Why nurses are the best teachers for medical students

It was 5:30 a.m., and I could barely contain my excitement. I was almost done with my clinical rotations.

I had worked tirelessly to improve my medical knowledge and spent hours mastering my clinical skills. Now, as I was nearing the end of my third year of medical school, I felt more than ready for what lay ahead.

I walked into my patient’s room. As she slept, I examined the lines and tubes hooked up to her body. But today, something was off.

Her Foley bag, which was collecting urine from the catheter in her bladder, was empty. It wasn’t that way before. And when I checked to see if the bag had recently been changed, I found that it hadn’t.

My heart leaped into my throat. At this stage in my training, I knew poor urine output was never a good sign.

Not knowing what to do, I ran to my patient’s nurse. She smiled and assured me that the Foley catheter was simply kinked, blocking urine from emptying into the bag. All we had to do, she said, was to just re-insert the Foley. Problem solved.

As we walked back to my patient’s room together, I replayed her instructions in my head. Sure, just re-insert the Foley. I can totally do that!

But the truth was that I had only done this once before.

My heart raced, and my palms grew sweaty. I was about to be a fourth-year medical student, and this was such a fundamental medical procedure.

How could I be so inexperienced?

In 1998, the American Association of Medical Colleges (AAMC) targeted eight procedures that each medical student is expected to know upon graduation, including drawing blood, placing IVs and managing urinary catheters. Unfortunately, many medical students are falling short of this goal.

Multiple studies have shown that medical students feel uncomfortable performing these core procedures, like this one, this one or this one. For example, one medical school found that 61 percent of its senior students did not feel confident managing urinary catheters.

These clinical gaps in soon-to-be-doctors are concerning. Proficiency in these skills is linked to better clinical outcomes and cost-savings in the hospital setting.

Becoming adept at procedures requires practice. As it stands, medical students don’t get enough opportunities to hone their skills. In fact, only one-fourth of senior medical students has ever placed an IV.

The competing demands of physician instructors often prevent them from providing the hands-on procedural training that medical students need. Fortunately, there is a solution to this problem.

Nurses are underutilized in the clinical education of medical students. Among their many skills, they are experts in clinical assessment, patient communication and providing holistic care.

Nurses are also experienced at both performing and teaching many fundamental procedures. They could be a valuable resource for medical students who need training in these areas.

Additionally, nurses can help medical students handle challenging situations. They can provide useful information that can make delivering bad news or working with complex patients more manageable. After all, they often spend the most time with patients and their families.

Medical schools would be wise to recognize what nurses can bring to the table when it comes to medical education. Students would benefit from more formal instruction by nurses. A nursing clinical rotation, in fact, could be the very solution that medical students need.

I approached my patient’s bedside and stared blankly at her urinary catheter. I simply had no idea what to do.

Sensing my uneasiness, my patient’s nurse offered to walk me through the procedure, step-by-step. Along the way, she answered my many questions.

As we untangled and re-inserted the catheter, a flash of urine emptied into the Foley bag. Feeling accomplished, I pumped my fist into the air in triumph.

Realizing that there were other people in the room, I embarrassingly looked over at my teacher. She was beaming. “You did it,” she smiled.

I imagine that there is a lot more I could have learned from her.

Vinay Rao and Kunal Sindhu are medical students.

Image credit: Shutterstock.com

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