Walking on eggshells at clinicals

[zilla704]

Anyone else feel like this? My group has had a few bad encounters with the RN staff. I feel like we are bothering them and they HATE us. One of them flogged another student on Thursday evening while we were there to get our MAR's and round reports for the next day. One refuses to let us help him. He's needed a BGL, or TED hose, or vitals and when 2 different SN's said "I'll take care of it for you", he's said "no, thanks. I'll find my CNA". So to keep the peace we ask as few questions as possible and stay out of the way. It's in no way a learning experience, for sure. I had one nurse who hung blood on a patient that I was assigned to do vitals for during the transfusion. She hung the blood and left. At the first 15 minute increment, her temp had gone up 3 degrees. I went to look for her to let her know and she had left the floor. She didn't tell anyone she had just hung blood, just left the floor. I asked and they said "Oh, she went upstairs, she'll be back in a few minutes", meanwhile I'm terrified this patient is having a reaction. I've hated every minute of this semester's clinicals and I dread every Friday. My clinical instructor said because it's a total joint floor and they are so overworked they are just tired and cranky. I just can't accept that. This is a teaching hospital.

Are you guys having similar problems?

[queenjean]

I see both sides of this; I am an LPN on an acute care floor with 7 years experience (and no, I am not jealous of RNs or student RNs); and I am also an RN student now, doing my own clinicals.

We students have the impression that we are there to learn, our RN is there to teach us, and that it is easier to have a student than it is to have the patient by themselves. Wrong. It is so freakin hard to have a student; it doubles your work load. AND you are responsible for everything the student does. My last student acted a bit insulted when I asked if she knew how to start an IV piggyback, "Yes, I've done *tons* of them." so I let her. Without directly observing her. Then the pt calls me to the room about 15 minutes later, while the student nurse is on break, to tell me that she is bleeding everywhere. Because the student nurse was not familiar with our tubing system I guess, did not screw the hub in properly (just pushed it in) and it worked it's way loose and the patient lost quite a bit of blood, and it is MY responsibility.

Answering all those questions the student nurse has is MY responsibility. Insuring that she does not harm my patients is MY responsibility. Insuring that she learns something (even though I have never taken any classes on education, nor am I familiar with what her classes have covered so far, or what she needs to work on, somehow I am supposed to know all these things); it's all MY responsibility. It is also not always great on the self esteem to work with students. When you ask me a question I don't know, it is hard to say, "I don't know," even if you dont' smirk after I admit my ignorance (and it certainly doesn't help if you DO smirk; do you think I really want to work with you after that?!?). Or if you criticize my sterile technique. Or the way our hospital does this and that (like hang blood, I noticed in an earlier post--yes, it is our hospital protocol that blood run very slowly for the first 15 minutes--in our hospital, anyhow, it wouldn't be the nurse being a freak, it would be her following protocol.) Point is, we all hear you griping about us in the break room--how we don't know anything, how we don't do things the proper way. Yes, sometimes you are right--sometimes, though, there is more than one "proper" way. So maybe you should hold your criticism for later, okay?

As a student, it is equally as difficult. How am I supposed to know the politics of the floor? If I don't get the opportunity to perform something, or watch you perform it, or have you help me by walking me through it, how am I supposed to learn? If you treat me as an aide, or worse, a nurse who is working with you, and you assign me my own patient(s) while you work separately with the rest, how exactly are you going to help teach me anything when you actually have no idea of what is going on with my group? I see charge nurses assign a *heavier* group to the RN with the student, because "she has help." No she doesn't! She needs a *lighter* group, so that she has more time to work with the student! And you don't need to make disparaging remarks about the students' abilities or physical attributes or the mistakes they made while you are standing at the nurses station or in the cafeteria. Nothing tears us down like that, knowing that you think so little of us that you are telling the world how terrible we are behind our backs.

As nurses mentoring students, we need to be more open. We need to be more attentive, and explain our actions and rationales. We need to tend to the student nurses, not turn them loose to sink or swim. We need to be encouraging and open, and invite (and then answer!) questions.

As students, we need to ask appropriate questions at appropriate times, and also need to learn that sometimes the best way to learn is to keep our mouths closed and our eyes and ears open. We need to ask for help when we think we might need it. When we make comments, we need to think before we speak; not "You are doing that wrong, in school we learned to do it XYZ." (a quote from a recent student): rather, say, "Why did you do XYZ like that? I learned a different way, could you talk me through your way?" Most importantly, we need to remember what it is like, so that when we are the mentor, and there is a brand spankin new student in front of us, we don't say "Oh, now I understand why my mentor nurses were evil, now I realize how difficult students are;" Instead you need to remember how hard it was to be a student, and how much your mentor could teach you (for better or worse), and become the mentor that you yourself wanted and needed as a student.

Climbing down from my soapbox today, because I work again tonight, and anyhow, I've probably bored you all to death by now...

[PedsNurse322]

It must be an ortho thing, eh? The ortho unit at the hospital that I am doing my M/S rotation at will not allow students on their unit, period.

The RNs that I've worked with so far have been helpful, although one of my classmates got a crab the other day - but then, this RN was bitter to begin with because she had been pulled from the ortho floor (lol) to work, and then got a student to boot.

Another RN on the unit tries to avoid the students, and our instructor says it's because she's afraid were going to ask her questions that she won't be able to answer, and she'll look dumb. Makes sense...

[charlies]

Technically, the pt we work with in clinicals is YOUR pt (from what we've been told and what it says on the whiteboard).

Then again, I am JUST a student and perhaps you can educate me otherwise.

.....the patient you work with is not my patient. Lol, the patient you work with is most likely Daytonite's patient. All four of us are much happier that way. All six of us if you include the charge nurse and the instructor.

[charlies]

Another RN on the unit tries to avoid the students, and our instructor says it's because she's afraid were going to ask her questions that she won't be able to answer, and she'll look dumb. Makes sense...

Of course that is the reason. That nurse is a big giant dummy who is only there because the hospital is so desperate in this time of need. It sounds like you have a fantastic instructor who really knows alot and is giving you a realistic view of nursing.

On the other hand, maybe she avoids the students because when she was a little girl, a student nurse said 'boo' to her really loud, and scared the bejesus out of her, and now she has an irrational fear of students. That makes sense too...

[Beeanurse]

I too experienced this when I was in nursing school. The staff always acted like we were bothering them. The whole group of us would be friendly, try to stay out of their way etc... but clinical after clinical it got worse. Finally after our instructor did not give us the answer we were looking for, a solution, we as a group went to the nursing supervisor of the floor and told her how we felt. The last 3 or 4 clinicals I had were the best the staff totally changed.

[S.T.A.C.E.Y, LPN]

OMG! We had this problem during my last clinical semester before my preceptorship. It was terrible. The nurses on the floor told us we could only look at one chart at a time....between all of us, couldn't go behind the nurses station, had to share one BP/Temp thing between all of us, couldn't do anything. We were told to all share this little ledge along a window at the far end of the hall to do our charting, then we were complained to about how we're always all huddled down the back hallway. Our clinical instructor was mistaken for a student several times, and even had her head chewed off. We had some plain ignore us, one even asked if we were stupid when we asked why she was doing something. We brought their lack of co-operation up several times with our clinical instructor, with our nsg director, and she had numerous meetings with the floor manager. Apparently it has been a problem on this floor for years, and they've treated all students the same way.

But, some payback.....they've been desperatly trying to hire staff for years, and since we're the only nursing school around they kinda rely on my schools new grads to fill positions. Our nsg director told the manager that the reason no student wanted to do their placement on her floor, or work for them was directly related to the way they treat/treated their students. My classmates have gone on to work on other floors at this hospital, but everyone knows to stay clear of this floor. The few new grads that have ventured there haven't lasted more than a few weeks. Good grief!

[PedsNurse322]

Of course that is the reason. That nurse is a big giant dummy who is only there because the hospital is so desperate in this time of need. It sounds like you have a fantastic instructor who really knows alot and is giving you a realistic view of nursing.

On the other hand, maybe she avoids the students because when she was a little girl, a student nurse said 'boo' to her really loud, and scared the bejesus out of her, and now she has an irrational fear of students. That makes sense too...

Well, I'm just repeating what the instructor told us... and she's worked as an instructor on this unit for a long time and knows the RNs pretty well, and how they practice, etc. She's a fantastic instructor, knows her stuff, so I don't question her judgement. Apparently this nurse has done some questionable things, practice-wise that my instructor has taken notice of.

You really don't have to be so snotty, either. :-)

[classicdame, MSN, EdD]

someone needs to contact the Chief nursing officer and/or the Director of Education. This is wrong on many levels.

[WDWpixieRN, RN]

....the patient you work with is not my patient. Lol, the patient you work with is most likely Daytonite's patient. All four of us are much happier that way. All six of us if you include the charge nurse and the instructor.

...We spend 8+ hours wishing for the he!! that is that day to be over -- and quickly.

I do find this attitude very sad, however. I can't imagine where it comes from or why. I can only say I am so very grateful for the Daytonites and others like the circulating nurse in my OR obs today who are so willing to help us understand how to be good, contributing members of the profession someday.

[WDWpixieRN, RN]

One thing to keep in mind....these student nurses will one day be real nurses in a hospital where YOU may end up.

One would think it would be in EVERY nurses' favor to help train their replacements and do so in the manner in which they hope to be treated as a pt.

[PedsNurse322]

But whatever, you teach the students all you want, I don't care. Unless your teaching of the students means your not getting your job done and I have to take up the slack. Because I will not do that.

Charlies, you were a nursing student at one time, right? Do you remember what it was like as a green student in those first clinicals? Why do I sense that you resent students? Believe me, when I'm in clincals, I rarely bother my RN unless I absolutely have to, and leave the teaching up to my instructor. But today, I was working under a wonderful RN who made sure to let me know that she was there for me if I needed her in any way. Once she gave me report, I think I asked her a question about something only a couple of times during the course of my shift... and in no way did I interfere with her time. Actually, I saved her time by doing things she would have otherwise had to do for this particular patient (pushing meds thru a dobhoff, hanging IVPBs thru a PICC via pump, BGMs w/insulin coverage, maintaining pt's continuous tube feed, trach care, JP drain care, etc...) I was busy with him all day. She thanked me when I left for the day for my help - not my "hinderance".

We're not so bad, really. Give us a chance :-)

Peace... Laurie

[Tweety, BSN, RN]

Yeah, I neglected to add that I'm in another hospital this semester and it's like night and day. I'm EXCITED to think about working with this group of nurses, techs, etc. They are kind, answer questions, don't roll their eyes, hide equipment, and they HELP us!! I've applied for an internship with this facility and their sister facility based on this experience. I let my CI and also the recruiter when she called to talk about the position know how MUCH I enjoy being there and love the staff.

I'm glad to hear you've realized not all places are that bad. I was thinking as I was reading the op that they are missing a vital chance at recruiting and helping themselves out. Nursing students are not going to work for a facility that is unwelcoming. Nursing students will gladly join a short-staffed busy stressful unit if it has the right team spirit.

I recently took a charge nurse position and the one thing I said was "the worst part about is I won't be able to be with the students." I precepted all the time. I was going to get a senior student for precepting later this month and had to assign her to someone else and I ached a little bit. Every Thursday a couple of accelerated BSN students came and I always took on a beginner for the day for one-on-one work (they do a preceptorship for all clinicals rather than appear as a group with an instructor)

Having students though is rough, I love to teach and explain things and challenge the students with questions. At the end of the day when they say their goodbyes, I'm there longer finishing up what I couldn't get done. It's not always about having someone do my work for me making my job easier. But I love it and wouldn't have it any other way.

I completely totally agree with the concept that it's every nurses job to guide the next generation of nursing students. And that might entail "picking up the slack" from time to time.