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.
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.
^THIS.
In school, we were expected to know the goals of our rotation; they were explicit in our syllabus what and how we were to progress throughout the semester; it was discussed during each semester as an overview; instructors were open to making sure we were able to speak up and be able to have opportunities to learn.
I think a talk is in order; one of the things that nurses do is advocate; that includes advocating for your self and allowing you to have a robust exposure into becoming a nurse.
Being on the preceptor side and known as one to take students, I sometimes would get the "observational" exposure students; and that happens in nursing school; you STILL have goals and one has to be ready to be active in the learning process; and at least the students that I engaged with DID...they knew I had questions and wanted them to think; it's crucial in this business to think and advocate; and sometimes it involves letting the instructor know what is happening during the clinical experience.
Maybe the school could restructure clinical and have it be more a "shadow" opportunity where you shadow the nurse and her/his patients and "help" with all the patients.
That is how my clinical was. For research/care plan purposes I had one patient but I usually ended up shadowing the nurse the whole time. I wasn't friends with any other classmates so I'm not really sure if other nurse/students interacted this way but I don't think it negatively affected me.
I know in LTC, they have a huge patient load, and very often feel overwhelmed and it is probably adding to that frustration having students around. If they have been taking students to this hospital for over 20 years, the nurses should be used to teaching students and shouldn't be talking about you guys within in earshot. I'm sure if you happen to work in this hospital someday, you will be making fun of how "dumb" nursing students are, but just hopefully out of earshot.
Here is what I would do, since you seem to be of the same personality as me, I would go up to a staff nurse and introduce myself. Then I would simply ask them what can I do to make your job easier today? If you present it like you are there to help them, they will respond better. Once you get a repoire going with a nurse, they will be far more likely to show you the things you are wanting to learn. Get on their good side, they are there to help you, yes, but you are also there to help them.
I don't understand the prohibition about helping with patients that aren't assigned to you. One of the best things a student can do if her own assignment is caught up, all her own assessments done, and her patient is asleep, is to answer call lights, ask the CNA or RN if she can help with baths, toileting, mobility, feeds, and the like, at the knowledge level she has already. Nothing p'os a staff more than seeing students "standing around trying to figure out what to do." This is a nursing unit; what needs doing is nursing. I have never had students on a floor that didn't welcome this, and never worked for a school that forbade it. So counterproductive.
Doing these sorts of things accomplishes a couple of things.
One, you lighten, not increase the staff workload. This is endearing.
Two, if you are assisting an RN, you get to observe a lot. (As Yogi Berra used to say, "You can observe a lot by watching.") Just watch, don't chatter; answer if the Rn asks you something, and don't forget to say "Thank you!" Later on, if the opportunity presents itself in a quiet moment, ask your question. If that moment never presents itself, ask your question of your instructor in clinical conference.
Three, you begin to see how an entire floor culture works together far more than if you only see one patient.
I would ask your faculty if they could reconsider adjusting this as above, with the permission of the staff/management. I'll bet the staff would love it.
We are allowed to ask the RN if we can observe them doing things, or if they can observe us doing things that students need supervision for, like IV push meds, but we are not allowed to ask our RNs to teach us how to do things. We have to ask our instructor, and once she has taught us and she feels confident we can do the skill, she gives us permission to either do it on our own if we can or with instructor or RN supervision if required. We are encouraged to ask the RNs questions, but it was stressed that if our nurse is too busy to answer questions or doesn't feel like answering them, we are to ask the instructor.
It is kind of weird to me that you can't help with patients who are not your own. We are encouraged to help the RN assigned to our patient with his/her other patients if our own is all taken care of. Before we can pass meds to other patients we have to look up what they are taking and determine if there is anything we need to to know about their meds (i.e.: are there BP parameters in place for a certain med) before we can give them, but having nothing to do is very much frowned upon and would get us very bad grades. I have not had a nurse or CNA who was not grateful for extra hands.
LadyFree28, BSN, LPN, RN
8,429 Posts
^THIS.
In school, we were expected to know the goals of our rotation; they were explicit in our syllabus what and how we were to progress throughout the semester; it was discussed during each semester as an overview; instructors were open to making sure we were able to speak up and be able to have opportunities to learn.
I think a talk is in order; one of the things that nurses do is advocate; that includes advocating for your self and allowing you to have a robust exposure into becoming a nurse.
Being on the preceptor side and known as one to take students, I sometimes would get the "observational" exposure students; and that happens in nursing school; you STILL have goals and one has to be ready to be active in the learning process; and at least the students that I engaged with DID...they knew I had questions and wanted them to think; it's crucial in this business to think and advocate; and sometimes it involves letting the instructor know what is happening during the clinical experience.