Problems with Rn's in clinicals

~Kitty~ · Mar 26, 2005

Sorry for your troubles.

I try to be helpful to the students. Much of the time I am appreciative of the help.

When the students are new to the floor they can be problematic when they don't get things done right (like putting I&Os on chart, then I come to find out that it's not there after students are gone, and I don't have that info because they were monitoring it during the day). However I am new to the hospital myself.

So, I am getting better when student's report off to me to ask did you do this or that. Once they have been up there a few times and getting the hang of it, they can be a pretty big help.

I also try to let them know when something is going on that may be a potential learning experience. (Chest tube removal, Foley removal, JP, suture, staple removals, etc)

I think I have a good relationship with the students.

mariedoreen · Mar 26, 2005

I am really sorry to hear that you are being treated like an indentured servant while you are in clinicals. As an RN, I am happy to have students and here in So Cal we have ratios in place which affords me more time to spend with my patients, and with the students.
You are on my unit to observe, learn and practice your nursing modules under the supervision primarily of your instructor and ultimately by the nurse you are working with, hopefully it's me! You are not there to fetch coffee for me, do me "favors" or "keep an eye on X,Y or Z" while I run to the bathroom. If you can grab a set of vitals for me on our patient, or pull up a lab and review it before we give that potassium chloride, it saves us both a lot of time, and you are also placed in a position to delegate to the nurses aid a task if you see something else as a higher priority.
You are learning a lot about everyone's job descriptions, responsibilities and obligations to the operation of the unit. Some of us do jump in and help the nurse aid with their task, some of us don't. I don't question them, I just know I like to be there to assist with a bed bath or when the CNA is ambulating the patient. It's not that I don't trust the CNA's observations, but I can add my own perspective to what I see and how the patient tolerates these treatments.
Keep a thick skin sweety, if I am ever lucky enough to work with students, I always assure them that I will never, ever ask them to do anything to a patient that would put any of us in jeopardy. Learning is an ongoing process, and some students can be overwhelmed with the expectations thrust upon them.

I wanna be you when I grow up :wink2:

mariedoreen · Mar 26, 2005

When I was an LPN student, we were assigned between 1 and 3 patients depending on where we were in our rotation. We total care for our patients...everything from bed and baths to meds to assessments and everything in between. CNAs were not allowed to do our patients' beds, baths, vitals, etc. We did all documentation (after writing it in our notebooks for instructor approval). We had to write a one page report on each patient's three most pertinent diagnosis. We had to do a med card on all medications that each patient was on. If we didn't understand a diagnosis, procedure, or whatever, our school had a library of books that we could pour through until we did understand it.
In report, we were not given the preprinted report sheets that the staff nurses were...we had to listen carefully and learned to quickly sort out what we needed to write down and what was just FYI. If there were not enough chairs for everyone, the students stood...our instructor did not allow us to lean against a wall or counter while we stood in report.
Now...students at the school I went to print their med information off the internet...a lot of them turn in a printout from the internet for their patient's diagnosis as well. They are allowed to use computer generated care plans...those didn't even exist when I was in school! :) In report, they are given the preprinted report sheets and there will be hell to pay from the instructor if we don't make enough copies for them! Students come in 45 minutes before staff gets there and sits around the report table before most of our staff arrives...staff who don't fit at the table stand around the room or sit on the floor to take report.
What a change from 15 years ago! It scares me to think that they are getting so much information from the internet and are simply allowed to print it out. Hopefully they are reading everything...they could learn and retain so much more if they actually had to look it up and write it out. And taking the chairs at the table in report...that just burns my biscuits! I am amazed that there are not enough chairs in the first place, but more than that, I am angry that students who are going to be there for 4 hours less than the staff are being allowed to sit comfortably while staff either stands, sits on the floor, or crowds two people onto one folding chair. I don't think the students should be abused or picked on, but I honestly do beleive that staff should come first.
On a positive note...from what I have seen, most of our students do give very good care...their patients are always clean and dry, rooms are neat, etc...

We're not all that way... our school makes us look everything up ourselves, no printing off of anyone else's material or we're kicked out for plagerism. They even imply that we'll be in trouble if we reprint any material from our previous care plans that WE developed... We write 3 page pathophys reports on all patients, look up a lot of info on all meds, write S&O assessment info on our patient and devise a care plan with nursing diagnoses etc.. for them. I collect patient info for an hour at the hospital from 4 to 5 the night before and then work on their care plan and the pathophys paper until 11 or 11:30 that night. we put a lot of prep into that one patient!

we get pre-printed report sheets too but only if the staff thinks to make copies for us. if they don't we keep our mouths shut and take notes on our own paper. and as far as students taking up all the chairs, that would really annoy me if I was an RN as well. I always stand until I know that all the staff is in the room and then I'll take a chair. If an RN, LPN, CNA etc.. ever walked in and there were no chairs left I would be out of mine in a heartbeat. But I am an older student (35) maybe that's just basic manners that the young uns don't have down yet (it's a joke guys, don't flame me!)

LPNer · Mar 26, 2005

We're not all that way... our school makes us look everything up ourselves, no printing off of anyone else's material or we're kicked out for plagerism. They even imply that we'll be in trouble if we reprint any material from our previous care plans that WE developed... We write 3 page pathophys reports on all patients, look up a lot of info on all meds, write S&O assessment info on our patient and devise a care plan with nursing diagnoses etc.. for them. I collect patient info for an hour at the hospital from 4 to 5 the night before and then work on their care plan and the pathophys paper until 11 or 11:30 that night. we put a lot of prep into that one patient!
we get pre-printed report sheets too but only if the staff thinks to make copies for us. if they don't we keep our mouths shut and take notes on our own paper. and as far as students taking up all the chairs, that would really annoy me if I was an RN as well. I always stand until I know that all the staff is in the room and then I'll take a chair. If an RN, LPN, CNA etc.. ever walked in and there were no chairs left I would be out of mine in a heartbeat. But I am an older student (35) maybe that's just basic manners that the young uns don't have down yet (it's a joke guys, don't flame me!)

Sounds like a great school! Kudos to your class and keep up the manners, the younguns seem to have missed that day pre-kindergarten (even my own! younguns!)

grimmy, RN · Mar 26, 2005

after reading all these posts, i am thanking the heavens that i chose to work as a pct (nursing assistant, etc.) while i was in nursing school. i learned the culture and process of the floor/unit environment before i ever had to do it as a student. i knew what happened right before shift changes, what was required, had lots of practice in bathing/linen changes, etc. by the time i was a senior in nursing school, i could read a nurse's face and know how the day was going. i could also figure out who was going to abandon their patients to me (the student) and disappear. it happened a few times in a particular icu. our instructors were extremely conservative, and we were expected to behave in certain ways, regardless of how the nurses on the floor/unit behaved. for example, there was one icu nurse who would curse like a sailor, everytime we were there. we could not do the same, nor were we supposed to even flinch when we heard her invective. we could (and did) talk about it later, but wow, we never talked about our nurse-preceptors until we walked out of the facility. i'm always amazed at how lucky i was to have the nurses and instructors that i did. most of them were professional and helpful. the few that were unprofessional taught me valuable lessons, too.

so, when it comes to advice, regardless of how someone else behaves, the relationship (however short it may be) can change because of how you behave. so, continue to act professionally, be assertive, do your work as best you can, and exceed expectations where it's possible. you cannot force congeniality where people have an axe to grind well before they even meet you.

irishnurse67 · Mar 26, 2005

W

:stone We do not get separate reports, that would be senseless. We are a signed patient's and make our own notes, and care plans. We listen when the nurses are giving report and do not interfear. We do not have attitudes to nurses that already are nurses and have the experience, we are there to learn and to help the nurses and not hinder them in doing there job. We just want a little respect while we are trying to learn as once they also did. And do a job of caring for patient's and for the money. I am sorry you have had a bad experience with student nurses, we are all not that way.

mysticalwaters1 · Mar 26, 2005

I am so sorry you are encountering this. I did in some of my clinicals, too. A lot of what they say about being overworked and understaffed is so true, but no excuse to treat students poorly. All you can do is resolve these things:
1. not to take it personally! Learn this one well, as you will need it when you are a nurse. Believe me.
2. report TRUE abuses to your instructors...no one deserves to be out and out abused by any other.
3. do not enter the unit "entitled", meaning, be willing to do your OWN research, fact-finding, lab reading, leg work, etc. Don't ask a busy charge nurse or primary nurse for things you can find or do yourself. (I know this is common sense, but I have learned common sense is not always that "common"). And be willling if you have an extra minute to help out anyway you can. Don't be afraid to offer to help do things like water passes/bed changes runs to lab, etc. IF your instructors permit. WE will be ETERNALLY GRATEFUL. NO that is not what you are there to learn and do, I know--- but if you DO have a minute, please try. It does make all the difference.
4. Remember those who DO treat you well and emulate them. Remember those who did not, and resolve never to be like them.
5. Enjoy school while you can. It's not "greener" on the "other side" always. Enjoy that safety net of your instructors while you have it and learn all you can while you are in school. Take every opportunity to grow.
6. Remember, nothing is forever, even nursing school. It WILL end and you WILL be a nurse one day and you WILL be able to look back on all of this and learn from it.
(((gentle hugs))) To ALL students here.

Oh that's all great! I graduated 2003 and I remember feeling critisized and treated as a nusance at times but not all. Our professor one time talked to one nursing supervisor about one rn and then the rn turned around. I'm finding HARD now is that it just gets so busy and is hard to try and help teach students as well. Sometime I feel the group is too large now. The professors partially fixed this by having half the students pass meds and not the other.

When students are around I don't have to deal with students much I work 3-11pm I try to remember how i felt as a student and treat them with respect. I like to help teach too it's fun!

When I first started nursing school I had NO experience whatsoever. NOw I am usually slow at new things then pick up and pick up well inorder to do a thorough job. I got upset one time i think i had 3pts and I guess the nurse just expected us to do am care and meds and charting and I just couldn't get to cleaning this one stroke pt. They had technicians their but they expected since I was a student and less patients i should do it. Now thinking back maybe the professors had an agreement that we would but so many of us just passing out meds with the instructor and being new it was alot. Anyway the primary nurse snapped at me and didn't quite yell but very angry and like she couldn't believe I didnt' do am care yet. She was very fast paced but anyway I was traumatized, i got over it but at the time I almost cried. Clinical can be scary the first time. The professor talked to her.

Ok after that I though I'd never treat a student like that and I don't believe I have but I do feel pressured sometimes. So I agree with the quotes above to follow that as students and work together to get meaningful experiences. Sometimes students refresh practicing nurses about different things so the benefits are for everyone. However when I was student were definitely taught to do your own research and tell the nurse where the charts are and ask questions but go mainly to the professor and don't ask anything you can find or look up in the chart. I would see students looking up pts the night before their clinical and when i would do this we would tell the nurse where the chart is going and look up everything. We basically just asked where the info was. NOW the student coming I really mean out of 10, 5 would come up to me and ask me what all sorts of abreviations ment how to find things in the chart. And i have to tell you it was too much. I got annoyed. Then i felt guilty i just graduated! But I realized when i was a student there was this code to follow to be their to learn but not hinder the staff nurse's work too much. Oh boy i'm going on and on just follow the above quote it's great because we have to work together. ONe time a student asked me to print labs for her. I did not have too but i wanted to help out and i said I would when i got a chance and i was busy but literally she stood at the station watching every move I made so please please understand your professor is their to teach you and staff will and most I feel cooperate and enjoy it but understand there is only so much we can do and need space. My professors strictly enforced to us that staff are great resources but to definitely do your own research and ask important questions when the oportunity arises but don't ask how to do every aspect.

I've recently started precepting and it's been great. I find many facilities i worked in as a student are great with students but occasionly it gets hairy.

mysticalwaters1 · Mar 26, 2005

Oh one more thing the original poster the issues going on seems they were treating you just as extra help and that's uncalled for. I mean if you help out at times that's wonderful and at least i would appreciate that I feel you are their to learn period and as the primary nurse that nurse still looks after the pt. I think most do. Not only that but understand or don't expect everything to be done. You are their to learn period. I think that's what upset me about an externship one summer or rather it appeared to be an externship at a hosptal but a fancy term to get technician work which is fine but don't advertise like your getting one to one nursing precepting experience when you are a technician. Whew sorry i blab and blab and blab!

nbnurse95 · Mar 26, 2005

I'm an Rn and I don't treat students this way because I remember being treated badly while I was a student. You're going to meet and work with "mean" people for the rest of your life. So, although I treat students with respect, there are some things that really irk me. Such as:

-Letting me know during report at 1500hrs that she didn't have time to change the drsg at 1000hrs and the order is "change drsg TID" (happens a lot)

-Charting lung sounds, heart soumds, etc, but not charting the CBI or abd drsg.

-Ignoring call bells because the bell that's ringing is not one of their assigned pts that day.

-Charting "RN notified" when they haven't.

-etc.

So, these things bug me and I tell them politely that maybe next time they should...(depending on the circumstance). Although these things seem so obvious to us, I truly believe they're oversights that will be corrected with time. If we make them nervous, how does that help? We don't want our children to be pushed around by bullies at school, so what's the difference? They have to come in everyday to face the same person that was so mean the day before. When I treat them with respect, they'll learn. I don't have to berate them to teach them.

Like I said, you'll meet mean people for the rest of your life. The Rns that are rude to you, are also rude to waiters, mechanics, store personnel, etc,etc,etc. They're just miserable. Don't take it personally.

jerryh55 · Mar 26, 2005

I think that as a student, we need to be able to tell when is a good time to ask questions and when we need to leave someone alone. I think we need to be respectfull of the staff we are working with on the floor. This makes for a much more relaxed atmosphere, and as lot more seems to get accomplished.

I have been very fortunate to have not run into these problems so far. The staff we work with at the hospital we do clinicals has been very supportive in every way. We generally get with the LVN who has this patient and set the rules for what we can do and can't do. Once this is done, she knows where she needs to fill in the gaps

As far as doing our own legwork, we are told where the charts are and it is our rersponsibility to find and get what we need on our patient. I would never ask an RN or an LVN to make copies of a lab sheet. That's why we bring plenty of paper and a few pens.

We as students are kept pretty busy, but there are slow times during clinicals. I always ask the other students if theres anything they need when I have free time. If nothing needed, I start askingh the LVN or the Aide if there's anything I can do for them. Yes, I have helped an Aide move a patient (not mine) from the bed to a bedside commode. Yes I have helped them change the linen on a patients ( not mine) bed. We are there to learn, but I find that we learn more when we offer to help those who can teach us more than we can ever imagine. It's a give and take, and if we give a little more than we have to, we will recieve it ten fold over.

When you see a CNA, an aide, or whatever you call them where you work, running around like there's no tomorrow with enough work for 2 people. Ask if there's anything you can do. Do what you can when you can. Makes for a better experience. One day you may be working on the floor with them, and trust me they will remember you taking the time to help them.

Have A Great Day And Be Safe

Jerry

caroladybelle, BSN, RN · Mar 26, 2005

I think that's what upset me about an externship one summer or rather it appeared to be an externship at a hosptal but a fancy term to get technician work which is fine but don't advertise like your getting one to one nursing precepting experience when you are a technician.

Well, let's see. Did you pay tuition money for this "externship" and was there a clinical instructor present while you were performing it? Or did you get paid for doing this "externship"?

If you got paid for this "externship" then it is called a JOB and if you do not have a license, then guess what! The work that you will be doing will probably be that of an aide.

Now, if you paid money and your clinical instructor was there to legally cover you with her license, then you have a grievance.

Because until you have a license in your hand, you cannot perform the actions of a nurse. And any nurse that lets you do more than tech work is violating the patient's rights. Not to mention, taking a big risk with her license.

And, in addition, WHAT IS WRONG WITH TECH WORK? If you are a good and caring nurse, you are going to be doing a heck of a lot of tech work in your career. If you have a problem with that, then Nursing is probably not going to be very satisfying to you.

mysticalwaters1 · Mar 26, 2005

Well, let's see. Did you pay tuition money for this "externship" and was there a clinical instructor present while you were performing it? Or did you get paid for doing this "externship"?
If you got paid for this "externship" then it is called a JOB and if you do not have a license, then guess what! The work that you will be doing will probably be that of an aide.
Now, if you paid money and your clinical instructor was there to legally cover you with her license, then you have a grievance.
Because until you have a license in your hand, you cannot perform the actions of a nurse. And any nurse that lets you do more than tech work is violating the patient's rights. Not to mention, taking a big risk with her license.
And, in addition, WHAT IS WRONG WITH TECH WORK? If you are a good and caring nurse, you are going to be doing a heck of a lot of tech work in your career. If you have a problem with that, then Nursing is probably not going to be very satisfying to you.

WOW RELAX RELAX RELAX!!! It seems you don't understand about internships and externships. Ok i'll explain. They have nursing externships. It's like an internship which is one to one experience with a fellow nurse. NOw in internships the nurse works with you, assists you in specfically assessments and other nursing activities. The school works with the facility to get a preceptor and you are allowed to do nursing related functions under the direction of that preceptor. With an externship you get paid. Actually the externship may only let you do assessments and charting I believe. It's basically the same as the internship exept geting money for it and usually maybe in the door for a position at the facility. I desparately needed to learn on a one to one basis especially on how to do efficient assessments. Our professors highly reccomended after our junior year to do one to get an idea how to run a shift and be more prepared for senior year that went into med surg nursing. The facility I joined advertised the program as an externship or saying all the descriptions of an externship only gave us 2 week learning about the work because we were nursing students and sent us on the floor. NOw I only had intro to nursing. The technicians there are trained 6 weeks. What I'm getting at I was not prepared, mislead about what I went into. That's all. Now thinking back and now not requiring to be specifically liscened to do pt care work I may have tried in highschool to get experience. I am not putting tech work down it's valuble. We were talking about nursing students and getting different experiences.

I'm sick people pulling the if you are caring you should do or like tech work. Techs are wonderful but overworked and more are needed. Externships and internships are in noway unethical are legal and valuble with becoming a better nurse or rather getting the most expeirience one can get out of school.