Are new grads receiving adequate preparation?

  1. I see more and more new grads who are totally underprepaired for the realities of the clinical floor. Many have never had more than 2 patients at a time and many have never performed common procedures such as suctioning. Additionally, they have often never been exposed to the complicated equipment crucial to providing care to the high acuity patients who are now the norm.
    Many new grads tell me that their program included role playing, seminars, and such activities as teaching kindergartners to wash their hands to meet mandatory clinical hours. Mandatory clinical hours should be just that- in a real-time clinical environment. Have any of you experienced this?
    I have also observed experienced nurses giving new grads less than helpful mentoring, taking a "I had to learn it the hard way, so can you." That is unfortunate since today's patients have higher acuity levels, nurses must perform more complex functions that in the past, and patient loads are unrealistic.
    Would appreciate some feedback on any of the above.
    Finally, I have observed clinical instructors who have bullied, brow-beaten, humiliated, and shown a general sadistic attitude toward their nursing students. I have seen students crying in the halls, exposed to humiliation in front of their peers, nursing staff, doctors, and patients. Having worked with some of these students, I have found that many of the more skilled are also the more compassionate but they drop out due to the lack of empathy on the part of instructors.
    I would appreciate any feedback on this.
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  2. 26 Comments

  3. by   laurab2jb2
    I am about to graduate from a BSN program (Dec. 20), and I am scared to death! I truly do not feel I have received the training to jump in there and start running. I hope I get a really good orientation and preceptor, as I know this can be the deciding factor on whether I stay in acute care, or go into Public Health where I won't have critically ill patients.

    After being in clinicals for the past 2 1/2 years, and watching the nurses working around me, I wonder what it is that I have learned. Sure, I can write a 20 page APA format paper about vent care, but can I do it? No! I've never gotten the chance. I know that it is not possible to learn everything you need to be an effective nurse while in school, so I hope I can learn through experience. This is where my preceptor and orientation will help or harm me. I hope it's the former.

    I know I'm not alone in this feeling. Most of my fellow classmates feel this way. It's the classmates that say they aren't scared that scare me. I would not want them caring for my loved ones - they don't ask enough questions! And, it's not a matter of what grades you receive on your tests. I carry a 3.9, but this means I am a good studier, not necessarily proficient at procedures. This will take practice - lots of it!

    I would say that I have to agree about starting on Med/Surg, much as I do not like it myself. During clinicals, it is where I was able to foley, start IV's, do sterile dressing changes, etc. - all the procedures needed to be able to do your job. But, getting to do this a few times does not make me feel as though I can just get in there and do it correctly right from the start, especially in a critical care unit!

    Sorry this is so long, but I guess you can feel my nervousness regarding this issue. Thanks for opening up the subject.
  4. by   neuroRN
    I think that it depends on the practice you get in nursing school and the preceptor you get in your first job. In clinicals I was lucky to get a LOT of great learning experiences, and I was glad. Then I started my first job this May and my preceptor was a new nurse (only 1 year out) herself! Thank goodness the hospital offered this "new grad" course every other week for twelve weeks to learn policies, share experiences, do mock cor zero's, etc. My only advice is to jump on every experience you get in nursing school, and then to hope that you get an experienced preceptor and a sufficient orientation because the first time its all you... it's a little overwhelming.
  5. by   GPatty
    I am a new LPN who has had no orientation to my job at all... I am "learning as I go" because one nurse has an attitude and I work by myself on the nights she has off. I don't like it, and I feel lost to a certain extent.
    Everyone has been kind and nice to me, so that's not an issue, but I don't think I have been well prepared at all to handle 60 patients on my own, as I have to do about 4 times a pay period.
    I would have GREATLY appreciated a better orientation to my job and the duties entailed in it. I do a good job at taking care of my patients and doing things for them, but the paperwork part still has me ina tizzy because I am trying to figure it all out on my own basically, and I am not the type to like to leave things undone for the next shift if I have time to do it myself. Just wish I knew HOW to do some of the things I am lacking.
    Schooling prepared me well, but "on the job" preparation is the one incredibly lacking for me.
  6. by   vashka25
    Wow, it is amazing to see how nursing training varies from state to state and similarily province to province up here in Canada. Currently during my training, you have classes 3 days a week and you are working (for free) on the hospital floors two days a week (8 hr days) starting first year....and we do 7 week rotations, which means every 7 weeks we change to a new unit (pedi, obs, emerg, surg, cardiac, tele, l&d, micu, psych, etc). While on the floor you do primary nursing for you patients (sometimes up to 4), which is all care, meds, tubes, specimen collection, injections, packings, charting, etc. (progressively taking on more responsibility over the years as you learn new skills in Lab) By the end of third year we have put in about 1100 hours on the floors, and do all care for our patients. For the last 4 months of classes (that will be Jan to end of April for me) of your thrid year you do "consolidation" which I am sure is similar to your "preceptorship"....in which you do two rotations of two hospital floors of your choosing (one specialty one general) of 325 hours each (basically 40 hrs a week for 7-8 weeks each) in which you are paired with an RN to hone all of your skills. During this time you have more mandates you have to meet, such as having 5 successful IV starts, etc. Once all of this is completed you can then write your boards and its off the world of employment!!!!!
    So I guess what I am trying to say is that I feel that I will be moderately prepared for work in the future. But I will far from know everything....that is what I love about nursing, is that it is a continual learning experience.
    And my two areas will be PACU and L&D/NICU/Peds

    Good luck to everyone in the future!!!!!
    I look forward to graduation in May !
    Last edit by vashka25 on Nov 26, '02
  7. by   Neon8
    I think the last year of my BSN program was a collosal waste of time. By the time I got to work, it had been two years since my last MedSurg rotation. No, I wasn't adequately prepared. The clinical skills were lacking. And who cares about nursing theory when it comes right down to it? I went to school to become prepared to do a job. I wouldn't reccommend the BSN program in my area to anyone. Get your RN first at a community college and then,if you still want to, go back for your BSN.
  8. by   2banurse
    Because I anticipate that the ADN program that I'll be applying to doesn't have a real strong clinical program and not wanting to go on a floor and feeling totally overwhelmed, I've decided to go for the LPN at the vocational school first. It is an 11 month program where you go to school every day from 8 - 3:30 and half of the 1350 hours are actual clinical hours. This way when I go into the ADN I can start with my head above the water and I'll also be able to work during the weekend as an LPN.

    For my ADN, the first semester they have only 2 5-hour clinicals a week, the second, they put it to 2-7 hours and the second year is a repeat of the 2-5 hours (fall) and 2-7 hours (spring). The idea of having a clinical on a Friday and then not having it again until the following Wednesday makes me wonder how much I will retain.

    So it'll take me a little longer to be an RN, but when I get there I plan on being as prepared clinically as possible.
  9. by   BrandyBSN
    So much of it depends on your program, and on your own personal drive. If you expect to just go sit in class, do the fewest number of clinical hours that you can do and pass without putting personal time into it, no, you wont be prepared. My senior year, i realized that I was not good with children. So, I volunteered for more hours, asked for extra work, and studied harder on every aspect of children. I felt much better, and ready to start working when I graduated. I still dont like to work with kids. but i know how to communicate with them much better than If I would have just done what was "required".

    You can't expect for classes and clinicals alone to teach you everything that you need to know to be a nurse. Thats 20% of it. They teach you how to be safe (atleast that is the goal), its your job to learn to be professionally worth your salt.

    When I graduated, yes, I was scared to death. I went straight to ER, and did more studying than I ever did in school. I had to show my co-workers that even though i was new, they could count on me. 6 months later, am I completely confortable? not all the time. but i know that i can do my job, handle the typical crisis, and be effective. My co-workers are there to help fill in gaps. they do that rather you are a new nurse, or a senior nurse who is just learning a new theory or technique. They teach me things, and I teach them things.

    No one fresh out of school should be 100% confident. That takes time. Lack of confidence and experience does not equate lack of adequate preparation. School teaches you HOW to learn. Your chosen field will dictate WHAT you learn.

    Just my opinion,
    BrandyBSN
  10. by   NurseAngie
    Originally posted by vashka25
    Wow, it is amazing to see how nursing training varies from state to state and similarily province to province up here in Canada.
    Good luck to everyone in the future!!!!!
    I look forward to graduation in May !
    Hi there,
    This is interesting because it sounds like your program is VERY similar to the hospital based diploma programs that are now becoming extinct here in America. (Ahh..the push to academics and some theory that having Art History 101 makes a better nurse....NOTE...I did not say it does not make a better educated person. I feel that all education is valuable in some aspect.) I am thinking you will be a well prepared !

    Best of luck,
    ~Angie
    Last edit by NurseAngie on Dec 11, '02
  11. by   NurseAngie
    Originally posted by Neon8
    I think the last year of my BSN program was a collosal waste of time. By the time I got to work, it had been two years since my last MedSurg rotation. No, I wasn't adequately prepared. The clinical skills were lacking. And who cares about nursing theory when it comes right down to it? I went to school to become prepared to do a job. I wouldn't reccommend the BSN program in my area to anyone. Get your RN first at a community college and then,if you still want to, go back for your BSN.
    Hi,
    I go to a community college and have been thinking I should have just moved to go to a BSN program...but after reading your post I am thinking that it wouldn't have mattered. I guess I need to keep READING my books and raising my hand at clinical! Ahh...nursing school.

    ~Angie
  12. by   NurseAngie
    Originally posted by 2banurse
    Because I anticipate that the ADN program that I'll be applying to doesn't have a real strong clinical program and not wanting to go on a floor and feeling totally overwhelmed, I've decided to go for the LPN at the vocational school first. It is an 11 month program where you go to school every day from 8 - 3:30 and half of the 1350 hours are actual clinical hours. This way when I go into the ADN I can start with my head above the water and I'll also be able to work during the weekend as an LPN.

    For my ADN, the first semester they have only 2 5-hour clinicals a week, the second, they put it to 2-7 hours and the second year is a repeat of the 2-5 hours (fall) and 2-7 hours (spring). The idea of having a clinical on a Friday and then not having it again until the following Wednesday makes me wonder how much I will retain.

    So it'll take me a little longer to be an RN, but when I get there I plan on being as prepared clinically as possible.
    Sounds like a plan to me. Best of luck and learn all you can!

    ~Angie
    Last edit by NurseAngie on Dec 11, '02
  13. by   jude11142
    I am an LPN and feel that I have gotten a good clinical education. Ofcourse, school can't prepare any of us for everything and as nurses we are always learning. But, during clinicals, we have had quite a few rn's tell us that we get alot of clinical time when compared to what time they spent at clinicals. I am grateful for the time I have spent in clinical, lol, though at the time I wasn't. Either way, it is very overwhelming when you begin as a "new graduate nurse"........Good luck in school. You will be fine.

    JUDE


    Originally posted by 2banurse
    Because I anticipate that the ADN program that I'll be applying to doesn't have a real strong clinical program and not wanting to go on a floor and feeling totally overwhelmed, I've decided to go for the LPN at the vocational school first. It is an 11 month program where you go to school every day from 8 - 3:30 and half of the 1350 hours are actual clinical hours. This way when I go into the ADN I can start with my head above the water and I'll also be able to work during the weekend as an LPN.

    For my ADN, the first semester they have only 2 5-hour clinicals a week, the second, they put it to 2-7 hours and the second year is a repeat of the 2-5 hours (fall) and 2-7 hours (spring). The idea of having a clinical on a Friday and then not having it again until the following Wednesday makes me wonder how much I will retain.

    So it'll take me a little longer to be an RN, but when I get there I plan on being as prepared clinically as possible.
  14. by   jessjoy
    I am in an ADN program and I think that my schooling has provided me with a good BASE for my nursing career. What I have found to be the most beneficial is working as a nurse intern. I take four patients and do everything a nurse does. This experience has made me feel SO much more comfortable about making the transition from student to nurse. Believe me, I am still scared to make that jump but now I know that I will be able to do it.

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