What to do (with clinical students) when the census is LOW.....

[iteachob, MSN, RN]

First of all, this was an OB clinical, but i could probably use some ideas from other areas. Yesterday, there was 1 post-partum patient on the 22 bed unit we use for clinical. No patients in L&D, and the only baby in the newborn nursery was rooming in with the mother. No post-ops (it's GYN also) expected....nothing. I had 9 students in the group! Going to another unit wasn't an option as the hospital is used by other clinical groups from my school and 2 additional schools. It is a regional hospital, but the only one in town.

What I ended up doing was having them meet me at the nursing school (it's not far from the hospital) where we watched a video on perinatal loss (an upcoming topic), and completed 2 unfolding case studies. We used all the clinical time allotted on these activities. They will also be turning in a care plan for a case study "patient". It was an okay day, and the students commented that they felt like they had learned something.

Still.....this happens to me about once every semester or so. I was wondering if anyone out there has something in their "bag of tricks" for this situation.

[NurseLoveJoy88, ASN, RN]

My OB instructor had us taking VS on every patient on the floor, doing NB assessments and VS, looking in some high risk pts. chart. and etc. I'm obviously not an instructor but hope this helps.

[AOx1]

Consider some issues in OB- for example, see if you can give (or have someone give) a lecture on fetal demise. Chaplains, L&D nurses, and parents who have experienced losses might make a great speaker.

Also, you could discuss our high intervention means of birthing. Have a debate with the students. The movie "The Business of Being Born" sparks good discussion. Explore the options in your area- are their midwives? Do local OB/GYNs allow low-intervention birth?

You could schedule a simulation on emergency scenarios using a volunteer "patient" or simulator- ex- cord prolapse. You could also walk the students through the BASICS of NRP (just the main points) and they could practice with the equipment (neopuff, bag-valve mask, etc).

They could also practice giving report and critiquing each other.

You can assign student pairs and have one come up with a diagnosis and "case study" and the other will try to "solve" the mystery and develop appropriate interventions.

You can have NCLEX drills and divide them up into teams for prizes based on OB questions answered correctly- and talk out the rationale.

You can play games over basic fetal monitoring.

You could form a panel of local OB nurses with varying levels of experience. A new grad could talk about the learning process and time management in OB, and what they wish they had known when they started in OB. They could talk about new grad concerns as an OB nurse. More experienced nurses could talk about unusual cases, give advice, and talk about how they have seen OB care change over time.

[nursebrandie28, BSN, RN]

I think what you did with the students was perfectly fine. I would have the same or similar. If I have run through the above techniques, I send them down the ER or same day surgery have have them put in foleys and IV's. I know you mentioned other students at the same hospital, but maybe they do not go to ER or SDS??

Just a tip... Good Luck!!

Brandie

[RochesterRN-BSN, BSN, RN]

see if the hospital has a lactation specialist/cosultant that could come and give a talk........practice reading strips, lots of learning things available that they orient new nurses with....

[HazeKomp, BSN, RN]

thanks for these ideas!

I'm "stealing" them!!!

I teach OB in a small hospital...some days we have a "feast" of patients... and other days a "famine" so your suggestions are wonderful!

haze

[imafostermom]

All are great ideas, I also have a scavenger hunt list of things for them to find. everything from fire pull stations to PPE's...things in patient rooms, pantry's, triage areas, housekeeping closets, refrigerators, and storage rooms. Things on the crash carts, and tons of things in the clean linen, dirty linen, drawers and cabinets in the nurses stations (P & P manuals, code charts, MSDS books) storage rooms (tons to find there) and rooms specific to various units (like the circumcision room). I also assign them to follow/help a housekeeper, volunteer, unit secretary whenever we are slow.

[organichombre, ADN, BSN, MSN, LPN, RN]

I've only been a clinical instructor for about 1 1/2 years so my experience is small. However on the rare occasion that we had low census, I had the students do case studies on different disease processes. This falls within the rules for the University and it gives the students a learning op that they have to participate in.

[classicdame, MSN, EdD]

I try to get speakers lined up whom I can call prn. Once I had a pharmacist talk about the drugs used on OB/GYN floors. Once a S.A.N.E. nurse came and talked about what the requirements and expectations are for her certification and showed us some pictures from cases (approved by hospital and patient). I even had an EMT/Paramedic talk about out-of-hospital deliveries. The Diabetes educator could talk about gestational diabetes - and even get the students to devise a meal plan and solve "what to do" when specific situations arise. Maybe a childbirth ed nurse or midwife? I like to show students that nurses are capable of doing many different things.

[AOx1]

Forgot one! the students love it when I bring NCLEX questions. I always keep a small supply in my bag, and they can play for paper money (buy it at the dollar store). The student who wins the most "money" gets a small prize.

[Teresag_CNS]

One teaching colleague of mine has developed a set of written emergency scenarios. Each student researches and then presents a scenario, including medications, potential causes/patho, etc. along with a description of nursing care. She has found that students like this learning activity and it gives them exposure to relatively rare events that they are unlikely to experience in nursing school.

[elkpark]

My area is psych, so, a little different, but -- I always "travel" with a few videotapes on psych topics that we can view and discuss; I have gotten clinicians in different disciplines (within the psych department) to talk to the students about their specific role, I've sent students to shadow house supervisors or observe in related outpatient areas, or done group role plays and case studies.

Sometimes you have to be v. creative ... :)