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.
Specializes in Oncology; medical specialty website.
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.
Wait...you got to put in a chest tube when you were a student? That is hard core cool!
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.
Wow. After reading this thread a couple of things come to mind:
1) I am more grateful than ever for my program and hospitals. I literally had NO IDEA that some programs had such intense limitations and dismissal policies. Never touching a CVC? I wouldn't have been able to care for any patients. We were on oncology floors during med/surg Pete's sake! Dressing changes, lab draws, TPN, IVP narcs, you name it. See one, do one, sign your skill sheet, teach one... With nurse, charge nurse, willing staff, or instructor. I have had random IV therapy nurses I've never met pull me in for tough starts... To teach me and guide me.
We can't waste narcs or sign off blood products (we can hang them and do vitals just not sign that the checks have been done). No chemo rate adjustments or messing with chemo infusions. That's it for restrictions. Co-sign and observation required for heparin or insulin titrations. I've had my own Pyxis access since second semester, so I pull and administer my own meds and am accountable for rights and checks.
I'm in my final practicum and I've hardly needed my preceptor for anything other than some unit specific skills, once we had developed a rapport and she got a feel for where I was in my learning.
Never dropping an OG or NG? *That* might get you written up in our program. And you had better be able to do it on anyone from infant to geriatric. Likewise for foleys.
2) The OP deserves a lot more support than what I saw here (along with some mega gold stars for teaching!) So some programs are super limited; that doesn't mean they all are and no one should ever get a chance to learn hands on with a great instructor. Sounds like OP was there every step of the way!
3) I think the whole "first year" struggle and a lot of issues new grads are venting about are suddenly making sense to me. Not that it's going to be a cake walk for any newbie, but I bet the learning curve is a whole lot steeper if you've never touched a patient or communicated with a family without someone standing at your shoulder.
As students, we are supposed to have at least enough sense and care enough about our patients to ask for backup when we are unsure, know we haven't practiced a skill, or are getting in too deep with an unstable patient. We have to be reflective and honest with ourselves. It is far better to say "I need help" or "I don't know" than fake it til you make it. Every nurse I've worked with has watched me perform skills extensively before turning me loose, and provides feedback about patient status, labs, etc so we can establish a plan of care together based on the patient's acuity before we start interventions and slinging drugs.
OP, thanks for your dedication and recognizing the importance of hands on care and supporting your student. I for one have grown leaps and bounds thanks to skilled nurses like you, and I am eternally grateful for their patience.
Yesterday my preceptor with 28yrs experience let me assist with PICC line placement on a 500 gram preemie, and a neonatal surgeon let me participate in and assist with a procedure after drawing me some awesome pix of crazy anatomy. These guys, and folks like our OP, are making good nurses; they and all of my teachers before them have made me a more competent entry level nurse. I will never take it for granted again.
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. It's no fun to have to hand hold for basic skills. But personally, I would rather work with new nurses that can THINK and problem solve and see the big picture. 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.
Stargazer, if I was assigned as your student nurse I would consider myself very fortunate indeed. You really seem to get where us students are coming from.
It's not a matter of laziness, or unwillingness to help. I'm simply following the rules of my program. Of course we will have the opportunity to do the more complex tasks as we advance in the program. And once I've been signed off on more than just therapeutic communication and vitals, I will be the first to run up and down the halls looking for RN's, LPN's and CNA's to offer my assistance to. And I will be the first to step up to participate in complex bedside procedures.
Oh well, thank goodness the nurses I actually deal with in real life have no problem with our temporary limitations. Apparently there still are advantages to hospital based diploma programs.
By the way, our program is actually VERY liberal in what they allow us to do in clinicals. We have 100% job placement (you read that right), and has been around since the late 1800's (you read that right as well), but we've only had 2 clinical days so far so we're not exactly at the point of being capable of running around shoving various objects into unfamiliar orifices.
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.
We must be reading different posts, because I saw no "high pressure tactics" - just an accurate picture painted of the situation as it unfolded. Clinical days are not structured skill labs where everyone methodically gets a turn after lecture/discussion and everyone is "ready" -- patient care evolves in real time, and the opportunity to see and participate in this while still a student (and so still with a safety net) is invaluable. New grad nurses might feel less shell-shocked by the reality of split second decision-making, if they availed themselves to opportunities to experience this kind of critical thinking while still attached to the lifeline of their preceptors.
Sometimes there is time for me to speak with a student about skills they haven't yet done, or pathophysiology they have not seen, and try to plan ahead. I'm known to get out supplies and hold my own impromptu skill labs if there is down time when we have students overnight or early in the morning. But many other times there is not this advance prep. It is an emergency department after all -- stuff happens, and you're either in the moment or you're not. If you'd rather just observe, trust me, the next nursing, paramedic, or medical student standing right behind you will gladly seize the opportunity. For while it is true that development of a sound knowledge base and the beginnings of clinical judgement are important for students, their confidence in their own beginner level of proficiency is difficult to attain if they have no hands on skills.
Its a tough call. On one hand, the student could have been saying that as a stall tactic because they didn't want to/were nervous/etc to do it. Or it could have been a legit concern. I would have had them grab the instructor, ask them real fast and then go from there. You obviously had time to wait providing the education to them before dropping the OG in.
And this is coming from someone who LOVES students. I love grabbing them into the room for something they are afraid to do or have never seen before. But I know my school here. If there is a student on the floor with us, they have free reign to participate in anything that us RNs can do. Hell I throw them in on any procedure even if it is just to watch. You can learn a ton just from watching.
Either way, I don't think it should have taken this turn but here is a big bowl of meh. Walk away from it.
To those talking about communication between nurse and student about what they can and cannot do, I had some great nurses that I worked with who, in about 15 seconds, knew what I could and couldn't do. This would happen at the beginning of the shift- "What are you allowed to do?" "Anything but IVP and playing with central lines." "We're doing CNA skills until our instructor checks us off for other stuff." "I've been checked off for meds, Foleys, IVs, but not yet for NG tubes. We are supposed to chart anything we do." Whatever. It doesn't have to be some extensive conversation, but this might be a good takeaway for the nurses working with students. I haven't yet had the opportunity to be a nurse working with a student, but this would be a quick question I'd ask at the beginning of the shift, and I'd ask for clarification of anything else. Some students may not be able to be quick and to the point, but this still doesn't need to take more than a minute. It would help eliminate some of the "OHMYGODIMGOINGTOGETKICKEDOUT" pressure some of the respondents have discussed.
We must be reading different posts, because I saw no "high pressure tactics" - just an accurate picture painted of the situation as it unfolded. Clinical days are not structured skill labs where everyone methodically gets a turn after lecture/discussion and everyone is "ready" -- patient care evolves in real time, and the opportunity to see and participate in this while still a student (and so still with a safety net) is invaluable. New grad nurses might feel less shell-shocked by the reality of split second decision-making, if they availed themselves to opportunities to experience this kind of critical thinking while still attached to the lifeline of their preceptors.
Sometimes there is time for me to speak with a student about skills they haven't yet done, or pathophysiology they have not seen, and try to plan ahead. I'm known to get out supplies and hold my own impromptu skill labs if there is down time when we have students overnight or early in the morning. But many other times there is not this advance prep. It is an emergency department after all -- stuff happens, and you're either in the moment or you're not. If you'd rather just observe, trust me, the next nursing, paramedic, or medical student standing right behind you will gladly seize the opportunity. For while it is true that development of a sound knowledge base and the beginnings of clinical judgement are important for students, their confidence in their own beginner level of proficiency is difficult to attain if they have no hands on skills.
Altra, we must be reading different posts, LOL. Either that, or we come from really different learning and work cultures. It's also really possible that our own life experiences are filtering what we're reading and interpreting.
OCNRN63, RN
5,979 Posts
Wait...you got to put in a chest tube when you were a student? That is hard core cool!