[JunebugRN28]

First, I want to say that it is awesome that you care enough about your students to seek this feedback!

I am fresh out of school (graduated in Decemeber) and I can clearly remember being incredibly nervous about doing skills. Looking back I cannot believe how worried it made me! When I started my job in February, I remember being so worried, thinking I have never done this, or this, etc., etc. Luckily one of my first days on the floor I heard a nurse who had worked for almost 1.5 years saying, "I've never put in an NG, could someone help me?" That was all I needed! I realized that everyone needs some help once in a while, and the big thing is being able to ask and to realize when this is necessary (if in doubt ask, pt safety is a priority!). From that point on I began to notice nurses asking each other for advice and input all the time! Nursing is always changing and new situations always arise. None of us will ever be prepared for every situation, but we need to know our resources and when/how to ask for help.

With that being said, here are some things I would have liked to have practiced more in nursing school:
-giving report (as someone said). It is sometimes hard for me to know when I am saying too much, not enough, etc.
-Also, practicing setting up my "brains" for the day would have been good. It has taken me a while to figure out what really works for me.
-Another key thing is learning to prioritize. In nursing school we really did not need to prioritze care for several patients. Knowing what needs to be done now and what can wait is one of the most crucial parts of being a safe nurse, IMO. Sometimes it is easy to get caught up with the tasks that need to be done.
-Also, telling students about time saving tips you have learned through your experiences is so helpful. I still think of a couple of my professors whenever I use these tricks. One example of a suggestion I have rememberd to use is to keep a couple of syringes in your pocket incase there is air in the IV line that you want to pull out (those pumps are always beeping!).
At the same time, I think it is important to remember that all of these things take time and experience and that there is no way to avoid feeling overwhelmed and frustrated at times! Good luck with your students!

[nurse educate]

Originally Posted by JunebugRN28

First, I want to say that it is awesome that you care enough about your students to seek this feedback!

Thank you!! I really do love what I do, and I want to see all my students succeed. I know I cannot teach them everything, and it takes time for them to get it together, but I try my hardest to prepare them for the next level, where the stakes are higher.

When I started my job in February, I remember being so worried, thinking I have never done this, or this, etc., etc. Luckily one of my first days on the floor I heard a nurse who had worked for almost 1.5 years saying, "I've never put in an NG, could someone help me?" That was all I needed! I realized that everyone needs some help once in a while, and the big thing is being able to ask and to realize when this is necessary (if in doubt ask, pt safety is a priority!). From that point on I began to notice nurses asking each other for advice and input all the time!

.

I try to implement this in clinicals now, having the students help each other. Hopefully, this will make them less afraid to ask for help. The thing is, it is much easier to hand off a skill to someone (when a coworker asks "what can I help you do:, rather than your assessments, notes and all the other stuff you need to do). There have been many times in my career where co-workers have offered help, and I was so overwhelmed that I said "no, I am beyond help!!". If I had been organized, it would have been easier to delegate a task to them.

Thanks to all who replied!! I see report is a big thing. I have talked about that in previous semesters, but did not so much this time around (I need to remember that next year!). I do remember that being a big deal as a new nurse.

While skills aren't the end all be all of nursing, they ARE a key function. A nurse will never be great at all skills because there are too many out there. But an experienced nurse has the confidence that they CAN learn more skills because they have ALREADY mastered some. If nursing school only introduces students to skills but never gives an opportunity to master any, then the student/new grad never has the chance to build confidence in their ability to learn and master new skills. They don't have a clear idea of their own unique way of learning such skills or gauging how long it will take them to feel comfortable with it.

Also, when students don't have the change to master a good number of basic skills, it slows them down considerably in regard to all of the other nursing responsibilities they are responsible for as new grads. When it takes 10 minutes to hang an IV instead of 2 minutes, 20 minutes to prep and insert a foley instead of 5, in addition to the newbie needing extra time and assistance in figuring out what to do, to prioritize, other staff quickly get frustrated that the newbie is SOOOOO SLOW.

You are absolutely right. I am not trying to minimize the need for knowing he skills at all. I know it slows the students/newbies down. This is the very reason I can only do a limited amount of NGs and IVs in one 6 hour clinical day. I feel like the entire day is spent on these students, where the other ones feel like they have not done anything.

New grads DO get hassled by experienced staff for not being quick at basic skills. "What DID they teach you in school?" "My school wouldn't let you graduate without knowing THAT" eyes rolling, sighs of exasperation etc.

Ah, how soon they forget what it's like to be a new grad . But I'll bet you they're not happy when they have to wait to get report as well, b/c they haven't finished taking care of their patients, and they are still there 2 hours later finishing up, holding on to the charts, haven't finished I&O's, etc. It's a no-win situation. It's all gotta get done.

What's the solution to this? The one that I know my students don't want to hear: practice in the lab!! We know repetition of a task reinforces your ability (as evidenced by my second grader, who has the same worksheets/assignments for 3 nights in a row ). The 'smart' students realize that they will not get the opportunity to do the skill every day (or even every week) in clinical. And now that summer is approaching, they will be very rusty when returning in the fall. I wish I could have all 10 students do an IVPB and NG meds every clinical day (I know some claim to do that, but I just can't see how it's possible). Over time, you will master the skill, but it's not going to magically come to you. And with the number of actual clinical days you have over 4 semesters, it cannot, nor is it expected to, be mastered (without practicing on your own)

[SoundofMusic]

Two words: Charting and paperwork.

If anyone had shown me what nurses are responsible for in these two arenas, I think I would have fun away right then and there.

I can relate to patients. i can critically think. I give great report even -- but paperwork is such a bear. I just can't believe the atmosphere of CYA at all times. It's just demoralizing sometimes to think i have to live in constant fear of my backside not being "covered" at all times.

[jAy-FibRN]

I am a recent grad and I will be off orientation in 2 weeks and starting nights (630pm-730pm) on a Med/Surg-Tele floor with 4 pediatric beds. I will be taking on 8-10 patients religiously. This overwhelms me a great deal. Does anyone have any advice for this overwhelmed male nurse?? Is taking 8-10 patients, most of the time 10, safe for a new grad? This doesnt really go along with the thread but I see some very experienced nurses here and would value their advice tremendously!!

[jjjoy]

Originally Posted by nurse educate

What's the solution to this? The one that I know my students don't want to hear: practice in the lab!! We know repetition of a task reinforces your ability

Our skills lab was only available during our scheduled lab classes. Any other practice had to be on our own with whatever supplies we could reuse for practice, without any feedback about whether the technique we were practicing was good or not.

And then there's text-book correctness of a skill (that we were tested on) and real-world competency of a skill. Being able to place a foley in an exact, robotic process of 30 distinct steps will only go so far in helping the student achieve the kind of proprioceptic (?) learning (being able to do something without thinking - like a tying a shoe) that will lead to clinical confidence and competence.

[carebearRN08]

New grad here, 3 weeks off orientation. The hardest thing for me right now is seeing the big picture. I feel like my night is filled with so many tasks; vitals, assessments, check orders, med pass, rinse, repeat. I feel like I don't have a whole lot of time to sit around and think about the patho of my patient's disease processes, especially when most of them have co-morbities and this processes can work together in interesting ways ( pt. with CHF and renal failure; what's causing that edema? did the CHF cause the RF? things like that boggle my mind). I have good enough assessment skills to know when something is WRONG, but when I go get second opinions from the more experienced nurses, they start asking me a ton of questions about the patient that I feel I should have thought of on my own. And the reason why they are asking these particular questions makes sense to me, I know why they are asking me about the electrolytes, CBC, etc etc, I just wish I could think of it on my own. Sometimes I do, I'm getting better, I'm hoping that this is the critical thinking stuff that just comes with time.

I don't even know if that helps answer the original question!

[jjjoy]

Originally Posted by carebearRN08

New grad here, 3 weeks off orientation. The hardest thing for me right now is seeing the big picture. I feel like my night is filled with so many tasks; vitals, assessments, check orders, med pass, rinse, repeat. I feel like I don't have a whole lot of time to sit around and think about the patho of my patient's disease processes, especially when most of them have co-morbities and this processes can work together in interesting ways ( pt. with CHF and renal failure; what's causing that edema? did the CHF cause the RF? things like that boggle my mind). I have good enough assessment skills to know when something is WRONG, but when I go get second opinions from the more experienced nurses, they start asking me a ton of questions about the patient that I feel I should have thought of on my own. And the reason why they are asking these particular questions makes sense to me, I know why they are asking me about the electrolytes, CBC, etc etc, I just wish I could think of it on my own. Sometimes I do, I'm getting better, I'm hoping that this is the critical thinking stuff that just comes with time.

Given how busy nurses are, there really ISN'T much opportunity to figure out the "big picture" for every patient that you care for. You manage from day to day, patient to patients and learn as you go. After awhile, you will start seeing the same types of things and it will be more familiar. One bit of info will 'click' one day. Another bit might click a few weeks later.

I think schools tend to go a bit overboard in emphasizing the need to see the big picture, perhaps overcompensating for the too common assumption that nurses don't have to understand anything, they just *do* whatever is orders. It IS important to grasp the "big picture" but like all of nursing, you have to prioritize. Keeping a patient from falling comes before flipping through a patient's chart to get a better grasp of their entire hospital course. Identifying that something IS wrong with a patient comes before understanding the relationship of the electrolytes, CBC, and the patient's symptoms.

Unfortunately, it often comes across that if you've been told once, you should *know* it and remember it for all time to come. And that's just not realistic. Each time the experienced nurses ask you those questions, instead of thinking of it like "I should already know this!" think of it more like "Five more times and THEN I'll remember this!"

[*ac*]

Nursing school did not adequately prepare me with skills. I know what many are saying: that skills can be learned by a monkey, but how can I critically think when I'm struggling so much with basic skills? If hospitals could give you many weeks of just skills training, without expecting you to think and prioritize, etc, then fine, don't worry about it in school. But they expect you to have it all pretty much under control within 8-12 weeks.

Nursing school did not prepare me to hold the needs of 5 patients in my head at one time. I don't know how this could be done in school, but one patient and a couple of meds is not even close to adequate prep.

Nursing school did not prepare me for mean, unsupportive, backstabbing nurses.

Nursing school did not prepare me for the fact that if you're in the room or assigned to the patient when there's any kind of a problem, and you have an RN after your name, than it's your fault.

I have not finished orientation and I may be done with hospital nursing.

[jjjoy]

Originally Posted by *ac*

If hospitals could give you many weeks of just skills training, without expecting you to think and prioritize, etc, then fine, don't worry about it in school. But they expect you to have it all pretty much under control within 8-12 weeks.

Well-put!

Nursing school did not prepare me to hold the needs of 5 patients in my head at one time. I don't know how this could be done in school, but one patient and a couple of meds is not even close to adequate prep.

So true!

[SoundofMusic]

Yeah. It's like you go to nursing schooland pass a few tests.

Then you start the "real" job, which is sort of like starting another school all over again.

Only it's with real live people, co-workers, doctors, and everyone else in between.