Which skills allowed during clinicals?

Posted

Hi! I am wondering who establishes the guidelines for the skills that a student is allowed to practice in the hospital? Is it the unit manager and/or charge nurse or is it the preceptor (from the school of nursing)? What do we do if there is a difference between the hospital's policy and the preceptor's policy? How can this conflict be resolved professionally? This is my first clinical. Thank you for your advice.

londonflo

Specializes in oncology. Has 44 years experience.

 

16 minutes ago, aspiringnurse12345 said:

the guidelines for the skills that a student is allowed to practice in the hospital?

In my experience, instructors had to attend a meeting where the hospital resource person told us about any limitations on student practice.

The instructor would learn what students are able to do in that hospital. For example, my students could not do accucheks at one hospital because the machine needed a personal code and that hospital didn't want to put them in the system for the brief rotation we had there. 

For any performance of skills, we were referred to the procedure manual or website. 

But what if the instructor blatantly ignores guidelines given by the nursing manager and charge nurse? What if most students don't care? This is a very difficult position for me to be in. Oral directions were given by hospital personnel to both the preceptor and students and they are being disregarded.

2 hours ago, aspiringnurse12345 said:

But what if the instructor blatantly ignores guidelines given by the nursing manager and charge nurse? What if most students don't care? This is a very difficult position for me to be in. Oral directions were given by hospital personnel to both the preceptor and students and they are being disregarded.

If the instructor and students are ignoring the guidelines established by the facility, and performing interventions not allowed, he or she is running the risk of having not only her or his cohort banned from that facility, but all groups from that program banned.  

londonflo

Specializes in oncology. Has 44 years experience.

3 hours ago, aspiringnurse12345 said:

But what if the instructor blatantly ignores guidelines given by the nursing manager and charge nurse?

What exactly is happening?

So, for instance, the unit manager forbade us students from administering insulin and heparin. Our preceptor praises students for administering insulin and heparin. The charge nurse asked the preceptor to accompany and supervise students passing meds. The preceptor asked us students to get her to supervise only if the nurses we are shadowing don't allow us to pass meds. She has her own rules, basically. Unfortunately, I can't find any of the rules in writing. I know that our preceptor simply wants us to learn as much as possible, but we also have to recognize that we are guests in the hospital and submit to a higher authority. I will probably just keep my head down for our remaining days on the floor, but as a natural rule follower, I'm just resentful of being in this position.

londonflo

Specializes in oncology. Has 44 years experience.

13 hours ago, aspiringnurse12345 said:

The charge nurse asked the preceptor to accompany and supervise students passing meds. The preceptor asked us students to get her to supervise only if the nurses we are shadowing don't allow us to pass meds.

Does the nurse you are shadowing who doesn't allow you to give meds know the preceptor (instructor) IS having you give meds?  This sounds like a safety issue. 

13 hours ago, aspiringnurse12345 said:

So, for instance, the unit manager forbade us students from administering insulin and heparin.

Did you hear this directly from the unit manager?

I agree you are in a tough situation. I have never heard of something like this happening before.

13 hours ago, aspiringnurse12345 said:

I will probably just keep my head down for our remaining days on the floor, but as a natural rule follower, I'm just resentful of being in this position.

Sounds like a good plan.  BTW, is there a reason you use the term preceptor instead of instructor? Does this person have at least an MSN?

So, for instance, the unit manager forbade us students from administering insulin and heparin. Our preceptor praises students for administering insulin and heparin. The charge nurse asked the preceptor to accompany and supervise students passing meds. The preceptor asked us students to get her to supervise only if the nurses we are shadowing don't allow us to pass meds. She has her own rules, basically. Unfortunately, I can't find any of the rules in writing. I know that our preceptor simply wants us to learn as much as possible, but we also have to recognize that we are guests in the hospital and submit to a higher authority. I will probably just keep my head down for our remaining days on the floor, but as a natural rule follower, I'm just resentful of being in this position.

I guess that I use the term preceptor/instructor interchangeably. She is a DNP and a FNP. I know that she has the best of intentions for us to get practice. We were given many directions/prohibitions from the unit manager on the first day, but I really wish they had been in writing.

I would not do anything that you heard the manager say not to do.

On 10/17/2021 at 8:19 PM, aspiringnurse12345 said:

The charge nurse asked the preceptor to accompany and supervise students passing meds. The preceptor asked us students to get her to supervise only if the nurses we are shadowing don't allow us to pass meds.

Then I would do as asked and call your instructor when you need to administer medication. That's exactly the kind of thing your instructor is there for.

You are right to tread carefully. Just be professionally kind, pleasant and assertive when interacting with your instructor related to matters of following the rules (such as medication administration). She is very unwise to be following her own script here. Definitely try to avoid both conflict and rule-breaking during your remaining days.

Leader25, ASN, BSN, RN

Specializes in NICU. Has 38 years experience.

On 10/18/2021 at 11:35 AM, aspiringnurse12345 said:

So, for instance, the unit manager forbade us students from administering insulin and heparin. Our preceptor praises students for administering insulin and heparin. The charge nurse asked the preceptor to accompany and sup

Who is signing for these meds?Big no nos,...It will be found out on chart review and your school will be banned.

Report it to nursing ED. don't do anything the hospital told you Not to do.

PMFB-RN, BSN, RN

Specializes in burn ICU, SICU, ER, Traum Rapid Response. Has 16 years experience.

On 10/17/2021 at 11:28 AM, aspiringnurse12345 said:

Hi! I am wondering who establishes the guidelines for the skills that a student is allowed to practice in the hospital? Is it the unit manager and/or charge nurse or is it the preceptor (from the school of nursing)? What do we do if there is a difference between the hospital's policy and the preceptor's policy? How can this conflict be resolved professionally? This is my first clinical. Thank you for your advice.

In my hospital there is a nurse practice counsel that decides these things. There have different rules depending on what year the students are in (first vs second). They are in the form of hospital policy that anyone can refer to. We allow our second year students to pretty much do everything when properly supervised by a staff RN preceptor or nursing instructor.