Friday, November 6, 2009

brainstorming to battle hindrances

Yesterday we spent some down time during clinicals talking to our clinical instructor about other possible clinical opportunities. Our program is very limited in the opportunities we have. First semester we do nothing clinically speaking, other than lab learning. Second semester we spend 6 weeks (maybe it's 8 weeks, dont quite remember), at a long-term care facility. Third semester we do med/surg/ortho/tele, OB/newborn, and we're supposed to do an observation-only Peds rotation at a local practice. Because of H1N1, those of us that are supposed to be going during the latter part of this semester have been prohibited from going. There is also a time period during this semester where each group has been "orphaned". We do not have enough clinical instructors in our local, small community hospital, and there are no contracts out for any of the larger hospitals or medical centers in the region. (Let's not forget I live in the DC/Northern VA region where there is a plethora of all that is medical.)

The other two community college's programs go to vast medical centers for their clinical experiences, and oh, you might have heard me mention in the past one of those programs is also sharing our local, small community hospital. It's not an extremely large group invading our territory; however, their instructor has asked one of our two instructors if they can take the one floor that one of our groups was supposed to have! From what I heard our instructor (our group wasn't with her at this point in time) conceded!!!!

I digress; so when we're orphaned, we go to other clinical experiences, which are usually observation-only or very limited hands-on experiences. They've been overall wonderful opportunities. Most everyone's enjoyed going to interventional radiology, the infusion center, wound care center, a local same day surgery center, staff development, ICU, (no, we don't get that as a regular rotation), etc. It's usually only been one day here or there.

In our bigger rotations (med/surg/ortho/tele, OB/newborn) we are only given one patient at a time. For instance, my patient yesterday was admitted with a GI bleed with anemia. He was completely independent, so all I did was vital signs, get his cup of ice chips (he was NPO as they were waiting on GI to get in to consult, and send him down for a procedure--didn't happen on my time), straighten up his bed (he'd been admitted the night before), and do his assessment, I&O and flow chart.

We're talking lots of down time. We bent our instructor's ear something fierce, because we want better opportunities next semester, and for future students. The program is being overhauled and this is a major need. Our instructor had spent some time earlier in the morning talking with the other program's instructor (OPI). The OPI informed our instructor of all the things they do clinically and that by their third semester they're taking on at least 2 patients.

Our mental health rotation is incorporated in as part of our LTC rotation because we work with patient's with dementia. We do have a mental health facility within 40 minutes--which in this area 40 minutes is nothing. All 5+1 (we had an orphan for the day) of us sitting there voiced that we would be willing to drive to other locations, at a distance, to be given better learning opportunities.

Bottom line is we want to feel somewhat comfortable when we're interviewing for our first nursing jobs that we we'll be a little more comfortable taking on our responsibilities. We know that we'll be oriented to the facility. We know that you really don't have your true nursing groove until you've been at it for at least 6 months. We just want the same opportunities as others.

I'm wondering: what clinical opportunities were you or are you being given as a student nurse?


Nursapalooza said...

We went to large hospitals.
First sem: small hospital, pretty much CNA stuff, but also learned total assessment and all po meds. Did this for 2 10 shifts wkly. No observation, just do! (one pt)
2nd: injections, L/D, Peds, (2 pts) L/D was definitely just observation, but the rest of semester was pt care. We added IV meds.
Third: Psych (pt involvement, interview), and Adv. med surg. 3-4 pt total care with IV meds
Fourth: Adv med/surg, and ICU, 4-5 pts in Tele, and 1 pt ICU. All care with aide of RN as supervisor. Added IVP.

Sooo hard! But good.

B said...

Sorry just a frequent viewer of your blog.. You and your fellow peers need to DEMAND more hands on experience.. I can not imagine getting as little clinical work as you do.. I attend Sentara's RN program in Southeastern VA and I'm in the 1st semester .. we've been working with patients since the 8th week of school and we go to the hospital twice a week where we have a patient we do everything (in our scope of practice) for.. foleys, blood draw, d/c of I.V's, injections, med admin etc... (under instructor supervision of course) We've been told we will start increasing patient load after our Specialty rotation next semester.. I'm so sorry you don't feel as though you are recieving enough practice to feel comfortable when you start working.. I'm a hands on type of gal && would be losing my mind if I were you!! Good Luck!!

carol said...

As a nursing instructor and a former nursing director of Labor and delivery I have to tell you it's hard to find clinical placements. The nurses at the hospital get burned out teaching and the patients get tired of being taught on. It's hard to find that happy medium where everyones needs are met. The nursing students need and deserve a great learning experience it's just not always easy to make it happen. Good lcuk

Anonymous said...

We did a LOT more than what you posted. We actually went into a lock-down unit for our mental health rotation, had at least 8 weeks each in peds and ob/gyn. We were hands on in everything except ob/gyn. We had 2 semesters on a med/surg floor (one semester was split between ltc and hospital). I would demand more hands on experience. There are so many hospitals in this area!!

12 weeks at a time said...

1st; assisted living/lab learning full assessments.
2nd; med surg floor, large hospital10 wks, once a week. assessments, meds, whatever the pt. needs
3rd: OB- labor and delivery one day, mother/baby 3days, peds 4days
4th; advanced med surg large hospital 2-3 patients, other rotations such as ER,OR,cath lab, IV therapy
5th; chronic care VA hospital, mental health locked unit, 2x a week
6th; preceptership 240hours with the nurse and unit that we're placed with.

alanaransley said...

I'm in my first semester, and we are at a rehab hospital. We do AM care on the patients, get them up and ready for therapy, PO meds, dressing changes, ostomy care, trach care, and are supposed to do tube feedings/meds but don't have any patients to do that on. We have to do 4 hours each of antepartum/pedi, but since we don't have a clinical rotation on that, it's up to us to find those experiences. I went to two childbirth classes at the local hospital, and followed my pediatrician around for four hours on Friday to complete those hours.

Next semester, we are at one of the local hospitals, but I have no idea what we will be doing.

Anonymous said...

This is my first semester in clinicals and we are doing AM care (and most of my patients are total bed baths), vitals (of course), head-to-toe assessments (listening to heart/breath/bowel sounds), PO meds and injections (I also got to give enteral nutrition and meds through a PEG tube this past weekend), wound care and dressing changes, and Foleys (a peer of mine got to do a straight cath). I think that's it. I'm on an orthopedic unit so there are a lot of patients that are s/p lumbar lami, or hip/knee a lot of patients with impaired mobility and/or on fall precautions. So there's a lot of moving/repositioning pts q2h, helping pts ambulate, etc. We have 1-2 patients on any given day.

Even still there's some down time--but that just gives us enough time to look up meds we may not know, and work on our care plans.

Next semester our clinicals are split between Health Assessment and Maternity.

Good luck--I hope they listen to your concerns! Observation is nice, and it's good to be exposed to all those different departments, but you definitely need more hands on opportunities!

Anonymous said...

1st-Med/Surg/Ortho (by the 3rd week of the semester), 1 pt each, assessments, p.o. meds and a.m. care

2nd-Med/Surg floor doing all meds (IVs included) on 2-3 patients each and an OR, SDS, and ICU rotation tossed in

3rd- Peds for 5 weeks with rotations in Oncology, NICU, and general peds floor and one well baby day in a local clinic. 1 patient each and doing all meds. 5 weeks of OB with one patient each doing most meds, all assessments. And 5 weeks of Geriatrics in LTC with 2 patients each passing meds and doing ADLs.

4th- 5 weeks of inpatient Psych, 5 weeks of Advanced Med/Surg doing all RN duties with 2 to 3 patients each and another ICU rotation and a Dialysis rotation, and Community Nursing for 5 weeks at various homeless shelters, community centers and schools through out our area. Leadership was built into all 3 courses.

I got a well rounded education with some serious clinical time from a community college. I just wish we had a longer practicum. It's only 1 week long.