RN's & Nursing Students

[QueenAnnissa]

I'm in my 2nd semester of nursing school and last semester clinicals were spent at a LTC facility. This semester is going to be spent on a med-Surg floor. After 4 weeks there (2 days a week from 7am - 1:30pm) I am feeling discouraged and am hoping for some advice on how to turn this around so I can gain as much learning/exposure as possible during this rotation.

I am an outgoing, cheerful, active student, a married mother of four, and truly invested in my education. I'm willing to get in there and do anything, as I feel it all helps with learning the many aspects of the large scope of responsibilities and skills of an RN. A team mentality is important to me; I strive to achieve it at home with my family, with my study group at school, and within my previous positions working outside the home.

My current dilemma: the RN's in LTC did not interact with us students, were extremely busy with a large patient assignment and were curt and less than patient with any questions. That was fine, as I was new to healthcare I really needed more interactions with the patient care aides as I learned and practiced things such as ADL's and communication with patients. These fundamentals were important and being new skills, I didn't really notice the lack of interactions with the nurses as I was learning the beginning skills more common to aides.

Now we are in acute care where more is expected of us from our clinical instructor and school. And frankly, I expect more for myself as well. But the nurses and even aides seem to not want us around. I know this is very subjective, but I feel I'm being polite to even just say it "seems" like they don't want us there. Very few people say hello or look us in the eyes. I've heard terrible remarks when it is assumed we are out of earshot, but we're not. I've seen two nurses looking at us and laughing while we stand around nervously and fidget as we try to figure out what to do. A few nurses are less directly rude but still seem burdened by our presence. It's very, very disheartening. The last two weeks after getting my pt assignment and trying to work alongside the co-RN for my patient has been difficult. Both nurses were unfriendly. I'm not sure how else to say it. Our interactions were the bare minimum. I was assigned one patient, and they each had several more to care for on the days I worked with them. I know they are busy and I truly don't want to slow them down, but I'm not allowed to help with other patients I'm not assigned to.

Our school has been going to this hospital for 20+ years with their students for clinicals. We have one clinical instructor for 9 students and I tend to hold back from seeking her out for help because there are younger and even more unsure students who need her more. I feel pretty secure in the skills I have so far and spend extra time in the lab to get practice as often as I can. I'm confused by the atmosphere. It seems like we are not wanted, that the nurses don't want to teach/mentor students, that we are more of a burden and inconvenience. This was brought up in post conference as we all are dealing with this experience. Our clinical instructor is very nice, truly wants to help us and has said if anything happens we should let her know, and she'll go to the clinical manager. I hesitate at this, I feel it will do nothing to improve relations. Besides, it's all very vague stuff, "the nurses aren't nice to us, I see them rolling their eyes at us, they are too busy to help us, we heard nurse A say to nurse B they don't have time for this ****" etc.

I know I'm not going to be friends with everybody, I can't choose the people I work with or learn with, and I am sympathetic to the fact there could be other factors going on here. Maybe previous students left a bad impression. I understand this is a small sample of nurses. I don't think all RN's are like this. But the ones on the floor I'm doing my clinical rotation on this semester are and I have to find a way to learn in spite of this.

I hope to work through this and change some minds. But my priority is to learn, and I have to find a way to do it in a difficult environment. I feel unprepared in some ways to deal with this. For the most part I have truly never been in such a hostile environment. And it does feel hostile. I'm not trying to exaggerate. My husband said I need to grow a thicker skin. My fellow students waver between being intimidated or feeling ****** off. Our clinical instructor is a ver nice person but is new to our school and this area and I sense she feels intimidated as well by our poor reception on this floor.

Any advice/thoughts/words of wisdom?

[Jhirschmann]

I'm kind of going through this right now and went through it last year to. Its tough when the nurses aren't excepting of you. I found that one day I was paired with a younger nurse who didn't seem to b bothered by my presence. After dealing with my patient I asked her if she would mind if I went with her to see all of her patients. She said sure. From this point on I was able to ask questions and she was happy to answer them. If this opportunity does not seem to come about talk to your clinical instructor, they should be there to help you and give you advice. Also, keep your ears pealed for nurses talking about special procedures or skills that you have yet to do. Ask if you can either watch or do it yourself. They like when students taker the initiative. I hope this helps!

[llg, PhD, RN]

I'm not going to defend the actions of the staff nurses. They should not be letting you see/hear their frustration. But they have a right to be frustrated. You are not paying them to teach you ... you are paying the school, who in turn is probably not sharing any of your tuition money with the hospital. So it is not surprising that the staff you are expecting to welcome you and teach you are not enthusiastic about having the extra workload of teaching added to their list of responsibilities that is already too long.

That said ... they should not be rude and should make some effort to be pleasant with you.

The previous poster made some good suggestions. I would recommend taking her advice. I also strongly suggest that you start making better use of your instructor. You say that you are hesitant to seek her out because you know she is busy with other students. Well ... the staff nurses are busy, too. Your instructor is the one you are paying to teach you, not the staff nurses. So stop placing the burden on the staff nurses because you don't want to bother your instructor. That might help improve your relationship with the staff.

I'm dealing with this issue from the other side today ... fielding complaints from a unit who claims that a certain instructor "dumps" her students on the staff and neglects her teaching responsibilities. If she continues to do this, she will not be allowed to bring students here any more.

Try to see the situation from all sides. The staff did not take jobs as instructors and may be totally unprepared to teach students -- particularly beginner-level ones such as yourself. While they should be friendly and polite, it is not their responsibility to be your teacher. The faculty members took jobs as instructors and should be the ones doing most of the teaching. Part of the problem here may be that your instructor is not being seen by the staff as taking enough responsibility for the students -- and the staff might be trying to push you in her direction to protect themselves from being pulled into the teaching role and away from their own jobs.

[Lev, MSN, RN, NP]

It is hard enough to keep track of our own activities as Staff RNs, but having students in the mix expecting to be shown everything makes it even more difficult to keep up with the pace. There will be good days and bad days, but there is no excuse for hostile behavior against nursing students. You can't blame staff RNs for not engaging students when they are super busy, but you can expect them to be polite 99% of the time and not take their frustrations out against students.

[elkpark]

Well, the reality is that no one asked the nurses if they want to have students, or be responsible for teaching and supervising them,and a lot of them don't. When I was a student, and when I've taught clinicals, the school's clinical instructor was responsible for teaching students, and we had v. little interaction with the staff nurses. I was in a hospital-based diploma school and, in fact, the staff nurses looooved having us around, because we did nearly all the nursing care for our assigned clients and those nurses ended up having v. little to do during the day. More recently, I've noticed this (to me) alarming trend of "assigning" students to staff nurses and suddenly the staff nurse is supposed to do the bulk of the teaching -- sometimes the students' instructor isn't even around (I've been in that situation, too -- students just showing up on the unit in the AM, unannounced, and couldn't tell us anything other than that their instructor told them to be there at 6:45. And we, the staff nurses, are supposed to construct an appropriate educational experience for them for the day). Many RNs feel that, if they wanted to teach students, they'd get a teaching job. It's unfortunate that students get caught in the middle of this dynamic -- I blame the schools of nursing who have adopted this style of "teaching."

[tokebi]

This is an issue that any nursing student can relate too, I'm sure. I've experienced it as a student, too. I'm also guilty of not having been most helpful to students on my floor.

In my opinion, what you have to do is, taking charge of your own clinical education, not your nurse. What do I mean by this?

At one clinical site, the nurse I was paired with was very busy and had little time or patience for me. From the start, she bluntly asked, "What's your goal?"

"Umm... excuse me?"

Rolling her eyes, she spat out her words, impatiently. "You're a student. Don't you have a goal for today?"

By that point, what little confidence I had had completely evaporated by her strong personality and I was a bumbling idiot all day.

However, that nurse made me think really hard about my attitude and I realized something. I thought I was being receptive by letting the nurses guide me however they saw fit. I had been telling them, "I"d appreciate if you can show me whatever you can. Thank you."

However, nurses aren't trained to be instructors as PPs pointed out, and there is no time to formulate any teaching plan when you're suddenly paired with students unexpectedly. If I tell them to "teach me whatever they can," it is exasperating. Once I started telling nurses specifically what I wanted to focus on, the relationship got easier. By telling them what you need in specific terms, you spare them from having to think of what to do with you.

So, try something like this:

"Hi, my name is QueenAnnissa. This is my second semester and I have learned blah blah so far, and comfortable doing blah blah. For today, I would like to work on my assessment skills. Can I go in with you during your assessment, and maybe you can observe me and see how I'm doing?"

Some nurses will still give you hard time no matter how you approach them. But, at least by being assertive and proactive, you will learn something instead of being at mercy of others.

[Lev, MSN, RN, NP]

Don't get me wrong...I love teaching and having students, but if I don't have time, I just don't have time.

[Qteapi]

I must say my clinical experience thus far has been different. at the hospitals we go to the nurses love having the students cause they know that is one less patient they have to worry about because for the hours that we are there we do every thing and I mean everything for that patient..we do even what the nurse would have the tech to do...the only time we see the nurse who was assigned the patient if the pt should need something like blood of which students can't do or d/c a patient. you don't brother the resource nurse..you got a problem get your clinical instructor....this way the resource nurse isn't saddled with teaching a student and they are happy campers about that fact...so they get attitudes when they aren't assigned a student...plus once you get a feel for the nurses and they get a feel for you and know that you know what you are doing cause the patients have raved about you the nurses will seek you out to show you stuff. At least that has been my experience. We try to "kill" them with kindness...and it doesn't hurt that many of the nurses that work at the different teaching hospitals are alums of my program...now don't get me wrong we have those grumpy nurses that you just have to serve with a long handle spoon, but they soon come around too...the point is you have to bring something to the table other than 50 million questions and if you do have 50 million questions .send them towards your clinical instructor. I am 3rd semester.

[PTKChic]

If this hospital has been having students there for more than 20 years, why would someone knowingly take a job there when they don't like/know how to teach a student?

[elkpark]

At one clinical site, the nurse I was paired with was very busy and had little time or patience for me. From the start, she bluntly asked, "What's your goal?"

"Umm... excuse me?"

Rolling her eyes, she spat out her words, impatiently. "You're a student. Don't you have a goal for today?"

By that point, what little confidence I had had completely evaporated by her strong personality and I was a bumbling idiot all day.

This is another thing that bugs me. When I was a student, we all knew our clinical goals for that particular rotation. We could recite them at any moment, for anyone who asked us. I've expected the same of students I've taught since then. And it bugs me to death when, working as a staff nurse, I get a student dumped in my lap, okay, that's bad enough to begin with, and, when, in an effort to figure out what productive educational experiences I can direct the student to, I ask, "What are your clinical goals for this rotation?", I get "Huh?? What are those?" as a response. Your clinical goals are your guideposts for that rotation, and everything you do during the rotation should be based around them. Clinical isn't supposed to be (or, at least, it didn't used to be) just showing up and seeing what happens during the day.

Again, I don't blame the students for this -- I blame the instructors. IMO, lots of nursing programs these days are really not doing their jobs.

Tokebi is giving excellent advice.

[elkpark]

If this hospital has been having students there for more than 20 years, why would someone knowingly take a job there when they don't like/know how to teach a student?

You're a student, aren't you ... Well, umm, because:

-- It's the only hospital in town. Or:

-- There are other hospitals in town, but this one is the best employer. Or:

-- Most of the time you don't have students and it's a chance you're willing to take. Or:

-- When you applied and were hired, no one mentioned that you would be dealing with students. Or:

-- You thought you would like working with students, but, as time has passed, you feel differently. Or:

-- You don't feel like doing the instructor's job for her/him. Or:

-- Etc., etc., etc.

[NICU Guy, BSN, RN]

Firstly you are paying the same tuition as your classmates, so you deserve to have equal time with the clinical instructor. Go to the patient you are assigned to and say "I would like to do an assessment on you. Can I do that 1pm when my instructor is free?" Then go to your instructor and say that you would like to do an assessment on your patient and arranged with the patient to do it at 1 pm will that work for you? That way the instructor can pre-plan to do that with you at a set time.

Read through your patient's chart and learn everything about your patient that you can. The more you know about the patient, the more the nurse assigned to the patient will understand that you are there to learn and not just put your time in. Maybe they will be willing to explain more about what is happening to your patient and why it is happening.