Student clinicals

ProudofmyNursingart · Jun 1, 2009

I totally agree.

The 'good old days' of hospital based training is long gone and no longer applicable in our now modern profession. With all it's boudaries and legal obligations.

But I do not think that we can learn most of what we need in a classroom.

How can we then practice what we have learnt in books into 'real' patient care?

I have always thought that we need to spend 50% studying theory. And 50% in a clinical setting.

We are moving too far now away from the hospitals into the classroom making for some Nurse's who do very well in the theory but find it very difficult to transfer that theory based knowledge into real life. With patient's who are valnurable and emotional.

I have had the pleasure of being 'hospital' trained only initially many years ago in Aged Care/Disability many years before I finally dare step into a classroom environment to make everything official.

AND be a student in an academic setting going out in clinicals to practice my new found skills.

So I trully get to see and feel the tug and pull of the struggle to balance theory and practice.

I feel so passionaltly about this very subject that I wrote a paper on it for my Diploma.

I am not sure really if we will ever trully get the balance correct.

llg, PhD, RN · Jun 1, 2009

I realize that we are from different countries, as I am in the US. However, I am very involved in those types of issues in my current job and wanted to throw a few thouoghts into the discussion.

To me, it seems to be as much about quality as it is about the quantity of clinical hours. I am familiar with several schools whose students get a reasonable number of clinical hours, but they seem to be wasted doing a lot of observation and not a lot of "hands on" care. The attitude seems to be that they are just interested in "putting in the required number of hours" rather than on how to best use those hours effectively.

I believe any discussion of clinical education requirements/recommendations should include specifics as the objectives, teaching methods, activities, and evaluation of that clincal experience. Simply putting the time is not enough.

I look forward to reading what you all have to say about the situation in your country.

JanisM · Jun 2, 2009

I am in my second year and have only done 2 weeks clinical in an aged care facility. (I have worked in this field for a few years now as a pc so I was lucky enough to be familiar with a lot of things!) We had specific competencies that needed to be achieved by the end of the two weeks and they come from the text 'Clinical psychomotor skills'. I don't know about other areas, but with this one we were expected to jump straight in and help with personal care of the residents. The rest was mostly observational, such as following the drug trolley around or listening to handovers.

I did feel that we weren't learning a great deal, and most of the staff saw us as an extra pair of hands for fetching linen, etc! I suppose it's understandable when you realise how understaffed they are, but it made it a bit hard to reach our objectives sometimes.

I'm really excited about doing more clinicals but as I'm doing this part time over 4 years I don't have any this year. Oh well, I guess patience is a good nursing attribute!

rachelgeorgina · Jun 8, 2009

I think one of the biggest problem with clinical placement for students is the attitude of the RNs on the ward. In my experience, a large majority of the seasoned RNs have no interest in students, see them as in the way and don't have a lot of interest in actually teaching them or involving them in the ward routine. This makes it exceptionally challenging to jump in and get your hands dirty, even more so for students from a non-english speaking background (of which there is an increasing number).

I've found that the people most willing to teach/let us get our hands dirty are the new grads. In fact, last week on clinical the person most willing to give me things to do around the ward was a TEN!

KirriG · Jun 25, 2009

I'm inclined to agree.

With a background in academia and a graduate entry into a nursing degree which I'm doing part time, I have had only 1 prac in an aged care setting as part of a 6 week bridging course on Clinical Practice (to get me ready for 2nd year).

Now while I appreciate the heck out of the opportunity to knock 1 FTE year off my degree, the hands on lack really worried me! So much so that I actually switched careers on the advice of a friend nurse to AIN work in Aged Care. The huge boost it has given my confidence has been awesome! In the degree I'm doing I won't have my first hospital prac until mid-way through Semester 1 next year and now I know I'll be a lot better for it!

Of course that's just a personal case, and the AIN work isn't the same as RN work so I guess I'm trying to say that it would have been wonderful for more prac to be involved in the course but it's probably just not realistic with current nursing shortages, and like others have said - we're essentially an added burden to their busy and overworked days. :rolleyes: It would have been wonderful to have a mentor who we would be linked with for our degree programme don't you think?

Kirri

scarah · Jul 3, 2009

I my 2-year graduate entry course we got a lot of prac time. We had a 3 days a week of med/surg for seven weeks each of the four semesters, this was integrated with uni the other two days. Being on the wards for seven weeks gave us time to become part of the team and even tho it was equivilant to 4 weeks full-time, I think it was more beneficial. On top of this we had two mental health placements, and a two week elective.

glam1 · Jul 16, 2009

I was toatally shocked at the quailty and quantity of clinical training in nursing compared to beauty therapy. In lab hours we basically did very little. I am extremly lucky in that i've manged to do 8 weeks prac already and due to changing unis i have to another 21 weeks. But it realy does matter about the students and the rns attitudes. I had 1 prac with a girlfriend and we had toatlly different experience. I was alot more foward always ensuring the Rn new what skills i needed to practice ( every day) And always jumping in the chance to try something. My girlfriend on the other hand wasnt so confident, so she really didnt get to experience as much.

next year in my last sememster it is all prac 3 subjects 15 weeks of clinicals , personally i like that.

cheers

rachelgeorgina · Jul 17, 2009

What has everyone found the best hospitals to do clinical at and why?

glam1 · Jul 20, 2009

wow - personally i have been on 4 clinicals. I choose to country hospitals. Kilcoy which has orthopedic overflow from the larger hospitals and stanthorpe which has A&E and threatre as well. Both were great. Great opportunities for 1st/2nd yr student of course i had the bed bath, showering changing etc but also drug rounds , patient loads , blood transfusions, nasal gastric, catheras, needles , A&E and a day in threatre plus the steralizing. Basically at both i got to try EVERYTHING i was able to do ( did in class). Plus i also got to watch help in other areas palitive care( such caring professional staff to learn from) ECG,s. Both of these were only 2 week placements but i crammed alot in. Compared to other students i had a absolute fantastic experiences ......but i also pushed for that. I'm of to alice spring hospitable next wow cant wait.

What was your rachel?

rachelgeorgina · Jul 20, 2009

I've only done two clinicals so far. The first was at RPAH (think the channel nine TV show) and the second and Concord. Strangely, despite RPAH reputation for brilliant medical staff and fantastic, cut throat procedures etc... it was pretty bland. Possibly because I was on a elective surgical ward (oldies with their new hips and knees etc) but the staff weren't interested in students at. all.

Concord I was on a respiratory ward so I got to see real sick people and work with them as opposed to just oldies coming in to hospital for surgery. We had five TB patients that week, plenty of MRSA, VRE, NGs, PICCs & CVCs, trachies, CPAP & BiPAP, respiratory failure... Twas much more exciting and the nurses were slightly (albeit if only slightly) more accommodating to students.

talaxandra · Jul 21, 2009

The theory is vital, but unless it's paired with practical application and practice it makes no sense and doesn't feel real. One of the advantages of hospital training is that we were given a full patient load and full responsibility (according to our experience, of course) after less than three months.

While that just isn't feasible now - both from professional perspectives and because patient acuity is so much higher now - it not only meant we knew really early on whether or not we liked actual nuring, it also meant we got a great grasp on the fundamentals before taking on more advanced cases.

To those of you who feel unsupported by the RNs on your placements I would like to remind you that teaching and supporting students isn't part of their job, it isn't soemthing they're paid for or given extra time to do, and must be done in conjunction with all the other work that needs doing.

I enjoy teaching, but last year my ward had five weeks where there were no students of any kind - constantly explaining, teaching, supporting and encouraging is exhausting. When we have to balance the needs of the students with competing patient, family , team and colleague needs, it's not surprising that sometimes the students will not be prioritised.

I'm not saying you guys aren't important - clearly you're vital - but I do ask that you view your placements from the staff's perspective as well as in terms of what you need from the placement.