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.
That is exactly why I said in my post it was up to the students and not the staff nurses to know what their scope of practice is. We were told that we would be in this precise situation the OP described, and if we did something out of our scope of practice we would be out of the program. I just wouldn't risk my career over it. While I applaud the OP wanting to show students new skills, it could cause issues. I know I personally would have gotten my instructor. If we didn't check off on it, we can't do it. And even if we did, we still need our instructor there. It's not that RN's license on the line, but it is my school's liability.
I think a lot of this, for the student, depends on the instructor, where they are in the program, how well the instructor knows the nurse and the student, etc. I had some instructors who would not let us do a THING without having observed us doing it before (and boy did we hear about it if we violated this), and I had others who had me TEACHING things I'd done as a corpsman before we had gone through them in skills lab. There are a lot of variables, but I think the initiative of the OP to help teach a student, whether the student was doing this hands-on or observing, is great. I know that my instructors would have been game for us observing at the very least anything that was "interesting" or "rarely done" for the sake of at least seeing the procedure.
That said, I would agree that students should take a certain amount of initiative. I had some AMAZING experiences in nursing school that others didn't because I didn't just do the minimum to get by. I feel that this attitude has made me a better nurse as a result. I have had comments from all of my managers (I have 3 jobs) about how much initiative I have, and I get a lot of work because of it, which only expands what I already know and makes me that much more valuable as a nurse. Few managers (or fellow nurses, for that matter) want that nurse that just does the minimum to get by. Just saying.
There is a fine line between initiative and dangerous, and it can take some time to find that balance, but knowing how to preserve safety above all else while still jumping in with both feel can be an amazing ride.
That is exactly why I said in my post it was up to the students and not the staff nurses to know what their scope of practice is. We were told that we would be in this precise situation the OP described, and if we did something out of our scope of practice we would be out of the program. I just wouldn't risk my career over it. While I applaud the OP wanting to show students new skills, it could cause issues. I know I personally would have gotten my instructor. If we didn't check off on it, we can't do it. And even if we did, we still need our instructor there. It's not that RN's license on the line, but it is my school's liability.
Yeah if the instructor/school found out or anything did go wrong during the procedure (which may not be permitted at all for a student) the school most likely would dismiss the student instantly.
But it depends how this nurse went about it too, if she pressured the student, if she was rude/a bit demanding. Or just nice and offering it if student was interested and if he said "i'm not ready yet can I watch" and she kept persisting or if she was okay with that and said "sure, you can watch! Don't worry!"....so before blaming her we don't see the full story, the student may have done it by his own will as well.
(Although from how she tells the story, it sounds like pressure)
Regardless of what "pressure" may have been applied at the time, I think it was completely appropriate for the nurses to offer that experience to the student. It's incumbent upon the student to know their limits and what their scope of practice is because the nurses aren't required to know. When I was in school, I re-sized the program's scope of practice list for students down to something that would fit on a 1/2 page label and stuck it to my clipboard. I could easily refer to that list if I needed to know what I could/couldn't do. For an ED experience, I got the "OK" ahead of time to do procedures with my supervising RN because there wouldn't be enough time to get verbal OK from my instructor or have him/her come to the ED to supervise that procedure.
In my case, as long as that OGT wasn't a Dobhoff or similar gastric tube, I could have done it under supervision. As a student, I knew what my allowed scope of practice was.
The way I read the original post, the only pressure applied by the nurses was to have the student make a decision to step inside or stay outside the curtain during the procedure. Even if the student declined to actually do the procedure for scope of practice uncertainty, the student still could have learned something by making a decision to step inside the curtain.
That's fine.. you aren't the instructor. Stop looking for educational opportunities. Just do your job, and leave the instructor's job to them.
Uh, no. It's up to all of us to help educate our future co-workers, if our own workload allows. Patients first, coworkers second, students third...at least that's my philosophy. Nursing school is so limited on what experiences they give students these days, especially with one instructor to 8-10 students. Morning meds passes aren't even allowed by all students because it would take too darn long, so a precious clinical day for a fourth semester student is wasted for their level. The last semester students will be orientees in a matter of months, and they can't do anything! Hogwash. It becomes up to the working nurses to help get them ready for the real world. Some nurses don't like to do it or don't feel it's their job. Fine. That's their decision. It's not my decision, and thank goodness it's not every nurse's decision.
Thats true, but when I was a nursing student..applied pressure like that would scare me and terrify me that the nurse will tell my instructor I declined a skill, am lazy, don't want to learn, etc. Pressure puts a lot of scared/stressed feelings on a student, especially in an unfamiliar environment and most likely the reason that poor guy did it after being uncertain and risked his diploma.
Thats true, but when I was a nursing student..applied pressure like that would scare me and terrify me that the nurse will tell my instructor I declined a skill, am lazy, don't want to learn, etc. Pressure puts a lot of scared/stressed feelings on a student, especially in an unfamiliar environment and most likely the reason that poor guy did it after being uncertain and risked his diploma.
When you have a nurse asking you if you want to do a skill and you don't know if you can do it, you politely decline, but offer to observe. Of course, if you're offered a skill that's definitely out of your current scope of practice (and all students should know theirs), you politely decline because of a scope of practice issue and should your instructor hear that you "declined" a skill, you can tell him or her why you declined that skill. If it's on your "never do" list... you're safe.
Specializes in Critical Care, Med-Surg, Psych, Geri, LTC, Tele,.
Thank you for being a nurse who is trying to help!!!!!! I recall situations like this while I was a student. If the "Nurse" said I could help her, then I jumped at the opportunity, feeling that it was okay.
Yes my school and each instructor had different rules r/t doing things without the instructor present, but if the nurse was willing to do it "with" me, I jumped in and did it!
Thank you for being that kind of nurse. That's the kind of experience we need!!!
I fully agree but not all nursing students are brave enough, which is why I disagree the op should have put any pressure on any student, and any nurse that does that should reconsider. That poor student did it afterall, and many others do it and do suffer consequences...some students feel they are in the wrong if they decline. So to prevent this, staff nurses shouldn't be pushing them into unknown territory, leave it to the instructor (that's already plenty to deal with)
You put the student on the spot, you forced him to make a decision. If that student got dismissed from the program because you wanted to teach him, that would have been a shame. Oh, I am done with the 'angle'.... you had no business doing that. It is not your job to decide when that student performs a new skill. I look forward to every learning opportunity in the future, but what you did is ******** And you should never put another student in that position again. Can you guys feel that!
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.
It is not your job to decide when that student performs a new skill.
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.
If it wasn't for me begging my nurse preceptor, I never would have done anything with one instructor. My other two instructors knew that I was a go-getter and never told me I couldn't do something. Only one student got in trouble and that was because she did a bronchoscope on a pt. That was out of our scope. So high five to the OP.
Dudette 10... They aren't your patients, you don't own them... And you need to remember how litigious this country is.... Precedence is set with first times, and there is a first time for everything.
NurseGirl525, ASN, RN
3,663 Posts
That is exactly why I said in my post it was up to the students and not the staff nurses to know what their scope of practice is. We were told that we would be in this precise situation the OP described, and if we did something out of our scope of practice we would be out of the program. I just wouldn't risk my career over it. While I applaud the OP wanting to show students new skills, it could cause issues. I know I personally would have gotten my instructor. If we didn't check off on it, we can't do it. And even if we did, we still need our instructor there. It's not that RN's license on the line, but it is my school's liability.