Too Many Crabby Nurses!!

grannynurse FNP · Jun 15, 2005

Sorry again Granny but according to california Nurse Practice act, I as the assigned RN am responsible for that patient until I am relieved by oncoming or that patient transfers off my unit, one way or another. There is no educational contract that exists that would supercede that code of professional conduct.
Maybe the exception exists wherever in the world you live, however NPA and hospital policy are all very clear on these definitions. Additionally, a student nurse is limited in liability, is unable to receive and carry out physician orders, especially telephone orders, and in most cases charting must be co-signed by the assigned nurse.
Your misconception is rather silly on many levels, are we to assume that a first semester RN student will provide care for a patient on 3 IV drips , a FC and possibly on a tele unit? Who's gonna give the IV push? Also, how many patients do you know that would accept a student providing nursing care without clinical guidance? SHEESH!

Sorry but a first semester student would not be in a telemetry unit, atleast not in any programs that I have taught in. And I have taught in both NYS and Florida. California may be different. must be the smog but you are the one that is in error, at least in the two states I've taught in. A first semester student in a tele unit, no way, now ay.

Grannynurse

Marie_LPN, RN, LPN, RN · Jun 15, 2005

Smog???? WTH???

Nothing like a good stereotype to prove a point....

:rolleyes:

grannynurse FNP · Jun 16, 2005

Smog???? WTH???
Nothing like a good stereotype to prove a point....

Hey, I lived in San Diego, for six years. :) And still visit relatives and friends out there. Of course, I always take my trusty gas mask with me :rotfl:

Grannynurse :balloons:

Tweety, BSN, RN · Jun 16, 2005

Then, I am not surprised that there are not more problems. The responsibility of an instructor is to supervise the students under her. It is not nor should it ever be, the responsibility of a staff nurse to supervise a student. You are not paid to do this nor, would your malpractice insurance cover you, if you did. The purpose of a clinical experience is to give students guided clinical experience. That means that the instructor choose patients that fit the needs of her/his students and the theory they are currently covering. They are expected to know the drugs, diet, treatments, IVs, tests, diagnose, etc of each of their patients. To assign a student to a staff nurse, no disrespect intended, is putting the responsibility off on someone who is not qualified, even for as something as minor as a bed bath. And spending ten hours, on a floor, just doing a bedbath and following you around, is really not providing much of a clinical experience for the student, no matter how good you are-no disrespect intended.
I have always had written objectives for my students, with the types of patients they can handle and with the aim of providing them the best clinical exerpience possible. Sorry but the p[rogram is not very good, in my opinion.
Denise :balloons:

I see exactly what you're saying. However, as long as I have a patient assignment, I'm going to supervise and manage the care of my patient. It would be another story if they weren't in my assignment and the students and instructors had their own assignment.

The program is indeed a very good one that we have with USF. It's a collaborative relationship between the school and about six local hospitals, with an instructor at each hospital. The students stay at those hospitals their entire time in school, rotating various areas, etc. It's a bit detailed for me to go into. But the students work with the nurses very closely, not independently with their insturctors. They have the highest NCLEX pass rate in the state of FL with 98%. And yes, they are responsible for knowing the meds, doing care plans, having objectives, knowing the diagnosis, treatment, rationale and all that good stuff.

When we begin precepting not only students, but new grad employees and new hires, we get a 4% raise. So in essence, yes are are paid to supervise the students.

Anyway, if I were an instructor I'd be wary of the large groups of students they have these days and setting them loose without staff nurse supervision. I'm surprise you didn't see more problems, rather than the other way around. :)

grannynurse FNP · Jun 16, 2005

First, no student takes any telephone orders, let alone transposes them or carries them out independently, in any of the programs I have taught in. Second, no student gives IV pushes, unless under the direct supervision of her/his clinical instructor and unless the student knows and can answer all the relevant questions regarding the medication and the procedure. Fourth, on average, I supervise ten first semester students and fifteen second and third semester students, at any given time. Fifth, the hospitals that we have used, do not use their Tele Unit for overflow patients. And we never, never assign a first semester student to shadow at staff nurse. It is a waste of the student's time, a waste of her clinical experience, a waste of the staff nurse's time, and it doesn't provide the student with any practical clinical experience, other then watching someone else do something she should have learn in her labs. The only time we assign a student to shadow is in the OR, ICUs and ER. And there is always a clinical instructor present to monitor her/his students and to supervise them.

Grannynurse :balloons:

grannynurse FNP · Jun 16, 2005

I see exactly what you're saying. However, as long as I have a patient assignment, I'm going to supervise and manage the care of my patient. It would be another story if they weren't in my assignment and the students and instructors had their own assignment.
The program is indeed a very good one that we have with USF. It's a collaborative relationship between the school and about six local hospitals, with an instructor at each hospital. The students stay at those hospitals their entire time in school, rotating various areas, etc. It's a bit detailed for me to go into. But the students work with the nurses very closely, not independently with their insturctors. They have the highest NCLEX pass rate in the state of FL with 98%. And yes, they are responsible for knowing the meds, doing care plans, having objectives, knowing the diagnosis, treatment, rationale and all that good stuff.
When we begin precepting not only students, but new grad employees and new hires, we get a 4% raise. So in essence, yes are are paid to supervise the students.
Anyway, if I were an instructor I'd be wary of the large groups of students they have these days and setting them loose without staff nurse supervision. I'm surprise you didn't see more problems, rather than the other way around. :)

I am very aware of USF's programs, both the basic as well as RN program, thu I have not been around it in five years. If they have too few clinical instructors, that staff assumes the responsibility of supervising them then they have gone down hill, rather then up hill. At the most, I supervise ten first semester students. And the program I worked in had an excellent pass rate for the NCLEX and a very low wash out rate of our basic students. Sorry but that is my take on the situation. And considering I was within my last semester of completing my MSN in nursing education and had done clinical supervise (both in my grad program and previously), I think I have a better idea of what consitutes a good program, that meets students needs, and one that just manages to score high on the NCLEX.

The cutbacks in nurses and nurse educators, in the late 80s and 90s, now coupled with the loss ratio and increasing acuity and patient load, has lead some programs to increase their student loads without increasing their clinical insturctors, atleast IMHO. This does not make for a good clinical experience.

Grannynurse :balloons:

VickyRN, MSN, DNP, RN · Jun 16, 2005

a gentle reminder to all to debate the issues and avoid personal attacks. this includes derogatory generalizations and stereotypes, inflammatory statements and condescending remarks.

thank you.

rach_nc_03 · Jun 16, 2005

In school, I only had one clinical rotation (NICU) where I met no cranky/burned-out nurses. My co-assigned nurse in the NICU had actually applied to the neuro ICU where I was working as a CNA when she'd moved to the area- her specialty was neuro trauma/ICU, and she absolutely loved the field. I asked why she'd chosen neonatal ICU instead this time, and she said, 'when I went for my interview in the neuro ICU, I spent about an hour in the unit, talking to the nurses. all but 2 were unpleasant, snappy, and seemed generally miserable. I'd rather go out of my comfort zone and have to learn a lot of new stuff than work with a lot of people who hate their jobs.'

I thought that was pretty idealistic, especially since the burnout seemed so pervasive in most places, but I remembered what she said when I started interviewing for jobs. I applied for a PICU job at the hospital where I worked as a tech, and shadowed for a day before I had my interview. EVERY SINGLE NURSE in that unit said they loved working there, and they couldn't have been more helpful and friendly. I asked about management, staffing, scheduling, advancement opportunities, training/precepting, nursing/medical staff respect...consistently, they had positive things to say. From the newest staff member (six months out of school) to nurses who'd been there twenty years, everyone loved it. Turnover was very low, and they had a much lower percentage of travel nurses than other ICU's in the same hospital. I was positive I wanted to work there after that day, and I'll be starting on June 27th.

I'm sure there will be *some* unhappy nurses and/or problems on this unit, but probably far fewer than in many places. In my former career, I learned the hard way that nothing will make you miserable faster than working in a miserable environment with miserable coworkers.

VickyRN, MSN, DNP, RN · Jun 16, 2005

In my former career, I learned the hard way that nothing will make you miserable faster than working in a miserable environment with miserable coworkers.

:yeahthat: Truer words have never been spoken :coollook:

Tweety, BSN, RN · Jun 17, 2005

I am very aware of USF's programs, both the basic as well as RN program, thu I have not been around it in five years. If they have too few clinical instructors, that staff assumes the responsibility of supervising them then they have gone down hill, rather then up hill. At the most, I supervise ten first semester students. And the program I worked in had an excellent pass rate for the NCLEX and a very low wash out rate of our basic students. Sorry but that is my take on the situation. And considering I was within my last semester of completing my MSN in nursing education and had done clinical supervise (both in my grad program and previously), I think I have a better idea of what consitutes a good program, that meets students needs, and one that just manages to score high on the NCLEX.
The cutbacks in nurses and nurse educators, in the late 80s and 90s, now coupled with the loss ratio and increasing acuity and patient load, has lead some programs to increase their student loads without increasing their clinical insturctors, atleast IMHO. This does not make for a good clinical experience.
Grannynurse :balloons:

I agree with your last statement.

I'm not communicating their program very well if you think they are passing off students for nurses to supervise rather than themselves. The insturctor to student ratio is not that high on any given day. But you seem well aware and have your opinions, so no need for me to try to change your mind. We're all aware the situation in nursing schools regarding the instructor shortage is a dire one.

But the bottom line is here at this hospital, I don't know where you've taught in FL because obviously it was different there, when I have an assignment on the board, it doesn't change and get turned over to students and instructors when they walk in the door.

GrnHonu99, RN · Jun 17, 2005

I'm starting my very first clinical in 2 weeks:) yay:) :balloons:

I am lucky to be going to a great hospital. MOst hospitals here in my area are good hospitals but the one I will be going to has a great reputation, ie. the nurse retention rate and satisfaction rate is very nigh. Every student in last years program absolutely loved the hospital in which I will be going to. There is one hosptial, which I may have go to later in my program, that does not have a great reputation...I hope that I do not run into any "crabby" nurses there even though I have heard some other students say that they have...I hope not!!!:)

cilky · Jun 20, 2005

Isn't this the saddest thing you ever heard. Crabby nurses. from a nursing student. I have changed jobs quite a few times just for this reason. I have great difficult when im treated poorly by my peers. Ihave to just move on

because the atmospher is terrible to work in. And there is nothing worse then having someone speak to you with condescending tone of voice. I must say treated so terrible, I continue to speak to staff and resident with respect. I guess i just move on thinking it will improve else where.

C