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

Nurses New Nurse

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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?:banghead:), 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 :no:)?

Specializes in Med/Surg, ICU, ER, Peds ER-CPEN.
For example, we would do our pre-planning the day before clinicals, writing 30+ page care plans with pathophysiology of each co-morbidity down to the cellular level, nursing diagnoses with interventions and rationales, serial labs and descriptions of the abnormal values, med tables with action, rationale, side effects, contraindications, interventions and administration guidelines, and different variations depending on the area (med-surg, critical care, peds, etc). We would generally take 2 patients, except in critical care where we took only one patient (and had longer care plans). These care plans took about 16 hours to complete. This all helped immensely to put together the big picture and see how all the comorbidities affected the patient and their treatment,

Now tack on the following disclaimer - "You will not learn EVERYTHING as it is impossible for us to teach you everything because we your instructors do NOT know everything, what you will learn is the foundation to be a safe competent new RN that won't kill someone" (one of my instructors actually has said this, several times lol) I think alot of students come in with way to high of expectations that they will graduate, take NCLEX and *poof* instant nurse! I graduate June 16th. During my clinical rotations I couldn't actually I wouldn't allow myself to think about all the stuff I didn't know or hadn't done yet or I'd be one big blubbering freaked out neurotic mess because let's face it, in 2 years you can not possibly learn as much as the floor nurse you are assigned to that has been working the floor for 20+ years, I'll admit that I was terrified for a week between recieving my preceptor assignment and actually starting practicum in the ICU (we didn't have critical care rotations so this was unchartered waters for me), yet around my 3rd day I had my :idea: moment where I realized I really did know what to do, I could do this and wow this is what nursing is all about! It turned out to be the best 128 hrs of clinical experience ever, my preceptor along with the entire unit treated me as one of them, not "the student" and at the end I felt like a part of the unit and was even offered a position (I'll work critical care someday but I think some med/surg time would REALLY benefit me as time management of 2 critical pts is nothing like time management of 6+) I can't wait to get out on the floor and learn more, but I have confidence now that my program has properly prepared me to start the real world learning process. Hope I made sense because my brain cells are moving faster than my fingers can type :lol2:

Specializes in ortho/neuro/general surgery.

I had a student last week. She was so focused on charting the Q1 VS. Great. Thank you. But did you notice that the pressure is now 80? Chart later, let's do something now!

Students that I see in clincal rotation are so focused on skills that they miss some really good stuff.

I precepted a student for 4 hours several months ago on the tele floor. She kept telling me her main goal was to learn and practice the charting. Whatever. We had a pt get dyspneic and go into CHF, then our 2 other patients also had issues pop up as well. We only had 3 patients, but I was literally running back and forth between rooms. Was she glad she got to see anything? No, she was just disappointed she didn't get to work on computer charting. And get this, so was her instructor! If it was so important for her to learn to chart, then she should set aside a day to learn it. I didn't have time to teach her.

Specializes in geriatrics,wound care,hospice.

Interesting thread.... As ya can tell by my name, I was a new grad in 1981. Lots and LOTS has changed in nursing and my field-geriatrics-since then, but essentially a few things have remained the same, albiet under different names, ie "Critical Thinking Skills", used to be "having your ducks in a row". Very important then and now. When the MD says to you"What do you/pt/family think you want me to do?", you are somewhat prepared to advocate for your pt. the best possible course (or NOT) of treatment based on what you've assembled on your assignment sheet. Which leads to my second point of DOCUMENTATION. The old rules of "if you didn't chart it, you didn't do it" remains a valid legal point. BUT, in working with students and new grads, our facility came across a small oddity: these folks were not being taught how to chart! Coming up in an techhie world these days, they were pretty much told-use the checklists on the EMR, NOBODY handwrites anything anymore, do whatever your facility does, etc. Consequently, when I sat a student down to chart on her one pt. for that day, she lost it-red face, tears-I felt terrible! She had no concept of a SOAP note(old timey I know,but good place to start), charting to numbered care plan problems-"You have careplans here?". I asked her to assemble a verbal report to me on her pt. That wound up being kinda scattered all over-"her ears are clear to auscultation, she walked to the dining room, liked her red sweater. I think her daughter called, she went to the bathroom about 3-4 times." Soooo, pulling together the critical ducks-what is the important things about this gal, and assembling them in a readable, relevant fashion that conveys information important to caregivers-a few lines, paragraph, coherent report to next shift are just 2 of the areas I have found where new grads are lacking. Skills, schmills-if you can't tell me how it was tolerated, what you noticed along the way, did it relieve any thing, then it doesn't matter how perfectly it was performed if you can't get it into the record. Thanks for letting me share..........

I am two months into my new grad orientation and some days are better than others, but some days I pretty much feel like I want to cry and that I have been run over by a truck. Overall, my nursing program was good but I had a rude awakening when it came to giving report, calling M.D.'s (and how to phrase things to them so they won't rip you a new one), and time management skills. The best nursing school in the world can only prepare you so much, I think the rest comes with experience and patience.

I find this really interesting because I'm a final year student in Australia and it seems like we do things a little differently. For a start on our clinical placements we work full shifts this includes handover (report) both at the start and the end of the shift. We are then "buddied" to a nurse and take on patients under supervision according to our skill level/goals/objective of learning. For instance as a final year I will take on a full patient load on a general med/surg ward. Now we don't have aides or anything so as an RN you do total care for your patient load.

I will do everything I can for these patients within my scope, this includes, washes, showers, medication IV fluid administration under supervision, venepuncture (but not cannulation), wound dressings, writing progress notes (charting which is by hand here) which are then countersigned by the RN, and giving handover (report) to the next shift with my "buddy nurse" there to prompt me on things I forget. I also page the doctors (with my "buddy nurse's" ok) about patients, speak on the phone to docs when they call back, page/speak to allied health and look up path results etc. I am not assigned patients until after the start of shift handover - so I listen to the report on each patient as if they were my patient - just the same as if I were an RN. This means I start at 7am or finish at 10pm or whatever the shift requires - after all I will be doing this as a job next year.

This is a gradual process, on my first clinical placement I might have only taken on one patient - this gave me time to look up their history and work out the whole picture, plus it meant i only had to give handover on one patient - then you work your way up. Now I get report and I know what a lot of the medical conditions are and the implications for nursing. Sometimes i don't - for sure, even as an RN I expect to keep learning but then I have a quick look at the patient file when i have time. The same way an RN would have to.

I think this is in recognition of the complex nursing role - that talking to doctors, giving report etc is all part of it and needs to be learnt. Time management especially is an important skill and one we're taught during clinicals. If we can't manage a full patient load by the end of the course then we'd fail - off course that's not as scary as it sounds but it's about making use of time and resources.

Anyway we don't really get to go into specialised areas in our clinicals like ICU - because here in Oz you need postgrad study to work in ICU. But it does mean we come out pretty competent in the general workings of the ward environment.

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