What overwhelms you the most? What did NS NOT prepare you for? - page 8

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... Read More

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    Quote from listener
    Imagine that you're playing softball (rookie), you're in center field and the batter pops up and it's your ball. What are you thinking about as it approaches? About the baserunner on 2nd and about how many outs there are already and where you should throw the ball once you catch it?? Hopefully so!! But if you aren't confident in your fielding skills the ONLY thing you're going to be thinking about is "I've got to catch this one!", or maybe "Oh my God, I'm gonna drop it!" And EVEN if you already know exactly what you should be thinking about in this softball scenario, if your mind is blinded by this insecurity in your own skills, it doesn't matter WHAT you actually know if you can't retrieve that information in the heat of the moment.

    That's my 2 cents on the importance of teaching the skills vs. "non-tangible" skills. This applies to any profession, it's human nature. Of course critical thinking and the science of nursing are the bottom line here, but if new nurses (obviously some more than others) have doubts about their skills, I can imagine that nursing education is going to get more bang for the buck by doing whatever it takes to get students comfortable with their basic skills.

    Once again, great thread. Luv this website!
    I love analogies. This is a good one. The most important lesson with this analogy is that "practice does not make perfect." If the center fielder throws to second base every time eventual speedy gonzales will burn him/her and take third base via tagging up. The correct play the caught fly ball goes to third base with pitcher backing up a poor throw. Perfect practice makes perfect.

    I am also from St Louis. I will start my clinicals Fall 2008. ( I am soooooo excited) I found this topic extremely interesting as to what I may need to extract from the next two years or try to extract as much as possible to help prepare me for post RN. Not focusing on the exam that gives you your RN title will be difficult for any student but I see the reasoning for those speaking in terms of experience learned being more important than book smart.

    As far as nursing not being ready for the real world work environment I am not sure how that could even be possible. RN's do or perform different jobs depending on their setting. Would a school nurse need the same structure as a ICU nurse? Would a dialysis RN need the same NS experiences as that or a RN that would work in LTC facility. I know that the core RN program is what it is, and the field that the RN decides to pursue will specialize and expand their experiences. On the job training is sort of expected by me. My ability to sink or swim does affect peoples lives but I hope to God that I or someone would discover gross incompetentcies during a 4-12 (or longer) week orientation depending on your chosen field.

    I have heard a couple of quotes comparing surgical MD's to RN's. This is not at all comparing apples and oranges. Would you expect a surgeon to learn on the job? I hope not. Thats why they go to school for 8 years instead of 2years pre-req's plus 2 year associates degree. Not to mention the huge internship required before they are a surgeon doing procedures on their own or the head of a team. They do learn on the job during these years preceding the internship. No Dr. leaves Med school and performs neuro surgery. This takes years of watching then assisting and then finally when residency is completed they get to become what they have specialized in.

    I hope do get out of NS skills that I need to progress as a RN. I hope to have an open mind to nursing politics. I wish to always be humble enough to ask anyone for help.

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    It is an unfortunate occurance but sometimes patients present with a complexity of sx that is very complex. Thats why doctors "practice" medicine. Or perhaps she is exhusted from the "problems", tired of the tests, Tired of trying to live. When you hurt and no one can stop it or explain it you get depressed. Perhaps you need to review the chart. Sometimes just sometimes we , nurses, the PATIENTS advocate, have to go toe to toe with the MD's just too open their eyes to something they might be missing - and chart, chart, chart (not your opinion) chart your observations, the patients actions, what she says - use quotes- anything. Some day that charting might make a big difference in her life because another MD may read your notes and figure it all out.

    Most of all keep on trucking and know that in some small way you can make a difference and do make a difference in the lives of evey patient you care for.
    Thanks for these thoughts. It really opened my eyes. I will start really reading those progress notes, and really charting some of my own, more than my one time a day "required" progress note. I wish I could have preceptors that would make me think this way .... But, alas, they do not.
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    Quote from mountainnurse
    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 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
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    Quote from cardiacRN2006
    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.
    Dragonnurse1 likes this.
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    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..........
    imanedrn likes this.
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    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.
    grace90 likes this.
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    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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