Okay, I'm not a nursing instructor yet but...

Nurse Ratched, RN · Mar 14, 2004

I'm sorry your students weren't as prepared as it sounds like they could have been. I can't speak to what they should or shouldn't know since I've been out long enough to forget how stupid I was when I started :). I can say my recollection is feeling pretty clueless in school up to a certain point when suddenly (seemed like overnight) everything seemed to click. Hope your kids are on the verge of that epiphany also!

suzanne4, RN · Mar 14, 2004

I felt the same way when I precepted. If they know that they are going to be observing in surgery, you would think that they would prepare themselves. Things are definitely very different with students nowform when we went to school. In the old days, the residents and med students had the responsiility for knowing which cases that they were assigned to and it was their responsibility to be in the OR on time and be aware of what the case is shceduled for. Before I moved overseas, I spent about the first 20 minutes looking for the resident.

Is the instructor over these students aware of the deficiencies? Personally, I think that you should write an anecdotal note on each one. We spend a lot of time preparing and they do nothing. I had some problems with some of my students coming late to class, things are different over here. Made a new rule, a quiz every morning at 8am, if you are late you don't get the test or dictation. Has made a big difference. Perhaps if they know that they will be quizzed that morning, they would get their act together. Sorry to be so negative about this, but this is what is happening with many of the students, whether they realize it or not. Common sense is just not there............... :uhoh3:

angel337, MSN, RN · Mar 14, 2004

I precept students in the OR every semester and have up to 5 students per week with me in the OR for the entire day. This week was a little disturbing.
I get these young ladies and gentlemen at the start of the day and take them through all the surgeries I myself do during that day. So in addition to showing them the paperwork and discussing nursing diagnosis for the surgery patient, nursing concerns pre-peri-post-operatively, explain the equipment, instruments, and the procedure itself, I also do some very basic questioning on anatomy and physiology. This is natural because we need to discuss why a certain procedure must be done, the benefits, the risks, etc. and you can't discuss those without getting into what the heck we're here for.
So this week I had all second semester Junior nursing students. So here's some of the very basic questions I asked: What are the parathyroids and where are they located, what do they do? In what system are the tonsils located and what do they do? Where is the gallbladder, where is the appendix, what do they do? Why would you inject lidocaine WITH epi at the incision site? What are the ramifications of femur fractures? Why do we pad patient's after positioning for the surgery at pressure points? This is basic anatomy and nursing considerations for post operative care as well a peri-operative care.
All I got were a lot of blank stares. Now let me say, I chose the surgeries we were in with some great doctors, there was no yelling or carrying on by the physicians. The rooms were relaxed, the residents were all in a great mood, we even had CD's playing quietly. We were basically having as good of time as can be had in surgery. I understand students can be nervous by the atmosphere but I picked great cases for them to observe with a great group of people involved. I either got blank stares or guesses that weren't even close. I'm not a drill sergeant, my questions were posed with some background leading up to the questions.
I'm very very concerned. The whole semester has been this way, but this last week was the pits. These students will be nurses in a year, they've had 3-5 years of classes at this point. What the heck is going on? These students are from the flagship university of the state in a program that looks down it's nose at every other program in the area, does immense nursing research, etc. Where's all the critical thinking that is the buzz word of nursing education? I'm just at a loss to describe how astounded I was by this past group.

as a recent graduate, i understand your frustration. i don't know why but some nursing students just WON'T speak up or answer questions about anything. i went to school with students just like the ones you described. these were 4.0 students that aced every test but they would only answer questions if the instructor pointed them out personally. believe me these students know the information, but for some reason they feel that the they may not answer the question the right way and that will make them look stupid. unfortuantely they don't understand that these responses are a direct indication of their lack of communication skills. what will they do when they get out in the real work force and a M.D. does yell at them. go in the rest room and cry? probably. when i was a student i looked at every experrience as an opportunity to grow and learn because their is no "stupid" question or answer when you are learning.

unknown99, BSN, RN · Mar 14, 2004

I understand your concerns, but, just remember, you were in their shoes once.

orrnlori, RN · Mar 14, 2004

Yes, I was in their shoes. And the one and only day I spent in the OR during nursing school I remember as being full of questions, looking at the patient charts, looking at the nursing documents, talking to anesthesia, and at least making a stab at answering the questions the nurse put to me. And I was far from the perfect student but thrilled to have the opportunity to see something besides the inside of a patient's room. I'm not even talking about asking them to form nursing diagnosis or care plans or anything requiring an introspection or reflection of nursing theory in a complex form. I base my teaching in the OR on real life nursing and common sense.

Well, maybe I need to just forget about this. I can't help but think that a 3rd year nursing student should have a clue about general anatomy, basic physiology, and the actions of extremely common drugs like lidocaine and epinephrine. It's just that I spend a great deal of time working out a schedule, picking the cases, enlisting the help of the surgeons and residents, and take time away from other things in order to teach. And this semester I'm not being rewarded with anything other than blank stares and the appearances of boredom from some. Maybe this is what makes some nursing instructors such sourpusses and I don't want to be that way.

My comments to the nursing instructors have been very general. So and so was quiet, so and so appears to not have much interest in surgical nursing. Most of the time I don't get to even talk to the instructors because they don't come down to the OR, the students simply leave at an assigned time to go to lecture elsewhere. Also, their day in surgery is picked by the student, this is an option, not a requirement, anyone not supposedly interested in surgery does not have to come to the OR. These students are supposed to be the ones interested in what goes on in the OR in terms of nursing practice. I don't understand why one of them was in the OR this past week. If it doesn't get better, I'm going to relinquish this to another nurse, problem is, no one else wants to do it. Three years ago, students clamored over each other to get into our rooms and were such a delight to teach. This week has really got me thinking that I don't want to teach.

Loribabble · Mar 14, 2004

I just wanted to thank you for taking all the time to prepare for the students, and for making it a learning environment. I graduated in 2000 and was quite the nervous nellie - I have since relaxed... but man.... school was really hard for me. I had been blessed to spend time scrubbed in while on a mission trip to Zimbabwe - if it wasn't for that I would HATE OR. My first c-section at school was with a scrub nurse from heck.... no one explained a thing to us... where to stand, what they were doing and why... etc... we were always in the way and could not see the procedure at all. This scrub nurse kept yelling at me and a co-student.... the student with me kept asking me questions about what they were doing... I stopped answering the student after the warning but still almost got kicked out of school for that incident (there's a lot more to the story and I won't bore you with details).... anyway, by the time I got to my OR rotation I was fit to be tied. I had such trouble with the last nursing instructor and we were at the same hospital and she LOVED to pop in on ANY of the students who were there. We were required to spend time in OR. I was really nervous but if someone would have taken the time like you has it would have really helped and made it more interesting. I just remember being in the way... and afraid to ask questions because I was "another bloody nursing student to babysit today" -I actually heard that when I walked in that morning!!!

So thanks for wanting it to be a positive experience!

Lori

barb4575 · Mar 17, 2004

She was an OR nurse who loved to have students. I have never met anyone like her before either. She would come to talk to my students as a group to inform them what they could expect when they rotated through her department. Not only was she vibrant and enthusiastic, she lessened their fears. I developed the OR objectives and assignment, but she reviewed them and gave me her input. We met every week to discuss how the students were in OR that week and the students were fully aware that we met ... this would not be a free week.

Yes, they were weak in Anatomy and Physiology which I knew already. I did discuss these weaknesses with that instructor and changes were made. I recently talked to an Anatomy and Physiology professor here and expressed my concerns with her... mainly that there just isn't time to review all of this material in class and they had to be held to the standard that it was a required prerequisite for the course. I recall discussing with her about the extreme weakness in Cardiac A&P. I was surprised to learn that she did not review preload, afterload and cardiac output concepts. No wonder they couldn't get those concepts without repetition and a review. This professor had won many teaching awards and taught medical students as well.

This OR nurse was also a nurse recruiter without the title and showed the students what it was like to truly love your profession. It is my hope that she did choose to go into academia because her skill at teaching was far above that of a baccalaureate nurse. Since the other nurses do not enjoy students, Lori, I would hope that you would resolve this by speaking to their instructor in specific terms. Perhaps her standard is not high enough? Without expectations being related to the students, very few will perform at a higher level. From experience, I can tell you that some professors will view the rotation in OR as a day away from those students and less of a burden on the floor...sounds like she needs to revamp that OR rotation to me.

Hope this helps you and I do understand your frustration,

Barbara

orrnlori, RN · Mar 17, 2004

Thanks for your replies. I don't have any students this week because it's spring break. That gives me a break too to think about what to do. I never thought that having these students rotate through the OR may be a break for the instructors. I have considered that maybe the students consider it a break and don't need to being thinking at all. I'm not a student hater and I do consider myself a recruiter to a great degree. We always need good nurses in the OR and we have a very elaborate training program that takes 7 months to get through to work in our ORs and grants 150 CEU's for the program. It's an excellent program that I went through myself 5 years ago. I've recruited 3 new nurse grads in the last 2 years to come into our program.

I really would like to teach someday. I read the student nursing board here and relive what it was like for me to be a student. I see how badly these posters want to be a nurse and how hard they are working and then I see a reality during the day that seems to reflect the total opposite of those feelings, and I worry what kind of students our university is putting out.

I would feel differently if I placed the student in a difficult room with raving surgeons and left them to stand in the corner alone. It's a lot of dedicated work to teach while actually running a particular surgery in real time, trying to take care of everyone in the room, keep up the massive paperwork, answering phones, and teach and inform every step of the way using nursing theory and objectives that should be meaningful to them. But I LOVE to do it. I only want them to be as engaged and involved as I am. Even the attendings will sometimes take a moment to ask the students to step near the field so they can show the student something or explain something. This is why I love a teaching hospital.

Anyway, I guess I will start the day by telling the student that whether they have clear objectives for the day or not, I have expectations of them and I need them to be thinking and asking questions. Up to this point I've been treating them more as a little sister/brother and trying to show them the wonder of what we do during surgery. Maybe I'm the one who is failing the student by not making my expectations for the day clear to them. I still can't help feeling they ought to have some basic info already in place in their brains. I shall revise and go forward. I guess I'm learning too.

ManEnough · Mar 20, 2004

I really respect your attempt to make the students' experience worthwhile. We need more nurses like you. :)

In defense of their lack of knowledge/willingness to answer questions, I have to say I completely understand where they're coming from. In the past two years, my brain has been so overloaded with info.. anatomy/physiology/pharmacology/med diagnoses/nursing diagnoses/procedures/tests/lab values.. I honestly don't think the human brain can absorb the amount of information we're required to know. I'm in my last semester of a four semester program and just now everything is starting to click. Things like ascites, pnemothorax, atelectasis, hepatosplenomagaly.. I never FULLY understood what any of these meant until I had a patient with these problems. I guarantee the vast majority of those students you mentioned have the answers to your questions somewhere in their brains. They're just saturated with so much information and things have yet to click!

orrnlori, RN · Mar 27, 2004

Well. I just had one of the best nursing students I've ever had come through the OR. She's from a different school than the ones I've had at the first part of the semester and a little older. Maybe they are just re-charged after spring break. Anyway, today was a breath of fresh air for me. Within an hour or so she was tying up the surgeons, asking questions, making observations, and yes, she was answering questions! My faith has been restored in students. I wrote down my name and home phone number for her and told her when she graduates to call me. Even the surgeon said, 'oooh, this one talks!'. Now I'm excited again about the prospect of finishing my masters and teaching. Hope this lasts at least until the end of the semester and I hope I get more students from this school.

Tamera · Apr 24, 2004

In defense of their lack of knowledge/willingness to answer questions, I have to say I completely understand where they're coming from. In the past two years, my brain has been so overloaded with info.. anatomy/physiology/pharmacology/med diagnoses/nursing diagnoses/procedures/tests/lab values.. I honestly don't think the human brain can absorb the amount of information we're required to know. I'm in my last semester of a four semester program and just now everything is starting to click. Things like ascites, pnemothorax, atelectasis, hepatosplenomagaly.. I never FULLY understood what any of these meant until I had a patient with these problems. I guarantee the vast majority of those students you mentioned have the answers to your questions somewhere in their brains. They're just saturated with so much information and things have yet to click!

I have to agree with manenough. The students today are a different breed with full time jobs, etc. & overwhelmed by many things both academic & personal. Not defending them because they should make an attempt to answer your questions. I am not sure what the answer is but it is comforting to know that there are nurses like you that care that are still out there. Don't get discouraged, we need you out there. Maybe try another tactic of asking questions somehow. Just hang in there.