What overwhelms you the most? What did NS NOT prepare you for?

BeenThereDoneThat74, MSN, RN · May 11, 2008

Many schools don't teach students how to function WITHOUT such extensive pre-planning or without knowing a patient's full history and course of illness to present.

I went to the school where I teach. When I was a student, we got our assigment the day before, and had tome to look up the meds and the disease process. We did not have to have a CP ready, but needed to at least know what the Dx meant and know the meds.

Somewhere along the line, they stopped doing this. Now the student goes in cold, more like real life. They still need to know their meds before they pass them. Personally, I will let things slide about the meds, and will tell them, "let's give it, then come back to me with the answer when we're done". Not all the time, depends on the med and what the issue is. And they do need to figure out what the Dx means. At this point, a good # of them carry a PDA, and some still have the old'fashioned med dicionaries with them. This is real life. After 13 yrs of nursing, I do not know every med or disease, so I have to look things up as I go along.

Just curious Joy: are you still a student?

Morettia2, BSN, RN · May 11, 2008

That's does sound pretty insane -- esp. to be called at home for the rate of NS! Wha??? Is there some intervention that mgmt or charges can take in these situations? It just sounds... weird.
As I said, I've had to adapt to different nurses' reporting style / some days being more difficult than others, but if you're dealing with this on a regular basis, then it sounds like a problem that needs some fixing.
Good luck!

yea tell me about it

Educator1234 · May 12, 2008

Educators must stop minimizing the importance of "skills"! Yes.. you need to prioritize assessment-critical thinking skills, but this minimization has lowered the standards of nursing practice. I see it every day as a hopsital orientation coordinator. We spend countless hours training nurses " skills". I am not refering to hospital specific equipment either...

In the current hospital environment struggling with multi-drug resistant diseases, medication errors and sophisticated equipment nurses need to have at least basic skill preparation out of nursing school. You would not hear of a surgeon learning his "skills" later!!! It is important to patient safety and to the profession.

oldiebutgoodie, RN · May 12, 2008

Educators must stop minimizing the importance of "skills"! Yes.. you need to prioritize assessment-critical thinking skills, but this minimization has lowered the standards of nursing practice. I see it every day as a hopsital orientation coordinator. We spend countless hours training nurses " skills". I am not refering to hospital specific equipment either...
In the current hospital environment struggling with multi-drug resistant diseases, medication errors and sophisticated equipment nurses need to have at least basic skill preparation out of nursing school. You would not hear of a surgeon learning his "skills" later!!! It is important to patient safety and to the profession.

Oh, thank goodness! The voice of reason! It seems that only you, Educator1234, and jjjoy agree with me on the importance of skills. I am quite distressed that everyone else on this thread thinks that skills are something a monkey can be trained to do.

Learning skills actually has a theoretical basis. I'm sure you are familiar with Maslow's Hierarchy of needs? Well, I think that new nurses also have a similar hierarchy, starting with learning the "ways of the hospital", and skills, and progressing to critical thinking and the "big picture".

Pat Benner also explored these issures in her "Novice to Expert" research. New nurses tend to progress through phases, beginning with anxiety over skills and progressing eventually to a more developed sense of the big picture.

Bandura's Self-Efficacy theory also touches on this.

"The most effective way of creating a strong sense of efficacy is through mastery experiences. Successes build a robust belief in one's personal efficacy. Failures undermine it, especially if failures occur before a sense of efficacy is firmly established."

(from http://www.des.emory.edu/mfp/BanEncy.html)

And in the realm of common sense, haven't you heard of the saying, "You have to walk before you can run"?

Medical schools teach skills, why don't nursing schools? I am a wound and ostomy nurse, and have had some students lately who are pitifully grateful that I let them change some dressings and change ostomy pouches. While learning these skills, however, we are also discussing assessment and theory behind the wound, reason for the ostomy, etc. A recent student (who would be graduating in a few weeks) did not know how to do a moist saline gauze dressing in a patient.

The students who come to our hospital stand around and read the chart ad nauseum. They are so grateful for some real life practice.

This is not to say that nursing schools create task-oriented drones. Obviously, critical thinking is an important and essential skill. But it seems like nursing school concentrates on 95% critical thinking, 5% skills. Nursing education has lost its way. But by teaching more skills, we can accelerate the student's progress through the novice phase, as well as increase their confidence level.

If you read the new grad forums here long enough, you will see the level of anxiety of new grads, much of it related to their lack of skills and experience with patients. Many hospitals experience retention problems with their new grads. WAKE UP, EDUCATORS!

And in terms of full disclosure, I am 54, went to nursing school at a highly regarded BSN program when I was 49, and was pretty clueless when I got out. I am now in an MSN program, and plan on helping my students acquire some skills when I begin to teach.

Oldiebutgoodie

lorbal · May 12, 2008

Hi new grads!! I am trying to gather some real life information to bring back to my clinical students. I don't want this to be a bashing thread about your instructors (because it's never OUR fault...ha ha ha ), but rather a reflective thing.
The reason I pose this question is this: My students (as many others before them) think that nursing school (and nursing thereafter) is all about skills!! If I had a dollar for every student that has complained that they have not inserted a foley, or are nervous about it, I'd be a millionaire!! Our graduating class did a survey (for a research project) and the most popular answer for "what skill do you feel most unprepared for as a new nurse" was that!! This beat 'taking care of a vent patient' :uhoh21:. Meanwhile my students (while very good this semester... 2nd semster) still at times could not give me a nursing diagnosis, tell me why patients were on a baby aspirin (pain?), where the MD orders are in the chart (or why we need to check MD orders to the MAR, not MAR to their cheat sheets) or other "non-tangible" skills.
I know skills are important. But as time goes on, you get these skills. I tell them a monkey can insert a foley and set up an IV. I also told them that I would never fail someone who did not perform a skill correctly (ie break sterility during a foley). Maybe it's just me, but the other things are more important, like how to assess, problem solve, prioritize, communicate, and most of all apply the theoretical knowledge into clinical practice. I tell them there is a reason they sit there in lecture.
So basically, I wanted to know: has anyone ever been thrown off orientation because they didn't remember how to perform a basic skill, or made a mistake with it? What gets you caught up as a new grad? And what can I tell my students (I have a feeling that nothing I say will help )?

Communication with other nurses, doctors, unit coordinators, supervisors is a key element in being a good nurse. If at any time you are unsure of something, you should be confident to go to someone with more experience an ask for help. Although so much has been taught to us in NS, being on the job is another learning experience. I feel asking fellow employees what they have learned thru experience is a major benefit to being a good nurse. I have gathered so much knowledge from not being afraid to ask. New students need to be open-minded and be willing to ask and accept experienced nurses knowledge of the nursing world.

marilynmom, LPN, NP · May 12, 2008

Gosh, after reading this thread I am extremely grateful for my BSN program making us go to clinicals 3Xs a week for senior year and pushed classes on us hard as well---and then to have to do research project and all the other BSN things on top of that! I hated it at the time, but now I'm grateful as a new grad in ICU.

I can honestly say I have done most basic nursing skills more than once when I was a student. I still have a lot to learn (but don't we all?) but I do feel that the basics I have under my belt--I do feel that I at least came out of nursing school with a basic foundation of skills and theory.

As a student I was able to started multiple IVs, put patient on continuous dialysis in ICU, assessed them, discharged, admits, teaching, tons of meds (po, IVpush, drips, etc), removed sheaths, Foleys and straight caths, assisted dr's with procedures, given report, worked with PICC and central lines, art lines, labs, sterile dressing changes, changed ostomy bag, most of the hospitals I have done clinicals at have a wound care nurse so I have never really done much wound care except basic care and would vacs, ETT tubes (sxn and extubation), chest tubes, dropped ng tubes, bubble echo on heart patients, pre-op stuff,and of course the basic basics like bed baths, changed sheets with patient in bed, etc, etc, etc.

I know a lot of the problems I have run into during clinicals is the RNs themselves....some won't let a student touch their patient! I have had some clinical days that were totally and completely wasteful because the RNs don't trust the students enough to let the students do anything! Some of the smaller hospitals also have way to many students.

In my program we went up to the hospital the night before to get a patient and do all their paperwork (look up meds, pathophys, read charts, etc) during junior year, but during our senior year we just went to the hospital that morning, were assigned a patient from charge nurse and got report from the offgoing RN and started our day and had to look up meds as we were giving them so that was much more like real life! I was slow with my 4 tele patients but at least I was safe.

nurseneek · May 12, 2008

I dont know if this helps but i remember my last clinical experience was on an HIV unit. The charge nurse was giving us our assignments and it was during a shift change and some of the nurses were doing their charting. So i got my patient assignment and i walked over to one of the nurses and asked her if i could sit and look at what she was doing. And she turned around and told me the best thing you can do for yourself is arrive at work if you can and i stress if you can arrive at work atleast an hour or 30 mins before shift change because you can familiarize yourself with your patient and see what the nurse before you did or did not do saving yourself time and helping your to prioritze. Prioritizing was my biggest issue until i got that advice so i hope this helps. I attach something from my everyday life like for example feeding the kids paying your bills on time they have to be dont right so i know i have to be at work before the previous shift is over, and though it might not be convenient for some i look at it as being a safety issue. I walk arond talk to my patients assess them before my shift starts and i find it takes a load off of my shoulders so i try and pass this on to everyone i know. Some call it good work ethics i call it taking care of my patient before taking care of my patients . :yeah: :yeah:

Heather56 · May 12, 2008

Managing my time was the most difficult thing for me. No amount of school training can prepare you for all the things that crop up during a shift.

One thing I took from my training was med checks. With frequent news artlicles about med errors it's taking the time to go threw the checks that make the difference between an error and an almost error.

Furwillfly · May 13, 2008

I would personally have to say that nursing school didn't prepare me for the emotional/mental aspect of nursing. I went from being a CNA for over 15 years to an RN, where you go from physical to mental stressors. The stress about doing and being a great nurse consumed me so to the point that I lost 'me'. May not make sense to others, but I don't think I'm the only one that had to have gone through that. My advice is to teach the students to take care of themselves in knowing that they are human and will learn. Some nurses are book smart, some are skills smart, some are leadership smart........we are all a part of a TEAM. Use your team! Early in nursing careers is a fragile time. Be good to yourself, don't degrade yourself. We have all made mistakes, some just don't admit them. We as nurses are nuturers, we need to remember ourselves!

I'm not a 'cut-throat' person, but some of the nurses I worked with were. And it almost cost me my very life. I was 'tested' by other nurses. At the time it made me feel like a failure, I wish I had known then, it was to make me a better nurse.

Be very careful not to fall into the 'escape' methods of the medical field.

Dragonnurse1, ASN, RN · May 13, 2008

ok - I had to give up reading the other posts my nursing school would flunk you for failing both areas. If we could not assess the patient and follow procedure (do the skills required according to the patients condition) then we got a critical zero. 2 zeros and you were out of NURSING period no second chances. Our passing rate was 100 percent for 7 years straight. A degree from our school could get you a job anywhere in the US. There is no seperating the two. I spent 9+ years in the ER and would still be there if not for latex. I worked with new grads that were not capable of caring for patients after 1 year in the ER. It takes both abilities. Skills don't always "come" for new grads without any experience in school. :uhoh3:

Did someone say something about not worring about breaking sterile field for foley? Is there some reason that the patient is not deserving of maintaining such a field, are they a true trauma, or are they in severe CHF, the nurse must assess the condition and respond with the correct treatment and in the CHF patient that means inserting foley while pt is only reclined not flat. I do not know of any monkey that can pass such a foley sterile or not. :banghead: Critical thinking and critial skills go hand in hand. Sorry guys but school should provide BOTH.

LadyTiger44 · May 14, 2008

I am also a new grad and mastering skills has held high anxiety for me. I thought the school I went to was great, but there are basic skills that I have not done. I start my new job on the 27th, and I am hoping I will be able to master these fairly easily. My last semester of clinicals I thought I learned more than I ever had. The first half of it we just had our one patient, and had to do our care plans etc. But the second half we had three twelve hours when we were paired with a nurse, and it was kind of like a job shadow. We also scheduled three other tweleve hour job shadows any where else we wanted to go. Until this last semester I had never even attempted to start an IV. I got to, and another student also let me practice on her. But I also graduated without ever starting a catheter, which is VERY basic! Our whole last semester we passed meds, did assessments, wrote nurses notes, hung IV meds, etc. But these basic skills of starting IVs, starting catheters, doing blood draws, are the things that worries me about starting my new job. I think these skills should be the ones most focused on in clinicals.

jjjoy, LPN · May 14, 2008

Just curious Joy: are you still a student?

Nope. I graduated some time ago, a two year jr-sr year RN-BSN program that seemed more focused on training us to pass the NCLEX, emphasizing that nursing was profession and not just a job, that nursing required "critical thinking" and not just "rote memorization" and encouraging us to look into advanced practice, nursing research, etc ... as opposed to training us to function as full-fledged RNs at the bedside right out of school. They definitely had the philosophy that hospitals should provide comprehensive new grad programs and we would learn skills on-the-job in no time.

Though I'm not a student anymore, I'm very interested in education in general and nursing education specifically, since I was quite dissatisfied with how the program was run. From what I've heard from others, my experience wasn't unique to my school.