Problem w/RN's & CT's on clinical day

fins · Mar 19, 2008

I was trying to think of a polite way to say this, but then I figured, screw polite.

If you think that you're just going to do all the cool stuff with a patient and leave the scut work to the regular floor staff, you need to readjust your thinking. Having nursing students is a serious disruption to a nurse's day. One of the offsetting compensations for this disruption is the fact that the student provides some help with his patient - that means, he answers call bells and he does AM care.

"You're not there for AM care" is not the same as "you don't have to do AM care on your patient." Well guess what - I'M NOT THERE FOR AM CARE EITHER. I'm there to provide for the needs of my patient. Part of that is AM care. You're there to learn how to provide for the needs of your patient, and AM care is part of that. For you, with your one patient (maybe two) to complain about lazy nurses is beyond arrogant.

If your instructor tries to insist that you aren't going to do AM care, then she can either find a Sim Man for you to play with, or she can lie down in an empty bed somewhere and let you take care of HER. Either way, you both better get the H*LL off of my unit, because I'm not going to stand for it.

vashtee, RN · Mar 19, 2008

I don't mind doing AM care (if I have time). When I am in clinicals, I do EVERYTHING for my patients that I am allowed to do. I don't know what the nurses are doing - I never really see much of them unless something comes up I am not allowed to do. I assume they are working with other patients, but maybe they are lazy. Some students are lazy, too. There are lazy people everywhere.

elkpark · Mar 19, 2008

Well, since you ask, my first thought is that surely you must have better things to do in clinical than spend time and energy passing judgment on the unit staff ... It's common for nursing students to get caught up in feeling superior and self-righteous about the slack, lazy unit staff but you're only seeing one quick "snapshot" of what life on the unit is like and how they do their jobs. Until you've "walked a mile in their shoes," you aren't really in a position to judge, and you'll have a different perspective once you're out in the "real world." Just because someone took advantage of the opportunity to catch a quick break and get off her/his feet for a minute, that certainly does not mean that s/he is "lazy" or not doing her/his job ...

As for AM care, your instructor may have told you you're not doing it, but that is certainly not the norm in most nursing schools, and it's perfectly reasonable for unit staff to expect that nursing students would be doing AM care. Perhaps it would be helpful for your instructor to review your clinical expectations and activities with the unit management and staff, if that hasn't been done.

As a long-time clinical instructor myself, I must say that, if you have time to keep track of how the unit staff are spending their time, you're not spending enough time on your own responsibilities in clinical.

jjjoy, LPN · Mar 19, 2008

I'd say part of the problem was a disconnect between what your clinical instructor expected you to do and what the floor staff expected you to do. I'm always amazed at how communication on the average unit is "get as get can." There's generally no full group announcement to the staff regarding what the students' goals are. And then, despite the lack of consistent communication, staff often come across as accusatory and punishing when they realize that someone didn't know something... as opposed to inquiring why something wasn't done and calmly explaining the expectations. I know it can't be avoided to some degree, but I'd think it could be lessened a bit as well as the accepted culture be more understanding of the inevitable miscommunications and differing expectations people may have.

But since we can't change everyone else, the next question is how to deal with such situations. Instead of feeling self-righteous and defensive in regard to who is supposed to be doing what, we can humbly admit that perhaps we misunderstood or made a mistake and tell them that we've now learned that we need to communicate better so as to work better with the nursing staff in order to best meet both patient needs and student learning needs.

Students often have little clinical time to try to get exposure to as much as possible. While AM is important, time spent on that may be a missed opportunity to see/learn something new. Patient needs most certainly come first. Ideally, though, the unit should be well-staffed enough that the regular staff can meet all of the patient needs without relying on the students. Of course, reality is often different.

The clinical instructor also didn't seem to let the students know HOW to carry out a day where "they are not there for AM care." To just say "we're not here for AM care" can come across as arrogant and nurses seem to be quite sensitive to that. The instructor could've told the students to tell their nurse their goals for the day and that while you would most certainly assist when needed, that your instructor didn't want you to be taking primary responsibility for AM care since you had limited clinical time and needed to focus on other skills (not that you don't want to "waste time" on AM care).

LeesieBug · Mar 19, 2008

I agree that the problem stems from a lack of communication. I recall very well having stress in clinical related to differences between what nursing staff were assuming we would be doing and what the instructor had planned for us for the day. I believe it was rare for most instructors to keep the staff up-to-speed.

I learned quickly that I had to take a few minutes each a.m. to discuss with the RN who had my patients exactly what skills we were working on, what skills we had not done yet, and what we were supposed to be focusing on for the day. I would also let them know what areas I needed more experieince in, so if it came up with another of their patients, they could pass it on to me and my instructor. MOST nurses were happy to oblige and appreciated the offer and initiative.

For the most part, having a little conference each morning helped a lot, and prevented errors or omissions in the patient's care.

Good luck with the rest of your clinicals...learn a lot!:)

donsterRN, ASN, BSN · Mar 19, 2008

Wow.

I'm really surprised that the OP isn't responsible for AM care this semester. My class is responsible for everything going on with that patient from the time we arrive to the time we leave. If that means AM care, meds, treatments, dressing changes, etc... that's what it means. But it always includes first assessment and AM care. This is the time to really assess your patient, and if you're not doing it, you're missing a great opportunity.

And if we have time left, we help on the floor with patients who are not assigned to us. We do, you guessed it, AM care. It's a biggie, at least in my program.

Corsair41 · Mar 20, 2008

Wow. I guess that's what I get for asking for opinions. Uh look, aren't y'all being a bit severe here? I never said I agreed with my instructor's idea of how to run clinical day. So, I did as I was told, and got my head bitten off not only from the RN in the hospital, but by at least 5 here. Is this what they mean by "Nurses eat their young"?

Again I say, wow.

vashtee, RN · Mar 20, 2008

Wow. I guess that's what I get for asking for opinions. Uh look, aren't y'all being a bit severe here? I never said I agreed with my instructor's idea of how to run clinical day. So, I did as I was told, and got my head bitten off not only from the RN in the hospital, but by at least 5 here. Is this what they mean by "Nurses eat their young"?
Again I say, wow.

5? I only count 2. I guess everyone has a different perspective.

studently42 · Mar 20, 2008

Corsair, these are experienced nurses giving advice to a nursing student (which I also am). Most of what I read was that there was a lack of communication between your CI and the staff. I treat clinicals as though I am being paid to do a job and have no problem doing anything (that I'm qualified for) that the staff ask me to do. The nurses I've met are wonderful and appreciate the help, but even if they weren't it would be irrelevent. I've worked for bosses that I didn't like before and the pay is the same. I've heard fellow classmates complaining about this lazy nurse or that lazy tech and I just sigh. Clinical rotation as a nursing student, while somewhat stressful, is NOT a hard job. I hope this doesn't come across as an attack, I just think we students can learn a lot from the nurses who came before us. Good luck, and I hope clinicals improve for you,

Mark

Flames9_RN, BSN, RN, EMT-B · Mar 20, 2008

I'm a RN student as well, but I pretty much expected to be abused,lol I guess with a military background I understand I'm near the bottom of the food chain, and just deal with it!! In reality i have been treated great, well except for my very first day on clinical!! On our first day, we teamed up with another student. So we went to our assigned nurse, introduced ourselves and explained this was our VERY first clinical and asked on what we could do to our assigned patient? She just said, do whatever you want and walked away!! In the 6 hours we were there, we only saw her twice and she wouldn't speak to us!! oh well, sucked to be her,if she had been friendly we would have assisted her with other patients, instead we looked after our patient and assisted other nurses and techs!! One can never get enough hands on-time as a student, even bed baths!!

EmBeMap · Mar 20, 2008

Not all unit staff eat nursing students. I had 4 yesterday (I am a CCT) and I put them to work to supplement staff we were missing in the EC. I made sure that any patient they did something gross on they got to do the cool stuff too. All of them said they were grateful for my help in keeping them cooridinated as my nurses didn't have much time to assist them. I showed them everything I usually do and walked them through IV starts, blood draws , putting patients on monitors, but they also were shown where to take patient to radiology and were extra supplies are. I looked to them as additional team members. Example One girl got to do a foley after having to try to assist that patient use a urinal. But then I also showed her how to empty the bag a take a UA specimen. I think they learned a lot and I kept them useful and off the nurses nerves. PS my ec is a county facility its usualy nuts.