Professional Behaviour & Conduct - help!

[rachelgeorgina]

This is a bit tough for me to explain coherently, so please, bear with me. I'd really appreciate the thoughts/opinions/advice of the members here as all the evidence (i.e. your postings and responses) are filled with intelligence, social awareness, warmth and understanding.

Here's the background: I'm a 20 year old nursing student - sort of second year, kind of first year. I did the first semester of first year but only one subject (non-clinical) in second semester, because I was unwell. So now I'm sort of meshed between the two. I also work as a nursing assistant in a nursing home and in a hospital for profoundly disabled children. I've also spent a good deal of time around hospitals as a patient (chronic asthma as a child) and a relative/visitor (elderly grandparents - the works.) So, I have a fairly decent basic understanding of how a hospital ward works (simply in comparison to many of my fellow students who've never set foot in a hospital!)

& the story: my clinical placement last semester was my second clinical placement for me, but the first for everyone else in my group. We were divided into pairs and assigned to different wards and we were to spend the week on AM shifts on this ward. I was placed with a shy, nervous, unsure international student (we had the same name!) on a respiratory ward, which was exciting as there were lots of things to see and to learn about.

The design of our clinical is that we are buddied up with an RN on the ward and our facilitator comes to check on us/visit once or twice throughout the shift. On the first day, this was fine and all went to plan. However from the second day onwards it became our responsibility to find a nurse to buddy with (most not being very receptive to students, we often ended up with casuals who had no idea about the ward) and try not to step on anyone's toes. It was very much a balancing act between learning/meeting our objectives and not getting in the way of the staff or treading on their toes. We certainly did the best we could, anyway. & though it was often very uncomfortable (dirty glares, being ignored etc) we did learn some amazing things (saw my first trach, TB pt, ND tube, PICC & CVC etc.)

However, my facilitator (who was barely around and took most of her reports from the staff on the ward, with whom which she normally worked) wasn't impressed with my performance and gave me an unsatisfactory grade. She cited poor professional behaviour as the reason and gave several examples which I'll share with you now:

1. I, naturally, have a loud voice and often failed to control this in the clinical setting
   
2. Whilst observing a bronchosocopy I let out a small, shocked "oh!" on the sight on an extra large glob of sputum on the screen. Totally unacceptable, as even though the patient was sedated, they were still concious and I could have scared them awfully! I recognised my fault immediately and shut the hell up and apologised to the nursing staff in the suite following. (Unfortunately, they intreperted my "oh" as an "ew" and passed this on to my facilitator.)
   
3. An exceptionally confused pt telling me that I spoke to loudly (after I'd gone to trouble of massaging his feet when no one else wanted to go near him because he was v aggravating!)
   
4. Myself and a casual nurse were tossing between getting a pt up for a shower or sponging him in bed. She'd decided on a shower and I went to hunt for the commode chair. When I returned the NUM had said best give him a sponge (probably a good choice, too) and reported to my facilitator that I wasn't following instructions or working as a team.
   
5. I appeared "overly confident". I'm not sure whether this should be put down to the fact that unlike the other students, I wasn't squeamish about giving a shower/sponge because I'd done it 100x before and knew my way around the hospital (which I was familiar with) or because when I'm nervous I dont withdraw, I tend to try to push through it by asking if there's anything I can do to help or asking questions about things Im curious about (e.g. the trach pt)
   
6. Asking the NUM at the nurses station about a pt's status and what her prognosis was. This was the wrong place to conduct this conversation, but I felt it in poor taste of the NUM to report me for doing this when she fueled the fire, so to speak, by providing the nitty gritty details
   
7. Apparently I interupted the NUM on the phone (I have no recollection of this and can't imagine myself doing so.)
   

I don't want these examples to come off as defensive, because there's really no point in my insisting that I'm right and they're wrong. On some accounts, I feel I've been poorly treated in terms of miscommunication of situations (e.g. the shower chair) however on the whole, I think I have some issues that I need to work on regarding professional behaviour.

My next clinical is coming up in three weeks time and I'm really looking forward to it. It's two weeks on a haemodialysis unit! I want to improve my performance in terms of professional behaviour and I was hoping that the collective knowledge of allnurses might have some ideas. Specifically, I think I need a hand with:

1. Appearing meek, proactive and willing to learn without stepping on anyone's toes, getting in the way of the staff or stepping outside my role as a student
   
2. Lowering the volume of my voice consistently
   
3. Carrying myself as "a professional" - not a friend of the patient or the staff (and not an equal of the staff, either)
   

I'm sure that's not everything but I'm about out of ideas. I really do need some prods in the right direction. Nursing has always been my dream, ever since I was a little girl. & I'm not bad at it, either. I work three jobs as a nursing assistant - they wouldn't have hired me or kept me on if I were no good, right? But I've got a lot to learn.

Thanks so much if you got this far!

[emmalou*]

What is the place and role of the student in the clinical environment?

We are guests on the ward, there to learn and improve our skills as nurses. We need to be proactive, willing and excited whilst keeping out of the way and not stepping on any toes. I have found, very often, that there is nothing for students to do. Asking for things to do more than once in the hour is annoying for staff, and once all the patients have fresh water, their call bells answered to the best of your ability the old ladies are sick of talking to you, there's little left to do. When your facilitator rocks up for a visit, it's hard to look useful! I generally read all the patient charts, look up medications, diagnoses and treatments that I dont know/understand and make myself clearly available if anyone needs a hand.

This concerns me. It is the role of your facilitator and the role of the unit and the nursing staff to educate and train you - yes, the student should be proactive and enthusiastic, but they are there to train you, that's the whole point of clinical practice.

Given how busy the hospital and aged care environment is these days, I find it hard to understand why you wouldn't have a lot to do - I'm getting the feeling the staff and facilitators aren't doing their job.

I'm not sure if your university does this, but your facilitator should be going over goals with you before the start of any prac - tasks and skills you would like to learn/need to learn while you are on that prac with appropriate time frames.

You should also be having regular discussions with your facilitator (daily usually) on how things are going. Always remember to give positive and negative feedback (there's always both in any workplace realistically).

[buttercup99]

Rachelgeorgina

I have found, very often, that there is nothing for students to do. Asking for things to do more than once in the hour is annoying for staff, and once all the patients have fresh water, their call bells answered to the best of your ability the old ladies are sick of talking to you, there's little left to do.

Hmmm..... I am not sure where you do your placements or why this is. I NEVER have time to talk to little old ladies. I NEVER have time to sit at the nurses station. You need to be proactive. Look at when the vital signs/observations are due and do them 5 minutes before they are due before the nurse gets a chance to do it. That way, you are doing something helpful and when they come to do it, they are happy that it's done, they can move on to the tasks that are not in the student's scope.

You need to work out a list of what is in your scope - your uni should supply you with something like this. Practical skills that you have learned at uni are in your scope, and you should go out of your way to be there to do them.

Keep your ears open, if something needs to be done and there is no one to do it - volunteer. I have been known to do jobs that the patient service attendants usually do (orderlies) such as retrieve the ECG machine from downstairs, retrieve the unit of blood or take the patient to the front entrance - if there is no PSA and the task needs to be done right now (and patient care hinges on it.)

When all your obs are done, ask a nurse that you are not paired with if she would like help. Be aware of what time it is, if Nurse B should have gone to lunch by now, offer to relieve them by doing as many of their tasks that are in your scope so they can go to lunch.

If you can't find anything to do, you are not looking hard enough. Either that or your scope is still very narrow as a 1st year. Work out what you need to do and do it before you are asked. Get the nurse to teach you new skills so you can do it next time.

Do you sit down at the beginning of the shift and fill out a shift plan? So you know what needs to be done at what time for each patient? You look through their folders and work this out, even the things that you cannot do, you write on the plan.

If the nurses are run off their feet, then there are things you can be doing - and I don't know any nurse who is not run off their feet. If there is nothing you can do, watch the nurses do what you can't do.

I barely have enough time to do all of my work, you will see me frantically finishing my last note at 3:35. Ask for a patient to be allocated to you if you don't already. Hint: If you can deal with your patient load, ask for an additional patient even if you don't HAVE to move up to an extra patient until next week.

Short story: Keep your eyes and ears open and find ways of keeping yourself busy. If there are only a few things that are in your scope, for crying out loud, do it before the nurse does it or you WILL be bored. Be helpful and be aware of what's going on.

Buttercup

[rachelgeorgina]

Thank you to everyone that has replied/provided me with feedback.

After a significant amount of reflection and introspective I think the crux of the issue is perhaps maintaining some sense of self whilst "fitting in" to the expected mould of the nursing student. In essence, doing my job, and doing it well, without letting "them" (in institution as a whole, I guess) squash me/my personality. To be honest, I don't know how possible it is for me to be meek/keep consistently quiet. I am an outspoken person by nature (which can obviously be culled to a degree) and also possess a degree of impulsiveness (perhaps related to my bipolar disorder.)

Over the next week and a half (before clinical) I'll be working on lowering my voice, planning how to manage myself when I want to say something that is out of place/may not be appropriate or appreciated (stop, count to five, think) and further reflecting on ways to improve my performance.

I think it's sad that the culture of nursing is often not conducive to nurturing of the future nurses. However, if this is the way that it is, there isn't much I, as a simple student, can do about it right now. So, I guess the thing is to suck it up and deal, right?

Again, thank you so much to everyone.

[Whispera, MSN, RN]

Suck it up and deal? No!

Not all nurses are negative. You wrote, yourself, that people here are supportive. Find the supportive ones where you work and have clinicals! Observe them. Make them the ones you ask for help.

All in all, your experience will be what you make of it, so think positive and do what you can to make it the best you can.

[Grace Oz]

You are heading in the right direction, Rachel!

Kudos to you and wishing you every success in the future!