Question about student nurses

allnurses Guide · Jul 24, 2012

You are still ultimately responsible for your patients, students or not. The instructor and the school are responsible for the students. I would check with your manager about what they are allowed to do and when; if the instructor cannot pass meds with the student, then the student should not be doing it (my program only allows first years to do it under direct supervision by the CI).

What kind of instructor can't do meds or dressings? BIg red flag to me, I would report this to your DON and ask her to get with the school about expectations of those they let do rotations with you.

metal_m0nk, BSN, RN · Jul 25, 2012

If you're the only RN working with 4-6 students at once then the facility needs to have a conversation with the school. I don't know of any facility that allows one RN to oversee that many students at once.

shortNsweetRN · Jul 25, 2012

It was a big red flag to me too. I know dressing changes are all different but theres some basic knowledge/common sense for every type of dressing. She obviously has no common sense/clinical knowledge, First I had to gather all the supplies for her, then she tried to put a whole sheet of Maxsorb on a tiny wound. She oversaw two students doing a med pass, didn't know what most of the medications/orders were for (i.e. asked if she could substitute prilosec for an order of zantac), and didn't sign out the medications as they "popped" them, instead signed them out about 20 minutes after giving them to the patient, then realized she forgot two of them. One of the students handed me the cup of pills and asked me if I could double check them with her instructor standing right there who helped her pop them out. Obviously the instructor is not competent to do her job, that's why I have a problem when I have 4-6 students assigned to my patients. My DON is useless and really didn't care when I talked to her about it, basically told me that everyone needed to learn and I had to deal with it..that's why I was wondering the about legal aspect of these things...like whose license are they under, and are the students assignments still my responsibility, and if its possible/legal to refuse to have students take any of my assignment. (At least for my own knowledge until I find another job haha)

NicuGal, MSN, RN · Jul 25, 2012

We had an instructer like that on our peds floor...we wrote it up, went to the director of nursing, who in turn went to the dean of the school and that instucter is no longer allowed in our hospital. CYA. I would keep writing it up and go over her head if I had to.

KateRN1 · Jul 25, 2012

I have been in your shoes and I have also been that brand new nursing instructor, overwhelmed with the tasks at hand. As a professional, have you tried talking to the instructor about her previous clinical experiences, areas of expertise, and/or expectations? Find out what she knows, expects, and expects of you, then discuss how realistic it is. If you have some ideas about how the student experience could "flow" better, by all means write them down and make suggestions. I don't know jack about this particular instructor or your situation, but in my experience, instructors get zero orientation to anything. No orientation to the classroom, how to create lesson plans, how to create an exam, and certainly no orientation to the clinical sites unless we have the foresight to create it ourselves--which many sites won't allow anyway. It sounds like she needs some basic orientation to your facility, including policies and procedures, common tasks, rehab schedule, patient goals (independence), and any other quirks of the facility that a newbie would need to know. Everyone will fare better if you approach this from a collaborative standpoint instead of an adversarial stance. If she truly is incompetent, versus just in over her head, then that it a different matter and should proceed up *her* chain of command--contact her supervisor at the school and explain your concerns.

metal_m0nk, BSN, RN · Jul 25, 2012

How many RNs does your unit staff during these clinicals? Why aren't the students more evenly distributed? How many students total are usually in attendance? This seems strange to me.

My clinical groups were sized based on the size of the clinical site (and by extension, the size/staffing of the units). Each student was assigned 2 pts (3 max), so that no single RN oversaw more than 2 students.

lovedijah · Jul 25, 2012

I would be concerned. This situation sounds like a free for all, and at the end of the day- it's you who will have to answer for her shoddy practices if things go wrong. I'm also shaking my head that the instructor has no idea what's going on. Seems like the administrators would have some sort of orientation with her. In addition, why did the school send her out there if she is lacking? It's so hard for schools to even secure clinical spots, you'd think they would want to live up to certain standards so people will want to work with them.

allnurses Guide · Jul 25, 2012

If you're the only RN working with 4-6 students at once then the facility needs to have a conversation with the school. I don't know of any facility that allows one RN to oversee that many students at once.

I've been a CI, we always had 6-8 students each. Which is why only 1 or 2 would get to pass meds on any given day. It takes a long time to oversee a student pull meds one by one and review them with her, and go through all the rights at each bedside.

And the OP has 14+ patients? The CI and the student should be a help, not a hindrance. We always did our best to NOT add to our RNs' burdens.

shortnsweet: I think if your DON is not supporting you, and there isn't someone over her head you can go to, you might want to think about contacting the school directly. I know my director listens to complaints/problems with CI's. We have had sudden mid semester changes before.....

jh56031 · Jul 25, 2012

I am currently a student and we are "working"/studying under our CI's license. In my program, we were told that we need to work WITH the assigned RN and for most tasks we have to have our CI with us until they feel that we can properly complete the task. Maybe that school/program doesn't lay down appropriate ground rules for their students or train their CIs. It sounds like you are in a tough situation and a stressful one. I hope everything works out for you.

metal_m0nk, BSN, RN · Jul 26, 2012

I've been a CI, we always had 6-8 students each. Which is why only 1 or 2 would get to pass meds on any given day. It takes a long time to oversee a student pull meds one by one and review them with her, and go through all the rights at each bedside.

My post referred to the staff RN overseeing a large number of students (associated with her specific patient load), not the CI.

decembergrad2011, BSN, RN · Jul 26, 2012

I thought all of this talk of working under someone's license was an old wives' tale told to students to keep them from getting too big for their britches. If not, I would love some elaboration on the topic.

When I was a student, the majority of care I performed was under my clinical instructor's supervision. If the RN was kind enough to supervise me while I completed tasks, it was only because I had already proven competency while with my clinical instructor, i.e. giving a SQ insulin. We needed to cosign our CI or RN on everything we charted on a patient in the computer, with the idea being that they would be following up on our care and assessments. Many schools do not even have access to chart, so I can see this being a huge problem for the RN if they have many students giving meds and performing tasks on their patients.

I think as the RN you are ultimately responsible for making sure your patients get what they need, but students can be a big help if they have the right direction. I agree with talking to the clinical instructor and seeing how you could help her with managing the students you have under you during clinicals. If she's a lost cause, you'll learn soon enough.