Walking on eggshells at clinicals

Nursing Students General Students

Published

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?

Whoa... stop the presses.

I just went back and read thru some of your posts, Charlies... and here's a nugget from you dated 3/4/07:

Hi,

what is the difference between CCU, ICU, and acute care?

also, what is the best way path to getting onto a trauma team, like the ones you see on 'critical hour' for example.

thanks

Ummm... how long have you been a nurse?

From you on 2/19/07:

I am in my final semester...

Oh, I'm sorry, you're still a STUDENT, right?

I am LMAO right now.

Up Vote Up Vote ×

However suspect Charlie's credentials are (and there are many of us who are nurses and students simultaneously, myself included, just FYI), he has a point. This is one of the few professions where, almost no matter where you go, you are expected to mentor/precept students. Not everyone is cut out to be a teacher (as we all are well aware). While I know our charge nurse tries to ask a nurse's permission before placing a student with him/her, she primarily makes her assignments based on the patients--which ones are appropriate for students.

I think in this discussion, I don't necessarily completely agree with Charlie or his/her attitude, I do agree that it is difficult and professionally dangerous at times to have a student. I'm not sure that the ANA's Code of Ethics (is the ANA *THE ONLY* authority on all things nursing?) necessarily means that every nurse must appropriately mentor all students in any environment the student or school sees fit. It could also be interpreted as donating time or money to your alma mater. Supporting organizations that in some manner -- through scholarships, classes, or legislative lobbying -- that support continuing education or primary education of nurses. Being a member of an organization such as the ANA, or a specialty organization (like AWOHHN, etc) would be an example. Helping organize a conference, raising money for scholarships, teaching a CEU class--all these things are also supporting the education of nurses and nursing students.

If we are ALL expected to be mentors, part of our education should be HOW TO TEACH NURSING STUDENTS. Would you want your child educated by someone who has never had any experience or guidance in teaching? Why is your education any less important?

I wish that when schools sent students onto the floor, they at least communicated more specifically with the charge and floor nurses about what to expect. Not "These are third semester med/surg students, do you have any interesting patients for them?" Something like "These are third semester med/surg students who have checked off on X,Y, and Z and need experience in A,B, and C. They are more than able to independently perform E, F, and G, but have not yet had instruction in M, N, and O and should not be expected to know how to do these things. Some of our goals for this clinical rotation are R, S, and T. We are new to your facility, so please help them with the computer system and the charting."

Why, if schools utilize the same facilities semester after semester, is not some continuing communication like that available to the preceptors? Would it kill the school to give each unit, prior to the start of the clinical rotation, a single sheet of paper briefly outlining what the students have already learned, what their specific objectives are for that clinical rotation, and a list of specific tasks, procedures, etc that the nursing students should either be performing independently, or should be assisted with/exposed to during that clinical rotation? The problems that Charlie and I have presented in this discussion are not necessarily always (or even mostly) the fault of the student or the floor nurse--it seems to me that the school and the floor director have some culpability here in terms of providing the floor nurses with enough specific information to be optimal, prepared preceptors.

Up Vote Up Vote ×
Specializes in Med/Surg <1; Epic Certified <1.
but i love it and wouldn't have it any other way.

thank you!! :balloons:

on behalf of all ns who have had bad days with their rns and staff, it's the rns like you that make us continue on to another day and hopefully, eventually, graduation!!

:kiss

Up Vote Up Vote ×

I wish that when schools sent students onto the floor, they at least communicated more specifically with the charge and floor nurses about what to expect. Not "These are third semester med/surg students, do you have any interesting patients for them?" Something like "These are third semester med/surg students who have checked off on X,Y, and Z and need experience in A,B, and C. They are more than able to independently perform E, F, and G, but have not yet had instruction in M, N, and O and should not be expected to know how to do these things. Some of our goals for this clinical rotation are R, S, and T. We are new to your facility, so please help them with the computer system and the charting."

Why, if schools utilize the same facilities semester after semester, is not some continuing communication like that available to the preceptors? Would it kill the school to give each unit, prior to the start of the clinical rotation, a single sheet of paper briefly outlining what the students have already learned, what their specific objectives are for that clinical rotation, and a list of specific tasks, procedures, etc that the nursing students should either be performing independently, or should be assisted with/exposed to during that clinical rotation?

That is exactly what my school/instructor does. Perhaps that is why we haven't yet had any major problems thus far. And no, I do not expect the RNs to "teach" me, per se, or be responsible for me... but I think that if I have a question about their patient or that patient's care, I would hope that they would be approachable and helpful, that's all. For anything requiring involved teaching, I go to my instructor.

Does that make more sense?

~Laurie

Up Vote Up Vote ×

But legally, Laurie, if you have one of my patients, I *am* responsible for you. And if you are asking me questions and expecting me to answer them, then yes, you are expecting me to teach you. I'm not saying these are unreasonable expectations; but perhaps it is unreasonable to expect that every single nurse who has a license is prepared to or interested in teaching students, particularly when their facility or the school does not provide any reasonable background information on the students' program, level of skill, or clinical expectations.

So there is a precedent of schools actually providing specific info to their clinical rotation sites? I wonder why it isn't across the board, then? That seems like a no-brainer. I mean, I assume that hospitals that have nursing schools directly affiliated with them have a little more communication going on between the clinical site and the classroom, since they are overseen by one umbrella organization. But our hospital is not affiliated with any particular school, and we have students from 5 different nursing programs, at a variety of levels. It can be confusing and it certainly doesn't help the students when the nurse has no clear idea of what they can or cannot do, or what they have learned thusfar. It would be nice to have some sort of specific information regarding the students' level of clinical skills and their specific objectives for the rotation.

Since there *is* a precedent, however, I think I will ask our unit director to request this information of our nursing schools. I thought I was perhaps expecting too much; but it's good to know that I am not!

J

Up Vote Up Vote ×
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?

I am experiencing similar problems at my clinical site and it is frustrating beyond belief. As SN's we understand how overworked and underappreciated nurses can be in some hospitals, however this entire experience has soured me on the profession somewhat.

Up Vote Up Vote ×
Specializes in Pediatrics, High-Risk L&D, Antepartum, L.
Please, that is a little general isn't it? It doesn't specifically say we have to educate students. You might as well say that that quote means we have to administer their education program, and develop their curriculum. Why not, right? After all, what else are we going to do in 12 hours?

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.

Do you work in a teaching hospital? I go to school at a teaching hospital. Anyone who goes to work there knows that they are working at a teaching hospital...therefore they will have students. That's how it works. Teaching hospital = students = students on floors = nurses working with them. Truth be told...so far ALL the nurses I have worked with have been wonderful and LOVE it when we are there because their work load is cut in at least half.

If you work at a teaching hospital and don't want students...you need a new place to work.

Up Vote Up Vote ×
Specializes in Pediatrics, High-Risk L&D, Antepartum, L.

I can't believe what some of you go through. I can't believe how one of people here acts, talks and feels about students (makes me question if they were a student once upon a time...but whatever).

I love my instructors. I seriously love them.

I've been on 2 clinical units so far.

I first did the CHF unit...what a way to start clinicals :uhoh3:. Just throw us into it . It was great. I worked with some AMAZING nurses. When I had to do my review at the end I noted some of them by name and for those I didn't name I made it clear that EVERYONE was wonderful. The nurses loved having us. They nurses loved the work we picked up, they loved showing us new things, they loved that we sometimes just stood back and watched things that were not on our patient. It was a great time.

I'm now on an med surg floor and talk about boring :sleep:...of course I'm comparing it to my previous floor. It's not really boring but a lot less going on so it's been relaxing for me. Anyway I again have worked with some of the greatest people. There are 2 nurses that come to mind who are wonderful. There's 1 of them in particular who is just an amazing person. She is great. She allows us to do what we need to do. She plays along with things such as us reporting off to her. She enjoys it...or so it seems. This Saturday we are feeding them. I'm making a cheesecake. I'm also making a dip to go with fruit another student is bringing in. They like us. They treat us well. We like them. We treat them well.

Now all that being said...I go to school at a teaching hospital. When you go to this hospital as an employee or patient you have chosen to go to a teaching facility. You have opened yourself up to having students working with you or if you are a patient having them offered to care for you. The employees can't refuse students. This hospital is for teaching and the lonely person who wants no parts of it is at the wrong hospital. It has been made very clear to the students that we are to inform our instructors of ANY employee that treats us poorly. If you don't want students don't work at a teaching hospital.

I should also add that there's 1 floor at the hospital I'm at that didn't use to get students. That changed. I used to work on the floor (not as a student) and the nurse manager told me she never knew why she didn't get students. So she called the school and told them to get her some students on her floor. She WANTED them. Well guess what...they are now on that floor.

When we go on the floor we do get report from our RN. We speak with the RN and any other staff assigned to the patient and inform them of what we can and can't do. We also tell them to let us know if they need anything at all.

The patient is the responsibility of the RN. As a student I remember that but I'm also supposed to take care of the patient as if I was responsible. I am to act in the best interest of the patient but when in doubt I am to seek out the assistance of my co-assign and instructor (if needed). My acting responsible is not about go above the RN but about me putting myself in that position when I make decisions but knowing that in the end the RN is ultimately responsible and she is who I ALWAYS go to with issues because those things are her decision.

I vow that when I am working with my RN I will always treat students with respect, dignity and how how I would want to be treated. I will expect students to do their best, keep my informed and to treat me with respect. I will be friendly, warm, encouraging and fun with them and I expect the same back. I am not better then them. I was in their shoes once and in the end we are all working towards the same goal...proper, caring, considerate care for our patients.

I know somebody I may get a student who just doesn't get it, has issues, has an attitude. I will not take it out on them. I will speak with their instructor privately. I will continue to be nice and polite to them.

I'm just floored by what some people go through. I'm floored by how 1 person treats students.

I love my school. I love my instructors. I love the people I have worked with.

Up Vote Up Vote ×

I had this issue last semester on a surgical/ortho floor. It was not all the nurses just a handful and those few were unhelpful and rude. I dreaded going to clinical that entire semester. The only time I really was upset was when I had a nurse that was widely known for not wanting you to report off to them. I was unable to give her report since she was rolling her eyes, walking away, etc. I told my instructor and found out A) My instructor had been standing behind me the whole time and B) this was not the first complaint or the first time this nurse had been talked to. My instructor also said that this nurse had graduated from my school a two years prior and should remember what being a student was like.

That was my first med/surg rotation and the sickening dread of not wanting to go really turned me off to that type of nursing. My second med/surg was much better on a medical/tele floor though so I guess we'll see.

Up Vote Up Vote ×
Specializes in Oncology/Haemetology/HIV.
The ANA Code of Ethics for Nurses states: "The nurse participates in the advancement of the profession through contributions to practice, education, administration, and knowledge development."

To me this means that nurses have a responsibility to assist in the education of student nurses. Of course the ultimate responsibility lies with the clinical instructors, but when there is only one instructor to eight students (or whatever the mandated ratio is in your state) and the nurse still has the ultimate responsibility for the patient, then it often necessarily falls to the nurse to make sure that the student has the information necessary to do the work at hand. I've heard too many stories of students hiding out in broom closets from fear. It's ridiculous. The nurses who tell us how much they love having students because we lighten their load... those are the ones that make us want to work all that much harder. We're all on a team, here. The more I know -> the less I bug you -> the happier we'll all be.

That's a lovely sentiment....now if the SCHOOLS and MANAGEMENT actually tried to reasonably implement it, it might be feasible.

I am a traveler. I have been assigned students ON MY FIRST DAY OFF ORIENTATION. Exactly how I am going to adequately teach a student when I don't yet know where the linen closet is, don't have a pyxis or omnicell code, or a password to see labs.

I have been assigned plenty of students. Virtually all have been assigned to me without me having no input or being warned that I was to be "teaching" anyone. I, however, get to wing it. Invariably I get assigned more patients as I have "help". Not one instructor/charge has ever consulted me before assigning them to me.

I love having students. But not when I am not familiar enough with the facility and it be nice to have more than a 5 second warning so I could plan for "lessons.

No matter how helpful students think that they are, it invariably takes twice as much time to do anything. And if they mess up, I will be cleaning up the fallout - no matter whose license that they work under.

If schools want their students well received, they need to speak to the nurse AHEAD OF TIME, give a skill list, and administrators need to give that nurse fewer patients as s/he is teaching and that will be part of her/his workload. But I have yet to see that done anywhere save two teaching hospitals (Hopkins and BIDMC Boston).

It is sad that the students take the brunt of poor planning/staffing by facilities and hospitals. But the nursing staff is also taking some unfair hits too.

Up Vote Up Vote ×
Whoa... stop the presses.

I just went back and read thru some of your posts, Charlies... and here's a nugget from you dated 3/4/07:

Ummm... how long have you been a nurse?

From you on 2/19/07:

Oh, I'm sorry, you're still a STUDENT, right?

I am LMAO right now.

That is very astute of you. If I ever claimed to be an RN, it would be even more astute.

I still have opinions, but if you would rather me not share them, fine. I won't.

Up Vote Up Vote ×

Charlies... I am not telling you not to share your opinions - that's what this forum is about. It's just that in all of your posts regarding RNs having students working under them, you definitely came across as an RN in your comments. That's all.

Peace. :-)

Up Vote Up Vote ×
+ Add a Comment