach the nursing students. I understand that is a different model than you've experienced, but I don't understand how that makes it "illogical."

I still think you misunderstood my original intent, which was to highlight the responsibility the student has to make the most of their own learning experience regardless of their clinical experience.

Thank you for this reply, as i appreciate your insight and perspective. From my frame of reference, all I can go by is that I had some good clinical instructors who did teach and were very involved, and some that were bad. Overall, I came out of nursing school pleased with my clinical experiences, and I would be lying if I didn't tell you that the nurses I followed were amazing and I learned a lot from them. I work with some of them now on the unit. But you sound like a seasoned nurse who has experienced a certain "evolution" from how nursing students used to be to how they are now. It is interesting for sure. But I'd like to point out that my good instructors didn't expect the nurses they paired us with to teach us, but that doesn't mean I didn't learn anything from those nurses. The point remains that students still take a patient (or more) that is actually being cared for by a staff nurse, and interaction with that staff nurse will inevitably take place, and the end result may be that the student actually learned something from the nurse. If I learned something from the nurses in my clinical experience, is that wrong?

Wuzzie · Jun 25, 2016

No cause for that reply. It was arrogant and rude. She wants help, not more snob.

Complete cause for that reply. She wrote something extremely snotty that she edited out after I suggested she do so. You apparently did not see the comment. And had you bothered to read further I DID help her by finding threads that would answer her question very nicely. How's the air up there on your horse?

suni, BSN, RN · Jun 25, 2016

As a clinical instructor I check all the charting my students do on their patients. I will tell you it is difficult at times due to the variety of documentation systems. I usually have 6 students and tell them I must be physically present for any procedure and they can only give Meds with me. Having said that, if there is a procedure I am not familiar with, after reviewing the policy, I will ask the staff nurse if we can observe her doing it once and we will do after that.

nursej22, MSN, RN · Jun 25, 2016

Chiming in as a CI here,

we do not have students go in the night before and research patients for multiple reasons.

It is almost impossible to predict if a patient will still be there the next day: they go home, to OR and to another unit, or worsen and go to ICU.

If they are predicted to stay, they most likely are not suitable for a student: too complicated or a placement issue.

The floor nurses expect to not have more than 1 student amongst their group, so assignments on the day of

care assure this.

And they may decline a student, which tosses all that prep work out the window.

Yes, I do all the meds with my 4 or 5 students and review their charting. And I do this with limited report, and zero training with the EHR.

I only have 2 hands, folks. I am so grateful to nurses who agree to work with students, and I definitely want to hear about unprofessional behavior!

Ruby Vee, BSN · Jun 25, 2016

No cause for that reply. It was arrogant and rude. She wants help, not more snob.

Evidently you didn't see the original post. Wuzzie's post was nowhere near as arrogant and rude.

sharonihum, MSN, RN · Jun 25, 2016

I am very sorry you all have had such rotten clinical settings and nurse preceptors. Not all of us are like that. In certain cases, maybe that person's dog just died, or their husband/wife/boyfriend/girlfriend just cheated on them; or maybe, they are really in a "burn-out" stage and barely get through the shift on their own. Maybe these particular preceptors don't have a lot of knowledge, or have no clue how to share what they do know. Maybe they struggle with understanding why they do what they do and having a cute little very intelligent student taggin along just rubs in that terrible secret truth only they know (or think they are the only ones who know). Bottom line, you have a clinical instructor and these nurses have managers and directors. You will learn this eventually, so you might as well learn it now and learn it well - when something isn't working well and you can't have a pleasant and rational conversation with the person who is a barrier to your learning experience (or care experience) - you need to immediately talk with your clinical instructor/charge nurse/manager/director and ask why you are having such a difficult time. Feel too timid? That's a shame....you will not learn if you don't speak up. And you can be direct and polite at the same time. It's all about what is best for the patient. In your position, learning all you can from various teachers is the best thing for all your future patients. AND as a profession, we are dedicated to producing top-notch nurses who practice from the heart. Take note from those who do not and learn how NOT to become like they are to you. Keep your focus on the main thing and you be kind and nurturing to the patients you attend while on clinical rotations. All people expect is kindness and caring compassion. Give it to them. Even the "grump-l-stilt-skin nurses" you may have the unfortunate "luck of the draw" from. Remember, we learn in ALL situations; even the unpleasant ones. Take a good look at who you do and do not want to be like when you are a professional registered nurse!

In the meantime, be blessed and have fun learning! :-)

HDFXDWGRN · Jun 25, 2016

I'm trying to understand what you have 4 years of experience in and how you specialize in ICU, trauma, and M/S if you're currently a student.