Our role in clinical?

1234student · Sep 16, 2010

Are they not letting you all do meds and dressing changes and that sort of stuff??? When we are at the hospitals and aren't busy with our patient or patients we are encouraged by the teachers to help out in anyway we can...Most RN's have 4 or 5 patients and are supppper busy with meds, dressing changes, assessments and stuff and usually with 1 or 2 patients we have free time to help them out. Yeah its not the funnest thing in the world but its kinda your way of helping the nurses out after they have allowed you to come on there unit. What we do to see more at clinicals is say to the nurses hey if anyone has a patient with a dressing change I would like to help or if anyone needs and IV or catheter or NG placed I would like to help.....

llg, PhD, RN · Sep 16, 2010

At my hospital, any nursing student who seems hesitant to do things like bathing, toileting, feeding, etc. is considered "not worth" the investment to teach her much more. We don't hire people who don't consider such responsibilities an integral part of the professional nursing role.

Students who willingly do such tasks are often asked to help with more advanced things, such as dressing changes, tube insertions, medical procedures, etc. Our nurses will allow the students help with any and all tasks (and precept them while doing it) -- IF the student appears sufficiently interested in learning and helping the patients. Most of the schools who use our hospital for clinical allow their students to help the nurse with these more advanced tasks and are grateful when the staff shows such an interest in the students that they give them these "extra" learning opporunities. But as I explained above, students with good attitudes are more likely to be offered these extra learning experiences.

DayDreamin ER CRNP · Sep 16, 2010

Yes, we are dispensing meds and doing any dressing changes if necessary. Up to date, I've actually gotten to do more than some people but I still find that many students spend a lot of time giving baths and not much else. I happen to work as a tech on the floor I'm doing my clinical on right now so I do have an advantage.

What I'm seeing on other floors is that when the instructors try to find us some experience in an ICU or other critical care unit, they students are just expected to do all the bed baths that day.

I totally agree that students that have a poor attitude won't go very far. I see that a lot. I also understand that there is a trust that needs to be built with the nurses and the instructor needs to be confident in the student's abilities too.

So far, no one in my group seems hesitant to do any AM care or changing of any patients. We all do our 2 patients and we move on. I guess what I'm asking is how do you handle it when you go to another floor, hoping to learn more about that particular specialty, how are you supposed to learn anything if you are just stuck giving bed baths and not seeing how anything "works" on that unit? Not all units are like this, but do the nurses there just not want students there?

How do you politely decline giving the bed bath w/o making yourself look like you have a bad attitude or aren't willing to help?

That Guy, BSN, RN, EMT-B · Sep 17, 2010

At our clinicals we get to choose what pt you get. So naturally I pick the one with the most cares needed. Was able to do dressing changes, catheters, IV sticks, Meds, central line meds out the wazoo and what not the first two semester. Third semester was L&D, that sucked as I didnt do anything. This semester it is ICU and since I was an intern there over the summer they basically let me do everything an RN would do. I've even been on code teams, trauma calls and what not and I am knee deep in it when they happen.

I find that I show that I am willing to do whatever I can right from the get go. Far too many times when the SHTF or there is down time, the other students just become wallflowers and stand there and watch. That is not my style I am right up in it so I can learn as much as possible.

imrn2b · Sep 17, 2010

It isn't that we are hesitant to do baths and such, it is that there are some very important skills that we are not learning. Giving bath after bath isn't going to prepare me to become an RN . Yes giving baths and changing beds are part of it, we have done it time after time but after those skills are obtained, then they shouldn't be the primary focus anymore. Just because we come to the floor does not mean we are primarily there to help the nurses with baths. I am not getting in debt to my ears to only lend a helping hand to the nurses on the floor (and I mean that like I am not just there to give a bath, I want to learn more and I am eager to learn). I am not going to school to learn to be a tech (that is not meant in any way negatively towards techs). We are there because we paid a very high tuition to achieve all of the skills to become great nurses (which includes much more than baths and bed changes). Yes, bathing is included but shouldn't be the primary focus at this point. I would hate to know I was a patient with a nurse who knew how to give me a bed bath but was incompetent when it came to assessing, planning, etc. oh and who didn't know how to work my I.V pump. :)

AOx1 · Sep 17, 2010

As an instructor, I communicate the clinical objectives with both the staff and floor manager. Students do some things each day (ex-assess, give meds) and also have a special focus for the day (ex-give report, communicate with another discipline, etc). The students are also aware of this and are expected to communicate daily with the staff as to what skills they can do. We also post a list of skills at the station and nurses not assigned a patient call me if the get a skill for a student to perform. Students are expected to behave as registered nurses in terms of prioritization- they do baths, but only AFTER higher priority tasks are completed such as assessment, meds, etc.

Communication of student roles to the staff and management is key. Both the instructor and student should do this. As llg mentioned, being willing to pitch in (as the op has done) is key to earning respect. I jump right in myself and d/c patients, bathe patients, help with admits and transfers. I want to show my students that I am not "too good" for these roles, but at the same time ensure they are really prepared for all aspects of the RN role.

llg, PhD, RN · Sep 17, 2010

If you really don't need to work on those basic skills (e.g. hygiene) ... that must mean you are really good at them and can get them done quickly -- leaving plenty of time to observe/assist/do more advanced skills.

Don't think of it as doing either the basic skills or the advanced skills. Plan on doing both -- getting your basic care done early in the shift and having plenty of time left over to "tag along" with whatever else is going on in the unit.

You can approach the nurses and say, "I have finished my patients' AM care and he/she is resting comfortably. Is there anything else I can help you with? ... or ... Is there anything going on right now that you think might be a good learning for me to see?" If you have done a good job with your basic care, the staff will see you in a very positive light and let you tag along with them as you do whatever it is they are doing.

That's how successful students do it ... and that' what most staff nurses want to see.

mspontiac · Sep 17, 2010

You can approach the nurses and say, "I have finished my patients' AM care and he/she is resting comfortably. Is there anything else I can help you with? ... or ... Is there anything going on right now that you think might be a good learning for me to see?"

I ask my nurse if she needs anything else done...nearly every time she says "not right now," and turns and asks other nurses if they need help, which is fine. They also ask the techs if they need help. So guess what...I wind up doing more baths. :rolleyes: By the time I graduate, I may not be able to do anything useful but I'll be able to give a kickin' bath. :lol2:

Mandychelle79, ASN, RN · Sep 17, 2010

When we are given a patient/2 patients... or more

We are expected to give the patients all of the care needed for the day. If we get in over our heads, we are supposed to delegate to the aides or have other people help. If our patient is safe and comfortable, we are expected to help the nurses or our fellow students. But a lot depends on the acuity of the floor, the census on the floor, and how the hospital staffs.

2 hospitals within 20 mins of my house

1st hospital- 5-6 to 1 ratio was common, we had more things we were asked to do, so the nurses could get everything done

2nd hospital 3-4 to 1 ratio for RN and more aides than I had ever seen on a unit.. there was nothing for us to do to help out. We were stepping on each other as it was :) I spent a lot of my time just talking with the paitients, giving them some extra time.

llg, PhD, RN · Sep 18, 2010

I ask my nurse if she needs anything else done...nearly every time she says "not right now," and turns and asks other nurses if they need help, which is fine. They also ask the techs if they need help. So guess what...I wind up doing more baths. By the time I graduate, I may not be able to do anything useful but I'll be able to give a kickin' bath.

Sometimes, there is just not a lot of exciting things to see at the moment. Real life can be boring. It's not like on TV, where something exciting happens every few minutes. The real life of a nurse is often just being busy with doing routine tasks over and over.

If you NEVER get a chance to see/do more advanced skills, I suggest you talk with your faculty and school administration and see if they can arrange for you to spend some time on floors where those specific things are more common. If your school does not have access to the best clinical experiences in your town, that might be a sign that you are going to a school that is not respected by the local hospitals. That doesn't speak well for your school.'

Good luck to you.

MissJulie · Sep 20, 2010

So far we've done physical assessments, bed baths, and assisted in dressing changes. After we check-off on medications, we'll be doing meds, and this is an ADN program... Oh, and there is going to be a health fair at the hospital we're at in November and they've invited the clincial groups to be part of it, giving screenings for B/P, blood glucose, etc, and giving flu shots.