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.
I used to love to see the students coming on the floor. Now, I hate it.
So my first request is PLEASE don't tell me that you will be doing "everything" for patient 1 and 2 and then you don't do "anything". Case in point.....nursing student left at 1230 to go to lunch and never came back. Didn't give me report either. Patient had been sitting up in a chair, but when I went to check on how things were going (and my student was gone) physical therapy was putting him back to bed. I checked the chart and there was an order for patient to be OOB to chair for all meals and the DR wanted a blood pressure while in the chair. It had not been done. Neither was the assessment charted. This patient also did not get a bath. Since the student said she would do "everything" my PCT and I assumed that also meant a bath and linen change. So, at 1300, my PCT and I are doing a bath and linen change and I'm having to call the DR and explain why his order didn't get done.
Thursday, again......I will do "everything". At 10 minutes to 1000, he tells me that he will not be able to do meds after all, because he has to have his instructor with him and she will not be available. So, my 0800 and 0900 meds were late and that looks bad on me. I can't go into the COW and write-----"oh, sorry, the student nurse was supposed to do these meds and couldn't, so they are late" Then he is leaving and I asked him if he did an assessment and did any documentation. Then he tells me "oh, we don't do that". I wanted to choke him.
I have numerous other examples, but you get the idea. Now when a student comes to me, my heart sinks. I want to give students a chance. I was once a student, but I am working hard, rarely get a break, take a 15 min lunch and many a night walk out an hour after my shift ended because I didn't get everything done. I don't need more work. I can't spend the time to teach you what your instuctor is not there to teach you or help you with. I only care that what has to be done for my patients gets done and gets done right and if you can help me with that---great. If you can't, then you are just in the way.
So------grrrrrrrrr-----------be very clear and up front with your nurse as to what you are going to do and what you can't do. If you tell her "everything", know that she has one concept of "everything" and it probably doesn't match yours. If you say you will do something, do it. If there are orders on the chart, at least have her go through those orders with you and determine if you can do any of it.
Finally, I want to let you know that most of you have had clinical experiences that do not in any way prepare you for the real world you are about to come into contact with. You get out of school and your preceptor has 6 weeks to teach you how to be a floor nurse-----because most of you are not learning it in clinicals. I'm not saying this because I think it is your fault. I know that there are all these rules that you have to abide by. However, enjoy school, because soon you will have a very rude awakening.
One last thing, students aren't getting paid for any of their work. It's unreasonable to expect nursing students to run and do everything all day, 7 or 8 hours a day. Not gonna happen. Trust me, you remember.
:twocents:
No, I don't remember that. I graduated from John Peter Smith Hospital School of Nursing in Fort Worth, TX in 1994 with 975 hours of classroom and 1500 hours of clinicals for the ONE year LVN program. We didn't get paid for that either and were lucky with 435 applicants for 30 seats to be there. One thing I do know, is that when you graduate, you will run and do everything all day and 7-8 hours will be something you only dreamed about. Things are very different now than when I went to school, and that is probably why at the end of the 6 week orientation program, new grads usually quit, stating that they are unable to handle the work load.
No, I don't remember that. I graduated from John Peter Smith Hospital School of Nursing in Fort Worth, TX in 1994 with 975 hours of classroom and 1500 hours of clinicals for the ONE year LVN program. We didn't get paid for that either and were lucky with 435 applicants for 30 seats to be there. One thing I do know, is that when you graduate, you will run and do everything all day and 7-8 hours will be something you only dreamed about. Things are very different now than when I went to school, and that is probably why at the end of the 6 week orientation program, new grads usually quit, stating that they are unable to handle the work load.
Yikes! Is that true? New grads usually quit because of the work load? If this is the case, why isn't anyone looking into why this happens and to address it somehow? It seems like a big waste.
I have heard that new nurses know surprisingly very little when they start working. Why? Is it that they are not trained well enough? Is it that there is more expected of them than in the past? Or is it that today's nurses don't really care enough about their job?
Yikes! Is that true? New grads usually quit because of the work load? If this is the case, why isn't anyone looking into why this happens and to address it somehow? It seems like a big waste.
I have heard that new nurses know surprisingly very little when they start working. Why? Is it that they are not trained well enough? Is it that there is more expected of them than in the past? Or is it that today's nurses don't really care enough about their job?
There are so many reasons why and no answers to address the problems. First, look at the clinical hours I was required to fulfill. 1500. I think the average now is 350-500. Hospitals stopped having nursing programs and it shows. Our program was at the hospital, so we were able to do more. Once we were checked off on a skill, we did not have to have an instructor with us. Our classroom was in the hospital every day, so there were lots of opportunities to see and do things that programs in colleges aren't able to provide students now. We were required to be able to take care of at least 5 patients by the time we graduated. The students I had this last week only were taking 2 patients and they are graduating in June. When we did clinicals in school, we hit the floor at 0600 and left at 1700. Students now are only on the floor for about 6 hours.
Now fast forward to a job. Hospitals that are not in California where they have mandated patient/nurse ratios do the best they can with the staffing they have. I now work on a step-down Neuro floor where we just have RN's and we do total care as our nursing model. Other floors in our hospital do team nursing. When our floor did team nursing, there were lots of shifts that we had only 2 RN's for 30 patients and 2-3 LPN's to give meds and 2-3 PCTs. Night shift is staffed with even less------after all, management thinks these patients sleep at night. We are supposed to have no more than 5 patients each and we are supposed to do everything. We do have 2-3 PCTs on the floor to pass trays and help with baths. However, this last weekend, we were short staffed and we had 6 patients each and we had to do our own admits and discharges. The other hospital in town does total care and sometimes those nurses have up to 8 patients each for total care. So, if you are graduating and all you have done is care for 2 patients (minimally) and now you have 6 weeks to learn to care for 6 (or 15 if you are doing team nursing) plus learn all the skills that you did not learn to do in school, you are overwhelmed. Add having to deal with patient families and answer their questions, deal with orders and doctors, assisting with proceedures, getting patients to surgical proceedures and making sure you did all the preop orders correctly, learning our computer system and often having to enter your own orders in the computer--------most of our new grads once on their own quit. The seasoned nurses that know the grass is not any different someplace else stay. Nurses from nursing homes also think it is easier at the hospital. Many of them report having to try and care for 40-50 patients by themselves.
I love having students! If I could tell them anything, I'd say choose my patients when choosing your patient assignment.
I like to have the company and the help during the day. I love to talk about nursing, and I'll talk my students' ears off during the day. Probably they don't get the chance to say much because I talk so much, so I'd probably also tell them to interrupt if they have questions I'm not answering.
I'd also tell them that when they come to an ICU rotation, don't expect it to be like the floor rotation.
I'd also like to tell students that a pediatric rotation - even a pedi ICU rotation - is totally different than an adult rotation of any kind. You really need to be prepared to deal with kids and talk to them on their level. Don't ignore the kids when you go in the room and talk only to me. The kid is your patient, not me. The kid needs your attention, not me. I get plenty of attention. I can answer all your questions when we leave the room. If you're uncomfortable talking to kids or don't know how, then tell me before you go in, so I can help you with that.
I'm a student (done in May) and agree with all of those except answering call lights. We are not allowed to answer call lights unless it is our patient. We are only allowed to answer lights for our own patients. So, that might be a policy they have to follow. I believe we can bring in food trays, but even that is questionable (if we don't know the pt diet and the food service sends up the wrong tray we would have no idea. I know I've had pt that are NPO that receive a tray and if a student just brought it in the pt may eat. I've also had pt that are on liquid diets receive trays with solid/regular foods). Otherwise, I can't believe some of the things the students on your unit do!! If we were caught reading or playing solitaire we would be written up and sent home. Where is their instructor??
Playing solitaire and reading books on the floor?! Seriously, where IS their instructor?!? What student seriously has time for that?! I am a student as well, I can barely even eat or use the restroom when I'm on the floor. And when I do have some extra time I ask the charge if there's anything I can help them with. They always find something for me to do. So seriously, if you have that much time, that's one option.
Also, I have passed trays/gotten water for a pt that was not mine before. All you have to do is call the nurse and ask them what the pt's diet is. I'm sure they dont mind having an extra, helping hand. But, this is if your floor/hospital has walk-talkies or cell phones. Otherwise, it may be more trouble to have to go search for that nurse in person.
1. Be very clear with your nurse what you can and cannot do. This will save frustration later.
2. Refer to #1 - if your nurse knows what you are permitted to do, more opportunities for procedures will come your way.
3. Clear up early in the shift what charting you will and will not be doing, whether or not the nurse would like you do to write a "dummy" before you chart in the legal record, etc.
4. Don't gossip about your nurse with classmates. This will come back to bite you in the butt.
5. If you have extra time, don't sit around. Any / all nurses would appreciate an extra pair of hands, gofer, etc.
I was a CNA for many years before attending nursing school, therefore, I was ahead of most of my classmates, so when it came time for first semester/year clinicals, I was ahead. When I had done all that we were allowed to do, I simply asked what I could do to help on the floor. The things I did were not fun, nor did they seem relevent, but they truely were. I remember being sent into the dirty closet to clean bedpans, IV poles, etc. Good learning experience! I got more in depth knowlege about MSDS sheets which we all need to know about on the job. I learned more about cleaning up after a person who had communicable diseases-another need to know that doesn't get covered enough in nursing school. I did a lot of running to the lab with specimens for other staff which helped teach me the layout of the hospital as well as taught me about labs. All this seems like it is piddly stuff that you don't need to know, but when you are on your own in an LTC facility as the charge nurse you DO need to know these things! Besides, when you are being graded for your clinicals, it looks good for cooperation, willingness to learn, help others, etc.
There is more than one way to do things and patients are never "textbook" so don't keep saying "but that's not what the book says", or "that not how we learned it in school". Sometimes you learn on the fly!
There is more than one way to do things and patients are never "textbook" so don't keep saying "but that's not what the book says", or "that not how we learned it in school". Sometimes you learn on the fly!
I agree with you and I don't think it's enough to just tell students that "there's more than one way to do things" or "patients are never 'textbook.'" The reason is that many nursing instructors are VERY particular about how to do things. They will be failed if they stray from protocol one iota, even if the variation is totally safe and effective. And hopefully students are also being taught to not just blindly accept whatever others tell them but to understand the rationale behind their actions. So I wouldn't suggest just quickly saying "oh, don't worry, this is okay" to a student and expect the students to just accept variations without further explanation.
I agree with you and I don't think it's enough to just tell students that "there's more than one way to do things" or "patients are never 'textbook.'" The reason is that many nursing instructors are VERY particular about how to do things. They will be failed if they stray from protocol one iota, even if the variation is totally safe and effective. And hopefully students are also being taught to not just blindly accept whatever others tell them but to understand the rationale behind their actions. So I wouldn't suggest just quickly saying "oh, don't worry, this is okay" to a student and expect the students to just accept variations without further explanation.
I agree with you completely! I guess I was thinking more about right after graduation and they are out of "school mode".
:twocents:
Mudwoman
374 Posts
I used to love to see the students coming on the floor. Now, I hate it.
So my first request is PLEASE don't tell me that you will be doing "everything" for patient 1 and 2 and then you don't do "anything". Case in point.....nursing student left at 1230 to go to lunch and never came back. Didn't give me report either. Patient had been sitting up in a chair, but when I went to check on how things were going (and my student was gone) physical therapy was putting him back to bed. I checked the chart and there was an order for patient to be OOB to chair for all meals and the DR wanted a blood pressure while in the chair. It had not been done. Neither was the assessment charted. This patient also did not get a bath. Since the student said she would do "everything" my PCT and I assumed that also meant a bath and linen change. So, at 1300, my PCT and I are doing a bath and linen change and I'm having to call the DR and explain why his order didn't get done.
Thursday, again......I will do "everything". At 10 minutes to 1000, he tells me that he will not be able to do meds after all, because he has to have his instructor with him and she will not be available. So, my 0800 and 0900 meds were late and that looks bad on me. I can't go into the COW and write-----"oh, sorry, the student nurse was supposed to do these meds and couldn't, so they are late" Then he is leaving and I asked him if he did an assessment and did any documentation. Then he tells me "oh, we don't do that". I wanted to choke him.
I have numerous other examples, but you get the idea. Now when a student comes to me, my heart sinks. I want to give students a chance. I was once a student, but I am working hard, rarely get a break, take a 15 min lunch and many a night walk out an hour after my shift ended because I didn't get everything done. I don't need more work. I can't spend the time to teach you what your instuctor is not there to teach you or help you with. I only care that what has to be done for my patients gets done and gets done right and if you can help me with that---great. If you can't, then you are just in the way.
So------grrrrrrrrr-----------be very clear and up front with your nurse as to what you are going to do and what you can't do. If you tell her "everything", know that she has one concept of "everything" and it probably doesn't match yours. If you say you will do something, do it. If there are orders on the chart, at least have her go through those orders with you and determine if you can do any of it.
Finally, I want to let you know that most of you have had clinical experiences that do not in any way prepare you for the real world you are about to come into contact with. You get out of school and your preceptor has 6 weeks to teach you how to be a floor nurse-----because most of you are not learning it in clinicals. I'm not saying this because I think it is your fault. I know that there are all these rules that you have to abide by. However, enjoy school, because soon you will have a very rude awakening.