this morning after giving report, i was walking towards the lounge and noticed a call light on. i go in there, and ask the mom "may i help you with something?" and she and the bsn nursing student answer "the iv is beeping"
so i go and look at it, and the student mentions to me "the iv bag is empty" so i said "ok no problem" and i go to the iv pump to go and put in the new bag next to it. then the student says "oh, i was gonna do it"
so i said it was ok, i would be there to watch him do it.
he took the bag, and looked at it, like as if he's never seen an empty ivf bag before...... and i said "ok, i do it like this..." showing him how to do it, and he asked me "wont the fluid come out (of the chamber)?" and i said "no, it won't it's ok".... then he did it the way i showed him.
and i think to myself that this is a bsn student, and they have already done medsurg before and he didn't even know how to spike a new iv bag.
i was spiking iv bags, priming, giving piggyback megs, flushing iv's the first semester of nursing school. and mind you, i went thru an asn program.
i don't understand why a bsn student from a state school would not know how to do this by the peds semester.
anyways, i heard their instructor telling the charge nurse "the students are doing everything but meds"
so back to the student, isn't spiking an iv a skill that they should know by the peds semester?
btw that school-bsn- has a 78% pass rate on nclex-rn exam, and my school has a 98%-asn-)
The next time you see a student struggling like that, you might want to try, "I can see you're having difficulty remembering how to do this. Can I help walk you through it?"
I love that you said this! BTW nursing school is great but it really only lays a foundation. I am sure that we can all think back to a time when spiking an IV bag wasn't something we could do with our hands tied behind our back, blindfolded, and hanging upside down. Given the right amount of experience I am sure that the student mentioned above will be more than competent when it comes to changing IV fluids. On a slightly separate note, has anyone watched some experienced nurses change IV bags and they pull the spike out with the bag still hanging and get a nice little shower. I know a few that do this regularly...cracks me up every time...
just to add my 2 cents...I graduated from an ADN program, I call these programs boot camp for nursing:bugeyes: Even though I was signed off for IV meds in school, it was not until I was an RN working that I really was taught how to really do IV meds and many other skillls...... Why? because I rarely had patients at my clinical sites that required IV meds. I do remember having one patient in the second semester where I had to mix a med in the IV then hang it.....but you do forget.......
Maybe the student just lacked confidence. As a new grad, I know in school even when I knew how to do something I still lacked the confidence at times b/c what student wants to screw something up?!!? They may have done it one or more times before, but in that particular setting was just a little nervous to do it on their own.
I am a student nurse in an associates program and will graduate in may.
The worst feeling is when a nurse looks at you like you are an idiot when a student expresses that they are not sure of a procedure or how to answer a question. We are students are nervous regarless of where we are in our program we DO NOT want to mess something up. In my program we are not allowed to touch any meds in the peds without an instructor. That student probably did know what they are doing, but was just maybe hesitating to make sure that things were in place before changing the bag. When you make judgements as you did, it justs makes us feel even more incompetent. Have patience and remember that you were a student once before regardless of the program you were in.
I graduated from a BSN program at a university that isn't all that great... but we learned this skill in first semester in the LAB before even stepping foot in the hospital. In fact, we had to pass a lab skills test (which included this) prior to being allowed to do clinicals.
Once I was in the hospital, I remember having issues getting the tubing primed properly or set up correctly in the chamber without the IV machine beeping on me, mercilessly... but I never thought twice about spiking a bag!
... And at the peds hospital where I work, students are never allowed to do anything with an IV, regardless of what semester they are in.
This is a REALLY good point! At my school, we rotated through many different hospitals in town -- along with students from several different nursing programs. You could tell the difference between us all by our uniforms/scrubs. Regardless, although the hospital itself welcomed us, the staff nurses didn't. We were usually thrust upon them at the beginning of a semester. In general, they didn't know what we were / were not capable or, nor what we were / were not allowed to do. I always felt like we were getting flubbed by this plan... If the hospital is going to contract with the school, then why not have some sort of understanding with your staff nurses??? As an RN now, I realize this must be just as frustrating for the staff nurses - like the OP.
Specializes in NICU, PICU, PCVICU and peds oncology.
... And at the peds hospital where I work, students are never allowed to do anything with an IV, regardless of what semester they are in.
I WISH!!! When we have students on our PICU during their pediatric clinical experience, they aren't permitted to do much. But if they came back for their practicum, there are very few things they aren't permitted to do, from what I'm seeing right now. We have five of them (yes FIVE!) and some shifts all five of them are on at once. I overheard one student on the phone telling his clinical instructor that he'd given rocuronium to a patient, which made my hair stand on end. It's hospital policy that GRADUATE nurses are not permitted to give neuromuscular blockers, cytotoxics or any med IV direct. In fact, we have a certification program for all three that each registered nurse must pass annually and policy states taht patinets on neuromuscular blockers must be attended by a certified RN at all times. When I asked him about it, he said that his preceptor (someone who has only worked in our unit since October!!) told him it was fine, he could just go ahead. When I told our manager about it, he looked alarmed, but then just shrugged. Before I had a chance to discuss it without educator, she broke her ankle and is off for eight weeks...
This is a REALLY good point! At my school, we rotated through many different hospitals in town -- along with students from several different nursing programs. You could tell the difference between us all by our uniforms/scrubs. Regardless, although the hospital itself welcomed us, the staff nurses didn't. We were usually thrust upon them at the beginning of a semester. In general, they didn't know what we were / were not capable or, nor what we were / were not allowed to do. I always felt like we were getting flubbed by this plan... If the hospital is going to contract with the school, then why not have some sort of understanding with your staff nurses??? As an RN now, I realize this must be just as frustrating for the staff nurses - like the OP.
My hospital has contracts with 8 different programs ... and each school has its own curriculum. In addition, the unit may have one group of students from one school in the morning and other group of students from another school in the afternoon. Also, within each school, each instructor emphasizes different things with her students. Finally, the students come at different stages of their programs. Some students come early in their programs: others come later. Even within the same program, the students' level of skill changes throughout a given semester.
In short ... the staff nurses have no way of knowing the exact level of expertise of the students who arrive on their floor on any given day. Each student must communicate well and regular with the staff nurse responsible for her patients. It's not fair to expect the staff nurse to "just know" anything about the student's abilities. The student is a stranger who might be very knowledgable and skilled -- or might be a beginner student or a student who is on the verge of failing the program ... etc.
As for "having an understanding with the staff nurses..." Yes, our staff nurses are well-aware that working with the students is part of their job. But it is unrealistic to expect them to automatically know the skill/knowledge level of each student who walks in the building. We can have 70 nursing students per day from any one of our 8 schools.
In my experience, the best *teaching* nurses are the ones who are eager to show or talk me through a skill they can see that I'm clumsy with. Instead of expressing shock about what the student doesn't know (how does that attitude help the situation?), try looking for ways to come along side to help them improve. IMHO your attitude of shock that the student isn't up to your expectation is a real barrier to you being an effective teacher. If they sense you're disgusted with them (and I'm sure they do), the last person they'll want to turn to for help and instruction is you.
It really doesn't matter when their nursing program teaches a particular skill or what you learned by their stage in school. There's an old saying that goes, "No one cares how much you know until they know how much you care."
My gut response to your original question, "Are they supposed to know this by now?" is does that really matter? They're at where they're at. The next time you see a student struggling like that, you might want to try, "I can see you're having difficulty remembering how to do this. Can I help walk you through it?"
:yeah::yeah::yeah:
I am currently a nursing student, however, have been raised in nursing. As a student, I have observed other students beening fearful to ask staff nurses questions d/t being preceed as stupid. I think that it is very unfortunate and sad that ones that are so eager to teach, can treat others this way. Sure, we might be in your way or ask to many questions, but this is our time to learn.
Personally, I learned to spike a bag first semester of lab, however, if I did not review the steps for a specific prodcedure, I would be nervous too. I have never, not once, spiked a bag on clinicals, so my only experience has been one day in lab. Sure I have mastered other skills, caths, gtube feedings, ng placements, etc. I have even been a CNA for many years however if you dont use it, you lose it.
My two is, be nice, if you like to teach, then try instead of judging the student.
I'm currently a second-semester ADN student and we just had our lab over IVs a couple of weeks ago. I still have yet to spike an IV or change/prime tubing in clinicals. Heck, others in my clinical group have yet to even give a shot.
Lucky for me, I have extensive experience with these skills from working in the ER/ICU for years, but I can understand how the scenario can occur.
I managed to get through nursing school and my time as a graduate nurse without ever having given an IM shot. I have been a "real" RN for about 2 months now, and the other day when I was passing meds, one of my pts had an order for an IM abx. I got all of my supplies ready, quickly reviewed landmarks in my pocket nursing guide, and asked the charge nurse to come "hold my hand" while I gave the shot.
As we walked down the hallway, he reviewed the basics with me. When we got to the patient's room, he watched while I found my landmarks and everything. Now I have the confidence to do it by myself - in fact, I'm an old pro by now.
Had he said "Oh my god! Shouldn't you know that by now?!?", I don't know how I would have reacted. And I'm not a student ~ I am a full fledged RN.
We were all new once. We haven't always known how to spike a bag, give a shot, or even give a patient a bath. There is a first time for everything. And to those that have the patience and willingness to share their knowledge and "hold our hands", I for one say THANK YOU! And for those that wonder if we shouldn't know that by now, try to think back. Unless you were born with an IV bag in one hand and a tubing set in the other, there was a first time for you, too!
:yeah:
is, be nice, if you like to teach, then try instead of judging the student.
JRD2002
119 Posts
I love that you said this! BTW nursing school is great but it really only lays a foundation. I am sure that we can all think back to a time when spiking an IV bag wasn't something we could do with our hands tied behind our back, blindfolded, and hanging upside down. Given the right amount of experience I am sure that the student mentioned above will be more than competent when it comes to changing IV fluids. On a slightly separate note, has anyone watched some experienced nurses change IV bags and they pull the spike out with the bag still hanging and get a nice little shower. I know a few that do this regularly...cracks me up every time...