What are somethings to keep in mind during job shadows?

[BeatsPerMinute, BSN, RN]

I realize that there is a post very similar to what I am going to ask about - which is about performing patient care during a shadow experience - but coming from an experienced critical care RN. I wanted to share my experiences and get some thoughts from others. 

I've been a nurse several years. Majority of experience is in cardiac ICU, Cath Lab and IR. Whenever I changed jobs I would request a shadow experience that would last from approx 3-4 hours. After meeting with the hiring managers / getting a tour, I would be assigned to follow a nurse. I wanted to "jump in" and help w/ patient care during those experiences vs stand by and watch (which would be boring to me anyway). I also wanted to show eagerness, willingness to help, and show that I was a competent nurse. Only once I got the green light from the manager and the nurse I would be shadowing with, then would I help with patient care tasks, and with only the things that they were comfortable with. Note: this is ME asking them if I can help, if its allowed and OK and NOT the other way around (aka potential employer seeking "free labor" or something like that).  

Never experienced any adverse outcomes. I would only do things I had much experience with and was 100% comfortable with, and if I experienced ANY doubt about whether or not I should do something, I'd speak up.

Example: one time while shadowing for a cath lab position, I jumped in during a STEMI. Things I would help with: hook the patient up to monitor, be a runner for supplies, calling out the ACT number when it resulted, if I noticed a change in the heart rhythm I'd call it out. During the case, the MD ordered pressors and anticoags and some other things. The nurse I was following was running around and asked me if we got Levo yet from pharmacy. I said yes. He asked if I'd hook it up to the patient. This was an emergency situation, and again, the nurse was running around trying to do 3 other things at once. I said to the nurse: "I got things started for you; the line is primed and hanging next to the pump. I also set up the pump, but its not loaded yet. I do not believe it would be wise for me to initiate / admin any medications since I am shadowing. Can we trade tasks? Will you please verify the medication and pump settings?" He paused for a few seconds and then suddenly said: "You know what - you're right! I got it, OK, could you get this item for me and also tell charge I need extra hands."

That experience opened my eyes to how one REALLY needs to be careful about what you do if offering to help during the shadow. I've initiated MANY drips, run codes (too many to count), and even though I would have been comfortable doing it, my gut told me that as a person not yet technically employed, that this was a task too high risk for me to complete. 

I can see why some people would have MAJOR issues with this because if ANYTHING happened it could come down hard on me, the nurse watching over me, and others for allowing me to do patient care with permission even though I was not employed... On the other hand, I see patient family members offer and even be asked to assist with patient care all of the time, and its generally OK. 

What are your thoughts on this situation? What rules/boundaries/practices do you adhere to keep yourself and patients safe during shadow experiences? Any opinions and advice would be greatly appreciated. Would also love to hear stories of your own personal experiences, or things you've heard happening, or seen happen, whilst a non-employee was assisting with patient care. 

 

[NotMyProblem MSN, ASN, BSN, MSN, LPN, RN]

When I shadowed, I used that time for nothing but note-taking and creating cheat sheets (pertinent phone extensions, codes to doors, where to find whatever, etc). If I’m given the resources that I need to do my job, I’d have little need to ask countless questions when I have my assignment (acute care).

When I precept others, I take the time to copy every single page in my binder and place them in page protectors so that I know without a doubt that the newbie has every available resource that I have, including items that are notated with my own little personal shortcuts with every detail spelled out, including ‘click this, then that, and the other’ to get to...whatever. Except for the name, the binders that I give them are identical to the one that I have...for them to update as we receive new information.  The only time I allow direct contact with patients during shadowing is for skills check-offs like EKGs and other minor tasks that are done in our clinics (primary care). I want the orientee to feel comfortable managing a clinic visit by taking notes from the time the patient checks in until the conclusion of the visit.

Some nurses in our clinic throw orientees into sink-or-swim situations. I just don’t believe in doing that with only a couple of days training. However, I will allow them to manage a simple visit so that they can get a feel for accessing/navigating the record while simultaneously gathering information from the patient as to the purpose of the visit. 

Here, the requirement is that nurses possess and have demonstrated substantial critical thinking skills as a condition of employment, as this department does not hire brand new nurses, due of the autonomic nature of the job for the RNs. Even so, when the shadowing experience is short-changed, it definitely shows in everyday performance.