This is in NO way meant to be a put down on student nurses. I was one once too, but I do have a question.
I am an LVN. I work on a post surgical unit. We take care of patients after they are discharge from PACU to their rooms.
We get nursing students regularly. One group from the local community college, one group from the university and one group of LVN students.
Yesterday i had a BSN student assigned to 2 of my patients. After she arrived late for report, I gave her report and asked what semester she was and what could she do. She told me 4th semester and she could do all meds except for IV pushes and starting IV's. Ok. So with that I told her, ok. Let me know if you have any questions. This is my phone ## and I have these rooms, so you can find me here etc. She sayd ok. Then tells me that her instructor doesn't give meds with them, that I have to. I have to watch her give the meds. I was kind of like, well....what? Then I told her that I was an LVN so she had better ask her instructor if that was ok, being that she is a BSN student. I told her that I cannot hang piggy backs with her because it is not in my scope. Then she asked who hangs them for me and I told her the charge, so she went to ask the charge. Our charge nurse didn't want to. I personally didn't think it was my place to watch her administer meds. We are busy with 5 patients.
Turns out, I had to do a WHOLE lot more teaching with her than I thought. For a 4th semester student. She hadn't used our computer system for drug administration before. She didn't glove up before giving heparin (I reminded her) then she asked in front of the patient if I could help her because "i never know where to inject it on a skinny patient" Fine, fine. I know. They are all learning. But these are things her instructor should see, should be there to tell her why or how. I never met the instructor once. In passing she said "OH this is my instructor so and so" and they walked away.
Then at the end of the shift, she handed me a form "Preceptor Evaluation" asked me to fill it in. I told her that I didn't precept her. I didn't feel comfortable filling it out. Especially since I am an LVN. Besides, she did a few other things that I would have liked to have spoken to her instructor about. It was just wierd. Strange. The wierdest student experience I had ever had.
At the end of the shift she asked me if she SHOULD report off to me because "you already know the patients" Oh dear. Oh dear. Still....I never saw this instructor. never.
The thing with the computer is kind of understandable since they don't teach it in a lot of schools (at least, not mine) because there's so many different computer programs out there. In all of my clinicals I've never encountered the same program twice. Still, a PYXIS is a PYXIS...
But late to report, no gloves, wonders if she "should" report to you...if I did that clinical, my CI would have my head on a platter! Actually, I probably would not have gotten past "late for report" because if I were late for clinical without a pretty darn good reason, my CI would tell me to go home.
And as far as the CI's lack of involvement goes...well maybe she felt comfortable letting the student function more independently, but the CI certainly should have told you about this BEFORE the shift started, and also should have told you about having to watch her pass meds. I'd contact her and express your concerns.
I am a second year nursing student and I absolutely HATE putting my nurse in the position you were put in. I know that the nurses on the unit have 4-5 patients, therefore they do not have time to stand there and supervise my clinical experience.
My clinical instructor has 10 students, and we each have 2 patients. I understand that she cannot be there with us the entire time, so I cringe whenever she says "have your nurse do XYZ with you." My nurse is not getting paid extra to teach and watch me give meds. He/she already has enough to do! Granted, I have had saints for nurses that have gone out of their way to help me, but I still feel guilty because I know how busy they are. This is my biggest gripe about clinicals.
It sounds like an adjunct professor... someone they hire to help watch the students during clinicals. (Not to knock adjunct professors at all... it was just my experience that they weren't as on top of rules like our other professors. You may happen to be a great adjunct but from my experience they aren't all great.) Either that or their program is horrible. Our professors had to be in the room with us when we gave meds. We checked our meds three times before we gave them. By law we are under our preceptor's license when we are in the hospital. If we screw up it is on them. All of our instructors watched us like a hawk. That student nurse would have never been allowed to pass meds in our program if she was that far along and still didn't know where to give injections. Our skills were signed off on in lab before we went to clinical. If we didn't pass that skill we didn't perform it in the hospital.
As far as you not being asked if you want a student nurse to help you out, if it is a teaching place you may not have a choice. If you want more guidelines for the student nurses on your floor you should talk to your head nurse and make sure the head nurse talks to the instructor when she/he brings the students back on your floor.
And thanks for being patient with the student nurse.
I am a new grad RN & in ALL of my clinicals we were NEVER allowed to give meds or perform a procedure w/o our instructor present, unless she was very confident w/ us & would give us the 'o.k.' for doing something alone for that one time.
The situation you described is very scary for the patients. I would try to let someone in authority know that the instructor is not doing her job. Sheesh! That's what she's being paid for!
It sounds like an adjunct professor... someone they hire to help watch the students during clinicals. (Not to knock adjunct professors at all... it was just my experience that they weren't as on top of rules like our other professors. You may happen to be a great adjunct but from my experience they aren't all great.) Either that or their program is horrible. Our professors had to be in the room with us when we gave meds. We checked our meds three times before we gave them. By law we are under our preceptor's license when we are in the hospital. If we screw up it is on them. All of our instructors watched us like a hawk. That student nurse would have never been allowed to pass meds in our program if she was that far along and still didn't know where to give injections. Our skills were signed off on in lab before we went to clinical. If we didn't pass that skill we didn't perform it in the hospital.
As far as you not being asked if you want a student nurse to help you out, if it is a teaching place you may not have a choice. If you want more guidelines for the student nurses on your floor you should talk to your head nurse and make sure the head nurse talks to the instructor when she/he brings the students back on your floor.
And thanks for being patient with the student nurse.
Let me set this straight....I NEVER mind when I have student nurses assigned to my patients. It happens quite often and actually we love it. What I had a problem with was that the student told me that I was to monitor her med administration and the instructor being no where in sight. There were only 2 student nurses from this program on my floor. I have no clue how many others were on other floors in the hospital.
When I was a student nurse, my instructors monitored me until they felt I was proficient enough to pass meds on my own. They made appointments with us and some days some students didn't get to pass meds, especially in 1st level. Still, they never depended on the floor nurse to watch us or sign off on us. That was only for preceptorships. Which this clearly was not.
I think that since this is a RN student she needs to work with an actual RN...no offense to you at all; but if she is going to be doing things that are out of your scope of practice, than she needs some one to be present who has those skills in her/his scope of practice.
I think that since this is a RN student she needs to work with an actual RN...no offense to you at all; but if she is going to be doing things that are out of your scope of practice, than she needs some one to be present who has those skills in her/his scope of practice.
That is why they have instructors. I have worked with many an RN student, but have never monitored med administration. I am also a Licensed Nurse.
I thought it was a general guideline that nursing instructors had to witness med passes, injections, etc., for nursing students, and not "hand" it off to the nurses working at the hospital or nursing home to supervise nursing students. I know that I (I'm an LPN student) was told by my instructors that I and my classmates are not allowed to pass any type of med without an instructor present, even if a staff nurse offers the meds to us.
Although my clinical experience also left something to be desired, I agree that something was very wrong with the organization of this program your unit hosted for clinical experience.
I have heard of other programs insisting staff nurses allow students to shadow and work under them, (opposed to the CI), though I can't say I agree with that nor experienced it myself. In my program, we are taught skills in lab, tested off on them and then are tested off again 'live' in clinical. If any skill is then found lacking on the floor, we will receive a clinical fail for the day and a note in our evaluation.
We have the same routine every semester: receive patient assignment, find primary nurse and wait for convenient moment to receive report, then off to meet patient, do initial assessment, take vitals, etc. before reviewing chart and getting ready to administer meds. We are allowed to pass meds independently after receiving report and reviewing the chart, (though we do have to be ready to answer questions about orders and meds.) We can ask the CI for help, (if we can find her), if we need support, but are advised to only consult the primary nurse if something is urgent. At the nurses' station, a chart is posted each week with our names, patient assignments, and the list of skills we are allowed to perform independently.
Regarding our nurses, staff nurses are asked prior to our arrival who would be willing to host students for the evening. Our patient assignments are made with this, patient consent and patient acuity in consideration. We are required to give report before signing off the floor and our CI rounds to talk to patients (and nurses) about our performance individually while we are getting ready for post clinical review.
Though you were obviously very gracious with this student, (and fellow students thank you!), the experience isn't reflective of an organized, responsible or respectful clinical experience, IMO. Perhaps sharing your concerns with the charge about this particular program and the lack of CI supervision can straighten some things out? In my clinicals first semester, the nurse manager had a brief, but stern, meeting with us to lay out the rules and chain of command on the floor...
believe me that it was a CTJ moment for people who didn't understand the reality of being guests in another's house.
Am I mistaken.. I understood the instructor is responsible for that student during clinical rotation, did the hospital sign a contract with the schools saying the nurses on the floor would be?
The OP's hospital and unit management should clarify the roles of the instructor and the staff. That way, everyone has the same set of expectations.
It is not the job of the school to tell the staff nurses what their role is. Nor is it the job of the staff to tell the school what the faculty's role is. What is proper is that representatives from the school and from the hospital meet together and negotiate the roles and assign responsibility for the supervising the students. Once that has been agreed upon between the 2 legal entities ... then each entity (school and hospital) can communicate the roles and responsibilities to their respective employees.
In some places, it is customary for the staff to supervise the students on a regular basis. In other places, staff does very little supervising. Both systems are OK. However, all parties need to be working with the same expectations that are agreed upon in advance.
The thing with the computer is kind of understandable since they don't teach it in a lot of schools (at least, not mine) because there's so many different computer programs out there. In all of my clinicals I've never encountered the same program twice. Still, a PYXIS is a PYXIS...
But late to report, no gloves, wonders if she "should" report to you...if I did that clinical, my CI would have my head on a platter! Actually, I probably would not have gotten past "late for report" because if I were late for clinical without a pretty darn good reason, my CI would tell me to go home.
And as far as the CI's lack of involvement goes...well maybe she felt comfortable letting the student function more independently, but the CI certainly should have told you about this BEFORE the shift started, and also should have told you about having to watch her pass meds. I'd contact her and express your concerns.
My biggest concern with this student would be the comment she made about not knowing where to inject in skinny person,that was totally inappropriate as well as the fact that when reporting off she assumed that the nurse doesn't need the latest assessment data since she knows her patients already.
Being late for report (who hasnt done that,life happens),not putting on gloves (who can seriously say that they never forgot to put on the gloves (I admit I'm guilty) however this lack of sensitivity is what worry me about this nurse the most or maybe lack of caring?
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Meriwhen, ASN, BSN, MSN, RN
4 Articles; 7,907 Posts
The thing with the computer is kind of understandable since they don't teach it in a lot of schools (at least, not mine) because there's so many different computer programs out there. In all of my clinicals I've never encountered the same program twice. Still, a PYXIS is a PYXIS...
But late to report, no gloves, wonders if she "should" report to you...if I did that clinical, my CI would have my head on a platter! Actually, I probably would not have gotten past "late for report" because if I were late for clinical without a pretty darn good reason, my CI would tell me to go home.
And as far as the CI's lack of involvement goes...well maybe she felt comfortable letting the student function more independently, but the CI certainly should have told you about this BEFORE the shift started, and also should have told you about having to watch her pass meds. I'd contact her and express your concerns.