Janey CNM

This is clearly unfair to the students who are paying for 12 hours of instruction! As a clinical instructor of traditional BSN students myself, I know that sometimes post-conference takes longer and other times finishes earlier, but that only makes a difference of 11 vs. 12 hrs and I've kept groups later when the floor was very busy and then at the end there were things that needed to be discussed/debriefed before leaving. If there aren't learning expereinces 'on the floor' there are always things that a good clinical instructor can do with her/his group to promote learning,such as case presentations and clinical thinking exercises. Perhaps a midafternoon unannounced visit from someone @ BON to see the CI and group of students functioning would end this charade. The job market is tight right now and no one will hire students from a program that they've heard "cuts corners." Unfortunately there are not enough clinical instructors, usually a master's is required and the pay is much Good luck to you- your honesty makes me hope you make it!

I teach maternity & community health nursing at a large state SON, where there are many hospitals. The enrollment in our RN

Public health looks at everyone from all over. We are concerned with things that may be coming down the pike and hit all of us (like bird flu, etc.). Community health mostly involves nurses and other health care professionals that tailor interventions to a particular community's needs, and they generally don't plan out for "the bigger picture", although they do a heck a job in their locales, since they know it better. I have an MPH, which a very multi-disciplinary degree, and currently teach CH nursing.

As a clinical instructor for student nurses (BSN and 2nd degree CNL's) I stress that everyone can make mistakes, and if they go to chart and realize they forgot to collect certain info (pain score, last BM- it could be anything) to make a list while finishing the rest of that particular flow sheet. Then go back to the patient and do whatever is necessary to collect the missing data. This is a sin of omission, and hopefully as they get more experience and are less anxious, they'll remember to do all of it the 1st time. What I won't tolerate is having anyone chart something that was NOT DONE- as in the example above, and students see that it happening all the time. I tell them on day 1 - falsifying a medical record is a failure for the day and could get you suspended/expelled. Part of the blame falls on peer-chart review, surprise visits from JCAHO/STATE H.Dept who are always searching through charts looking for "things that are missing." The patient/nurse ratio is dangerously high and the nurse doesn't have time to do everything and also to chart all of it - especially in 3 different places :-(. Since the written chart or EMR eventually gets reviewed, too many times the decision is made to meet the charting requirements by cutting corners on the actual delivery of care. Here is a place that looking for evidence can help; does all of this info really need to be collected/documented every (hr/shift/whatever time frame) or are we still collecting stuff because we always have, plus now we do 17 other things during that same hour? Does the new mom 2nd day after birth who delivered with no meds and has 0 co-morbidities really need her lungs listened to in 3 places? However, the PO day 1 c-section sure does, along with bowel sounds +-so we can advance her diet if she also + gas. We need to have charts that reflect what really needs to be done so that a critically thinking nurse can deliver evidence-based care, and a way to update/change what data is collected when the patient's status/risk factors change. When staff are asked to collect & document data that never seems to mean anything, they become complacent.

Another thing to consider, if you submit the paperwork but lie about anything, even if it is inadvertent-( you forgot that you had chicken pox as a kid cause you had 4 siblings and your mom can't remember who had what) you could at some future time be dismissed with cause for the mistake on employment application. so if they are in a cycle of getting rid of those with more years invested/higher salaries, they can use something like this to stip the employee of any/all accrued benefits on termination.

I am a clinical instructor for traditional BSN candidates, accelerated candidates/previous BA/BS in something who end up with MSN/CNL and sit for NCLEX, and because I teach community/public health I also have RNHere in this major metropolitan area where there are lots of highly regarded "brick & mortar" SONs, there's a ready supply of BSN grads from those type of institutions, so recruiters might have a bias. Many hospitals who aren't even magnet yet are refusing to interview ADN new grads

A few years ago I had students someplace where a few RN's would pull all their 4-5 patients' meds from the Pixis/Omnicell, then go to the hallway computer, log into each patient's electronic MAR and mark it given "so I won't forget to mark it given later when i get back to the nurse's station." Then they'd visit each pt, do assessment and whatever, which usually took 90 min. But the meds were charted as being given "on time". Now, it got complicated when a student had the pt and we withdrew the med and then discovered that RN had already marked it given- when we caught up with the RN she'd say "Oh, I have A-9's colace and Advil- does the student want to give them since it is her pt?" If med was still in "bubble wrap" with ID info, we'd do it, but I would remark on that fact that the student needed the experience of charting that she gave the med, but MAR showed it was already done." this might be 1 hr later, so the time really given and the time marked in MAR were not the same. Knowing when to give the next dose is then compromised. I did eventually go to the manager and report the repeat offenders, but that meant the students got even less help and nurturing on the unit, as I became the "tattle-tale." I'm much happier now in a clinical site that uses bedside scanner MAK for all meds!

I've taught nursing student for 9 years and before that I worked as a CNM in the same SDA hospital n Maryland for 10 yrs. I also have community health students at SDA health & wellness activities. I have not found them to be in the least discriminatory towards staff, physicians, patients or families of any belief system or lack there of. I am Presbyterian, my husband is Jewish. We have clients from all over the world; being near DC we have lots of folks connected to embassies and here for research at NIH. There are typically many Muslims from Asia and Africa, Hindu's from India, Buddhists from Cambodia, and I'm sure many with no stated belief system. The only overt religious theme each day is the 9am prayer over the loud speaker and it is very generic. I really like the SDA holistic philosophy- their perinata/neonatal grief and grieving program is one of the best run that I've encountered. The night L&D charge nurse is orthodox Jewish, as is one of the lactation consultants. Except at the very top levels of management, CEO, chairman of the BOD, being SDA does not seem to be required. I'd suggest doing a share day and see how you feel there. Good luck!

I realize on charts that time of of the essence and hopefully soon we'll all be signing electronically. However, when using professional title, such as on business card, email preset signature, the rule is, always put what is yours forever (earned degree) next to your name. Then add any certifications (which frequently have some updating/renewal features and therefore someday you might not still have that certification) and last, license RN, CRNM, CRNA which at least in MD must be renewed every year. i teach at major SON and ther are lots who do this incorrectly (Jane Doe, RN, PhD) but ignorance is no excuse. Also, to answer the student who started this post, does your school right now have you use identifying initials after your name? Such as SNUM Student Nurse University of M..... Many sites have students from different schools there on many days and it is extremely helpful to see what school a student is from connected to a note.

One more big consideration. To be a PI (principle investigator) anf get the big bucks in research grants from NIH, Walker-Woods Johnson Foundation, etc, you need to be PhD, DrPH, EdD. Clinical doctorate is NOT acceptable, whether MD, DNP. That's why MD's who are highly into research also have PhD. in accidemia, the realy great sallaries are ONLY for those who can bring in the huge grants that pay them a big salary as the PI