DL-SNUP

Thanks Esme! I have a few that have served me well in nursing school, but I'm getting the feeling I'm going to have to step it up a notch. Plus, I've never done time on a renal unit, so these sheets may be better suited than what I have.

Hey all, So, I'm a new grad as of today (wooohoo!) and am wondering if anyone has some tips about how to orient and go through my preceptorship smoothly. I've seen a lot of threads(on various sites) about how some new grads can be royal pains in the behind, and I really want to avoid that as much as possible. I'm going to be working on a 17 bed renal unit on night shift. I plan to do lots of research and study up/review renal issues while I'm waiting to start work next month, but does anyone else have any ideas on how to make the transition as smooth as possible? Thanks! Dev

Hi All, So, I've been offered a position at both Wellmont and MSHA, and I'm completely at a loss about which to chose. Here is the down and dirty: Wellmont Holston Valley: Slightly (very slightly) higher pay but day shift (I prefer nights), benefits are not *quite* as good. The unit is a ortho/neuro/trauma unit, which sounds super interesting and would be a great learning experience. MSHA JCMC: (slightly) lower pay, better benefits, night shift. The position is for a renal/dialysis floor, which also sounds interesting. Plus, I'd learn some dialysis which would be neat. Does anyone have experiences with either of these hospital systems? Or even the cities? I'm from OR, so any information would be a HUGE help. Right now I'm leaning towards MSHA because the benefits are better, but I'm a little worried that by going into renal I'll be too close to "specializing" and may have a hard time finding a job on a general med/surg floor eventually. Like I said, any opinions would be wonderful! Thanks in advance!

I started applying super early because I'm paranoid. But anyway, I worked as a Med Aide/CNA in school, did lots of volunteer work, and spent hours on my applications. I was offered two positions actually--neuro and renal. I would definitely recommend applying soon though--don't wait until the last minute. :) Also, does anyone know if JCMC is union? Or what their uniform requirement is?

Misrepresented how?

Hi Everyone, So, I'm a BSN student graduating in May, and was just offered a position as an RN at the Johnson City Medical Center. I've accepted, but I'm a little nervous because I haven't had to sign any sort of paperwork, and was told that I wouldn't have to until a few weeks before I start. I'm going to be moving from northern Oregon, so I'm feeling a little paranoid that I'm going to get all the way out there, and it will fall through. Anyone have any experience with anything like this for MSHA? Or any experience with MSHA in general? Thanks!

Thanks for the help! I was offered the job. :)

So, I have an interview coming up for an RN position on an Acute Renal Unit. I'm a new grad, and don't have any clinical experience on a solely renal unit (although I've worked with renal failure patients). I feel incredibly silly asking this, but would an acute renal unit be similar to a dialysis unit? Or would it be dialysis combined with other cares for those in renal failure? The job description is very vague, and doesn't really address specific nurse responsibilities. I do know that the pts are very sick, since it's an ICU step down unit, but other than that...I don't know much. Anyone have some advice? Also, it's a nurse preceptorship program, so I wouldn't just be thrown into the position. It would just be nice to have some more info going into the interview. Thanks! DL.

I'm not saying it would take 2 seconds to show me what to do....I'm saying it would take 2 seconds to tell me to grab my clinical faculty and go do it. The nurse wouldn't have to be there, because my clinical faculty would be. And, in this case, it would save her the time of having to do it because my clinical faculty, registered nurse (who, like I said, works at the hospital on her free time as well) would be there with me. I understand thoroughly why my nurse wouldn't show me-she's busy. But she easily could have let my CI show me (especially since my CI is ALWAYS on the floor).

I agree with this. In my area, it's the opposite. Portland hospitals job listings are starting to spread the message that by 2013, they won't be hiring ADNs without previous RN experience, and they flat out say that at this point in time, BSNs are preferred. So for me, it makes a hundred times more sense to get my BSN (especially because the school here is great and provides excellent financial aid). I can see that's different in other parts of the country, and I totally agree that each situation is different.

You know, I do see what you're saying...but sometimes it can't be helped. For example, I've never inserted an NG tube. Most of my classmates have, but I've never had a patient who has needed one. I know the theory behind how to do one, and I've performed it on a dummy....but I know it's not the same as doing it on a patient. Is there anything my school can do about that? Not really, unless an instructor wants to let me do it on them. And it does get frustrating as a student when you miss these opportunities. For example, last week I had a patient who needed one, but the nurse inserted it without thinking about it. It would have taken two seconds for her to grab me and my clinical faculty and have us do it (my clinical faculty is also employed by the hospital as an RN, so it's definitely within her scope to do). She simply didn't think about it. And while I'm not mad and definitely understand what it's like to get in the grove of it, that opportunity might not present itself again before I graduate. So on one hand, I do see what you're saying. It has to be frustrating to be an experienced nurse having to do an NG tube type of thing with a student. But on the other hand...sometimes it can't be helped, especially with things that students can't practice on each other (ie....IVs, blood draws, so forth)....

Thanks! At the end of the day, the message that I was trying to get across is that "This is how it is". Whether or it is or isn't fair, nurses have to work with students. That's real life nursing. But it's not fair to punish each other for something that neither party can help....and being constantly negative, angry, and bitter will not facilitate patient care. Because I don't care what anyone says---when you're in a bad mood, it's going to come off to your patient. If you're busy being annoyed that you have a student/the RN your working with isn't 'nice', you're taking time that could be spent a) learning something and b)helping your patient. I'm not asking for nurses to become the teachers of students, or to be excited about having one. I'm simply asking for some understanding that poor attitudes are a waste of time and energy, and don't benefit anyone. Sure, sometimes you can't help and you'll be annoyed. I get that. But getting an attitude adjustment will go along way (on both sides). Students need to realize they aren't the center of the universe, that the patient is. And the nurses need to stop taking their frustrations with the system out on the students. At the end of the day, I'm hoping that most of us, registered or not, are semi-intelligent people who deserve respect. Treat people how you would want your mother/father or daughter/son to be treated in their situation. Seriously...we're all adults, and we should all act like it. That goes for nurses and students across the board--there is NO excuse for cruelty.

Scary! I guess I'm lucky....the hospitals here let us pull all medications except for narcotics, and we can give most meds and hang most IVs w/o an RN present (provided they trust us, obviously). IV teams have made practicing IVs tricky though... we just had to practice on each other until we looked like drug addicts

Ooh, I see what you're saying. One thing is that not all the nurses on the unit are DEU nurses--most of them don't want students. It's more that a unit asks their nurses if they want to work with students. Plus, they work normal shifts the days their students aren't there and they typically take the higher acuity patients since they typically only take 4. And since most new grads in my area get hired by these hospitals, they end up with new grads who have at least some skills...so in that sense, I think that the hospital benefits....in addition to the fact that students have been shown to contribute to better patient outcomes in this setting. I'm definitely grateful for it--I look at the "regular" clinical setting and I don't know how most grads are getting the skills they need. But I don't think this is entirely the faults of the schools. I mean, the schools can show you on a manequin a hundred times, but unless you've done it on a patient, in clinical....it means nothing. And unfortunately, the shortage of nurse educators mean there aren't enough CIs for students any more. And then with so many staff RNs not wanting to work with students, it just creates this messy, broken system.

I don't really see it that way. It's the same as having normal clinicals, except that you're in a better environment for learning. If anything, I'd say it's an improvement. I've never met a student who didn't have a great relationship with her nurse. It seems like it benefits everyone. We're more prepared for patients, we gain more experience, the nurses who want to teach get to, you form relationships, and it's not simply a student being shuffled. These aren't in addition to "normal clinicals"...for medsurg, these are just considered our clinicals. And it seems to work well for the units I've been on. There seems to be less stress, less ****** off nurses and upset students, and more positive learning experiences occuring.

I do understand that. You don't need us as students. But you do need coworkers, and I'm sure at one point one of them will be a new grad who was in a situation like this. Students don't stay students forever.

DEU= Dedicated Education Unit. It's a system that my school uses that they're trying to get other schools and hospitals to adopt. Nurses from the unit volunteer to work with students. Typically, the nurse gets assigned 2 students and works with them for the entire rotation. This allows a trust relationship, so that students aren't constantly having to prove what they are capable of to several nurses a week. The pt load is also limited to about 4pts per nurse, so that he/she has the time to help the student one on one. Basically, the student assumes all care of the pt, and the nurse sorta follows up and does quick little checks here and there, based on the level of trust and the student's strengths and weaknesses. We also "prep" the night/morning before...which involves coming in an hourish early, getting your assignments, looking up meds/dx/labs, etc, and forming a care plan to show your nurse. It's essentially a mini preceptorship, with the responsibilities growing as the student grows. At the start of the shift, my nurse would sit with me and go over my plan of care, and then she'd basically just follow me around offering little suggestions here and there. I'm sure there was still stress for her, but she really loved teaching and the unit structured the situation in a way that seemed to help. Plus, I feel like I learned worlds more in one week on a DEU than I have on a non DEU unit. The nurses also get paid a little more, and they receive some training and benefits from the university. It seems like a pretty great situation. Plus, you really get to know your nurse well, so you end up with a huge advocate come job application time. Here's some more info on it: http://nursing.up.edu/default.aspx?cid=7744&pid=2959

That seriously terrifies me. Luckily, I feel like my school has trained us better than that and the nurses I've worked with have been able to trust that. By the time we're done our first 6 week rotation, we're expected to be able to do all medications (including IVs), many procedures (ie, caths, IV starts, blood draws), as well as our assessments, care plan, and VS. Granted, it starts out with 1 pt and only gets to 4-5 during our preceptorship, but still....it's a little scary that what you're talking about is the level to which some schools are preparing their nurses. And I've been spoiled--I was on A DEU for both of my med surg rotations, and my clinical instructor has limited herself to 6 students so that she can stay really involved. All of this talk really makes me think that DEUs should be pushed more though. As least that way, only the nurses who are capable of teaching ARE teaching, and they are being reimbursed for it.

I'm sorry if it came off that way--I'm really just frustrated with the situation and feel like there has to be a better way than having everyone ticked off when students work with nurses. I just don't see how it is beneficial to anyone, and think that we can all do better. I'm sorry if that came off conceited, it wasn't intended to.

I'm really sorry you feel that way. On the units I've been on, we essentially take over as the aide so it's pretty much like communicating with them. And while the student may not be part of your permanent team, they are part of the pt's team. They're providing care for that pt, communicating with that pt. If you really feel like students are that much of an inconvenience, I hope that you're able to work in a facility that does not require you to step forward to teach a new generation of nurses. It's not fair to you or them. This is why I really hope the DEU system starts to become more commonplace. This is my first rotation of working with rotating nurses, and it's been frustrating for nurses and students alike. I guess I was just super spoiled with awesome teaching-oriented nurses on my DEU for my medsurg rotations.

No, but it was similar. The surgeon had placed a semi-permanent tube into the pt's pleura and out the skin that allowed us to use luer lock syringes to remove fluid from her pleura. They actually do it quite a bit on the peds floor I'm on right now. :) Super neat!

Hm...that's an interesting thought. I'm really hoping that's not how I'm coming off to nurses, and I don't think that my peers tend to behave that way. If I ever told ignored my nurse or told her to find a tech and my CI found out, I'm sure I'd be put through a disciplinary hearing at the absolute least. I'm truly sorry if that's coming from personal experiences of your's with students--that type of behavior is beyond unacceptable, and I really hope it's not common. I do try stay out of the way when there is a lot going on. But it's hard sometimes, because this is my education. If I don't learn it in clinicals, I'll end up being a new grad who is vastly under qualified and who can end up seriously harming a patient because I was never shown something. At the end of the day, we literally depend on staff nurses. It might not be fair, but there isn't really a whole lot that the students can do about it. So I guess what I'd like to know is what you'd suggest. If you had a student, what would be the best way for them to benefit from learning from you and gain skills as a nurse, while respecting your duties to your patient? I can't stand that to learn HOW to be a nurse, I have to be a burden to a nurse. Any advice you have on how to make the relationship go as smoothly and mutually beneficial as possible would be greatly appreciated :)

I can appreciate that, but I really do believe that nurses should try to help the students as much as they can. For example, today I got to do a pleural aspiration. Yes, it took my nurse a few extra minutes to explain it to me, but then she was able to delegate four more to me that day so that she could care for other patients. I do see what you're saying though. In clinical, we've been taught to just mention something along those lines at the start of the shift. As long as I'm polite, most of the nurses I've worked with are more than willing to come get me if the opportunity arises and they have a minute to spare. The nurses already know that they're expected to try to teach us, so I think being polite goes a long way. I think it also helps that all the hospitals I've had clinical in tell their RNs when they apply that teaching students is a part of the gig. I don't think most get paid extra, but when that's the expectation and part of the job description, they seem to suck it up and be as positive about it as they can. It's really a poor situation though. It doesn't benefit the nurses who can't stand students to have students, it doesn't benefit the students when they have an RN who won't teach them, and it doesn't benefit the patient to have all the poor communication (like you mentioned with the NPO thing) going on. And yet, students have to learn somewhere and we need to make the best of it. :/

I do see what you're saying and can understand it, especially depending on where the student is in their education. However, it isn't really fair to punish students and write them off as useless simply because they are students. And my point was more that staff nurses should try to accept that we are students and they're simply trying to become RNs. And that students should understand that teaching us can't always be the staff nurse's primary concern. I've been on the "teacher" side of similar situations in other settings, so I can (to a point) see what it's like for the staff nurses. But I've also found that the units that function best and are known for their patient care are the units that attempt to be positive about the student/staff nurse relationship. I know it's impossible not to get frustrated--I'm not 12 years old, I get it. I know what it's like to work with new people who slow you down and drive you batty. But getting ourselves into this pointing fingers, negative mentally can't HELP patients. It's draining emotionally, and it doesn't really benefit anyone.

I'm sorry if it came off that way. I simply meant it in that sense that not every ADN nurse is great, just like not every BSN nurse is great. I believe Associate and Bachelor level nurses are equal in terms of nursing skills at graduation, and that it's who we are as individual nurses that set us apart. I apologize if my wording offended you, perhaps the term "most" would be more appropriate. :)