precepting nursing students?

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I have a confession...I hate to be followed by a nursing student.

I work ER and yesterday was from hell. Started my day with a code/death. (lots of family issues, lots of paperwork) I swear I had every nursing home pt with "change in neuro status" in the valley...I was really getting my butt kicked. My charge nurse is pretty good, but she just kept loading my rooms. I had charts from one end of the dept to the other...and then she gives me a nursing student:confused: :chair: Usually one of the more experienced nurses has the students. I'm not sure why she gave me this particular student. This student had only been in the ER for a brief show and tell of where everything was. I was very nice and told her that I was going to need to catch up on paper work, but I could probably come up with some procedures for her. She said "thats ok, I will just watch you do the paper work" and proceded to sit by my side actually watching everything I wrote or typed. One of our pt's was using a commode chair every 5 minutes (or so it seemed) and the student would not help pt by herself. She would go in the room, get started and then come find me to help her. She had already had a orientation to our unit and knew where the basics were. I asked one of our tech's to let her follow her and do ekg's and blood sugars. She watched one ekg and came back to stand over my shoulder. She told me that she needed "nursing experience" not "tech" experience.

Give me some tips on how to be a better preceptor.

or...Can I ask my director that I not be used as a preceptor to nursing students? I know some nurses LOVE to have a student. I remember nursing school very well, and I remember having some wonderful preceptor nurses with me...But I am new enough in the ER that having one makes me nervous!

thoughts???

[ragingmomster, BSN, MSN, RN]

I have been in L&D for a little over a year now and when a request went up for preceptors for the summer nurse externs, I signed up and was turned down:uhoh3:

So when we were told at staff meeting last week that we are getting 17 new grads between now and July I spoke up and asked who would be their preceptors. Only some of us have gone to coach class (I was not asked).

I was frank and told my NM that while I could have handled an extern with my years of experience in Med/Surg etc. and could cover all the basics of all kinds of nursing care with students I was absolutely not interested in trying to train new employees. I still have to hit the P&P's at least once a week for myself.

Her response was that everyone would be expected to pick up a new employee for a day or two here or there when assigned preceptors might not be available.

What a load of crap. Not just a new grad to teach, but a new grad with whom you are unfamiliar and you don't know what their experience is.

In my 12 hour shift, how will I have enough time to plumb the depths of what I can expect from a new grad? And pick up a full pt load of high risk antepartum/labors too?

[PANurseRN1]

I just spoke with my director and asked that I not be assigned students.

apparently my nursing student requested to have me as her regular preceptor for the 2 weeks she is on ER rotation. I certainly do NOT want to hurt her feelings, but I am just not comfortable teaching. Like I said, I only have a year under my belt in the ER. The student told my instructor that I was one of the first nurses who didn't just pass her off to do the grunt work...

I just accepted the compliment and declined. For some reason the thought of someone over my shoulder every shift for two weeks really makes me anxious!

You did fine. That student needs to grow up, big time. Nursing is full of "grunt work." Is she too good to learn the basics?

I forsee troubled waters for this student's future. If she doesn't lose the attitude, she's in for a lot of learning the hard way.

[smk1, LPN]

As a current student, thanks to all who put up with our strange questions and ideas, and teach us often times without any extra monetary benefits. Also I always appreciate smiles or greetings. It is intimidating being thrust upon a unit where you don't know all the unwritted rules and procedures. You don't know everyone's role/name or who is a nurse and who isn't. You have all of this clinically significant information that you are finding (per the books) but a lot of the nurses get irritated when you let them know, then others get irritated by the fact that we HAVE to do things exactly by the book and our school policy. It is frustrating for us as I am sure it is for the nurses. I will say that though the student does need to do "tech" work (because it is all nursing work) /heshe may have been in a situation where all they have been doing is "basic tech" things in her clinicals and there does come a point (particularly if you are already a CNA) where you don't want to miss out on learning new things and getting experience in the higher level procedures and nursing functions (because that is really what we need to learn to grow) Obviously the patients needs have to be met, but i have had this happen already to me, where you are to busy answering call lights (even for people you aren't assigned to) and not learning anything new from your clinical because you aren't transitioning enough from the CNA role to the nursing role. The student may have had this problem a lot recently and decided that she needs to stay in a more "RN" focused role to get the best learning experience. I hope i worded this right, because i in NO WAY mean that students don't need to do ADL's. I just mean that clinical time is precious and a lot of us have already worked in the CNA role and are comfortable with that skill set. When we find that we aren't getting to practice new skills and assesments that we are learning in class and the skills lab, then we have to find opportunities to learn and get familiar with RN level skill sets to become good future nurses. Staying busy for 8 hours changing briefs and helping people to the commode isn't the best use of clinical learning time. Communication is key, and obviously the nurse is the licensed person in charge of the patient so what he or she says goes, but try to be aware of learning needs for us. It really helps. We know we are the unwanted 4th cousin twice removed that has come to stay, but try and bear with us, one day hopefully we will be one of you and will be able to lift some of the burden of understaffing.

[PANurseRN1]

I don't think there was any reason for the student to be breathing down the nurse's neck while she was charting. And excuse me, but refusing to learn to do EKGs? I never had the opportunity to learn that as a student.

One of the things students need to learn to do is work as a team. So yeah, it's not unreasonable to ask a student to answer someone else's call bell; we do that for each other as nurses.

The student described sounded flat out lazy, and with an attitude that certain things were beneath her.

It would have been one thing for her to ask to read the nurse's notes after she'd written them, but to just stand there peering over her shoulder while she was writing? Inappropriate.

[traumaRUs, MSN, APRN]

I work in a busy ER and for the most part I like having students as long as they are clear about what they need to learn. Because I'm one of the senior nurses, I do take all kinds of students: surg techs, EMTs (all levels), RN's (ADN and BSN). I really enjoy teaching for the most part and I try to include the students. However, I always preface my day with the comment that there may be a time that a student might not be included (and this is individual to the pt) and not to take it personally. Some of my students have been totally awesome and we just click. However, like everyone, sometimes our personalities don't mesh and maybe another nurse would be a better preceptor for that particular student.

[mandana]

I was the student in the ER yesterday. First day there, no orientation, thrown into crash. The RN that was tolerating me was awesome, super smart and very kind as well. I just wanted to tell you from the students perspective that I was scared senseless and I probably hugged the walls a little bit because I was so scared. I tried to get involved, but I have to admit that there were times when my nerves got the best of me. My hands were shaking the entire day. Every time they hooked the "chest pain" up to the monitors, I kept thinking that if they'd hook me up, my EKG would look much worse than the patients.

I don't think that I'll be very good with students if and when the time comes, mostly just because I tend to get into my zone and don't really want to think about what others are doing or how to help them learn. I don't think there is any shame in not precepting students if it's not your bag. But do consider that she may have just been like me - scared senseless. I have to go back, and I'm looking forward to it, but I hope I have a different nurse the next time so she won't think I'm a bone-head basket-case from the get-go.

Amanda

[CardioTrans, BSN, RN]

I was the student in the ER yesterday. First day there, no orientation, thrown into crash. The RN that was tolerating me was awesome, super smart and very kind as well. I just wanted to tell you from the students perspective that I was scared senseless and I probably hugged the walls a little bit because I was so scared. I tried to get involved, but I have to admit that there were times when my nerves got the best of me. My hands were shaking the entire day. Every time they hooked the "chest pain" up to the monitors, I kept thinking that if they'd hook me up, my EKG would look much worse than the patients.

I don't think that I'll be very good with students if and when the time comes, mostly just because I tend to get into my zone and don't really want to think about what others are doing or how to help them learn. I don't think there is any shame in not precepting students if it's not your bag. But do consider that she may have just been like me - scared senseless. I have to go back, and I'm looking forward to it, but I hope I have a different nurse the next time so she won't think I'm a bone-head basket-case from the get-go.

Amanda

hehehe, this one clicked with me........ last week my student showed up for the very first time. She will grad in Aug, and really hasnt had any critical care clinical experience. Well, my assignment that day.......... everything that a pt could possibly be hooked to was hooked. Pressors, meds, sedation, vented, CVVHD, a line, the whole nine yrds. In the first 15 min I could see the look of "overwhelmed" on her face. So I told her at first just watch how I start and go about my day......... as she felt more comfortable, she could join in, and please ask questions............ all was rolling along just fine until 10am............ the pt decided that he needed to scare the unit a little and ran a 2 min run of VTach. In comes the crash cart and other nurses, some precordial thumps later, SR....... pads placed, as Im looking to my left, I see the student backing as far up in the corner as she can get, as white as her uniform.

When things settled down, I asked her if she was ok........... she literally could not speak. I told her to go take a break and collect her thoughts.... think of the things she saw and come back with any questions she had. About 20 min later, the color had returned to her face.... her first comment was "How will I know what to do?, backing in the corner was all I knew how to do"

Of course I told her, you may not know what to do, but as you saw... there is always help around (about 4 nurses and 3 or 4 MDs were there within 30 sec), if you dont see someone YELL LOUDLY!, hit the call light for help anything to get attention.

Luckily she came back today, and was actually wanting to help. She went home and over the weekend, looked up all the meds that she saw, every diagnosis the pt had, and even found an ACLS website. Of course I like to ask questions to make students think about whats going on.......... she knew alot of what I asked her today, even though shes never really been in critical care.

Sorry this got so long, but the "hugging the wall" comment made me giggle.

[mandana]

CardioTrans -

The only way I am sure that you aren't actually speaking about me is because my uniform isn't white! The rest is pretty much how it was....

:rotfl:

Amanda

[jb2u, ASN, RN]

well i don't know what school those students go to, but at my school we are assigned a pt. and not a nurse. we take total care of that pt. ADLs, meds, charting, etc.. if we have questions, we ask our professor. anyway...

the OP stated "Give me some tips on how to be a better preceptor."

1. pretend that you are the student! (what would you like to learn, how would

you like to be treated)

2. use your experience (this is what makes you wise, what have you said i

wish i would have known then what i know now about)

3. think small (if the student learns one thing that day it is a success)

4. remember that every teacher is a student (by teaching you will learn

something about yourself, maybe a weakness that you can now focus

on strengthening, this will make you a better nurse. and why would

anyone not want to take the opportunity to become a better nurse.)

all that said, i know that some people just don't like to teach. that's fine. i just wanted to answer your post with what i thought you could do to be a better preceptor ( as per your question ). as a student, i value my clinical experience and because i know that my professor can not be in all of our rooms at the same time, i truly appreciate a nurse that takes time out of their very busy day to answer a question or let me observe a procedure. does anyone remember being in nursing school and sitting at a lunch table and telling everyone who unfortunately have not had the privilege to pack a decub the size of a softball the whole wonderful procedure? yes, the excitement will pass (unfortunately), but if you just think back to the day that you were at that table maybe you can make a students day.

sincerely,

jay (a bright eyed, pie in the sky, cups half full, student nurse)

MAY 2007 HERE I COME!!!!

[smk1, LPN]

well i don't know what school those students go to, but at my school we are assigned a pt. and not a nurse. we take total care of that pt. ADLs, meds, charting, etc.. if we have questions, we ask our professor. anyway...

!

I think probably because it is ER, there are no patients to assign. You have to assign a nurse because thses are walk in patients or ambulance patients and there is no way to know who or what you will get.

[jb2u, ASN, RN]

i can understand that. at my school we do not do an er rotation though.

my main thing is a lot of people forget about when they were students and how they were treated. we know we can get in the way and of course there are some lazy students, but i think that should not keep someone with valuable knowledge/experience from passing that down.

[anonymurse]

I don't understand all the discussion. The unit has a workload. Managers and charges have to assign that work. I have never refused legitimate work assigned me by a superior and I never will. I don't go to work and expect to get paid for picking and choosing activities according to my own tastes. BTW, students have a job themselves. It's to learn. They aren't aides. They are paying for the experience. They aren't getting paid.