Precepting students

[ilikesharpthings]

So, I am fairly new to the medical/telemetry floor where I work (about 8 months in) and we recently began having the influx of nursing students. I have had students assigned to me a few times - both ASN and BSN students at different points in their programs. I really enjoy teaching (although I feel like I am still learning a lot) but sometimes I feel at a loss about how to best help these students. They show up often looking like deer caught in the headlights and when I ask them what their goals are, or what skills they need to work on, or how many patients they want to take sometimes they seem as clueless as me about what they need to get out of their clinical experience. Is it better to just have them follow me and do things for my whole patient load, or should they try to take 1-2 patients? Some of them seem to have no idea what is expected of them or even what skills they are allowed to perform alone, with their instructor, or with a staff nurse.

Also, I feel bad when I get caught up the the whirlwind of phone calls, procedures, charting, and putting out fires because they end up just sitting around while I'm trying to do my job. I try to offer suggestions like having them do an extra assessment on an interesting patient, or to ambulate a patient, or to review notes/H&Ps/labs but to be honest sometimes my brain is fried! I just feel like I could do more to be a better teacher.

So if anyone has any suggestions as to how they work with nursing students in a positive way or how they organize their time, especially when those students seem to rely on staff nurses for so much of their clinical education, please let me know!

[RescueNinjaKy]

As a nursing student myself,I really enjoy it when the nurses allow us to perform procedures as simlabs really aren't the same thing.I do get nervous when I do it on an actual patient so it is helpful when the nurse either demonstrates and allows me to assist or guides me through it in a non judgemental way.it is these practical hands on experience that gives me pride and confidence in what I do.

Things like med passes, injections, iv, Foley catheterization, suctioning, tube feedings/meds, ng care, nebulizer/oxygen administration.

And giving the student a heads up on the interesting/unusual cases on the floor also does wonders. Most importantly be nice to the students and put them to use is what I like. I rather be busy than bored.

Of course find out what your institution and their instructor defines as their scope of practice to avoid any issues.

[cayenne06, MSN, CNM]

While I agree with the previous poster about the importance of getting a chance to practice skills in clinic, I think it is equally important for students to be assigned 1-2 patients that they are totally responsible for. It gives you a better idea of what nursing is really all about. Skills are fun, but they are just tasks- nursing is so much more than that. When I think back to nursing school, I think my ideal would be to be assigned one patient that I was 100% responsible for, and then having my preceptor call me in to do skills on other patients, observe procedures, assess interesting patients etc, when time allowed.

[BluegrassRN]

We had this issue with our students, and a lot of us complained. There was no guidance as to what the students were capable of, expected to already be a proficient at, etc. Our ed department met wih the local nursing schools and now each clinical day, the instructor leaves a little form at the desk, which has 3 sections: tasks that the students can do, tasks that they are not yet allowed to do, and then a section for the objectives and expectations of the clinical day. Under that 3rd section, the instructor usually puts how many patients they expect the student to have, or if they want them to follow the nurse, etc.

We survey our nursing students, and one complaint they routinely have is that they are not included in the nursing process, that they do a lot of clinical activities but don't get enough practice of critical thinking and of the whole picture. So now I try to "narrate" what and why I'm doing something. I used to not ask students questions, as I didn't want to put them on the spot or make them uncomfortable, but now I say something like, "Our pt is

C/o abdominal pain, why do you think that is and what should we do about it?" And then after I get their answer, I try to talk them through what we are, in fact, going to do about it and why.

i feel like this means I'm doing a lot of talking (particularly when I'm narrating what I'm doing), and I worry this decreases their attention. I'm trying to find a happy medium. Also, I don't think the realize that critical thinking skills are difficult to teach; on the other hand, I think their complaints that they do too many skills and not enough of the planning and evaluating is a valid complaint.

[elkpark]

Where the heck is the instructor, and why isn't s/he doing her/his job????

[ilikesharpthings]

Something like what you described, BluegrassRN, would be so great.

Not all students are completely clueless, and there have been times where they seem really proactive or the instructor is really involved but I feel like there is a communication barrier sometimes. Like the students are super nervous and don't want to be intrusive and so they don't take charge of their own experience and leave it up to the staff nurse to decide how the experience turns out. And while I know that lots of nurses aren't super welcoming to students, part of it may be that expectations aren't clearly defined by schools or facilities. I will be asking my manager what we have in the way of helping staff nurses become better preceptors as well as taking a more proactive approach toward the clinical instructors when I see them. But I also think students need to be aware of what they need to get out of their clinical experiences and communicate that clearly.

Thanks for the feedback so far!

[lovin]

I am also a new nurse and have started taking on more students. One thing I do with each student is take report together and then discuss priorities for the shift - which pt to see first, what tasks are time sensitive, what things can we delegate safely, etc. Then, I have them chart a full assessment on at least one patient and go through that with them.

Otherwise, I let the student guide the day- some want to care for one pt, some want to tag along. If a student is clueless / not motivated, I have them read up on Drs. notes, lab values, and orders for one of the patients they assessed to get a full picture. I often learn something from what they find since I usually do not have time to read anything but the most recent progress note and I can ask them questions about care such as "why are daily weights ordered for this pt?" or "what is the purpose of ordering a sed rate?"

Can't wait to hear more tips from others! Teaching is hard and an important part of being a nurse.