October 19, 2012 My clinical group was on their game in the busy Med/Surg. unit. The Safety Auditor (SA) arrived and made the student nurse (SN) assignments. Everyone was ready to take on a full three patient assignment. The SNs received report from the SJDC student nurses leaving the floor, read their patients charts, and made introductions to the primary nurses.The Med/Surg nurses were very happy to have SJDC SNs the entire shift for their high acuity patients. The SA and I quickly informed the SNs that they would only have two patients.
  
During the SA rounds, one SN was assigned to care for an inmate.  This mis-step was remedied with a soft reminder to the SN and SA that it is not appropriate to assign students to inmates. During clinical orientation, the SNs were made aware of two things that they could NOT do:
 1) may NOT care for inmates(SNs are vulnerable to this population and must be kept safe).
 2) may NOT do finger stick/glucometer without their primary nurse present.

The SNs assigned to the ICU/ED had a very different story. Low census in the ICU meant few opportunities for SN clinical experiences.The primary ICU nurse for one SN refused to have a SN. The ICU nurse stated that she was too busy to have a SN.  This nurse was reminded that she would be leaving at three o'clock, she then reconsidered having a SN. In the ED, the charge nurse was not thrilled about having SN and she told us so. As diplomatic as I could be, my request to leave the SNs in the ED was granted!
What a day! I am very proud of myself and my students. The time spent on the concept mapping and nursing care plans really paid off when it was time to document in the patients records. The students were able to use clinical reasoning skills based on information collected, formulated their plans for  care, and offered rationals for what they were doing and why! I learned that My students need to be protected and it is up to me to speak on their behalf... My2cents

Student Orientation to Clinical Site

October 18, 2012 Student nusre (SN) orientation to clinical site started at 1300 in the lobby at SJGH. It was my responsiblity to create a form and distribute hospital access badges for my 10 students. Once everyone received their assigned badges we proceeded to our reserved conference room which was conveniently located on the floor where our clinical experience would begin. After I welcomed the students to "Transition to Nursing Practice" which involves nursing leadership and management skill development, we discussed expectations for their clinical experience.  I gave a brief introduction about myself, then I discussed changes in the syllabus.  The students signed a student  agreement statement form that they were made aware of the changes to the syllabus.
 
We toured the Intensive Care Unit, Emergency Department, and Med/Surg units. Two students would be assigned to a primary nurse in the ICU and ED for each day of clinicals. Clinical area assignments were made with student input. One student, the Safety Auditor (SA) for each clinical day is expected to make student assignments and check in with each SN in the clinical areas. In order to give the SA a global perspective of nursing responsibilties as a leader, the SA/ charge nurse duties included a two hour shadowing with the nursing supervisor for the hospital. A math test was administered and I gave a one hour lecture on Data Action Response (DAR) charting with a SJGH policy review. A documentation activity was incorporated in the lecture that engaged the students in care planning. They were encouraged to use concept mapping tool to formulate a plan of care, clinical reasoning skill development. The SNs were oriented to IV pump and each SN practiced how to use it.

  My experience for the orientation to clinical area was exciting and exhausting! I had an agenda with scheduled breaks and we finished the day on-time, 2100! The last minute syllabus changes, conference room reservation/confirmation, and post-conference lecture preparations was stressful.  Flexibility and a sense of urgency got me through the day, successfully. The students were eager to hear my expectations and they were patient with me. I look forward to the interaction with my students in the clinical environment... My2cents