[Megsd]

I can definitely understand the OP's frustration with new grad orientation. I feel I have, in general, been fortunate with my orientation experience, but I have seen glimpses of the flaws the OP points out.

I am doing an internship where I rotate between 4 different units over 3 months or so. My first rotation went smoothly -- one preceptor every night. My second was a different story. Long story short, the unit was supposed to move to a larger space, and hired extra staff in anticipation. The week before the move, admin decided not to move the unit for another 6 months, leaving them incredibly overstaffed. Staff could choose to permanently float to one unit for 6 weeks at a time, or get floated regularly (once every 3rd shift or so). My preceptor chose the latter.

So I had the option to A) float with my preceptor constantly, or B) stay on the unit and work with different people every day. I chose option B at first, thinking "well if I want to work on this unit, I want to actually be here." But I quickly grew frustrated (my first day there I was told my preceptor wasn't scheduled to work, then found out she had floated, so they stuck me with another nurse who got floated at the last minute, so they stuck me with a third nurse who ended up getting floated 8 hours later). Every time I worked with a different person, I had to reexplain what I could/couldn't do, what I did/didn't know. I had not been checked off to do in-line suction as a nurse yet but my temp. preceptor thought I had and told me to suction and before I could say anything, left the room (and left the floor). I ended up finding another nurse to help me with the suctioning.

I got sick of that and felt I would learn more, in general, by sticking with my original preceptor, wherever she happened to be. I think of the 12 shifts I was scheduled to be on the unit, I was there about 5 days. But I did get floated to a variety of med-surg units I would not otherwise have visited, and did a few things I may not have done elsewhere. And I was working with someone who knew me, what I was capable of, and was able to help me progress, rather than starting from square one every day.

Whew, what a novel. Anyway, I totally understand the frustration with the rotating preceptor game. It's really difficult to learn when you're put with different people who may not want to orient you, and don't have any idea where you are in the orientation process. My one recommendation is pretty common sense, in my opinion. Pick a preceptor for an orientee, and schedule the orientee to work on all the days that preceptor is scheduled to work. That way, unless the preceptor calls off or takes PTO, they will always be paired together, and consistency can become a more concrete possibility.

[elkpark]

Originally Posted by llg

About closing bad programs. Have you tried to actually do that elkpark? It's not easy in any state -- though it may be harder in mine than in yours. I don't know. There are a lot of considerations. How do you prove that it should be closed when there is not minimum standard for their NCLEX pass rate? What if their NCLEX pass rate is actually OK because they do so much test prep and don't let people take boards until they pass HESI? What if the program in question is a state school that focuses on the education of minorities and students from underpriveledged backgrounds? What if the program is the local community college that has thousands and thousands of alumni? etc. etc. etc.

I had a private meeting with one of the State Board inspectors. They know that some of these programs are weak -- but can not do anything until a violation can be proven that is so bad that the public will support the BON in taking action. Until then, we wait and hope that the schools improve themselves. So far, that's not happening.

As for blaming the students ... I don't blame all the students. I think most students are pretty clueless when it comes to picking a school. However, I read an awful lot of posts on allnurses.com that say things like, "I'm looking for the quickest route to becoming an RN." .... and ... "C=RN" .... and .... "Just choose the quickest, cheapest ADN program you can find and let your hospital pay for you to go back and get your BSN." "I have kids and don't have time to do all those clinicals." .... and "I already have a BS in something else and don't want to spend a any more time in school than I have to." ... "I've already spent 2 years in school with another major and I don't want to spend any more time or money than necessary to get my basic RN." "I want to finish as quick as possible so that I can get on to grad school as soon as possible." etc. etc. etc. Yes, those students have to bear some of the responsibility for the fact that they end up with poor educations.

Heavens, I wasn't accusing you of anything, llg , I was just curious. No, I haven't ever tried to get a program closed -- it just seemed to me, based on my experience and observations in nursing academia in my own state, that the kind of programs you described wouldn't be able to survive in my state (and, of course, every state's regulatory process is different), and I was surprised they would be able to survive in any state. I'm not sure what you mean by "there is not a minimum standard for their NCLEX pass rate." That really jumped out at me, since, right before I came to work this evening, I was looking at my latest BON bulletin/magazine (came in today's mail), and it included the list of schools in the state that have been put on probation for having NCLEX pass rates that are too low, and the article about that explained exactly how the BON determines the minimum acceptable passing rate they use. Does your BON not do that? Again, I guess that's something that varies from state to state, but I didn't realize it varied that much from state to state ... I was vaguely aware that my state has higher standards and tougher enforcement about a number of things than lots of states do, but I never heard anyone really explain how differently things work in another state (I don't mean that to sound stuck-up or superior , I'm just still trying to wrap my head around the nursing school situations you've described!)

Also, I am right with ya on all the comments about the "quickest," "easiest," and "cheapest" way to become an RN -- and my personal favorite on this board, some variation on "Why does nursing school have to be so HAAAAAARRRRD?????" (Well, ummm, because being a nurse is "haaaaarrrrd" ....) Those comments also make me cringe, knowing what I know. But I can see the argument that others have made here -- when legitimate, well-respected schools with good reputations are offering these streamlined, abbreviated, watered down programs, why wouldn't potential students assume that the programs must be okay? I know that, when I was "shopping" nursing schools, a hundred years ago , I didn't have any way of drawing any intelligent conclusions about which school was "better" than another (but I didn't ultimately decide based on which school was quickest or easiest, either ... )

[nursemike]

Originally Posted by jjjoy

I wouldn't only place blame on the students. The fact that such programs exist is a problem as well. Often the accelerated programs are offered by big name schools with overall shining reputations, so potential students figure that they wouldn't offer such a stream-lined program if it wouldn't be sufficient for entry-level practice. I went to a traditional BSN program with 2 years of nursing coursework and still didn't feel it provided a strong clinical foundation. Looking back at how we rushed through thousands of pages of nursing texts, I now realize that our lectures & texts were to meet the NLN educational content requirements. And looking back at those strange mulitple choice test questions that didn't seem to really reflect lecture or text materials I realized they were written to approximate the NCLEX. We had the required hours of clinical time, but I remember being worried about the ability to check off the pages of clinical skills because we had so few chances to practice many of those skills.

I think a big part of the problem with the development of nursing as profession has been it's strenuous efforts to make it appear more academic than it need be. The nursing profession has traditionally been a skill-based one. Of course, you must use you mind as well in the application of those skills. But so does any professional. Carpenters don't just mindlessly saw and hammer. But they don't insist on a unique theory for carpentry or a language to differentiate carpentry from construction. You can study carpentry as a profession and measure it's influence on the construction industry without getting a PhD in carpentry.

Another more recent issue is liability. Hospitals, staff nurses, clinical instructors, and schools don't want to take on too much liability for students. I think that may be another reason clinicals have become pared back. And then as others have noted, there's a demand to educate more nurses but available clinical time for students is limited. More students can mean less clinical time as schools compete for clinical space. The high per student cost of clinical instructors also creates limitations as groups of 8-10 students must share the clinical instructors and patients and staff on any particular unit.

Anyway, I'm off on an tangent. I'm not sure what the answer is to the current nursing education conundrum. How prepared should new graduates be? I'm not sure who should be responsible for that. MDs don't graduate ready to "hit the ground running." They get paid (albeit a relatively low amount) for their first years of practice. Many nursing schools now explicitly say that a new grad isn't expected to "hit the ground running." But many hospitals don't seem to be in agreement in regard to the minimum required skills for a new nurse. What to do?

I was preparing to post on this thread with some pithy comments about NCLEX pass rates and accreditation, but I got called away before I finished. Now I see you've beaten me to it. Well, fair enough, but I was also going to offer some keen insights based on my previous career, as a carpenter. RIP OFF! I spent all those years driving nails, and you get to use my keen insight? It ain't fair! (However, I do find myself in agreement with your points, so, clearly, you are very astute.)

If I might expand a little, in carpentry, a journeyman is one who can work independently and perform most tasks with little or no supervision, but a master is one who can do all that while supervising and instructor others. It isn't easy to do your own tasks, keep a project running, and teach newbies how to measure a board or drive a nail, but you aren't a master carpenter until you can do it.

"See it, do it, teach it," is a saying I first encountered in nursing. In my case, it's more "See it, see it again, try it, see it done correctly, do it sort of marginally okay, see it one more time, get better at it, and teach someone what not to do..." I used to worry for my patients, but they're a resilient bunch and usually survive.

The point is, for whatever reason, not many new nurses can hit the floor running--not at full speed, anyway. My instructors used to say almost daily that education is an important part of nursing. Sometimes I felt like pointing out that education was also an important part of education, but I reminded myself why my father always said they don't send donkeys to school: nobody likes a smart ass. In retrospect, my instructors did the best they could under the circumstances, and I learned more than I realized, but I think maybe they should have emphasized that nurses not only educate patients, but other nurses, as well.

I don't know. Maybe those grouchy, grumpy nurses really didn't need as much help, starting out. But, it seems to me, the floors need to be staffed, so the choice comes down to either helping today's newbies or driving them off, then facing the same problems with tomorrow's newbies.

As for my fellow newbies who might be thinking someone should have applied Maslow's heirarchy to nursing education--get the basics, like starting IV's, dropping NG's, emptying bedpans, then worry about the higher levels, like critical thinking, all I can suggest is that if you can't hit the floor running, be ready to hit the floor willing to work hard and listen. I once heard one grumpy, grouchy nurse remark, "The only thing I can't teach is work ethic. If they show up with a good work ethic, I can teach everything else. If they don't, they'll never be any good."

[lareine23]

As I read this thread I can't help but to feel a little apprehensive about entering my new grad position on a telemetry unit. I want to know, how can I prepare myself to meet my preceptors half way and make the best out of my experience. I want to be a great nurse and if it means tapping into outside resources that will provide the training that I may not get either in school or during orientation.... I WILL DO IT, because ultimately someone's life is in our hands and I want to save lives.

[Angie O'Plasty, RN]

Originally Posted by lareine23

As I read this thread I can't help but to feel a little apprehensive about entering my new grad position on a telemetry unit. I want to know, how can I prepare myself to meet my preceptors half way and make the best out of my experience. I want to be a great nurse and if it means tapping into outside resources that will provide the training that I may not get either in school or during orientation.... I WILL DO IT, because ultimately someone's life is in our hands and I want to save lives.

An EKG course and ACLS training would be excellent. My hospital required neither when I started on a tele floor, and by getting those on my own, I was much better off than some of the others coming in fresh to tele. Other than that, read up all you can on the cardiac meds. Plavix, Coumadin (antiplatelets and anticoagulants versus clotbusters) are helpful to know also. Know the patho for CHF, MI. Know what the following procedures are and why they are done: 2DE, TEE, Cardiac Cath, stent, balloon angioplasty, fem-pop, D-Dimer, CT Angio.

[jjjoy]

Originally Posted by nursemike

I was also going to offer some keen insights based on my previous career, as a carpenter.

I appreciate hearing from someone who actually has experience with another profession, and even the one I happened to choose as an example!

If I might expand a little, in carpentry, a journeyman is one who can work independently and perform most tasks with little or no supervision, but a master is one who can do all that while supervising and instructor others. It isn't easy to do your own tasks, keep a project running, and teach newbies how to measure a board or drive a nail, but you aren't a master carpenter until you can do it.

In school, they kept saying how we'd need to be leaders and to be responsible for the work done by those we delegate to and to recognize questionable MD orders and to stand up for proper care... yet meanwhile, we barely learned the practical WHAT that we were to be leaders of and taking responsibility for and delegating. Without experience, only the most egregious of orders would be noticeable to a newbie, and who allows newbies time to look up every new order to check if it's okay? Finally, proper care? Isn't that a detailed 5 page care plan? No?

"See it, do it, teach it," is a saying I first encountered in nursing. In my case, it's more "See it, see it again, try it, see it done correctly, do it sort of marginally okay, see it one more time, get better at it, and teach someone what not to do..." I used to worry for my patients, but they're a resilient bunch and usually survive.

That sounds like me! Seriously, it takes me awhile and several repetitions to really "get" something. To pass clinicals in school, we had to check off that we'd done certain skills at least once. That by no means means that I could just do that without any help or review next time.

My instructors used to say almost daily that education is an important part of nursing. Sometimes I felt like pointing out that education was also an important part of education.

So true!

Maybe those grouchy, grumpy nurses really didn't need as much help, starting out.

Nursing education used to be a lot more clinical intensive. Students would live at student dorms adjacent to the hospital and work several shifts... they got to learn and become licensed while hospitals got cheap help. By the time they graduated, they were supervising the lower level students and practially running the floor themselves. So, they were actually experienced with full nursing responsibilities by the time they graduated.

Now that's going way back and I don't know how many of those grouchy, grumpy nurses actually had THAT kind of training. But it seems that over time, the clinical portion of school has changed from turning out proficiency to giving an introduction.

As for my fellow newbies who might be thinking someone should have applied Maslow's heirarchy to nursing education--get the basics, like starting IV's, dropping NG's, emptying bedpans, then worry about the higher levels, like critical thinking,

Yeah, that!

But, it seems to me, the floors need to be staffed, so the choice comes down to either helping today's newbies or driving them off, then facing the same problems with tomorrow's newbies.

Hope so!!

I'm very interested in questions of nursing education but am not sure where to get started in finding out more or becoming involved somehow. ANA?

[llg]

Originally Posted by elkpark

Heavens, I wasn't accusing you of anything, llg , I was just curious. No, I haven't ever tried to get a program closed -- it just seemed to me, based on my experience and observations in nursing academia in my own state, that the kind of programs you described wouldn't be able to survive in my state (and, of course, every state's regulatory process is different), and I was surprised they would be able to survive in any state.

The Nurse Practice Act of my state has no strict minimum pass rate requirement. And even if it did, the schools would get around it by only allowing those "graduates" who scored high on an exam like HESI take the NCLEX. That's the tactic that they are using now. Students complete the program and pass all their courses ... but the school won't send the paperwork to the BON for processing their NCLEX applications until the student achieves a certain level of success on HESI. The BON hates that approach, but it's not against the law. The schools say the students haven't really "passed their last class and finished the program" until they pass the test. They use it as sort of a "final exam" to their last class. I know of people who have finished their coursework over a year ago who still haven't been allowed to take boards. In the meantime, these students have to pay some tuition to keep their student status active while they figure out a way to pass HESI ... which will then let them move on to take NCLEX. Thus the school boosts its pass rate. I think it is immoral.

It's all so political. If a school gets closed, the alumni of that school will be furious and cause political problems that people want to avoid. And its not just the alumni of the nursing programs. It will be all the alumni of the colleges who are offended that the state does not think their school is good enough. The graduates of the community college will portray any discipline as an elitist plot to funnel resources to 4-year programs and a slap in the face to every state resident who ever got an Associate's Degree in anything. The graduates of the schools whose student populations include a lot of minority groups and/or disadvantaged students will say it is discimination based on race or culture -- again, a plot concocted by the elitist schools to funnel resources to themselves. The 2 local trade schools with new "quickie" AAN programs will say that the board is stifling its right to compete with traditional colleges -- a plot to prevent them from offering practical alternatives to working people for whom traditional programs are too difficult. etc. etc. etc.

It's a real mess.

In the meantime, we staff development folks are faced with a group of new grads ... some of whom come from programs that provided a strong foundation and who are ready to begin their careers ... and and a growing group of others who bought a diploma and passed the NCLEX, but never really learned much about how to actually do nursing. In the past, that 2nd group was very small and we could handle them: if they seemed like great people, we might give them a little extra attention and they would make it. If they did not seem like great people, they would be fired. But now, that 2nd group of poorly prepared students is growing beyond our capacity to deal with.

That's the problem.

[janfrn]

The nursing school I graduated from closed to new admissions the year I graduated. We were actually the last diploma class to complete our education there. But it wasn't because the school was turning out sub-standard nurses. Quite the opposite... the school had the reputation for providing the best education and turning out the highest-quality nurses in the province. It was considered quite an advantage to have graduated from St. Boniface when it came to that first job. The reason the school closed was because the provincial regulatory body had detemined that the Baccalaureate in Nursing was to be the minimum requirement for entry to practice. The last diploma nurses in the province graduated in 1998. Whereas the province annually had been graduating about 2000 new nurses through diploma, community college and university programs, they now had about 375 nurses graduating. By 2001, the community college nursing program had been rejigged and reopened, much to the dismay of the academic world... who bemoaned the 'fact' that the province had essentially dumbed-down nursing education and reverted to a blue-collar mentality rather than a professional one. They said the 23 month (continuous study... no extended breaks for anything) program would result in the destruction of the nursing profession. A side-by-side comparison of the college program and the Baccalaureate revealed that the actual number of hours of education differed by only a few dozen; the clinical portion was heavily weighted on the college side and the liberal arts on the university side. [Tell me again how a C+ in Intro to Earth and Planetary Science or The History of Textiles makes me a better nurse...] The college program included ethics, issues and trends in nursing, statistics, and a number of other university-level courses in addition to the clinical component so the students were not being short-changed educationally at all. The first year they could have filled twice as many seats as they had. Of course, the college program has once again been discontinued, and the province is actively recruiting new grads from ther provinces and countries to fill their vacancies. Let's not learn anything from our history...

[RNperdiem]

This is a very interesting discussion and I'm glad it has remained civil. I didn't realize until I was working as a nurse for a while, the differences between nursing school experiences.
I would rate my ADN program as OK, but the BSN students at the university my hospital is affiliated with seem to see more things, have access to internships, externships, and have more clinical time than I did in nursing school.

[amj12]

I've been reading this thread for a while. I too enjoy the fact that everyone has been pretty much civil on the topic. I must say regarding degrees, an nurse with a BSN is no more qualified than a nurse with an ASN. It really has nothing to do w/the degree but more to do with the education behind the degree. I graduated with an ASN this past fall and am actively pursuing my BSN b/c I am young and had no idea when I transferred into this program that it was an associate degree program. I still spent the same amount of time in the nursing program as a traditional 4-year degree university, 2 years. I had the same clinicals. The only difference is the final clinical I didn't do a preceptorship. I think in the case of not getting to see as much, had mre to do w/the fact that I was at a satellite school of a major university in a smaller town, so our rotations were done at local community hospitals. Which anyone who works or did rotations at the smaller hospitals know you do not see as much, and that has nothing to do w/your education. I do not feel any less prepared to start my job b/c of the degree that I have, in fact I am only making a dollar difference as of right now. Critical thinking was emphasized ad nauseum in our program, so the arguement that ASN nurses don't have critical thinking skills doesn't apply in the case of grads from our program. Not to mention, that the BSN classes I am now required to complete our actually masters classes at any other program.