What should we doing by last clinical?

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I'm set to graduate in 2 months and am in my final clinical rotation in oncology. I have yet to start an IV or foley, change dressing, do teaching, suction a trach, draw blood, put in an NG or any of the skills we've been tested out in other than giving meds. I have seen nurses do it but have never done it myself.

We started in our first clinical doing bed baths, emptying bedpans and giving foot rubs which I did gladly. However, 2 years later, that's still pretty much all we're doing. Since our first day on the oncology floor, we've been directed to change sheets, get coffee and clean up feces and vomit. We haven't done anything else (except vitals and the occasional meds). I don't even know why are we coming in an hour early to get patient assignments since we barely do anything with them except food trays and bedpans.

To be fair, our instructor almost gave me an opportunity to put in an NG tube yesterday but the patient said she didn't want a nursing student.

I don't mind doing these things but we're starting to feel that we're not actually learning ANYTHING in clinical. Isn't that the whole idea? Is this common?

elkpark

14,633 Posts

By my last clinical rotation in school, I was functioning the same as the staff RNs, albeit with a somewhat lighter client load. We were prepared to function independently (at an entry level) when we graduated. However, this was in a hospital-based diploma program. I really fear for the future of nursing education.

leekaye

79 Posts

It seems to be due to a combination of both your clinical instructor and the expectations of the nurses on the unit. Some floors have been hostile to having students on the floor while others at least let us shadow them. And some instructors have been bad time managers and overwhelmed splitting time between 8 students. Since we can't do anything in their absence and they're only with us for about 1 out of 8 hours, we can't do much of anything.

When I mentioned my concerns to the instructor, I was told that you learn all the technical skills on the floor when you're hired and this is all about just learning to think like a nurse so observation is all we should be doing. But even so, we get to observe perhaps 5-10% of the day and the rest is really just cleaning up messes. There's very little interaction with the patients.

IrishErin

256 Posts

Specializes in ER, Addictions, Geriatrics.

I really didn't get to do a whole lots of crazy skills I'm my program until I did my final three month consolidation placement at which time I was one on one with a full time staff and doing as she did.

During my clinical rotations I did a few neat dressings and watched a whole lot of procedures but other than that not too much

Kuriin, BSN, RN

967 Posts

Specializes in Emergency.

I think during your preceptorship is where you really shine, which happens to be in the final semester of school. Before then, you have little to no autonomy and are at the mercy of your nurse, regardless what you may have learned.

If it makes you feel any better, our school -- we are not allowed to do insulin WHATSOEVER. lol.

flyersfan88

449 Posts

Specializes in Trauma, Orthopedics.

This makes me sad. I wish you were having a better final semester. I'm in my last semester as well and my clinical is my capstone preceptorship (no group, no instructor to guide, just you and your nurse) and I do everything with my RN. We're not allowed to start IVs, but do pretty much everything else. I'm assuming you have spoken up about how you feel? In my experience, if you dont make it known you want to do more, the nurses arent going to be bothered seeking you out for experiences. If you see them doing something youre allowed to do, just say "hey can I do that??"

Edit: sorry, I just saw where you said you brought it up to your instructor. But how about the nurses? Are they flat out denying you, or just not offering to let you do stuff? If so...I guess make the most of what you can do. Get really good at assessments. ..assess your classmates patients if they have interesting cases. I had an instructor who was phenomenal with in depth assessing...and learning how to do things like her was one of the things I learned that sticks out the most.

elkpark

14,633 Posts

When I mentioned my concerns to the instructor, I was told that you learn all the technical skills on the floor when you're hired and this is all about just learning to think like a nurse so observation is all we should be doing.

This is one of the main reasons so many hospitals are now balking at hiring new grads. The hospitals don't want to have to spend the (significant amount of) time and money to teach new grads what the hospitals feel (quite reasonably, IMO) they should have learned in nursing school.

leekaye

79 Posts

This is one of the main reasons so many hospitals are now balking at hiring new grads. The hospitals don't want to have to spend the (significant amount of) time and money to teach new grads what the hospitals feel (quite reasonably, IMO) they should have learned in nursing school.

Agree 100% which is why we want to be prepared! But some nurses and hospital policies have made it difficult as well.

Some nurses don't like students and the hospital is not enforcing its rule that nurses train us. While the majority of nurses have been great, during one rotation the nurses were openly hostile, complained loudly about us in front of us stating they didn't understand why they had to train students (so they simply didn't). At another, the hospital assigned us to an understaffed unit where the RNs said they simply didn't have time to work with students.

Due to liability, many of the hospitals are also implementing policies hindering what students can do. Every time, it's due to an unnamed "previous issue" so a blanket policy affecting all future students is instituted. One unit forbid us from assisting any patient to the bathroom. At our current rotation, we are forbidden to do glucose checks.

Additionally, there has only been one rotation where we had badge access to supplies. Last rotation, we had to get someone to let us in to the pantry just to get patients popsicles, juice, coffee or saltines. At our current rotation we have to get someone to open the door for us to get supplies for a bed bath. I understand not giving us access to the Pyxis room but linens? Dynamaps? Chucks? Bath wipes?

IThinkICan100

102 Posts

Specializes in Cardiac, CVICU.

My gosh! My first semester (fundamentals) we learned all of those skills (except for drawing blood) and were encouraged to practice them in clinicals and did.

elkpark

14,633 Posts

Some nurses don't like students and the hospital is not enforcing its rule that nurses train us. While the majority of nurses have been great, during one rotation the nurses were openly hostile, complained loudly about us in front of us stating they didn't understand why they had to train students (so they simply didn't). At another, the hospital assigned us to an understaffed unit where the RNs said they simply didn't have time to work with students.

Due to liability, many of the hospitals are also implementing policies hindering what students can do. Every time, it's due to an unnamed "previous issue" so a blanket policy affecting all future students is instituted. One unit forbid us from assisting any patient to the bathroom. At our current rotation, we are forbidden to do glucose checks.

Who said the hospital had a "rule" that the nurses are required to train you? Why is that not the responsibility of your school faculty? You're paying tuition to the school, not the hospital, which gets nothing for having you there and is, in fact, doing the school a favor to allow you to come.

Plenty of nurses "don't like students" (although it's usually more a matter of not liking having their workload significantly increased, and their productivity decreased, without any kind of additional compensation), and feel that, if they wanted to be teaching students, they would get a job at a nursing school. No one asked them if they wanted to be responsible for students' education; they just get told this is how it's going to be.

And a lot of those policies are in place precisely because something significantly bad happened in the past, involving a student. Hospitals have gotten really "gun-shy" about what they'll let students do. It's a bad situation all around; not at all the students' fault (I blame the administration and faculty of many nursing schools), but the students are the ones who end up caught in the middle.

leekaye

79 Posts

Perhaps I could have worded that better. By obligation to teach, I only mean that these are teaching hospitals and it is in the job description for all RN positions within the hospital to "provide regular teaching and support to nursing staff, medical and nursing students." I would think if they prefer not to do this, another hospital or unit that doesn't have a constant influx of students would be a better fit. At the very least, they can remember that they were once a student. They should remember how it felt to be so nervous and alien to the floor and how an overworked nurse spent a bit of time with them or, at the very least, wasn't overtly rude to them.

Although I realize hospitals don't have to allow students, I do think the hospitals benefit from students and it's not merely an act of charity to allow them in. They get free patient care from students, even it its just changing sheets. I was told by the nursing manager at the hospital that they book fewer CNAs on the days students are on the floor. Additionally, hospitals benefit from a trained student workforce. I doubt they would hire a nursing grad who had never set foot in a hospital.

I've disgressed from my OP. My point isn't really to argue over whose "fault" it is, but to determine if our experiences are the norm and, if not, the best way to address it so we are well prepared nursing grads.

SHGR, MSN, RN, CNS

2 Articles; 1,406 Posts

Specializes in nursing education.

If a patient sees you come in passively and embarrassed that you are just a student, or if you appear nervous, then they will be unlikely to let you sink an NG. I wouldn't either!

If you walk in knowing that you have successfully placed an NG tube into the dummy in skills lab so many times that doing it "for real" for the first time will be a confident experience for you, then I bet the patient will sense that and have no problem with you doing it. Know the policy and procedure for verifying proper placement. Have the water handy for the patient to drink. Have the chux and emesis basin handy. All those things.

Establish the relationship first, then place the tube.

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