This "us" vs "them" mentality....

xtxrn, ASN, RN · Oct 1, 2011

Ooh, I see what you're saying. One thing is that not all the nurses on the unit are DEU nurses--most of them don't want students. It's more that a unit asks their nurses if they want to work with students. Plus, they work normal shifts the days their students aren't there and they typically take the higher acuity patients since they typically only take 4. And since most new grads in my area get hired by these hospitals, they end up with new grads who have at least some skills...so in that sense, I think that the hospital benefits....in addition to the fact that students have been shown to contribute to better patient outcomes in this setting.
I'm definitely grateful for it--I look at the "regular" clinical setting and I don't know how most grads are getting the skills they need. But I don't think this is entirely the faults of the schools. I mean, the schools can show you on a manequin a hundred times, but unless you've done it on a patient, in clinical....it means nothing. And unfortunately, the shortage of nurse educators mean there aren't enough CIs for students any more. And then with so many staff RNs not wanting to work with students, it just creates this messy, broken system.

Yes...and some (seems like quite a few) have employed nurse educators who are not invested in the long term good of the student. And having nurses who don't want students on the DEU will only keep the perception (and likely some valid dislike felt by you guys) going...that won't help.

I think that a huge "generation" gap has happened in the last 10 or so years (when I was still working 7 years ago, it wasn't so bad- though the students weren't doing procedures on me when I was hospitalized that were standard issue for students back in the early to mid 80s (some of y'all weren't even born then - LOL ).

It's the schools' responsibility to get you the patient exposure- NOT the staff nurse. The instructors are supposed to check you off on skills- not the staff nurses :)

Hopefully things will level off- but it takes a lot of understanding (that I'm only just beginning to grasp from the kind students/new grads on the First Year Forum). I like you guys :) But with some newbies, there is a "vibe" of just get the staff nurse to tell me- NOT the initiative to look things up and come to the conversation with some information that form your questions. That gets old. :) Sort of a drive-by education- which won't do anybody any good :)

I give you credit for wanting to understand this better, and not just getting on the polar opposite band wagon :up:

VICEDRN, BSN, RN · Oct 1, 2011

Let me just step in here with a few comments from a second year nurse...

the studies are out there. task orientation training in nursing school does not produce successful nurses. in fact, the opposite is true. nurses that learn to do tasks in nursing school (traditional programs) generally perform better in the first 6 months at work as an RN and then suffer from failure to thrive thereafter then those folks who were trained to understand concepts and critically think do better. I have seen this at play myself.

Forget doing tons and tons of skills. you won't remember them and you won't do them well until you do them everyday for months on end and by the way, half of these so-called "skills" aren't even protected job activities so you're making a big deal out of stuff you can delegate to a tech, a phleb, an EKG tech, etc.

furthermore, NCLEX has gotten harder, not easier. the questions are supposedly more difficult. the test asks you progressively harder questions until you have statistically answered enough difficult questions to pass. if it takes you 75 questions, great. if it takes you 300, also great because you can still pass.

as for students, i have limited experience with teaching. i have done it but only very minimally (parts of shifts) to help other RNs. I don't mind it and yes, it is in my job description, but more like a looming threat to do yet more work, not less and frankly, I appreciate when the student appreciates she is riding side car on my license.

Spikey9001, BSN, RN · Oct 1, 2011

How come you never see the ultrasound, PT, OT and med students being treated the way nursing students are treated...? In regards to the "I don't want you here, **** you" type attitudes?

There needs to be more camaraderie.

xtxrn, ASN, RN · Oct 1, 2011

Let me just step in here with a few comments from a second year nurse...
the studies are out there. task orientation training in nursing school does not produce successful nurses. in fact, the opposite is true. nurses that learn to do tasks in nursing school (traditional programs) generally perform better in the first 6 months at work as an RN and then suffer from failure to thrive thereafter then those folks who were trained to understand concepts and critically think do better. I have seen this at play myself.
Forget doing tons and tons of skills. you won't remember them and you won't do them well until you do them everyday for months on end and by the way, half of these so-called "skills" aren't even protected job activities so you're making a big deal out of stuff you can delegate to a tech, a phleb, an EKG tech, etc.
furthermore, NCLEX has gotten harder, not easier. the questions are supposedly more difficult. the test asks you progressively harder questions until you have statistically answered enough difficult questions to pass. if it takes you 75 questions, great. if it takes you 300, also great because you can still pass.
as for students, i have limited experience with teaching. i have done it but only very minimally (parts of shifts) to help other RNs. I don't mind it and yes, it is in my job description, but more like a looming threat to do yet more work, not less and frankly, I appreciate when the student appreciates she is riding side car on my license.

I respect what you are saying- but the ED isn't the same as the floor.

There aren't always people to delegate to in all hospitals or all departments. The skills are important to know. And it's not the hospitals job to provide nursing school.....orientation- absolutely- but basic skills- no. You do not know what the NCLEX was like in 1985. it was plenty difficult and LONG. 2 full days of 4 separate sections. There's no way to compare the two. :)

xtxrn, ASN, RN · Oct 1, 2011

How come you never see the ultrasound, PT, OT and med students being treated the way nursing students are treated...? In regards to the "I don't want you here, **** you" type attitudes?
There needs to be more camaraderie.

I think part of it is that they are very task specific ancillary staff....nursing deals with them, the docs, patients, families, etc. Those depts come in, do their job, and go back to another patient. jmo

Spikey9001, BSN, RN · Oct 1, 2011

I also think it's completely backwards and asinine to think that an instructor can teach up to 10 students all the ins and outs of skills, patho, and things like that on her own without SOME help from the nurses on the staff.

To you guys that are opposed to having students and teaching, what do you think should be done? Because apparently there's a lot of "I got mines! Good luck" type attitude and that is counterproductive. I mean if you aren't going to try to revamp the nursing education system and change it, then I suggest you just keep quiet about it or try your best to be a good teacher.

I mean, I've never seen other disciplines in the healthcare field act like this.

Med Students: The resident/attending is right there beside them explaining every aspect of the procedure or disease process even if they have to round 40 patients by 10 am.

PT/OT: The student is right there helping get patients out of bed and documenting with the supervision of a licensed PT/OT.

Either way, I don't receive the "I'm not welcomed here" vibe from students of other disciplines. But for nursing students, it's like we have to hide in the closets or something or are looked at as vermin. Umm hello...

VICEDRN, BSN, RN · Oct 1, 2011

I respect what you are saying- but the ED isn't the same as the floor.
There aren't always people to delegate to in all hospitals or all departments. The skills are important to know. And it's not the hospitals job to provide nursing school.....orientation- absolutely- but basic skills- no. You do not know what the NCLEX was like in 1985. it was plenty difficult and LONG. 2 full days of 4 separate sections. There's no way to compare the two. :)

You don't know what today's NCLEX is like; :) LONG testing is not smarter testing albeit I am sure it tests the stamina after a day...lol. Objectively, today's test is more difficult, not less.

The skills are important to know but they aren't difficult to learn or master really. You can put in 100 foleys in nursing school but until you are nursing full time and throwing in a foley in an 88 year old screaming hissing dementia patient for the nth time, you really just don't get it down.

I will add the field is more complicated by the fact that hospitals are increasingly more and more strict about what nursing students could and could not do. When I finished nursing school, one hospital did not even want nursing students pushing IV meds AT ALL and certainly no one will let you access medications so that you can think the task through. Increased regulatory and bureacratic requirements do not help students learn either.

DL-SNUP · Oct 1, 2011

When I finished nursing school, one hospital did not even want nursing students pushing IV meds AT ALL and certainly no one will let you access medications so that you can think the task through. Increased regulatory and bureacratic requirements do not help students learn either.

Scary! I guess I'm lucky....the hospitals here let us pull all medications except for narcotics, and we can give most meds and hang most IVs w/o an RN present (provided they trust us, obviously). IV teams have made practicing IVs tricky though... we just had to practice on each other until we looked like drug addicts

cheyoda · Oct 1, 2011

I had one really good nurse that I followed. She was an ICU/ED nurse. We had a full patient load that day. She was floating to the floor that I was on. It was amazing to watch her. She did not rush, she did not panic when things were not going as planned. She just calmly moved from one room to the next. It was weird because not once did I feel rushed or like she was rushing it was like we were in slow motion compared to my other nurses, but we still finished everything before everyone else. It was the most relaxing, calm shift I had ever had. Not because of the patients, but because of her attitude. She answered every question I had, whenever I got a nurse that was not always flustered, or somewhat approachable I would ask her or him questions. I hope to be like her one day, not easily flustered, taking things in stride, in control, thorough, and approachable. I wish every nurse could be like that, but it is ideal. Learn what you can, even from the nurses that are not as friendly, they will still have valuable experience to offer. It would be great if students were put with only the approachable nurses. Side note: I know why nurses get flustered with students. I know some students are just plain rude. But it absolutely shocked me that this particular nurse was truly relaxed and at ease, with what I perceived were difficult patients, and truly helping me along and asking me all the time if I had questions. I was shocked she told me to ask her about anything I want to know. She thanked me. Her kindness was needed, because it was sometimes difficult to find a friendly face like that.

Anna Flaxis, BSN, RN · Oct 1, 2011

CAT testing is more precise in measuring individual ability than standardized testing. Also, the passing standard for the NCLEX was increased in 2010. Just because you had to sit for hours and answer hundreds of questions does not mean the test was more difficult then vs. now. Those that pass the NCLEX with the minimum possible questions (like I did) passed by answering progressively more difficult questions correctly consistently enough to meet the passing standard without wasting our time on "gimmes".

As for the original topic, we don't have nursing students in the ED where I work, and for very good reason. I simply do not have the time to teach a nursing student without compromising patient safety.

However, I was a nursing student myself not too long ago. Our clinical groups were limited to eight students, and it was our clinical instructors who were responsible for supervising us; it was our CIs that we developed the primary teacher/student relationship with. In addition, we were only on the floor for five hours each clinical day, and our responsibilities included whatever patient care tasks our clinical instructor assigned, as well as meeting with our CI to review our care plans, then revising them as needed, doing whatever research we needed to do in order to do it, writing learning objectives and reflections, etc. If we needed to be check off on a skill, we had to wait for our CI to come and supervise. If we were fortunate enough to be assigned to patients with a staff nurse who liked to teach, it was just icing on the cake, but never expected.

I was only treated rudely by one nurse, who muttered under her breath "You only have two patients and don't have time to do a bed bath???", when I really did not have time due to the agenda that my CI had planned for me that day. Other than that, I was at worst treated indifferently, and at best welcomed by friendly nurses that liked to teach.

I was treated the worst by CNAs. To them, if there were nursing students on the floor, they expected the nursing students to do their work for them. I would overhear them saying to one another "Well, I have a nursing student, so I only have [their patient assignment minus however many patients I was assigned to] patients today", or walk into a patient's room and introduce themselves to the patient saying "I'll be your CNA when the nursing student leaves at one o clock", or tattle on me to the charge nurse for not doing something they made the incorrect assumption I was supposed to do.

What they did not seem to understand was that I had a set of skills that I was expected to practice correctly under the supervision of my CI, and that when my CI showed up, I had to be ready to go. I could not be caught up in a patient's room getting the patient out of their SCDs and CPM machine, assisting them to ambulate to the bathroom with their walker and IV pole and getting stuck in the bathroom with them because they're a fall risk, when my CI shows up to supervise me. For one thing, I already knew how to do that, since I had to be a CNA to get into my nursing program and had worked as a CNA for the 2 years prior to starting it. Plus, learning how to delegate was part of the expectation; talk about awkward!

I had to know every single medication; its mechanism of action, why the patient was receiving it, whether it was a safe dose, possible adverse reactions to monitor for, and all of the nursing implications. I had to be able to answer any question my CI might ask me about any medication or treatment or procedure I was responsible for. I had to be prepared to practice a new skill such as a sterile dressing change, central line dressing change or DC, drain DC, insulin or LMWH heparin injection, etc. etc. when my CI showed up and said "It's time".

Anyway, I like the model where the CI is responsible for supervising, because even though the students aren't able to shoulder a lot of the workload because they are on the CI's schedule, it does take the burden off of the staff nurses to do the teaching. In the program that I graduated from, that changed during the preceptorship that happened in the final term prior to graduation, when we were paired with a staff nurse (who's participation was voluntary, plus they had to have a certain amount of on the job experience and go through an orientation process to be "allowed" to precept a nursing student) working toward taking full patient loads and practicing independently but under the watchful eye of the preceptor. I had a really great preceptor, and overall a very good experience, and I chalk it up to her actually wanting to teach and feeling like it was a privilege that she signed up for, not a burden thrust upon her.

xtxrn, ASN, RN · Oct 1, 2011

You don't know what today's NCLEX is like; :) LONG testing is not smarter testing albeit I am sure it tests the stamina after a day...lol. Objectively, today's test is more difficult, not less.
The skills are important to know but they aren't difficult to learn or master really. You can put in 100 foleys in nursing school but until you are nursing full time and throwing in a foley in an 88 year old screaming hissing dementia patient for the nth time, you really just don't get it down.
I will add the field is more complicated by the fact that hospitals are increasingly more and more strict about what nursing students could and could not do. When I finished nursing school, one hospital did not even want nursing students pushing IV meds AT ALL and certainly no one will let you access medications so that you can think the task through. Increased regulatory and bureacratic requirements do not help students learn either.

Not saying it's easier- I'm saying that it takes 1/8 of the failing grade from the 'dark ages' to pass.....our students that failed could have 599 right, but fail. That's 8 times the number of questions (that you know nothing about :)). The broader scope was useful in weeding out those who really hadn't gotten it. That's all.

75 correct answers is not reassuring about the competence of a nurse......sorry- not much will change my mind :) But I respect your view on this :up:

Skills aren't difficult to master- but the students need to be exposed to actually doing them IN school.... If the hospitals are fussing, that's another indication that the process of educating nurses is flawed.

Here (2003) on pediatrics, we had students a lot (and med students). And the instructor was there. I worked 7p-7a, so didn't see them much after day orientation. The instructors were attentive. The students were not a problem...(I did see some on days during my own orientation). But they seemed to walk down the halls in groups, and not much patient interaction. I can see not doing IVs on pediatric patients- unless an older adolescent with healthy veins. But it looked like a lot of looking in rooms.

It's not really nursing school without knowing how to do basic skills- that is a liability to the staff nurses who get stuck with a nurse who has no clue- and is understandably terrified. But it's not the staff nurse's job to finish the student/newbie's education ....they need to have basic skills - and those are lacking. Basic patient care needs have to be good enough to at least do SOMETHING on their own.....a PCT can take the vitals, the nurse needs to have the 'real' skills.....they are not trivial :)

We can agree to disagree I'll still sleep- and still feel the students' got ripped off.

Sample NCLEX questions.....look pretty basic....JMO

http://www.studyguidezone.com/nclexrn_practice1.htm

Anna Flaxis, BSN, RN · Oct 1, 2011

It's not really nursing school without knowing how to do basic skills- that is a liability to the staff nurses who get stuck with a nurse who has no clue- and is understandably terrified. But it's not the staff nurse's job to finish the student/newbie's education ....they need to have basic skills - and those are lacking. Basic patient care needs have to be good enough to at least do SOMETHING on their own.....a PCT can take the vitals, the nurse needs to have the 'real' skills.....they are not trivial :)

That's the thing. In my program, you had to have your CNA certificate just to be accepted, and acceptance was so competitive that only students who had actually worked as a CNA were accepted. So it was assumed that if you were in the program, you already had those basic skills. They didn't teach us how to do bed baths or denture care, because we already knew how to do those things. In clinical, our focus was not on basic care, since we already had those skills down. We were there to learn things that you need a license to be able to do. We certainly weren't forbidden to help out and take someone to the bathroom or help them clean up in the morning or help pass meal trays, but only if those things weren't interfering with what our CI wanted us to be focusing on that day.

It's my understanding that not all programs have the CNA requirement, and sadly, the program that I graduated from has done away with it as well. I think that's a mistake.