I very often read posts on this board which complain about the staff nurses. I was a nursing student, too, and I know that such criticisms can be valid but you should know that a lot of us really dig having students around and look for opportunities for you to learn.
I work mid-shift (which means that my shift overlaps both days and nights) and I recently was helping out a colleague who had a student assigned to her. We had just intubated a patient and were tending to our post-tube tasks (e.g. OG tube, Foley, etc).
The student was just standing at the end of the bed so I looked at him and said, "Alright, time to do an OG tube."
He responded, "Um, I don't know if I'm allowed to when my instructor isn't around."
I replied, "Well, I don't know either. Please close the curtain and either come in or step out."
He closed the curtain and tentatively stepped inside at which point my colleague handed him the OG kit. He stepped up to the HOB and we talked a bit about NG vs OG, indications and contraindications, followed by guidance as to what to do.
A couple of minutes later, he'd dropped his first OG on an intubated patient.
I still don't know if he was or was not allowed by his program to drop the tube but those opportunities are relatively rare and I figured he should take advantage of it when it presented itself...
So, young Padawans, know that some of us staff nurses are actually invested in your learning... not because we have to but because we like to.
And what position is that? You, student, either do it or don't do it. His choice. It happens every day to many students. I personally hold no grudges toward students who back away from the chance to do a procedure because they are afraid of getting into trouble.
Imagine clinical experiences where nurses never offered opportunities to students. Instructors can't acknowledge orders and just do them with students.
They are MY patients, in case you've forgotten. So, yes, I DO decide when a student performs a new skill on MY patient. I offer or say yes or no to an inquiry about a student performing a skill. If any instructor decided to allow a student to do a skill on my patient without my knowledge, the instructor and I would be having a little talk. These patients are not the instructor's patients nor the student's patients. They are mine, and I am responsible for them for 12 hours on that day.
Got a little possession complex there, don't you? You don't own patients, and you can be overruled by any number of other personnel who have jobs to perform on "your" patients -- such as physicians, charge nurses, ancillary staff.
Look you don't have all day to wait between rapid sequence intubation, placing an OGT and getting a PCXR to confirm placement. Placing an OGT during an ER nursing clinical sounds entirely appropriate and if you are limited to just watching well that's not getting clinical experience now is it?
Back when I was a nursing student in the ER, the Dr numbed the pt who had a pneumo, cut a hole in between the 4 and 5 ribs told me to put my sterile gloved finger in it, handed me the tube and told me to push it in. As a student. That is getting clinical experience.
If you are a student in my unit I am going to assume that you are there to learn hands on skills not just observe. I am going to put you to work. You are going to perform skilled nursing tasks and assist with procedures under my direct supervision all day long.
Students: If your instructor or school has an issue with that speak up. Bring your clinical guidelines so that we're all on the same page. We are not mind readers. Don't wait until the nurse is dealing with an unstable patient to mention your restrictions. Thank you.
The problem with doing a chest tube insertion is that it is a provider intervention, not a nursing one. In other words, it's out of scope for a licensed RN.
Got a little possession complex there, don't you? You don't own patients, and you can be overruled by any number of other personnel who have jobs to perform on "your" patients -- such as physicians, charge nurses, ancillary staff.
You know exactly what I mean by my choice of words, but you're just ticked off that I disagreed with your statement that it is not our job to teach students.
If you don't want to teach students, fine. But some working nurses have to do it because the instructor cannot provide meaningful experiences to 8-10 students for every clinical.
Agreed. The OP in their quotation sounded like they were short with the student. "Either come in or step out." Do you talk to your patients like that too?
And I would have felt pressured as well.
When a procedure needs to happen RIGHTTHISSECOND, you don't have the time to hold the student's hand and discuss their feelings about every option. I doubt the OP is consistently "short" and "impatient" with students and patients (or maybe he/she is, I don't know them personally), but I've been short and to the point during emergency situations as well, as have most people I've worked with. When we had a stabbing victim, and I was doing a rotation in the ER, the nurse didn't ask nicely if I would hold back the guy's foreskin while he slammed down a Foley, he just told me to do it, and I did. Was I offended? No. It needed to happen NOW, along with everything else that needed to happen NOW.
I'm only basing my opinion on the content of the original post. I was not there. The student in the original post did not eagerly step up to practice a skill that was within the parameters of his nursing program. The picture painted was quite different. As much as I admire the intent to give the student an opportunity to practice a skill, I just can't get behind the high pressure tactics described in the OP and the disregard for any limitations to the student's practice by his program, and what consequences could befall the student because of it. I don't believe that the OP meant any harm to the student, and I do believe the intentions were good, but you know what they say about the road to Hell.
I'm also a little disheartened by the emphasis on procedures and skills as the focus of a nursing student's clinical experience that I'm perceiving in this thread. Yes, it is nice to have new grads who come out of the gates with a basic level of competence at basic nursing tasks, but I'd rather help a new nurse insert a Foley because s/he didn't get a lot of practice in nursing school than have to work with someone who can't effectively problem solve (yes, I know it doesn't have to be either/or, but that's a subject for a whole different discussion and I don't want to get into that angle here).
Of all of the things I would want the student to walk away from this experience with, having dropped an OGT would be at the bottom of the list. I would want the student to understand why the patient needed to be intubated, what the RSI process consists of, standard doses for RSI meds and potential contraindications for certain meds or why the doctor might order one over another, the purposes and functions of all of the other interventions being provided, why continuing sedation is needed and what to look out for, basic vent settings, how to monitor the sedated and intubated patient, and so on. It's really cool that they got to drop an OGT, but really what I would want to impart is the bigger picture and how all the pieces fit together.
Tasks can be taught any time. It's the big picture thinking and putting all the pieces together that I think is the most valuable part of clinicals, in my opinion. I'd like the student nurse to be able to stand outside the room and look in and be able to tell me what is going on with that patient by what they can see from outside the room. It's developing that critical thinking skill that is at the top of the list for me. Hands on learning is great, and it's an important part of the clinical rotation- but to be honest, I think developing good observational skills and clinical judgment are far more important.
Again, this is just my take based upon the language used in the OP, and I am not condemning anybody- I'm just sharing my own individual perspective and I think this is a really interesting discussion. I really wish some clinical instructors would weigh in here, because I'm curious about this issue from their perspective.
I completely understand what you are saying here, but it doesn't have to be an either/or proposition.
What the instructors I've seen are exceptionally skilled at is helping students see the big picture. I overheard an instructor quizzing a student before she entered a room to a pain med. He essentially said, "Give me a report on this patient." She could recite the course of the patient's stay when it came to procedures, but then he asked the most important question: "Why did she have a lap chole?" The student couldn't answer it, and the instructor made her take off her PPE and go back the the chart.
I previously used the phrase "meaningful clinical experience," and I have to back track on those words a little. Instructors try very hard to develop their students' critical-thinking skills, like in the example above. Their experiences are meaningful, but I feel the task-based stuff--what working nurses can consistently contribute to their clinical experiences--are just as valuable.
ETA: excellent post, btw, and it made me stop and think about my use of "meaningful clinical experience." Thank you!
Point of reference, some of my posts may be a little confusing because I am one or two cognitive levels above a gerbil... So I apologize if some of you like ersne12(sorry if I didn't spell that correctly, like I said only one or two above) can't feel them
Until this post, I go back and forth to whether or not I think you are an arrogant, self-absorbed....whatever, to believing that you are actually engaged in this conversation and interested in others' points of view.
This post, however, puts my belief in the former camp. Honey, they are confusing because your communication style leaves something to be desired. Do you feel that?
It's upon us, the students, to decline such invitations. Now if it was me in OP's story, I would have done it, because what happens behind the curtain stays behind the curtain, also yolo:ninja:
It's upon us, the students, to decline such invitations. Now if it was me in OP's story, I would have done it, because what happens behind the curtain stays behind the curtain, also yolo:ninja:
LOL! Not true, necessarily, but funny. Remember that the instructor usually checks in with the nurses.
You know exactly what I mean by my choice of words, but you're just ticked off that I disagreed with your statement that it is not our job to teach students.
Disagree all you like; it isn't your job to teach students. I'm going to assume you are a bedside staff nurse. Reread your employer's job description for your position, and if you please, can you quote the passage where it states that your role includes teaching nursing students?
I work at a large teaching hospital, when I worked on the med-surg units clinical instructors supervised 7-9 students and needed to be present when students were doing new tasks and when passing meds. As a staff nurse I could not ask the students to give meds with me -because their school didn't allow it.
In the ED and some other specialty units that students round on, there is never a clinical instructor present. The student is assigned a nurse preceptor and they follow that nurse. Most schools allow students to do any task with their preceptor (staff nurse) as long as they are present. Their are some schools however let let students "observe only" for a day too. I think the OP did a great thing and honestly it is the students job to know what is allowed in their program not the staff nurse. I think this is a learning opportunity to ALL students reading this. If you have a clinical rotation and are assigned a preceptor/your instructor is not present, ASK beforehand if you are allowed to assist in tasks supervised by the preceptor.
As of late, I have been assigned a student nearly every shift, either an RN, medic, or med student doing their "nursing day". I always start the day off asking them what their goals are and if their is anything in particular they would like to do...like the medic students usually need IV's, meds, electricity etc. Most nursing students cant start IV's but I usually want them right there to get tips for the future when I do it. The med students dont usually have any goals lol, they are forced to work with a nurse for a day prior to starting their internships. With them I usually like to give them tips on how to have a good working relationship with nurses-like nurses with love it if you cycle the BP on your own versus coming out of the patient room and asking the nurse to hit the button, or let them know that we love it when the providers ask us about the new patient etc.
I enjoy explaining rationales and things to look for throughout the day and try to expose the student to as much as possible. I figure I must be decent at precepting if I am always asked to do it.
I like the OP however am very clear with the students that I have no idea what their program rules are, I only know what my hospitals policy is on students and what they allow me to let students do. Just because my hospital allows something does not mean their school does.
We walked a fine line in school. My clinical instructors desperately wanted us to have great learning opportunities, but we were flat out not allowed to do things we hadn't already learned to do. If we hadn't studied it in lab, we couldn't do it.
However, we were always allowed to "help" the nurse with anything. We all learned to phrase anything remotely outside of our scope that way fairly quickly. But there was always a risk.
RNdynamic
528 Posts
Got a little possession complex there, don't you? You don't own patients, and you can be overruled by any number of other personnel who have jobs to perform on "your" patients -- such as physicians, charge nurses, ancillary staff.