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.
Just a general comment, to nobody in particular, whenever I have a student/new nurse/new tech, I always make a point of asking them if there are any skills they need to check off on, and I always familiarize myself with their scope of practice- mainly for the one reason that I *don't* want to put them in the position that the student in the OP was put in. As I said, I love to teach, but my love of teaching is secondary to the students' needs as well as, what hasn't actually been mentioned in this thread yet, the PATIENT'S experience.
Granted, in the OP, the patient was intubated, but I am always honest with the patient about whether or not the person about to perform the skill has any experience or not. When I did my first IV, for instance, I told the patient it was my first time, and asked their permission to do the skill. For instance, the other day, I supervised the new tech placing a Foley. The *very first step* in the procedure was explaining to the patient that this was the tech's first Foley placement and obtaining the patient's permission. I would not progress in the procedure until the tech had gone into the patient room and obtained informed consent. I was completely prepared to place the Foley myself if the patient said "No", which was their right.
The intubated patient does not have the luxury of giving consent or not, and I think it's important that we think about that. If I were the family member of the intubated patient and there was a poor outcome, I'd be really concerned to learn that a student nurse performed procedures they were not allowed to perform. I'd definitely be asking questions...
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.
When I was in school, if I'd never worked with that particular RN before, at the beginning of the shift (and as needed throughout the day) I'd go over my scope of practice, beginning with my "never do" list and my "can do without supervision" list. Anything that's not on that list is a "can do with supervision" so it makes things easy to remember. Probably the biggest source of RN confusion over student scope happens when you have students from the same school on the same floor that are in different semesters.
What is nice about that particular arrangement is that it gives "senior" students a chance to do some leadership and help their junior students learn how to function on that floor. When I had a chance, I'd check in with the junior students to see if they had any questions about where supplies were or where to look something up in the computer or various things like that.
When I was in school, if I'd never worked with that particular RN before, at the beginning of the shift (and as needed throughout the day) I'd go over my scope of practice, beginning with my "never do" list and my "can do without supervision" list. Anything that's not on that list is a "can do with supervision" so it makes things easy to remember. Probably the biggest source of RN confusion over student scope happens when you have students from the same school on the same floor that are in different semesters.
What is nice about that particular arrangement is that it gives "senior" students a chance to do some leadership and help their junior students learn how to function on that floor. When I had a chance, I'd check in with the junior students to see if they had any questions about where supplies were or where to look something up in the computer or various things like that.
We never had students from different classes of the same school on the floor at the same time, but we had small classes at our school (SSU). The nurses got to know us, and I think that as they developed trust in us and saw what each of us was capable of, they'd give us more or less leeway from there. Same goes for the instructors (going back to that post from Music in my Heart...). I was definitely one to dive in, where some of my classmates really needed their hands held and went very slowly. The nurses I worked with frequently let me do pretty much anything and then delegate to them (as my instructor wanted me to do) PRN, and of course, I'd refer to them for any questions. The nurses that hadn't worked with me before (which was uncommon toward the end) were a little less trusting until they could see better how I worked. I think that toward the end, what each of us was really allowed to varied from student to student, to some extent. I know I had 4 patients when most of my classmates had 2. I know I freaked out an ICU nurse when I was working with a patient I'd had the day before and I was automatically changing the bags on the CRRT machine, silencing the alarms and adjusting the angle of his line. She tore my head off! However, by the end of the shift, she was cool with it. We'd been off to a rough start. Anyway, had we had the "what can you do/have you done?" conversation, I think things might have started off better! :) We did have a good rest of the shift, at least.
I did work with students from other schools in my preceptorship, and I'd try to rope them into learning opportunities. What drove me nuts was when they were clearly too interested in sitting at the nurse's station gossiping to have any interest in what I (or any "real" nurse, for that matter) was trying to show them. Whatever. It was nice when someone had some initiative, though, and was actually interested in what I was showing them or in a reference I was giving them (like when I had a Coombs + baby and I was explaining what that means). There was one school in particular that had students that were really bad about this.
I wonder if this type of discussion has anything to do with locale? For instance, I'm on the West Coast, and there is a lot of lip service to things like collaboration and patient centered care, holistic care, yada yada yada. For example, we have Reiki volunteers in my hospital. I've even referred them to certain ED patients who I think might benefit. We even have an aromatherapy kit in our ED.
I wonder sometimes if, perhaps, there are different approaches to nursing education depending on geographical and cultural differences?
RunBabyRN, in my last semester, we had a clinical component we had to complete and we also had a preceptorship as well. Most of us stayed on our "home" units for our preceptorships precisely because the nurses there knew us and our capabilities. While we all had to follow the "never do" list at all times we were in the hospital, like you, we often were allowed much more independence on an individual basis to do certain tasks under general supervision instead of direct supervision. I ended up getting to do quite a bit because of this. Because of the way that particular hospital was set up, we usually didn't have to go to a Pyxis to draw every patient's medications every time we needed it. It also meant that we had to be much more vigilant about doing the checks. That was a great experience because occasionally I'd find meds that were no longer prescribed or certain meds not being available, and the like so I'd have to do more interaction with the pharmacy on a daily basis.
We rarely had students from other schools on the same floor at the same time as us unless they were precepting. The hospitals in our area tend to schedule things that way so that (ideally) all students on one floor are all in the same semester and school. That way even though the floor may host students from several schools and semesters, there'd at least be some consistency during a given shift.
Can somebody explain to me, in the interest of learning, why it makes sense to say perform this or step out? And if those were the options, are people in agreement that the student should have interjected with option 3... Observation??? I'm just curious. I realize that this thread has been beaten from the US down into China, but I would like to know someone's thoughts. And I am curious if anyone puts any credence into the IOMs and various other academic journals regarding coaching in lieu of supervising... Gotta love evidence based philosophy regarding advanced practice nursing and clinical leadership.... And being that the future scope of nursing practice is way beyond nursing skills, do you guys think focusing on this type of stuff reinforces the publics view that nurses wipe peoples asses
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
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
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
It is Esme12 ...I am confused to your reference that I "can't feel them" I think I "get them", and their intention, just fine.
Could you reference some of these articles from the IOM
and various other academic journals regarding coaching in lieu of supervising
No thanks, nobody should "drop out" and nobody should be pressured in any way to go against their comfort zone student or not. & especially with an attitude that says "close the curtain and get out if no", how about "thats totally okay if youre not comfortable or your school doesnt allow this, come watch me instead and I'll talk about each step."
staying in your comfort zone leads to no learning, and stagnation.
you are misrepresenting the OP, he didn't say the student had to do the procedure or leave, only that he needed to close the curtain and make up his mind if he was staying or leaving.
Can somebody explain to me, in the interest of learning, why it makes sense to say perform this or step out? And if those were the options, are people in agreement that the student should have interjected with option 3... Observation??? I'm just curious. I realize that this thread has been beaten from the US down into China, but I would like to know someone's thoughts. And I am curious if anyone puts any credence into the IOMs and various other academic journals regarding coaching in lieu of supervising... Gotta love evidence based philosophy regarding advanced practice nursing and clinical leadership.... And being that the future scope of nursing practice is way beyond nursing skills, do you guys think focusing on this type of stuff reinforces the publics view that nurses wipe peoples asses
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
It's funny that of all the people on this thread, you decided to single out Esme. She is, without a doubt, one of the most knowledgable members of this board, and has diverse job experiences in high acuity nursing specialties, spanning over decades.
So I'm willing to bet, if there was something about your posts she wasn't exactly "feeling," it probably wasn't due to her inability to grasp the ideas put forth by your superior intellect. She was a flight nurse for goodness sake. (Since you're a student, you might not realize what being a flight nurse entails. But, just so you know, you should be impressed).
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.
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?
Anna Flaxis, BSN, RN
1 Article; 2,816 Posts
Just a general comment, to nobody in particular, whenever I have a student/new nurse/new tech, I always make a point of asking them if there are any skills they need to check off on, and I always familiarize myself with their scope of practice- mainly for the one reason that I *don't* want to put them in the position that the student in the OP was put in. As I said, I love to teach, but my love of teaching is secondary to the students' needs as well as, what hasn't actually been mentioned in this thread yet, the PATIENT'S experience.
Granted, in the OP, the patient was intubated, but I am always honest with the patient about whether or not the person about to perform the skill has any experience or not. When I did my first IV, for instance, I told the patient it was my first time, and asked their permission to do the skill. For instance, the other day, I supervised the new tech placing a Foley. The *very first step* in the procedure was explaining to the patient that this was the tech's first Foley placement and obtaining the patient's permission. I would not progress in the procedure until the tech had gone into the patient room and obtained informed consent. I was completely prepared to place the Foley myself if the patient said "No", which was their right.
The intubated patient does not have the luxury of giving consent or not, and I think it's important that we think about that. If I were the family member of the intubated patient and there was a poor outcome, I'd be really concerned to learn that a student nurse performed procedures they were not allowed to perform. I'd definitely be asking questions...