What do you want to tell Nursing Students?

[jessiern]

Our latest group of students passing through prompts this question. Here are a few of mine:

1. If the nurses have no where to sit and chart, and 5 of you are sitting gossiping-GET YOUR TAIL UP!

2. If you are capable of doing it, like passing trays and answering call light, then- DO IT! Don't reply it isn't your patient. You aren't my student either, but when you ask me a question I don't make that my response, do I? Help me out, and I'll be better able to help you.

3. At your level, in and out the patients room in 3 minutes is probably not a good assessment. Especially when you tell me that the patient has a reg heart rate, and his admitting diagnosis is new onset A-Fib.

4. Reading a Stephen King book in the nurses station is a bad idea, and you look like you don't care. As does playing solitare on the computer in OUR breakroom.

5. If you have had a patient for two days, and he is your only patient, you should be able to tell me the diagnosis. You should also know a fair amount about his medications. At least read your drug guide before coming to clinicals.

I could go on and on. This new group we have takes the lazy/stupid cake!

BTW - I love having students that are motivated and are truely there to learn.

[futurecnm]

One thing I always do at the start of the shift is to tell my nurse that she can let me know if there is anything she needs help with. I also tell some of the other nurses they can use me for things I'm allowed to do. Some nurses get really annoyed by students and some are great. I think as students we just have to get as much out of clinical as we possibly can!

[Wendy_RN]

just remember that you were a student and didn't roll out of bed one day and suddenly were a nurse. as a first year student, we have been limited with what we are allowed to do....and in my situation we were very intimidated by the nurses and aides on the last units we were on. as stated in another post, i remember what it was like to be a student. yes, some nurses can be intimidating. in most cases, i don't think it is personal. as a student you don't understand that the nurse may be stressed because the floor is understaffed and having students is actually an added stress at times.

most of the time the nurses do not speak to us, treat us as if we are not welcome, and definitely don't go out of their way to want to teach or show us anything. i am sorry you have experienced this.

i'm not a slacker, but i'm not paid to be an aide.....especially when the aides who are supposed to be on duty are sitting at the desk ordering stuff off the internet. i take care of my patients, provide excellent care within what i have been trained and authorized to do by my school & instructor, and i don't stand around with my hands in my pockets.....

the "i'm not paid to be an aide" comment is more than a little inappropriate. you are a student. you are there to learn. as a nurse you will be responsible for whatever goes on with your patient. that includes whatever the aide is supposed to do. a nurse is not above doing anything the aide does. i am an rn. i am paid the salary of an rn. i also do whatever i need to for my patients, whether that be something that falls within my scope of practice or something i think an aide should have done. it is all part of the job!

(my comments are in red)

[linzz]

Here's a few things to add to the many great points already posted:

1. Try to get there and just listen to report without interupting, it is great experience learning how to give report.

2. Look up any additional dx. you find your patient has, many of them have lots of things wrong with them.

3. Talk to your patient as

much as they will allow you as this is part of your assesment and don't forget to roll them over, lift legs up and yes change briefs if needed as this is a skill you will need at some time esp. with elderly patients who tend to develop pressure ulcers.

There is nothing wrong with helping one of the nurses do even the most simple tasks like moving someone up in bed, who knows the nurse might later take the time to teach you something.

[luvmy3kids]

the "i'm not paid to be an aide" comment is more than a little inappropriate. you are a student. you are there to learn. as a nurse you will be responsible for whatever goes on with your patient. that includes whatever the aide is supposed to do. a nurse is not above doing anything the aide does. i am an rn. i am paid the salary of an rn. i also do whatever i need to for my patients, whether that be something that falls within my scope of practice or something i think an aide should have done. it is all part of the job!

(my comments are in red)

i think you might of missunderstood what she meant by that comment. i'm guessing she is saying that she wants to learn what an rn does, not just the duties of an aide.

while i'm sure she understands that nurses do all of the tasks that an aide does + the work of an rn, she probably feels that she is just doing the work of an aide without learning the role of the rn in addition to. does that make sense??

of course, i'm just speculating... but i'm thinking that was what was meant by the comment...

[GeminiTwinRN, BSN]

I'm not a slacker, but I'm not paid to be an aide.....quote]

That attitude will get you exactly what you're complaining about. You say the nurses don't offer to teach you things, don't roll out the welcome mat for you and show you everything they're doing. (paraphrasing :) ) Trust me, the attitude in that one statement is enough to turn me off of teaching you anything too. Because, if an aide is having a rough time with a patient and you're standing there with me, WE are going in the room to assist with whatever catastrophe has happened. And if you try to avoid the situation because you're not an aide or not paid to be one, that will be the last time I agree to have you as a student on our floor.

I'm not "paid to be an aide" either. But guess what? I can and do do all that an aide does. I am competent to do any and all tasks that they do. In fact, I am their superior and I am also resposible for anything that they get done or don't get done. If something they were supposed to do doesn't get done (like an accucheck, or vitals, or a BATH), guess who the clinical manager is going to come to? Me. Because ultimately, it's MY job to make sure that the aide does the tasks or that I do them. We can and do work with limited staff some days, and that requires us to do total patient care, including ohmygosh baths and bedpans and assist to bathroom and linen changes. And sometimes, the techs are on break and those tasks have to be done then too. Just because you see a tech on a computer somewhere, don't assume they are just sitting around. Sometimes they are, but sometimes they are legitimately on break.

Sorry, but that really got to me. I was a student, for several years. I didn't jump up one day and waltz out the door as an RN. But along the way, I did everything and anything I could to get in as many good graces as I could. I did as many thankless chores as needed to be done, and sometimes I got thanked for them. Did I like doing the messy stuff even though our instructors said that it wasn't necessary for us to do that stuff? No. Did I do it anyway? You bet.

Good luck.

[nurturer]

i so totally understand where you are coming from. when i was a student, we worked our bottoms off to know our stuff- i would very very rarely take a break and if a nurse needed a chair i jumped out of my seat 1st! maybe i was wrong in not taking a break but i lived and i knew i needed the experience. how did i make it w/out food? energy/meal bars. the slimfast ones really curbed my massive hunger. yes, i did this with 5 kids and a hubby at home sometime with very little sleep because i had to be a mom and wife and still know my meds and give good patient care.

i have 3 kids....i'm glad to know it can be done....i'm just starting with this whole thing....prerquisites.

i'm certainly ready to work my tail off.

on the other hand, i work with a seasoned nurse who is just a total witch to students and will do anything to be a witch to the instructor. granted - the instructor isn't the brightest bulb in the socket but still. i think her (the nurses) behavior is very unprofessional.

how can this be??? don't you have to be fairly intelligent to be a nurse? this kind of witchy nurse is my biggest concern. i'm actually more worried about witchy nurses than horrible patients. i expect patients to be irritiable....they're in the hospital!!! but if my co-workers are unbearable....that's another story.

[jjjoy, LPN]

In regard to "not being paid to be an aide"... I agree that that's not a good attitude.

However, it is true that students have limited time on the floor and don't want to get so caught up in taking care of aide duties (for which there is paid personnel to take care of) that they miss out on opportunities to learn and practice other nursing skills. Paradoxically, it is MUCH easier for the student to find and take care of or to be asked to help with aide work than to find or be asked to help with other nursing care. The nurses are generally too busy to take the time to show the students what they're doing, explain it and answer questions. How many nurses would have the time to spend discussing with a student how they assessed a particular patient in less than a minute to determine the problem and change their plan of action? More likely, the nurse will have other patients demanding attention and often isn't consciously aware of the process they use to quickly assess and decide on an action plan. And with all of those competing demands, a student's questions - "why didn't you take this other line of action? what about that other symptom? is that normal?" - can quickly become cumbersome and discouraged. There are also many nursing responsibilities students usually can't help with, such as taking off new orders or the like.

So what happens to some students is that they try to avoid getting sucked into an endless cycle of assisting with aide work and end up standing around the nurses station looking and feeling useless since they can't as easily assist with non-aide work

[GeminiTwinRN, BSN]

I don't think I ever answered the original poster's question.

I would like to tell nursing students (especially the ones who are precepting before graduation) to please come in before report is given. I do not like to get report on 4 patients and then have to turn around and give report to a student who couldn't be bothered to be there before report was given.

Also, to please give me the same courtesy that they would their instructor if the instructor is not going to be present for the shift. That means, if you are going somewhere off the floor or on break, let me know. I don't want to have to be looking for you if you aren't there because something interesting is going to happen in another room and you might like to watch.

If you are there with an instructor and there is a group of you, please let us know what you will be doing and what your goals are individually. If you will be administering medications, I need to know that. If you need me to get them out of the pyxis for you, I need to know. If you are going to be waiting around for a long time for your one instructor to be able to get and give 0900 meds with 6 other students, it might be prudent for you and me to go get the meds and give them together so they aren't late. If your instructor won't allow that, then I need to know that too, so that I can give the patient's meds on time.

If you are going to be doing assessments and then charting them as well with your instructor, I need to know that too. I'd like to know if you are responsible for more than one patient but will only be charting on one, I want to know that before noon. I want to know those things when you get there and make those decisions, not at a time when I now have to rush and put in 3 assessments on the computer.

If you are with me for the day and you have not yet hung a piggyback or started an iv, or hung tube feeds, or given meds through a peg tube, or dopplered pulses, please tell me those things when we are finished getting report. That way, I can show you or your instructor can be present for them. You'll learn more that way. And if you're there for report, you'll know whether or not those things are going to come up, except for maybe starting an iv.

I know there's more, but that's enough for now.

[jjjoy, LPN]

Here's an idea... if your unit is having trouble with nursing students, maybe you could create a handout to give to nursing students who will be having clinical on your floor. For example, you could note that it's not okay for students to sit at the nurse's station if they aren't busy. Every unit and ever hospital is different, and each clinical instructor is different. So letting the students explicitly know how YOUR unit would like students to act and interact could be a big relief to all involved.

I know I hated missing report but some instructors had us come later and we were told to wait for the instructor. Some facilities specifically asked us NOT to be present for report (usually due to lack of space). I had also mistakenly assumed at the beginning that the instructor was familiar with the unit and that the staff knew how to work with students from our school. So it wasn't obvious to me that I needed to be more communicative with the staff. Plus, the staff always looked so busy that I was afraid of causing them even more strife by interrupting them (and you're always interrupting a nurse because they are always busy).

With a handout from the unit, I could've known if it was okay to listen to report if my instructor weren't there or where I could and couldn't sit, so I wouldn't have to find out by an evil glare and snipey comment and other useful suggestions for getting the most of the experience on the floor while causing the least number of problems.

[Wendy_RN]

I just want to say that none of the responses from nurses are intended to offend any student. We are simply answering the question that has been asked. The answers are from our experiences working with students. We all remember what it was like to be a student. As a student you do not understand the real world of nursing until you have your license and are working as a nurse. It is totally different than in school. I heard that time and time again when I was a student. Believe me, reality hits when you cross the line from student to nurse. Students are on the floor for a short time and do not have the responsibilities and liabilities a nurse has. You may be taking care of my patient while you are there, but that is still my patient. I am sorry but I worked too hard for my license and I have to make sure that when I sign the chart off at the end of my shift that I KNOW my job was done. I will be the one called in to court and my license on the line if all is not well.

As far as helping out the assistants, what is the harm? That is nursing. In some places there are no assistants and the nurse does everything. When you help to bathe a patient take the time to assess them. That is one of the best opportunities you have for an assessment to begin with. You can do a thorough skin assessment. When you clean an incontinent patient check for breakdown. Your experiences are what you make of them. There is so much more to nursing that med passes, IVs, and Foleys. Anyone can learn the skills, it is the critical thinking that makes a nurse. So instead of complaining about nurses not giving you anything to do, use those critical thinking skills and think about what you can do for the patient.:nuke:

[jjjoy, LPN]

As far as helping out the assistants, what is the harm? That is nursing.... There is so much more to nursing that med passes, IVs, and Foleys. Anyone can learn the skills, it is the critical thinking that makes a nurse. So instead of complaining about nurses not giving you anything to do, use those critical thinking skills and think about what you can do for the patient.:nuke:

The "harm" is that the students graduate with competency as an assistant but not as a nurse. Critical thinking skills alone can only take you so far. Most lawyers should have quite refined critical thinking skills but they'd still be at a total loss in regard to how to take care of a patient.

So while doing aide work is important and not a waste of time, that experience isn't going to do more than make them great assistants. The student can use their critical thinking skills in carrying out aide work, but when it comes to higher level nursing care, without a nurse there to get feedback from, any critical thinking that they do in regard to higher level nursing care may or may not be practically effective - critical thinking needs to be applied for it to be developed and honed.

[pagandeva2000, LPN]

Do a treasure hunt when you first go to your unit to find out where the medication room is, the charts, supplies, fire exits, and all of the good stuff so that you are more familiar when you return back.