Although nursing students are usually of some help to their preceptor, they can be a significant factor In increasing the workload and responsibility of the RN.  Depending on whether or not they are doing their consolidation, student nurses are not solely self reliant, have limited autonomy, and need their work supervised and signed off by their buddied RN.  Therefore, they should not, and cannot be counted as licensed staff. 

I agree with Jo. 

And quite frankly, this has been the norm for nursing education since the time of Florence.  Hospitals can't count students as staff, but they rely on them to avoid improving staffing for both nurses and CNAs.

Thank you both Ms. Gomez and Ms. Crittenden. I would like to ask Ms.Gomez: 'What is the role of the preceptor in your country?' Thanks again.

hello dears

its depended to the ward and level of student

all things said is about intensive wards or low or initiate semester student

in iran student work as a staff about 5-up semester

but in in intensive wards no its possible

The students are not counted in numbers where I come from. They are in the unit to learn and be trained. The nurse who's mentoring the student has extra responsibility in mentoring the student. The Mentor is responsible on student's action and  the student (has no PIN registration) would only be partially held responsible in case of a litigation. the students need to be observed and supervised during their placement and obviously that is an extra work for the RN mentoring.

It depends on what you mean by preceptor.

In most American community colleges, precepted learning experiences are not the norm.  An instructor accompanies the student to clinic.  If the student is in a care environment without an instructor, it is usually an observational experience only (not precepted, the student does no care).  The clinical contract usually requires an instructor on the unit to supervise students directly.

In University or four year College BSN programs, precepted experiences are common.  The school has a clinical contract with the hospital to provide preceptors who supervise the student (who is usually unlicensed) and guide their learning experiences.  In lower level courses, who the preceptor is may change from day to day.  In capstone or practicum courses the student often follows the work schedule of the preceptor.

For new graduates, the hospital usually assigns them a mentor (preceptor); the grad will follow their preceptor's work schedule during their six week orientation before taking patients independently.  These preceptors may or may not want this responsibility.  Some hospitals require additional training to be a preceptor, and pay the preceptor extra.  In my experience, that produces the best experience for the new grad because the preceptor is doing the job because they want to, rather than because they have to.  Some people just aren't cut out to be preceptors.

I'm very fortunate in that the unit I always use for clinic has developed a good relationship with me over the years.  I require a high standard of my students, and so they give the staff a lot of help.  As a result, the staff are VERY student friendly, and provide awesome learning experiences for the students.

Thanks to Mr. Hojat and Ms. Briazu for the information. I also thank Ms. Crittenden for the explanation regarding preceptorship.  It would be of interest knowing what the additional training program of a preceptor consists of.  Thank you.

It's been awhile since I had that training.  As I recall, it involved goal setting, learning to supervise, learning how to give constructive feedback, and familiarizing myself with the checkoffs new grads were expected to complete as part of their orientation.

It was not very involved training, IIRC.

Thanks Prof. Crittenden.  Any more information would be appreciated.

In my 7 years of nursing education and 32 years in practice, most in leadership positions, I have found that a lot depends on the students and the attitude of the nursing staff.  I have never counted the students as staff.  However, when I worked at one large facility, the manager decreased the staff by one person the days we had students.  I was a clinical nurse specialist at the time.  It seemed to work out.  In this same facility, however, they did not include a new nurse as part of the staff until functioning independently.  I have seen the same in all my positions, that new nurses are not counted until they are fully functional.  I have always worked critical care and this would usually be 3-6 months.

Unfortunately the presence of nursing students increase the workload of the staff.  Clinical supervision and guidance is undoubtedly necessary but let's deal with reality, whilst it is essential for the student to learn how to apply knowledge, acquire  skills and demonstrate the most appropriate attitude, it does take time.

It is important for students not to be counted as a part of the workforce, but in some organizations this does happen, although 'they' would never straight out admit it when questioned.

I don't believe students should be included in staffing numbers, simply because they are there to learn.  When students are in their final year, I believe they should be managing a full patient load with the RN supervising and providing guidance.  Having a student with you does increase your workload significantly but it is part of our nursing registration that we be a part of student education.  So, whilst they are supernumerary, we make them feel as part of the team as much as possible and encourage them to do as much as they can.  The facility I did my first placement at as a first year student, decreased staff numbers when students were present.  All this did was increase the workload of the remaining staff.  They not only had a LOT of work to do in the aged care facility, but they had to teach nursing students who had nil nursing experience.  It was not fair on them at all!

Just my opinion, but in todays modern technological society, it is quite possible (through RFID, Nearfield sensors, and WiFi) to exhaustively enumerate every single pair of hands and every single set of feet that touch anything or walk into or out of any given patient care delivery area.

With that in mind, and understanding that the ability to passively monitor, record, and time every meaningful healthcare delivery transaction is not ubiquitous just yet, questions such as the one posed as to whether student nurses should be counted as staff or not, are very good ones that could serve as a research question.

If an appropriate and meaningful clinical outcome metric, such as the number of injury falls per thousand patient days per week, or number of pressure sores not present on admission, or number of adverse event medication errors, etc. , were set as the Dependent Variable, and count of and type of staff (or non-staff) were included in the model as Independent Predictor Variables, and other confounding variables such as hospital and patient demographics were controlled and risk adjusted for, then perhaps an answer to that question could be translated from opinions into actionable insight leading to targeted intervention (more student nurses or less student nurses?).

Until then, we all have our various opinions, and nursing informatics science has a research question that is in need of a PI and research team to investigate and report upon. It is a good question in search of many convoluted answers that may discover many more issues that in their turn would lead to more good questions.

i just finished my clinical rotation. We were six of us and though not counted as part of workforce, we definitely did much to ease the workload of those with whom we worked. The more we were able to do in patient care the more time we would get to discuss nursing issues with our 'guides'. Not being counted as part of workforce, i feel is important to help regular nurses guide student nurses without much workload pressure. Reducing workforce in such times may actually increase nurses workload and be counterproductive.

I am not sure when students shifted from being a blessing to have on the ward to being a burden. Rather than discussing if they should be supernumerary or not (which of course they should), we should be discussing how to make them a valuable part of our nursing teams, acknowledging the help they give us, and working to provide them with the valuable experience they need to join our nursing workforce.

In Norway we have had this discussions as well - and in our system, nursing students are not allowed to be counted as personell/workforce at the wards. I support Wendy Blair's reflections in this. In addtion, I think we should pay attention to theories and research regarding Clinical Teaching and Learning in general and in  Clinical Learning Environment in particular. Btw - I am busy in research in this topics  Kind regards Karin Berntsen, Norway

To properly mentor, supervise, and instruct students takes time.  The students need enough assistance to make their experiences valuable, and that requires time from the staff and clinical instructors.  Students, especially novice students, need a great deal of attention to provide safe care.  They should not be counted as staff.

Amy explained the role of a preceptor precisely. As well, as Susan mentioned some unit managers do take advantage of the increased bodies and lower the staffing count to reduce their budgets, but there are just accidents waiting to happen in doing so. 

When I was a student nurse and even a new instructor, student nurses were the majority of the  staff.  I supervised 26 senior students in an inner city hospital that only had 2 RNs working the evening shift at the time.  Thank goodness those times have changed.  However, there is still some residual desire to pull current students into  staffing numbers.  

Students are not employees of the hospital.  They are not hospital staff and should not be counted as staff.   Hopefully the assistance students do provide to patient care compensates some for the time employed RNs spend with them.   The old days of students seen as staff in hospitals need to be gone.

Student nurses quite often get counted in the staffing numbers, even though they are supposed to be supernumerary, but no organisation would admit this.

I think it is the institution's policy that should be followed. It is not about how much workload they can do, but if the hospital policy says that they should not be counted in the staffing plan, then that should be complied upon. As JCI would always ask, "what does your policy say?" Hence, it depends on what our institution where we work have to say in the policies. Good day.

Learners need to focus on their learning. Just like staff orientees are not counted. All hands accomplish tasks that help the workload. Students should begin to feel a part of the multidisciplinary team as they advance to the level of doing most of the care of the patient.

i think students are there to learn so they need to be given that opportunity, they are not yet qualified as result they should not be counted as a working force, 

Students should not be counted with nurse staffing! If they are, then they should be paid!  Students' goals are learning with the instructor having the decision about sending to students off the unit for any valuable learning experiences or calling a conference, etc. I repeat, students are there to learn not provide staffing with the instructor retaining the discretion for selecting additional learning experiences as needed within the clinical hours. 

I think students should maintain their supernumerary status to enable them to utilise learning opportunities within the workplace. However they should also be considered to be a valuable member of the workforce to help them to learn to work within a team.

I strongly believe that students should always be supernumerary- for the optimum learning opportunities, for them to have adequate experience in their role but also to ensure sufficient supervision and support from qualified staff. In my experience, patient safety is at risk when students are not properly supported or supervised.

Furthermore, when students are supernumerary they can a) take the lead in patient care and manage a caseload/several patients with proper support; b) experience or observe things they would not be able to if they were counted in the numbers (for example, observing a resus call or observing in theatres).

In my opinion, students practice under supervising of  RNs.  RN have to look after the patients and also closely  supervise students. Students should not be counted with nurse staffing

I agree with those who have expressed the view that the supernumerary status enables students to learn and utilize facilities made possible by the staff supervisors. In that role they are not supposed to receive salaries, but though they do not count for staff strength and can not be used to calculate the staff: patient ration, they can add quality to patient care and services.