I had mentioned in another thread that I wouldn't allow a student nurse to attempt insertion of a foley on me (unless I'd been anesthetized prior).
So that got me thinking....
What would I and what wouldn't I allow a student nurse to do for me?
Here's my personal thoughts
I WOULD allow:
Vitals
Venipuncture
PO meds dispensed and IVPB meds to be hung (and main fluid bag changed/hung)
*SC or IM meds administered
EKG
SLIV/HLIV flush
D/C IV or SL/HL IV
Foley emptying and flushing (if RN with SN for flush)
Unchecked assessments for lung sounds, bowel sounds, DTRs etc (as in, SN can do it, as long as RN there to assess and verify)
I WOULD NOT allow:
Catheterization
IV insertion
*SC or IM meds administered
IVP meds
NG tube insertion
*I listed SC and IM under both categories. If SN had experience giving injections, well, then shoot away. But if not, sorry. I've seen way too many students get scared or try to be nice, etc, and push the needle in so slowly, push the med too fast into the tissue, not feel comfortable with location and hit a bone, etc.
I know I'm leaving lots of stuff out--haven't slept in over 36hrs, so brain ain't what she could be right now, yk?
What about you all? Where are you willing to aid the learning process and where do you draw the line(for you personally-not your kids/family)?
***We're assuming these are not emergency situations. ie, I'd let a student venipuncture me, but not if it were for STAT Mag levels because they think I have MagTox, or T&S because I'm bleeding, etc.
I had mentioned in another thread that I wouldn't allow a student nurse to attempt insertion of a foley on me (unless I'd been anesthetized prior).
So that got me thinking....
What would I and what wouldn't I allow a student nurse to do for me?
Here's my personal thoughts
I WOULD allow:
Vitals
Venipuncture
PO meds dispensed and IVPB meds to be hung (and main fluid bag changed/hung)
*SC or IM meds administered
EKG
SLIV/HLIV flush
D/C IV or SL/HL IV
Foley emptying and flushing (if RN with SN for flush)
Unchecked assessments for lung sounds, bowel sounds, DTRs etc (as in, SN can do it, as long as RN there to assess and verify)
I WOULD NOT allow:
Catheterization
IV insertion
*SC or IM meds administered
IVP meds
NG tube insertion
*I listed SC and IM under both categories. If SN had experience giving injections, well, then shoot away. But if not, sorry. I've seen way too many students get scared or try to be nice, etc, and push the needle in so slowly, push the med too fast into the tissue, not feel comfortable with location and hit a bone, etc.
I know I'm leaving lots of stuff out--haven't slept in over 36hrs, so brain ain't what she could be right now, yk?
What about you all? Where are you willing to aid the learning process and where do you draw the line(for you personally-not your kids/family)?
***We're assuming these are not emergency situations. ie, I'd let a student venipuncture me, but not if it were for STAT Mag levels because they think I have MagTox, or T&S because I'm bleeding, etc.
Can't wait to see your answers.
I actually feel a bit more secure when there is a student nurse as opposed to some of these half-*** nurses that half do things and don't do it properly; nor do they care. At least with the student, you know that they can't do anything invasive without the instructor being there. So, I know there is a watchful eye there if they are going wrong. On the other hand, I would not go to the facility where I work if I get sick. That's because some of the nurses I work with are some sorry sap-suckers and just as little as they can get away with.
no-"attitude"- more like -"disbelief"- that just because a person has rn behind their name makes them automatically better at an ng tube insert than a student. i am not allowed to do any invasive procedure without my instructor, same cannot be said for an rn.
everyone has to start somewhere, and if students are never allowed to do something when all the "experienced" rns retire you are going to have a bunch of nurses who dont know how to do anything.
sorry....phrases like "people like you" and "don't go there" imply attitude to me. too many years raising a teen-ager, i guess.
fortunately, there isn't going to be one particular day when all the "experienced" rns retire. not sure why you felt the need to put experienced in quite that way, but i'll leave it alone, i guess.
orientation is the time to do procedures that you didn't have a chance to do during nursing school. there should be a competancy sheet, and (i'm happy to say it's the case where i work, and i know this may be unusual) you should not be off orientation until you have shown your competancy with these procedures. so, when you've graduated and taken your nclex, take charge of your orientation and ask your preceptor to watch for procedures that are being done, go in when the rn/lvn is doing them, and ask to do them yourself. hopefully you'll find that patients are more accepting of new rns than students.
sorry....phrases like "people like you" and "don't go there" imply attitude to me. too many years raising a teen-ager, i guess.
fortunately, there isn't going to be one particular day when all the "experienced" rns retire. not sure why you felt the need to put experienced in quite that way, but i'll leave it alone, i guess.
orientation is the time to do procedures that you didn't have a chance to do during nursing school. there should be a competancy sheet, and (i'm happy to say it's the case where i work, and i know this may be unusual) you should not be off orientation until you have shown your competancy with these procedures. so, when you've graduated and taken your nclex, take charge of your orientation and ask your preceptor to watch for procedures that are being done, go in when the rn/lvn is doing them, and ask to do them yourself. hopefully you'll find that patients are more accepting of new rns than students.
i meant " people like you " in ref to the op saying she would not allow a student to do certain things... and i did not want posters to go the route of "go to your learning lab and practice, practice" because my first ng insert on a real person was nothing like the practice mannequin. sorry if i sounded snotty :)
i totally agree, compentency should be checked off for rns almost same as a student, that was my point. and thats also what i meant by "experienced".. someone could work as an rn for 10 years with loads of other experience but has very little, if no experience with certain skills. the point i am making is just cuz the name tage says rn does not mean
"can/have done it all, and better than a student" the op could refuse a student inserting that ng and end up with an rn walking in who has done maybe 2 in her whole career and is going to do no better of a job than i would with my instructor at my side
Bottom line...being a student in a teaching facility gives you the opportunity to learn to do procedures. It does not entitle you to anything. Pts. have the right to self-determination, and that does include the right to say "no" to a student. Believe it or not, that right to say "no" extends to pts. who also happen to be healthcare workers. It's not personal.
Moon-Sorry to shock you. That's life I guess-shocking sometimes.
Don't try to paint me as some hard-headed whatever who's against students and learning. I've taught medical assisting and have had more venipunctures and EKGs and "PPD tests" (done with NS) than I care to remember. I take in the students on my floor while the other nurses roll their eyes and huff and puff about what a PITA students are. When I was hospitalized, I actually asked if there were any students on the floor.
There's no need to tell me where not to go, I'm not stupid. I know a latex and plastic doll is not the same as a human, which is why I would refuse. If it were the same, then I'd consider you experienced and let you do pretty much whatever to me.
On invasive tasks that are not routine, yes, I would ask the MD/RN/NP/PA if s/he has performed this prcedure before-so as a person with "RN" behind your name, I would not automatically trust you to drop a tube in me-especially unsupervised. As sisukas mentioned-this is MY body, and I have every single right in the world to chose who does what to it, and when. I don't owe anyone anything, and while I am happy to help, I do have lines that I will draw.
Re: the NG in particular. It just occured to me that that one is a moot point. I would not let ANYONE with little or no experience insert one, as I have nasal issues resulting from a surgery I had 2 yrs ago (and no, not a nose job, lol...I wish it were something simple like that!).
My list of things I wouldn't allow (*scratching off NG tubes) is quite small. And there are plenty of people who will let you do that. All the power to them, and to you!
As sisukas also mentioned, many hospitals will verify skills during orientation--IVs are not taught in most nsg schools (other than a "Well, here's what happens. [quick demo] Your hospitals will train you, or they'll have an IV team. Moving on!") which is why I said I would refuse that procedure. If we had all the time in the world, and the SN could show me that she's familiar and comfortable with the equipment and tell me her basic technique--stab away sweetie! But chances are, if I need an IV, it's for a reason and we don't have an extra 15 minutes to do this.
Depends on the situation, the student, the preceptor, my mood. I'm generally pretty laid-back. We all have to learn somewhere. I'm far more willing to let someone practice on me than on my son. Mama-bear instinct, I guess.
I finished NS without ever having started an IV outside skills lab, never giving an IM inj, & no NG insertion.
I did, however get to do many other things that a lot of my colleagues didn't get to do, of course c a preceptor stuck to my hip (as it should be). I did a female cath, took care of a fem-stop pt, integrilin drips, read lots of tele, lots of g-tube meds & care, plenty of insulin and other SC stuff.
With NG tubes, they really do scare me. I didn't get to do any as a student; the one that I happened to be near, was on a really violent patient, so I got to shake the charcoal instead.
Since being licensed, I've done one and I've assisted with one. I plan to have another nurse with me for the next few NG tubes that I start, just as a backup. I like having two opinions as to placement before I turn the suction on. Also, since it's something I rarely do, it is always good to have another set of eyes to make sure I don't do something dumb. The nurse that I assisted with, it turned out to be her second; but it was her patient so she did the tube.
I'd prefer that the instructor and/or a nurse that I trust (probably that'd be my nurse) assist with and supervise anything invasive. If not supervised properly, I might not allow it to be done. I wouldn't count myself as adequate supervision since I might be distracted, in pain, or drugged.
As to the list from the OP, that's exactly what we can and cannot do in my nursing school, so I think you summed it up pretty well. As far as students working on me, I had a student CNM deliver one of my babies, no problems for me. She did a great job, until the umbilical cord stopped coming out, retained placenta, and then she felt real bad. I wasn't worried, the doctor came in and did a 45 min D & C, and all was good. She really felt bad, though, like if she held on a little tighter it would have been all good. And from now on, I will ask to have students do procedures on me, I volunteered first to let a fellow phlebotomy student do her first draw on me, and she was excellent.
My husband (critical care nurse) and I (nursing student) would allow a nursing student to do anything to us so long as they have their instructor present for things such as NG or foley insertion, anything really invasive. But IM or IV? Bring it on. In fact, my husband is in the hospital now and is very open to student nurses.
Kanani_Ikike
167 Posts
I actually feel a bit more secure when there is a student nurse as opposed to some of these half-*** nurses that half do things and don't do it properly; nor do they care. At least with the student, you know that they can't do anything invasive without the instructor being there. So, I know there is a watchful eye there if they are going wrong. On the other hand, I would not go to the facility where I work if I get sick. That's because some of the nurses I work with are some sorry sap-suckers and just as little as they can get away with.