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.
OP, for all your good intentions, you are putting your students in a tough spot. There are good reasons that many nursing programs require the instructor to be present when a student is doing something invasive. Had I been your student back in the day, I too would have stepped out. It's not worth losing my slot and failing nursing school over dropping a tube. It's also not fair of you as a nurse to put students in a position where they have to choose between doing what's right by their school and doing something new and exciting.
Please think about what such a situation does to your students. Teaching them to do what's safe and ethically right is just as much a part of our job as it is to teach them new and exciting tasks.
We had a student dropped from our program for assisting a nurse with a task - mostly just observing, actually, but the instructor found out they handed some equipment to the nurse during the procedure and they were gone. You're an awesome nurse, OP, but I couldn't justify the risk, personally.
I love nurses like you. Thank you for giving a student that opportunity. Having said that, I would have had to step out as we were not allowed to do any invasive procedures without asking our instructor.Generally, she had to be present but in my last med-surg rotation, she let us do things with nurses. But we absolutely had to ask first. She told us day one that if we did any invasive procedure without her present or without her explicit permission, we would be sent home and failed. She'd failed students for it before us. I wouldn't have taken that chance. So the thing I hope nurses understand is that sometimes students want badly to do things, but there are rules we have to follow that sometimes interfere.
This is very common, and is the case in my program early on, 1st and 2nd semesters primarily. 3rd and 4th semesters allow certain invasive procedures to be performed with primary nurse supervision if the instructor can't be there or is unreachable. Had this been my 2nd semester, I would have said that I would be glad to observe but I can't "do" the procedure. Third or 4th, since it's the ED, I'd pre-clear the doing of certain invasive procedures with my instructor because of the rapidity that the ED does them or I'd ask for 30 seconds to try to call my Clinical Instructor and then hop right on in. I would just have to be mindful of our "never" list which essentially is a list of procedures/skills that students are never to perform even with a clinical instructor.
It was incumbent upon students to know that "never" list and what they may do with RN or Instructor supervision. Still, that being said, I would have jumped in on that as a learning opportunity even if that meant I could just observe. Hesitation wouldn't have been an option.
We risk the same fate. For as much as I would love to assist and learn new tasks, I will not take the chance of getting in trouble or getting kicked out of my program. My instructor has made it VERY clear we are not to go beyond what we are allowed to do, which at this point is nothing more than therapeutic communication and doing vitals. The other day I could not even assist the RN with giving the pt. a boost.
I appreciate the fact that my awesome instructor is easing us into this whole new world and I know my time to shine will come :)
Okay, I understand but you have to know where you are in your training. For a first year student it is all about effective communication and ADLs. If you are a 4th year student and pass on placing a NG tube just because you are waiting on an instructor then that isn't good. Remember it isn't done alone, it is done with an experienced RN with their guidance on their license. If you have concerns that it you cannot do it then for sure step out.
I had some nurses like this as well. I believe it was triggered by my attitude and performance. If I knew it was time for a particular scheduled intervention I made sure all my needed tasks were caught up and then I would be waiting for my nurse with all the needed supplies for the intervention. The first thing out of my mouth would be," Mrs. _____, I have watched you perform this intervention, would you mind allowing me a chance to complete this with your help?"
In my second year my nurse allowed me to drop an NG tube on an infant. It came out in debriefing and I was "Talked to" but we discussed that the nurse allowed, helped, and approved it. In the end she said, "Nice job, way to be proactive.
I guess other schools might have a problem with it. We have students at work and I always help them with tasks BUT!!!!! They have to show me that they are capable and interested in learning. I am not there to hold someone's hand all day.
I had a few nurses that were like that in school. Remember why you're in school. You're not there to huddle around the nursing station or break room. I would be willing to bet that if you show some initiative and a willingness to learn and just jump right in... even if it's just to observe, do it! Just by being willing to do stuff and see stuff, you can turn a rather boring clinical shift into one where you get all your clinical skills checked off quickly and in the multiple.
Know what you may only do with your instructor present. Early on in your clinical experiences, there'll be more of these than ones that you can do "on your own" or with a supervising RN. Toward the end of your clinical time, you'll find that the reverse is true. There'll be much you can do on your own and/or have RN supervision and only a very few things you're not allowed to ever do or may only do with your instructor. When certain opportunities happen, and you'll know what they are when they do, try to get in touch with your instructor so that you can get the OK.
As a nursing student there will be opportunities that will happen that you'll get to do that just aren't available to a regular floor nurse. I've been able to follow patients from the floor to surgery, the EP lab, the cath lab, x-ray, ICU... and so on just because the opportunity presented itself.
Whatever you do, take active control over your learning experience. If you don't, your experience won't be all that good. You'd be amazed what you can find to learn, even on a very "boring" Med/Surg floor...
You make excellent points, akulahawkRN. Thanks. Also, it's good to remember that the nurses who take on students are putting their licenses at risk by delegating to us students. It's a pretty awesome act. Thanks to all who have and will take on students.
Also, I wonder: doesn't a nurse need to volunteer to take a student? Students can't be forced on someone, can they?
I would like to clarify from my earlier post, I have never done anything that was in a "no no" list. For example, we are to NEVER do anything involving a CVC as a student, so I wouldnt go near one if offered. I just mean simple things. And I would of course always ask an instructor for permission before doing invasive skills that have higher risk of harm to the patient. But the OP wasnt wrong for offereing. They didnt force the student to drop the tube. He could have easily said since he wasnt sure he just wanted to observe and just watched. He made the conscious choice to practice the skill when passed the tube. Even just being offered to watch would have been an opportunity to learn. And if patient safety isnt being risked, and the student doesnt go toot his horn to everybody, then the risk of getting in trouble is minimal.
My med/surg clinicals are at a teaching hospital. The nurses there are required to take a student if the charge nurse gives them one. Im not sure how it works at regular hospitals. I think the nurses are just used to it because there are students on most floors every day of the week.
During my clinical rotations, I was actually told not to talk to the other nurses, ask for help tp the other nurses or even do any procedures with nurses other than our clinical instructers. I must say, I did have great experiences and I am greatful for that.
I think the conundrum is that so many schools and facilities are dealing with the big L (liability) that some students sit on their hands and don't get the best experience, unfortunately.
I am grateful for the many instructors that thrust my clinical groups into the workload if my clinical groups and exposed us to many well seasoned and natural teachers that helped expands practice.
As a preceptor to many students, I made sure I tried to have students have a well rounded experience; I made a point to immerse the student into the experience, whether they wanted to or not; I can't remember not one who wasn't grateful for the experience.
You make excellent points, akulahawkRN. Thanks. Also, it's good to remember that the nurses who take on students are putting their licenses at risk by delegating to us students. It's a pretty awesome act. Thanks to all who have and will take on students.
Also, I wonder: doesn't a nurse need to volunteer to take a student? Students can't be forced on someone, can they?
No, staff nurses don't always get a choice about it. If a school is scheduled to be on your unit that day ... the staff nurses don't get to tell them "Go away. Today is not a good day." Having the students around is just a routine part of the workload for the shift -- to be divided up among the staff along with the patient care work.
This is stupid. Please don't prompt students to perform procedures that they are unsure if they are permitted to do. It's really, really inappropriate. I would have wanted my instructor present for my first insertion of a feeding tube. Also, half the staff nurses in my clinicals (way back when I was in school) ratted you out to your instructors if you didn't perform up to par, and you would get an unsatisfactory score if they said something bad about you. It happened to me, and because of that, I did the least possible to get by -- just so I wouldn't get in trouble.
My med/surg clinicals are at a teaching hospital. The nurses there are required to take a student if the charge nurse gives them one. Im not sure how it works at regular hospitals. I think the nurses are just used to it because there are students on most floors every day of the week.
This is how mine are as well. They are talking about switching up the format next semester and are "interviewing" 5 nurses to pair with 5 lucky students to trial a 1:1 student:nurse thing, but for now all ten of us at a time are just plopped onto the laps of the 4th floor nurses, whether they want us there or not.
And yes, the permission thing. It is frustrating as a student because as much as I want to learn, I have to ask. it is not always clear what we are and are not allowed to do (I have asked for clarification from my instructor and gotten nothing) so if I am ever unsure, I always ask. It's not worth possible consequences but I do understand that it may look to you, the nurse, like I am unsure of my abilities, don't want it badly enough, etc etc.
SoldierNurse22, BSN, RN
4 Articles; 2,058 Posts
OP, for all your good intentions, you are putting your students in a tough spot. There are good reasons that many nursing programs require the instructor to be present when a student is doing something invasive. Had I been your student back in the day, I too would have stepped out. It's not worth losing my slot and failing nursing school over dropping a tube. It's also not fair of you as a nurse to put students in a position where they have to choose between doing what's right by their school and doing something new and exciting.
Please think about what such a situation does to your students. Teaching them to do what's safe and ethically right is just as much a part of our job as it is to teach them new and exciting tasks.