As I watch the nursing students come through the ICU each semester, I’m seeing a big change in attitude… and not for the better. As I went through nursing school, we had very strict rules impressed upon us by our instructors- our uniforms were to be ironed, we were to stay out of the nurses’ way (i.e. don’t take their computers or chairs), and we were to prepare for the day by studying the assigned patient’s condition and pertinent labs and medications. And, I’m not talking 40 years ago… I’m taking 4 years ago.
We had one particular nursing school come through our unit in rotation this fall and I was disheartened by each and every student I met from this school. I had one student who was assigned to my patient. She came in that morning (and was late and we were already halfway through shift report), she did not know what CHF, congestive heart failure, was nor how it is treated… and this was the patient’s diagnosis. We had morning medications to give and the student said “I dont know” when asked about each of the 3 medications we were giving. I asked her to look up the medications and come back to me with the pertinent information and she stood there for a moment, then came over to me and said “I dont have a book”, I told her that there were online resources as well as several books in our medication room. Next, we had to take this intubated patient down for a CT scan and upon our arrival to the unit, I hooked the patient’s cardiac leads to the monitor and I asked the student to hook up the blood pressure cuff and pulse oximeter (finger probe). After taking a phone call, I came back into the room and the student was holding the blood pressure cuff in her hand and said “I can’t figure out how this goes on”. That’s it. I was mentally checked-out as a teacher.
This woman (and I say woman because she was about 35 years old) was going to graduate, potentially, from nursing school in just a few months. Upon probing her to get a better idea of her clinical experience, she told me that she has been an LPN for years, but has never actually worked. She got divorced, gets a large alimony sum, and just needed something to do to get out of the house while her kids were at school, which is why she went to nursing school. Students just don’t seem to care. They went into nursing school because they heard it was an easy road to a good salary. But, now after being on a waiting list to get into nursing school for a year, and being about ready to graduate, the market has turned around and hospitals are not hiring new graduate nurses (things will change, and they can easily get experience in LTC for a year and then apply for whatever their “dream job” is).
Throughout my posts, I keep going back to the topic of professionalism. I think that is huge for nursing. If we as a group show that we deserve to be treated with respect, then we will be. This is a big topic that seems to be missing in nursing education. What could we do as hospital-based preceptors to get this message across to students that we only see during a one-day shift?
My biggest peeve is when students are months away from graduating and they obviously don’t understand the gravity of the job they will assume in full very soon. I have had a lot of students who are either super cocky (they think they know everything when they really just know a lot of facts… not the big picture) or who just don’t seem to care, just as you described. Students who don’t know what aspirin is for.. who don’t come in on time… who don’t come to me to tell me when they’re leaving the unit for lunch of breaks.. who don’t give me a hand-off report as they leave. They don’t realize that school is only as good as the time and effort you put into it… and that it doesn’t last for very long before you’re on your own, with your license and other peoples’ lives in your hands.
Exactly. Attitude is everything in this career. There are so many nurses that don’t have all of the answers (heck, that’s most of us), but as long as you understand the gravity of your job, have the ability and drive to find the answers, and the compassion to care about your patient as a person, then you can do it.
Why do we have so many nursing students without any of these three characteristics? I really don’t understand.
Hey Amy- I found your blog somehow online and have enjoyed reading it recently. I just graduated from nursing school last month and take my NCLEX this friday!
Anyways, I wanted to respond to your post about ‘apathetic’ nursing students. I definitely can relate. I grew up with a mom who has been an ICU nurse for 25 years- so when I went off to college, I knew that was the last thing I wanted to do! :) I saw how hard my mom worked, how much she cared and how exhausted she was. Don’t get me wrong- I could tell it was rewarding but I wasn’t sure if that’s the kind of job I wanted. In the end, I changed my major after TWO years and went to nursing. So- not only did school take me much longer than appreciated but now I have my mom rooting for me! :)
I have not worked in a hospital before but I have worked for a general surgeon as his primary ‘nurse’ (glorified MA basically) for two and a half years. I definitely find myself stressed and overwhelmed so I can only imagine what it’s going to be like when I start in the ICU in the next few weeks. Don’t get me wrong- the stuff I was doing was not rocket science but it is definitely hard to juggle 15 things and keep a type A doctor happy….
I think it’s hard for nursing students to fully comprehend what it’s like to handle all of the patients because we really never have the opportunity to handle that kind of a load during clinicals. In my last semester, they forced us to work up to four or five patients for each day…. it was definitely out of our comfort zones but I know it was for the good.
Seeing your article makes me sad that nurses view students like this but I understand where you’re coming from. The only suggestion I would have about what to do to leave an impression on your student is to really try and walk them thru your ‘thought process’ throughout the day. That’s what I loved about the ICU- the nurses loved to TEACH. A lot of times the nurses I would follow would really only let me ‘follow’. They wouldn’t clue me in on why they do something first, next, last, etc. It’s hard to develop a nurse’s mind set so it helps to be challenged and informed at the same time.
All that said- any advice for someone about to enter into the ICU on feb 15th?
First of all, congrats on finishing nursing school! It sounds like you have a great head on your shoulders and have that “passion” that I”m always talking about. I’m sure you’ll do fabulously on your NCLEX. Just make sure to breathe in between test questions :)
Thanks for the well-thought comment. I appreciate the point of view of a former nursing student (pretty cool that I can now say “former”, right?). I love the part about walking students through the thought process of a nurse. It’s something that we can easily lose sight of in the middle of a busy day.
I’m one of the preceptors in our ICU and my favorite thing to tell our new graduates is to plan out their patient’s day right after they get report from the previous nurse. So, for example, if we get report on a patient who had open heart surgery the prior day, their plan for the patient would be to wean off any vasoactive medications (what might we do to help that? Maybe start the beta blocker to get them off the nipride?), get the patient delined (remove the swan), remove the chest tubes (if the drainage had slowed), get the insulin drip transitioned over to an ACHS sliding scale, ambulate, etc, etc. That way, they will be prepared with the information they need to progress the patient which helps get the critical thinking in sync with advancing the patient’s care as quickly as possible, and get them transferred out of the ICU.
Also, don’t be afraid to ask a lot of questions. Ask your preceptor why he/she is doing what she is doing and build the foundations of critical thinking- it’s the most important skill in any ICU, in my personal opinion. Be confident but careful. If you act confident, you will feel more so that way yourself and others around you will pick up on that feeling, but keep in mind that you have lives in your hands and don’t overstep boundaries that you’re not comfortable with.
Good luck at your new position. I hope you love it! If there’s anything I can do, just let me know. I’m always here :) You’ll be great
Thanks for the advice- definitely taken as a mental note to self for the upcoming transition into the ICU. :) I look forward to reading your posts.
I was a nursing student just about three years ago. Now as an ICU nurse and a preceptor, I find the younger new grads/students to be the ones I have “problems” with. I am 35 and was taught very good work ethics by my parents. I find the younger generation lacks good work ethics and sometimes plain old common courtesy. I know, I know….it’s not fair to generalize all of the Generation-Y and Generation-Z kids, but overall, this is what I see.
I forgot to mention that my BIGGEST pet peeve is when I am precepting a new grad RN and they DON’T ask questions. When a new nurse doesn’t ask questions, it scares the living daylights out of me. I still, to this day, ask at least one question a day; whether it is a question to a pharmacist or a medical based question to a doc (ie…why does this lab go up when the patient has this and blah blah blah.)
I stumbled upon your blog today and was pursuing your past posts, when I read this one I had some mixed emotions. I’m a 5 year RN, ICU nurse for all those years and graduating in May with my masters in nursing education, meaning I plan to be a professor for the nursing students you are blogging about. A few things I learned in my career and in my schooling: students don’t know a lot and if they know something they aren’t sure they know it and are afraid to speak up (most of the time) unless encouraged. Please don’t forget that nursing school teaches a student a lot about a little and only a little about a lot… many schools don’t leave time for a student to get additional hospital experience as a tech or nursing aide because of heavy academic requirements so their comfort is limited and their anxiety level is high.
While the story of your student not knowing how to put a blood pressure cuff on is sad, I truly hope it is rare. Students are taught quite strictly (too strictly in my opinion, that whole “nurses eating our young thing”) about the fundamentals of patient care, sterile technique, assessing a patient, placing foley and NGs, yadda yadda but much of it is completed in a lab on a simulator and those experiences do not prepare them for the real world.
I’d love to give that student the benefit of the doubt that ICU scared her and the patient on a vent was overwhelming and she feared touching the patient and accidentally pulling something out. I hope the student learned something about that such as responding immediately to say, “I’m not comfortable touching the patient” or “I’m afraid to pull something out, can you help me put the cuff on?” and hopefully you might say next time, “are you comfortable placing the BP cuff on the patient?” or “do you have any concerns about taking care of a ventilated patient?”
I hate to sound like I’m on a soapbox because I’ve seen crappy students as well in my practice but I remind myself that they aren’t all ICU nurses, and experience comes with practice and repetition so I try to allow for that and I was a student once and I wasn’t perfect or sure of myself back then either. Remember to guide them, yes they need to learn to critically think but as the previous student commented, they might not understand how. Ask a question, encourage their thinking (out loud if they want so you can see their direction) and if they still aren’t sure I love to say this, “ok, I’m going to think out loud here so you can see what I’m thinking”. I had a student say to me just yesterday, “wow, no one has ever told me how they think…”
Above all, don’t eat your young! If the student is so bad that it scares you they are graduating ask to speak to their instructor, express your concerns, that might be your grandmother they take care of someday. And have patience with them, they are so nervous they’ll kill someone, it’s crazy.
Thanks, Jenn
Jenn-
Thanks for your comments – very insightful from a different point of view. I do a lot of teaching with nursing students, I’m actually a preceptor for students in their final block when they do several weeks on the same unit, with the same nurse to get some continuity. I know that my example with the blood pressure cuff was to the extreme, but that was the point of the example- to make the reader step back and say “wow”. Despite how I may have come across in this post, I am a very “mentoring” type of person- I really do enjoy teaching those who want to be taught. I love going through the critical thinking process and I actively do it each morning with my students and have a “this is what I hope to accomplish today” discussion right after I get report and go through the patient’s labs/diagnostics with them.
But, the purpose of my post was to discuss the fact that I’ve seen a lot more students lately have the attitude of not really wanting to learn. And, unfortunately, that’s not something that we, as bedside nurses/preceptors, can cure. The students need to come to the hospital unit with a “lets go” attitude, even if they’re shy or timid around the nurses/patients. You can’t learn if you don’t speak up…that’s the point of the clinical rotation.
Thanks again and I hope to see you back here :)
Hi
I am a nursing student and am about to undertake my first placement at the end of this year. It is four weeks in aged care. I must admit that I am very nervous – as it is very new to me.
What I am interested in knowing is some advice for me to help me along my way in my placement. I am very keen to ‘do well’ (for lack of a better term) and would like any and all advice you might have to offer.
Thanks
Shell
In my opinion, the best things you can do to be successful in your placement is to have a positive attitude, open mind, and willingness/desire to learn. Nurses don’t expect students/new grads to know everything… that’s what the preceptors are there for – to show you what you need to know. What we do expect, however, is that you have the drive to learn. If we ask you a question and you don’t know the answer, admit it, then make a note to look it up (even if the nurse verbally gives you the basic information about it, you’ll definitely find more in your books, and maybe next time you’ll be the authority on that topic).
Be enthusiastic to get new experiences under your belt. If you overhear a nurse say that she’s going into a patient’s room to discontinue a PICC line, and you’ve never seen that, jump at the opportunity (if you aren’t in the middle of a task for another patient) and go in and watch.
I wish you the best of luck & really hope you love your first placement. I work in a CVICU, where our population is generally over the age of 70 and I’ve really enjoyed it. They have so much to teach and share with you if you take a few minute out of the day to chat with them. :)