I've been in two different hospitals in both my first and second semesters and come up against some ROUGH nurses who would rather do everything themselves than let me touch a thing.
I'm trying to wrap my head around the fact that they are BUSY, they have a TO-DO list, they have patients that NEED meds, help, EVERYTHING. But, I'm here to help. I'm wearing these bright purple scrubs not because I like the color, but because I want to learn, I NEED to learn. I will take them to the bathroom, I will bathe them, I will take their vitals, just PLEASE let me.
When I say 80% of the nurses I've followed have done NOTHING with me I am not exaggerating. Why is this? Last week the nurse I was following wouldn't even let me take vitals, VITALS!! I am in my second semester of nursing school, I think I can handle that.
Anyway, I wanted to know whats up with that! I recognize that they are busy. I also recognize the few nurses that have taken me under their wing and shown me SO MUCH. I'm thankful for that, and grateful.
Specializes in Complex pedi to LTC/SA & now a manager.
One thing I would do (that you can do solo) was dig through patient charts. EMAR, labs, notes, vital sign trends, ect... It was helpful because I learned the facilities charting system and how to access information faster. I also really loved being able to use all of the information I found to put together a clear overall picture of the patient. I still love digging through charts!
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Be very careful with this idea. Digging through random charts, especially in an EMR or accessing areas you are not assigned without express permission from the right personnel can be seen as a HIPAA violation and get you in big trouble. Students have been given clinical failures or worse clinical dismissal for exploring charts of patient they were not assigned. Yes there are educational exceptions to accessing medical records but be certain to do so within the guidelines of not only your clinical program but the facility. A classmate got a verbal warning for reviewing labs of the wrong patient in the EMR. The facility changed it so each morning the charge nurse and clinical instructor had to call IT each day for student access to the charts for our med passes and only relevant areas (read only nursing notes, MAR, VS trends and labs) were visible
I have a story that completely supports what the seasoned nurses are saying. I am about to go into my final semester of nursing school. When I was in second semester on my first med/surg rotation this poor nurse had to deal with something because of me and I will never forget it.
First for a backstory on how clinical works at my school, my school requires clinical instructors to do all teaching at the facilities and over the course of the program they slowly loosen the reigns to let us do more with staff nurses that our assigned patients are assigned to. If the RN we are paired with is willing to let us practice a skill on their patient we have to first ask the CI if they are able to come up and supervise. This frees up the RN for a few. Even though they will still have to come in after and assess whatever we did for their patient's safety. But straight cathing or IV insertion and things that take more time, they are usually appreciative. If the CI can't make it for whatever reason, then it is up to the RN if they want to instruct us through a skill or just do it themselves. I don't get offended or upset if the RN just doesn't have time. From following them around, they have a ton to do. What I do for every clinical is in the first few minutes the first question I am alsways asked is what level I'm at ad what I can do. I give a quick run down of skills I'v already practiced on patients and what else I'm aloud to do. Then I follow quietly as the nurses assess. When we get to "my" patients, I just follow her in the assessment. SHe checks lungs and moves on, so I check lungs. I just copy what she does so the patient doesn't have to get assessed twice unecessarily, and then I'm freed up to watch the nurse some more. I then answer all call lights in the area I can throughout the day. I help with things I'm aloud to do solo (read basic care CNA stuff). I do this happily because my hope is that saving the staff time while I toilet a patient or clean a soiled patient or feed them lunch or whatever, will free them up to let me do things or ask questions. A lot of times it works and the RN will review things with me. I have even been tracked down by another nurse to start and IV because I was helpful on the floor. But other times, the RNs were so busy that it didn't help enough and they still had too much and couldn't really review anything with me. And that's ok. It's just the nature of the beast. They have a job to do whether I'm there or not, so I would do my best to keep out of their way and soak up whatever I could from just following them and answering call lights.
Anyway, to the point of this post.
That time a nurse tracked me down to offer an IV insertion that I spoke of. I was so thankful. My instructor was free so the nurse gathered the supplies for me and my CI and I went into the room. I had already asked the patient if she was ok with a student and CI could start her IV before the instructor got there. She was completely ok with it. Alert and oriented. Was even joking around with the CI while I set up and found a good vein. Patient was well aware that I was a student, and i told her everything I was doing as I was doing it. It came time for the stick. As I inserted the needle, the vein rolled. I had my thumb stabilizing the vein, but away it went anyway. I attempted to "fish" for the vein for a few seconds and got flashback. Thinking I had got the vein I advanced the catheter and attached the j loop. I drew back with the syringe and got return, but as I flushed the vein ruptured. Right as I was removing the IV, the patient's daughter called her. Patient was telling the daughter what was going on, and I could here the daughter start to yell and get upset on the line. I bandaged the patient and stepped back because I knew something was wrong. The patient then hands the phone to my instructor and the daughter proceeds to curse out my instructor about how we were using her mother as a guinea pig and never had her consent and on and on. My instructor then started the second IV (successfully thankfully) and we went and told that patients nurse. The daughter then called the unit and yelled at the nurse over the phone. Then the daughter came into the hospital made a scene and saif that it was abuse to let students practice on patients (because I guess she didnt understand that all nurses start as students). It was bad. This nurse who was so kind as to find an eager student to let start and IV on her patient now had to spend about 2 hours out of her day on the phone and in person dealing with this patients daughter and charting on it, then filling out an incident report because the daughter threatened to sue, and then trade that patient with another nurse so they had to give report to each other. All because I was "helping." I am sure that the majority of the time, allowing a student to do something goes smoothly albeit slowly. But those few times that it blows up in the nurses face has to suck bad. The nurses know there is potential for something to take forever or have a negative outcome, and for them to let us practice, means they are willing to take the risk of that happening. This is why, if I'm not offered anything "cool" at clinical I am not upset. i still learned by asking questions during down time and watching the nurse work and manage her day. But when I am offered to do something, I jump at it and do my best to do it right.
I have a story that completely supports what the seasoned nurses are saying. I am about to go into my final semester of nursing school. When I was in second semester on my first med/surg rotation this poor nurse had to deal with something because of me and I will never forget it.
First for a backstory on how clinical works at my school, my school requires clinical instructors to do all teaching at the facilities and over the course of the program they slowly loosen the reigns to let us do more with staff nurses that our assigned patients are assigned to. If the RN we are paired with is willing to let us practice a skill on their patient we have to first ask the CI if they are able to come up and supervise. This frees up the RN for a few. Even though they will still have to come in after and assess whatever we did for their patient's safety. But straight cathing or IV insertion and things that take more time, they are usually appreciative. If the CI can't make it for whatever reason, then it is up to the RN if they want to instruct us through a skill or just do it themselves. I don't get offended or upset if the RN just doesn't have time. From following them around, they have a ton to do. What I do for every clinical is in the first few minutes the first question I am alsways asked is what level I'm at ad what I can do. I give a quick run down of skills I'v already practiced on patients and what else I'm aloud to do. Then I follow quietly as the nurses assess. When we get to "my" patients, I just follow her in the assessment. SHe checks lungs and moves on, so I check lungs. I just copy what she does so the patient doesn't have to get assessed twice unecessarily, and then I'm freed up to watch the nurse some more. I then answer all call lights in the area I can throughout the day. I help with things I'm aloud to do solo (read basic care CNA stuff). I do this happily because my hope is that saving the staff time while I toilet a patient or clean a soiled patient or feed them lunch or whatever, will free them up to let me do things or ask questions. A lot of times it works and the RN will review things with me. I have even been tracked down by another nurse to start and IV because I was helpful on the floor. But other times, the RNs were so busy that it didn't help enough and they still had too much and couldn't really review anything with me. And that's ok. It's just the nature of the beast. They have a job to do whether I'm there or not, so I would do my best to keep out of their way and soak up whatever I could from just following them and answering call lights.
Anyway, to the point of this post.
That time a nurse tracked me down to offer an IV insertion that I spoke of. I was so thankful. My instructor was free so the nurse gathered the supplies for me and my CI and I went into the room. I had already asked the patient if she was ok with a student and CI could start her IV before the instructor got there. She was completely ok with it. Alert and oriented. Was even joking around with the CI while I set up and found a good vein. Patient was well aware that I was a student, and i told her everything I was doing as I was doing it. It came time for the stick. As I inserted the needle, the vein rolled. I had my thumb stabilizing the vein, but away it went anyway. I attempted to "fish" for the vein for a few seconds and got flashback. Thinking I had got the vein I advanced the catheter and attached the j loop. I drew back with the syringe and got return, but as I flushed the vein ruptured. Right as I was removing the IV, the patient's daughter called her. Patient was telling the daughter what was going on, and I could here the daughter start to yell and get upset on the line. I bandaged the patient and stepped back because I knew something was wrong. The patient then hands the phone to my instructor and the daughter proceeds to curse out my instructor about how we were using her mother as a guinea pig and never had her consent and on and on. My instructor then started the second IV (successfully thankfully) and we went and told that patients nurse. The daughter then called the unit and yelled at the nurse over the phone. Then the daughter came into the hospital made a scene and saif that it was abuse to let students practice on patients (because I guess she didnt understand that all nurses start as students). It was bad. This nurse who was so kind as to find an eager student to let start and IV on her patient now had to spend about 2 hours out of her day on the phone and in person dealing with this patients daughter and charting on it, then filling out an incident report because the daughter threatened to sue, and then trade that patient with another nurse so they had to give report to each other. All because I was "helping." I am sure that the majority of the time, allowing a student to do something goes smoothly albeit slowly. But those few times that it blows up in the nurses face has to suck bad. The nurses know there is potential for something to take forever or have a negative outcome, and for them to let us practice, means they are willing to take the risk of that happening. This is why, if I'm not offered anything "cool" at clinical I am not upset. i still learned by asking questions during down time and watching the nurse work and manage her day. But when I am offered to do something, I jump at it and do my best to do it right.
You poor thing. I would have died if that happened to me as a student- I already felt so bad about sticking people at first! But... it happens.
I promise you, a family member who would flip out about not having "given consent" for that (when her mother is alert and oriented and already did!) was a control freak who was probably going to cause a problem sooner or later whether you were there or not. And I promise the nurse knew that, too.
I have a story that completely supports what the seasoned nurses are saying. I am about to go into my final semester of nursing school. When I was in second semester on my first med/surg rotation this poor nurse had to deal with something because of me and I will never forget it.
First for a backstory on how clinical works at my school, my school requires clinical instructors to do all teaching at the facilities and over the course of the program they slowly loosen the reigns to let us do more with staff nurses that our assigned patients are assigned to. If the RN we are paired with is willing to let us practice a skill on their patient we have to first ask the CI if they are able to come up and supervise. This frees up the RN for a few. Even though they will still have to come in after and assess whatever we did for their patient's safety. But straight cathing or IV insertion and things that take more time, they are usually appreciative. If the CI can't make it for whatever reason, then it is up to the RN if they want to instruct us through a skill or just do it themselves. I don't get offended or upset if the RN just doesn't have time. From following them around, they have a ton to do. What I do for every clinical is in the first few minutes the first question I am alsways asked is what level I'm at ad what I can do. I give a quick run down of skills I'v already practiced on patients and what else I'm aloud to do. Then I follow quietly as the nurses assess. When we get to "my" patients, I just follow her in the assessment. SHe checks lungs and moves on, so I check lungs. I just copy what she does so the patient doesn't have to get assessed twice unecessarily, and then I'm freed up to watch the nurse some more. I then answer all call lights in the area I can throughout the day. I help with things I'm aloud to do solo (read basic care CNA stuff). I do this happily because my hope is that saving the staff time while I toilet a patient or clean a soiled patient or feed them lunch or whatever, will free them up to let me do things or ask questions. A lot of times it works and the RN will review things with me. I have even been tracked down by another nurse to start and IV because I was helpful on the floor. But other times, the RNs were so busy that it didn't help enough and they still had too much and couldn't really review anything with me. And that's ok. It's just the nature of the beast. They have a job to do whether I'm there or not, so I would do my best to keep out of their way and soak up whatever I could from just following them and answering call lights.
Anyway, to the point of this post.
That time a nurse tracked me down to offer an IV insertion that I spoke of. I was so thankful. My instructor was free so the nurse gathered the supplies for me and my CI and I went into the room. I had already asked the patient if she was ok with a student and CI could start her IV before the instructor got there. She was completely ok with it. Alert and oriented. Was even joking around with the CI while I set up and found a good vein. Patient was well aware that I was a student, and i told her everything I was doing as I was doing it. It came time for the stick. As I inserted the needle, the vein rolled. I had my thumb stabilizing the vein, but away it went anyway. I attempted to "fish" for the vein for a few seconds and got flashback. Thinking I had got the vein I advanced the catheter and attached the j loop. I drew back with the syringe and got return, but as I flushed the vein ruptured. Right as I was removing the IV, the patient's daughter called her. Patient was telling the daughter what was going on, and I could here the daughter start to yell and get upset on the line. I bandaged the patient and stepped back because I knew something was wrong. The patient then hands the phone to my instructor and the daughter proceeds to curse out my instructor about how we were using her mother as a guinea pig and never had her consent and on and on. My instructor then started the second IV (successfully thankfully) and we went and told that patients nurse. The daughter then called the unit and yelled at the nurse over the phone. Then the daughter came into the hospital made a scene and saif that it was abuse to let students practice on patients (because I guess she didnt understand that all nurses start as students). It was bad. This nurse who was so kind as to find an eager student to let start and IV on her patient now had to spend about 2 hours out of her day on the phone and in person dealing with this patients daughter and charting on it, then filling out an incident report because the daughter threatened to sue, and then trade that patient with another nurse so they had to give report to each other. All because I was "helping." I am sure that the majority of the time, allowing a student to do something goes smoothly albeit slowly. But those few times that it blows up in the nurses face has to suck bad. The nurses know there is potential for something to take forever or have a negative outcome, and for them to let us practice, means they are willing to take the risk of that happening. This is why, if I'm not offered anything "cool" at clinical I am not upset. i still learned by asking questions during down time and watching the nurse work and manage her day. But when I am offered to do something, I jump at it and do my best to do it right.
Thats BS. If the pt was A&O, she can make her own decisions regarding her care.
Thats BS. If the pt was A&O, she can make her own decisions regarding her care.
Of course but oftentimes the patients are fine and it's the relatives that are bat crap crazy. A normal person who gets upset about something has their say and then life goes on. People like this gal perseverate and continue thd BS drama with as much fanfare as possible. Usually to the horror of the poor patient who never had an issue to begin with.
I've had a different experience in my clinicals. In fact, after my clinical in a Neuro ICU some of the nurses were asking me to apply to the hospital and said they would vouch for me.
My advice. At least this worked for me.
From day 1 in my first clinical I jumped in to help the patient care assistants with all the work that the nurse didn't want to do...cleaning up soiled bed linens, draining full Foley catheter bags, etc and charting I & O. I kept myself busy doing little things that I knew they would appreciate, like answering call lights and taking care of simple requests like getting extra pillows, ice chips (if they weren't NPO), etc.
When a nurse was overwhelmed in medical-surgical clinical I would jump in and just ask to help. They are scrambling and it's time for 11am vitals. I asked if I could check vitals and chart for them. Even the patients that weren't assigned to me by my clinical instructor.
I'd be listening to the physicians. They are talking to the nurse and telling her to put in a Foley. I've got all the stuff she needs by the time she finishes the conversation with the Doc.
By the last 4 weeks of the semester nurses would call me into the room when they were doing something interesting.
The same was true in my critical care clinical. I was there helping the patient care tech clean up from a displaced fecal tube with a 400lb paralyzed patient. I help clean up a room where the patient had projectile vomited all over the place. Wherever the nurse went I went and jumped in and did all the stuff I could do that I knew wasn't pleasant for them.
By the end of the semester not did only the nurses teach me how to do procedures but more than once the doctors took me aside and explain to me what their residents were doing as they were doing their procedures and what kind of care they would expect the nurses to provide in the aftermath. I think it was because they nurses were talking me up as a team player.
In my observation too many nursing students don't jump in and clean poop, pee and vomit. They don't do the little things that take up time and are a little unpleasant.
My advice is to jump in and be a part of the healthcare team and work hard every clinical day. It will be noticed after a while.
I had terrific experiences in most of my rotations. The times when it wasn't so good was when the energy of the floor was negative. I found that it was highly dependent on the nurse supervisor's mood.
Specializes in Tele, Interventional Pain Management, OR.
I understand the OP's frustration but...as a nursing student myself, I don't consider shadowing my nurse a waste of time. It's still a learning experience. And I'm in that hospital to learn!
When I'm assigned to a nurse who doesn't want me to do a whole lot, cool. I know there's a lot more for that nurse to do than be my unpaid teacher for the day. So I don't spend time "leaning against the wall" or trying to look busy. Instead, I take note of how s/he manages his/her time. What are the patient interactions like? What is s/he assessing? I ask questions when appropriate but don't find it necessary to make it all about me. Also, I answer every call light I see and intervene to the best of my ability.
There's plenty to observe and consider in the clinical environment without getting hung up on practicing "skills." The patients aren't there strictly to advance our learning. Nursing is more about assessment, critical thinking, and implementing/revising the plan of care anyway. Students always amount to added work/time for the nurses despite (mostly) good intentions. We are guests at our clinical sites and need to roll with whatever happens there. Adaptability is also a good thing to practice in nursing. :)
ETA: I'm lucky to be in a program where CIs require students to fill out nurse-student communication forms on each shift that delineate what we can/can't do, and if the skill/procedure requires nurse or instructor supervision. We go into each shift knowing exactly what the rules are. I can only hope this kinda makes up for us being sprung on the nurses when all they're wanting to do is get AM shift report!
Be very careful with this idea. Digging through random charts, especially in an EMR or accessing areas you are not assigned without express permission from the right personnel can be seen as a HIPAA violation and get you in big trouble. Students have been given clinical failures or worse clinical dismissal for exploring charts of patient they were not assigned. Yes there are educational exceptions to accessing medical records but be certain to do so within the guidelines of not only your clinical program but the facility. A classmate got a verbal warning for reviewing labs of the wrong patient in the EMR. The facility changed it so each morning the charge nurse and clinical instructor had to call IT each day for student access to the charts for our med passes and only relevant areas (read only nursing notes, MAR, VS trends and labs) were visible
True! I am sorry that I wasn't more specific, the only charts I would view would be the ones of patients that I was assigned to. I wanted to point out that you don't have to be doing tasks/skills to learn.
I love teaching and enjoy having students. Even when I don't have time to let the student figure it out i invite them to follow along and provide a running narrative of what I'm doing and why.
In the last few years, the clinical groups have really started to irk me, as a whole. Many of the students recently aren't interested in the things I do that take up most of my day like "CNA jobs"(as in 'no I'm not toileting that pt; that's a CNA job'). I have pointed out when the Drs are rounding and that this is a great way to learn how to teach pts, especially with some surgeons that really like teaching, and gotten blank stares and no move toward the room.
Oh well, I tried.
The behavior of most of these groups of students lately almost makes me not sad that I'm not allowed students anymore. My BS degree is in biology and chemistry and my hospital/the local schools only allow BSNs to work with students/residents/precept new nurses.
Look, I like students and I like teaching but I get $1.25 for precepting and am usually behind my whole shift. In addition I have to be extra vigilant for mistakes when I allow my students to hang drips, calls docs or chart assessments because it is ALL under my license. I have found many mistakes even after teaching/reinforcement.
Sometimes it just isn't worth it and usually we don't get a say. "Hey Dranger, you are good at teaching we are giving you a student for the next two months".
Specializes in Medical-Surgial, Cardiac, Pediatrics.
I understand both of these points of view and appreciate the feedback. It is just really frustrating to be a student paying good money to lean against a wall for six hours. I hope that in the future, when I'm a nurse, I'll be more apt to this teaching roll. I understand that not everyone is equipped to teach, and have been tossed between nurses because of this. I feel that if we are trying to create a better environment for nurses it should start at the bottom- with the students. We are the 'future of nursing' as everyone keeps touting and what better way to equip us than with teaching.
I'll add my two cents on this.
You will NOT learn how to be a nurse during clinical. You won't. You don't call the doctors, take responsibility for medications, call pharmacy, chart, or have to coordinate anywhere near as much as you will when you hit the floor. NOTHING you do in clinical will do much more than give you task practice for skills.
Which is super valuable, yes. But the actual foundation of nursing lies in the ability to prioritize, manage, and keep track if EVERYTHING that is going on with ALL your patients. And their families, physicians, home health needs, follow ups, history.. You will never learn how to do that well until you hit the floor and have to stretch your skill set past your ability to task.
Unfortunately, the things you're asking are helpful, and as a student, they are valuable, but they're tasks. And there is a reason RNs have CNAs take over many tasks with their valuable hands, eyes, and ears: RNs don't often get to task, because they manage so much around the tasking. And students can't do that on the floor.
Granted, there are nurses who teach, and nurses who don't. Ideally all nurses should teach well, and explain the focus of what they're doing, but more often than not, clinical time tends to just focus on tasks, which can be time-consuming and take away from the managing part. And not all nurses can be patient in the face of that being interrupted to teach effectively and well, especially if they're short-staffed or have several discharges/admissions on top of difficult or complicated patients.
Have patience with them. Balancing a stressful and hard work environment with teaching, especially when nurses are rarely given the resources to do one effectively, much less both, is really hard. They're just as frustrated as you are, more than likely.
JustBeachyNurse, LPN
13,957 Posts
Be very careful with this idea. Digging through random charts, especially in an EMR or accessing areas you are not assigned without express permission from the right personnel can be seen as a HIPAA violation and get you in big trouble. Students have been given clinical failures or worse clinical dismissal for exploring charts of patient they were not assigned. Yes there are educational exceptions to accessing medical records but be certain to do so within the guidelines of not only your clinical program but the facility. A classmate got a verbal warning for reviewing labs of the wrong patient in the EMR. The facility changed it so each morning the charge nurse and clinical instructor had to call IT each day for student access to the charts for our med passes and only relevant areas (read only nursing notes, MAR, VS trends and labs) were visible