Nursing students: you gotta love ’em

by Linda Turchin, RN, MSN
Okay, nurses, maybe you don’t have to love them, but does having them on your unit really have to be an unpleasant, stressful experience for the students and for you?

Sure, most students aren’t as efficient or as organized as the typical staff RN – but they usually aren’t as busy or tired, either. They are always asking questions and forever looking over your shoulder, but they seem to have boundless energy and are thrilled to do a fecal occult blood test. Of course, you will have to show
them where you keep the extra intravenous pumps, and asking them to call the pharmacy for the first time might reduce them to tears. But they will be more
than happy to ambulate all of your postoperative patients and will jump at
the opportunity to teach your patient newly diagnosed with diabetes to do
his own finger stick.

Nursing students are passionate patient advocates and eager to learn anything you are willing to teach them. They will cling to your every word and spend most of today’s post conference telling their peers about the “awesome job” you did caring for a patient’s stage-3 pressure ulcer. They want to be just like you – an expert clinician who every day successfully combines academic knowledge with technical skills to provide high-quality nursing care. Now, you gotta love that!
As a nursing instructor, I facilitate the clinical experience for 16 associate-degree nursing students each semester. The goal is to provide the students with a safe, controlled environment in which to develop their clinical skills and to integrate theory with practice – and to assist their transition into the world of professional nursing. It is only when you reach out and welcome them as productive, responsible members of the unit’s nursing team that their real learning can begin.

Okay, those are the benefits for the students, but what’s in it for you? Well, when you create that safe, nurturing environment, they quickly learn how to be efficient, effective members of your team. You help mold practitioners capable of providing safe, competent patient care. It’s a win-win-win situation. The students win real world nursing experience, you win competent assistants, and most importantly, the patients win quality nursing care – for now and for the future. Oh, and by the way, it makes you a better nurse, as well – honestly, it does.

My clinical area is a 26-bed oncology unit in an acute-care hospital in north central West Virginia. Over the years, United Hospital Center’s 4 North staff nurses have come to welcome the students genuinely and to view them as capable hands (hands that just need a little mentoring, that is). Their motto is, “Let’s train them so they make us proud.” In implementing that philosophy, however, they initially struggled with these questions:

Who should make the assignments?
As the clinical instructor, I know my students’ individual strengths and weaknesses.

I am also aware of our clinical goals; for example, it really reinforces learning when the students care for patients experiencing the health conditions the students are currently studying. But the unit’s RNs are the clinical experts and have firsthand knowledge about the level of care their patients need. While the nurses know I welcome their input about who the “really interesting patients” are, they defer to me to decide which patients will provide the students with the most appropriate learning experiences. Even though there is always that glimmer of hope, they now understand that the students will not be taking all the “complete baths and feeds,” because students are on the unit to gain experience and provide nursing care, not to become expert bathers and bed makers. With those guidelines firmly in mind, any nurses who are uncomfortable with a student’s assignment know that they can discuss it with me and that we will always find a way to resolve the problem.

How involved should I get?
As a clinical instructor, I am usually outnumbered by at least 8:1, and the laws of physics keep me from being in all places at all times. To add to the problem, hospital policy dictates that I must be with a student when he or she is performing certain tasks, such as preparing or administering medications. And you can be sure that a teachable moment will certainly arise when I’m literally “up to my elbows” in something with another student. I am always grateful when the staff gives me a heads-up about procedures being scheduled on the unit. With this type of cooperation, I can then prearrange for the students to observe or even participate in the procedure, if appropriate. Whenever possible, they invite a student to shadow them as they perform procedures that might be new or interesting. I tell them to let me know what they have in mind, though.

I am always more comfortable when I know what the students are doing; if I know that Susie has been known to get a little woozy, I will want to be there when they invite her to watch a bone-marrow biopsy. The students always appreciate the opportunity to see something out of the ordinary, and you can be sure it will be the topic of that day’s post conference. The nurses on 4 North are great about “thinking out loud.” Imagine the benefits of having a student watch as well as listen as you talk your way through a respiratory assessment on a patient with exacerbated chronic obstructive pulmonary disease. By sharing the why and how of what you are doing, then giving the student the chance to listen to the abnormal breath sounds and, finally, discussing what you both just heard is teaching at its best. Your hands-on mentoring will help nursing students develop great assessment skills and a healthy sense of self-confidence. (Remember: A competent, confident student is a valuable asset to your team.) Finally, expect students to be slow and adjust your expectations accordingly. Don’t ask them to do a procedure that must be done quickly or expect them to retrieve something from central supply stat.

So who is really “in charge”? While the clinical instructor is responsible for the students’ performance, the staff RNs are responsible for patients’ care. Communication among all parties is vital. The instructor is accountable for keeping the staff informed about the comings, goings, and doings of the students. Each afternoon, I post the following day’s student assignments
in the nurses’ station. This posting includes the students’ initials, room/bed assignments, and the nursing interventions the students will be performing during the time they are on the unit. This assures that the 4 North nurses are aware of who will be doing what to whom. My students are also required to interact with their nurses. While this can be intimidating at first, the students are soon reporting directly to the RNs. This regular communication strengthens the nurse-student relationship while keeping the RNs on top of what is happening (or not happening). It also provides the students with the opportunity to practice the formulation and presentation of a concise, thorough shift report. The oral report is a nursing expectation on 4 North that seems to work best when each nurse has his or her student report to the group. The students benefit from hearing about the assessments, interventions, and evaluations that their peers have performed, as well as assuring that this information has been communicated to the RNs. A group report is a much more effective use of the nurses’ time and certainly minimizes the interruption of patient care. The students also come to realize that patient safety demands that the RNs know when they are leaving the unit, no matter what the reason. The 4 North staff set a good example for stating their expectations for both the students and for me. I recommend that you do the same.

If I tell the instructor, will it help or hurt?
Certainly, share with the clinical instructor when a student performs well – and be sure to tell the student, too. While everyone enjoys hearing about their strengths, we learn from being aware of our weaknesses. If you witness problems with a student’s nursing care or professional demeanor, you have an obligation to discuss it with the instructor. If the problem affects patient safety, you obviously must intervene immediately. Nevertheless, remember to follow up by sharing the details with the clinical instructor. I cannot help the student correct the behavior or strengthen the weakness if I am not aware of it. The 4 North nurses know that constructive criticism is an effective means of moving a student toward becoming a proficient nurse.

What’s in it for me?
I did say that working with nursing students would make you a better nurse – and it will. Here are five things students always give you:

They put humor back into your day. Their innocence and enthusiasm will bring a smile to your face, and their charting will almost certainly make you chuckle. Sharing a laugh with (not at) a nursing student is a wonderful bonding experience, not to mention a potent stress reducer.
They keep you on your toes. Students are always watching you, and although I realize that memories of your own clinical instructors may still make you weak in the knees, don’t be intimidated. Neither the student nor the instructor is there to scrutinize your technical skills. Remember, you are the clinical expert; look at it as an opportunity to show off your first-rate skills.
They give you an opportunity to shine. Yes, they ask questions. Good students ask lots of questions. They invite you to share your knowledge and experience with them. They want to know everything you know, and I guarantee you will never have a more attentive, appreciative audience. Who knows? You might even learn something new from the students.
They remind you of why you became a nurse – and why you continue to be a nurse. Listen to a student comfort a confused patient or teach a patient about a new medication. Watch the look on a student’s face as he or she helps a family pack up Grandma’s flowers for the trip back home or sits with them as they say goodbye to their beloved father.
They give you the opportunity to influence nursing practice. Remember 4 North’s motto? “Let’s train them so they make us proud.” Here is your opportunity to prepare the nurses of the future – your future colleagues.
At the core of nursing is human interaction – with patients, with families, and with other healthcare providers. By providing a nurturing environment and sharing your knowledge and experience with students, you practice nursing at its finest. The next time you have the chance to work with nursing students, I hope you will embrace the opportunity and smile as you remind yourself,

“Nursing students…
you gotta love ’em.”
Linda Turchin, RN, MSN, is an assistant professor of nursing at Fairmont State College, Fairmont, WV, and a diabetes educator at Mon General Hospital, Morgantown, WV.