[Kiringat]

My
I graduated on Saturday. I am scared to start practicing. I feel like my school has prepared me to take the NCLEX - not take care of patients. I can think critically, list and describe SE and actions for meds, prioritize patients on paper, go through the pathophysiology of a dx, and describe all possible aspects of procedures.
However, I don't know if I can recognize symptoms of a dx in a real breathing patient, much less prioritize them. I don't know how to delegate and supervise UAP. I'm not sure how to give report or talk to a MD. And sure, I can tell you how to drop and NG, but as for actually doing one...
I just don't know. I've been through and learned so much over the past two years, but its not enough. I feel like I've learned all this theoretical perfect world stuff, but have no experience in applying it to the real world. I can't believe that I'm going to be "the nurse" now, I'm just not ready for it. But it kinda helps to know I'm not the only one who feels that way!

[nurse educate]

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!

Wow, I didn't know I was asleep .

You lumped 'lack of skills' and 'experience with the patients' in the same category. While I am certainly not minimizong the need to know the skills, the 'experience with the patient' is one of the things I am referring to. The assessments, and the 'what's going on here' apsect of it. I do get that it has to be a mix of all these things, theory and practice.

I do appreciate your input, and hope that you can see where I am coming from, having been teaching for three years already. I knpow it is not a long time, but I too felt like you did when I started doing this, that it is all about the skills.

I feel like my school has prepared me to take the NCLEX - not take care of patients. I can think critically, list and describe SE and actions for meds, prioritize patients on paper, go through the pathophysiology of a dx, and describe all possible aspects of procedures.

It seems to me that a good number of my students are just so focused on NCLEX (and all tests leading to that) that they lose sight of why they are in school. Example, I recently taught 3.5 hours of content, and my class was so disappointed to see that I only had 8 test questions on the topic (not my choice, i am told how many questions I was alloted). Their rationale? How can I narrow it down. how can I figure out what your 8 questions will be? Not sure if I am explaining it right, but it seemed to me that they were only focused on the test, not knowing and understanding the material, just figuring out what I could possible ask them.

However, I don't know if I can recognize symptoms of a dx in a real breathing patient, much less prioritize them. I don't know how to delegate and supervise UAP. I'm not sure how to give report or talk to a MD. And sure, I can tell you how to drop and NG, but as for actually doing one...

I totally see your point. And apparently others here agree with this, the things that are not so cut-and-dry, like delegating, giving report, etc. These are not concrete tasks that can be memorized, but rather concepts.

The reality is, there is NOT enough time to be taught everything you need to while in nursing school.

[oldiebutgoodie]

Originally Posted by nurse educate

I do appreciate your input, and hope that you can see where I am coming from, having been teaching for three years already. I knpow it is not a long time, but I too felt like you did when I started doing this, that it is all about the skills.

Hi, nurse educate,

I don't want anyone mislead--you quoted my post as well as a new grad's post in the same posting. The first two quotes were mine, the second two quotes were from Kiringcat.

And I did not say that it is all about the skills. I did say that there is not enough (hardly any) training in skills, and that there is a theoretical basis to this, based on Benner, Bandura, and Maslow.

Regards,

Oldiebutgoodie

[jjjoy]

Originally Posted by nurse educate

Wow, I didn't know I was asleep .

I don't think that was directed to individual educators but to nursing education in general. Many instructors (I'm not saying you do this) blithely assure their students that they don't need to master x,y,z in school because hospitals will provide them with on-the-job training. Many hospitals (and nursing colleagues), on the other hand, don't seem satisfied with the abilities of new graduate nurses and aren't so gung ho on having to provide extended preceptorships to new grads.

Example, I recently taught 3.5 hours of content, and my class was so disappointed to see that I only had 8 test questions on the topic (not my choice, i am told how many questions I was alloted). Their rationale? How can I narrow it down. how can I figure out what your 8 questions will be? Not sure if I am explaining it right, but it seemed to me that they were only focused on the test, not knowing and understanding the material, just figuring out what I could possible ask them.

While I definitely see your point that students should be concerned with learning as much as they can whether or not they are tested on it, it does seem a bit strange that you're only allotted 8 measely questions to test students on 3.5 hrs of content. It's not a criticism against you, but against nursing education in general. Why doesn't nursing education TEST students on "knowing and understanding the material" instead of just 8 random points out of 3.5 hours of content? Why are instructors limited to such an extent in their ability to test students? I'm sure it's to "prepare students for the NCLEX"... but that doesn't prepare students to be nurses. That kind of limited testing only encourages the kind of 'bare minimum' studying that you rightly criticize.

The reality is, there is NOT enough time to be taught everything you need to while in nursing school.

So true. So what is the MINIMUM that *should* be taught? I find it a challenging question myself without an easy answer.

[nursemike]

Originally Posted by nurse educate

Wow, I didn't know I was asleep .

You lumped 'lack of skills' and 'experience with the patients' in the same category. While I am certainly not minimizong the need to know the skills, the 'experience with the patient' is one of the things I am referring to. The assessments, and the 'what's going on here' apsect of it. I do get that it has to be a mix of all these things, theory and practice.

I do appreciate your input, and hope that you can see where I am coming from, having been teaching for three years already. I knpow it is not a long time, but I too felt like you did when I started doing this, that it is all about the skills.



It seems to me that a good number of my students are just so focused on NCLEX (and all tests leading to that) that they lose sight of why they are in school. Example, I recently taught 3.5 hours of content, and my class was so disappointed to see that I only had 8 test questions on the topic (not my choice, i am told how many questions I was alloted). Their rationale? How can I narrow it down. how can I figure out what your 8 questions will be? Not sure if I am explaining it right, but it seemed to me that they were only focused on the test, not knowing and understanding the material, just figuring out what I could possible ask them.



I totally see your point. And apparently others here agree with this, the things that are not so cut-and-dry, like delegating, giving report, etc. These are not concrete tasks that can be memorized, but rather concepts.

The reality is, there is NOT enough time to be taught everything you need to while in nursing school.

One of my NS clinical instructors used to get on us a bit because it didn't seem like we were "having fun" in clinicals. Was she out of her flippin' mind?

Funny thing is, along about my second or third week of orientation, it finally dawned on me that, hey, I was having fun! Granted, it's just about the hairiest rollercoaster ride around, but being a nurse is a blast, when you aren't peeing yourself.

I guess it's true--you just can't learn everything in nursing school.

[nurse educate]

Originally Posted by jjjoy

I don't think that was directed to individual educators but to nursing education in general. Many instructors (I'm not saying you do this) blithely assure their students that they don't need to master x,y,z in school because hospitals will provide them with on-the-job training. Many hospitals (and nursing colleagues), on the other hand, don't seem satisfied with the abilities of new graduate nurses and aren't so gung ho on having to provide extended preceptorships to new grads.

I know there is a huge communication gap between my world (the academia world) and the staff education world. one of my colleagues recently came from a career in staff ed, and, as she put it, it all makes sense now, as to why the students come to them knowing as little as they do. She said she would curse us under her breath, wondering what exactly went on in nursing school. She now realizes how contranied the nursing programs are. I truly beleive until you walk a mile on the other side of the fence, you can't make judgments.

While I definitely see your point that students should be concerned with learning as much as they can whether or not they are tested on it, it does seem a bit strange that you're only allotted 8 measely questions to test students on 3.5 hrs of content. It's not a criticism against you, but against nursing education in general. Why doesn't nursing education TEST students on "knowing and understanding the material" instead of just 8 random points out of 3.5 hours of content? Why are instructors limited to such an extent in their ability to test students? I'm sure it's to "prepare students for the NCLEX"... but that doesn't prepare students to be nurses. That kind of limited testing only encourages the kind of 'bare minimum' studying that you rightly criticize.

Do you know how long the exams would be if we had carte blanche?? My students would hate me even more!!!

So true. So what is the MINIMUM that *should* be taught? I find it a challenging question myself without an easy answer.

That is the million dollar question

[nurse educate]

Originally Posted by oldiebutgoodie

And I did not say that it is all about the skills. I did say that there is not enough (hardly any) training in skills, and that there is a theoretical basis to this, based on Benner, Bandura, and Maslow.

I get the theoretical basis of all that. But again, it boils down to time. There aren't enough hours in the day/week/semester for it. Back in the days of diploma programs, students did much more clinical time, but in a 3 year program. And with class sizes and clinical groups being filled to capacity, there is no way that the time can be devoted during regular class/lab/hours. I wish we could, because then clinical time could be spent more on actual patient care, assessments, and all the other stuff our new grads are also not prepared for. So much of the clinical day is spent on reviewing techniques and steps in the skills.

[jjjoy]

Warning - off topic - please feel free to continue on the discussion answering the original questions: what overwhelms you most? What did NS NOT prepare you for?

Nurse educate (or anyone else interested) What are your thoughts on the idea of a standard nurse "intern" period that is done after completing a mostly didactic (sp?) program of study? Say something like an accelerated one year/1.5 yr RN program covering common diseases, pathophys, symptom management, and of course, nursing care and care planning. (For time's sake, specialty areas such as maternity, ICU, OR might be left for further optional study later as a specialty). Toss in skills lab coverage of a range of nursing skills - but less actual patient care/clinical time than currently required - mostly to ensure that students are safe to administer medications and have adequate assessment skills.

Once this section is passed, students receive their RN license. This license, by itself, though, wouldn't qualify them to work in any RN role. They would have to complete a clinical internship before being qualified for acute care RN jobs With the license, they could be qualifed to apply for full-time internships where they work one-on-one with preceptor nurses on a 2/3 schedule with 1/3 education component. There might be other available internships that could focus on specialty areas not covered in the basic training, or perhaps specifically on LTC or community health.

In the acute care setting, maybe interns spend at least 8 weeks on at least 4 different units for a time period of, say, six months. As interns, they legally could NOT be counted in RN-to-patient ratios. However, with their own license (based on having passed a rigorous year of study), they wouldn't be such a burden on staff as nursing students are. Once interns successfully completed their internship, only then would they be qualified for acute care nursing jobs and be counted as FTEs in staff scheduling. If an intern isn't ready to fly solo by the end of the internship, they can apply for another internship to hone their skills.

But who would pay for such an internship? If basic RN training were shorter and required less clinical time, then student/school costs would be lower for the basic RN training. And it wouldn't create a delay in time to actually working as a full-fledged RN in a hospital.

I can see many objections and problems with such an idea besides the fact that it's much too drastic to expect any time soon, if ever. Liability issues? I can only imagine. Potential for hospitals to take advantage of interns if unpaid. Unmanageable costs if hospitals were expected to pay even just an token stipend for supernumary (sp?) nursing staff. And a list of other reasons it could never work that goes on and on.

For whatever reason, I find these issues interesting and find myself mulling over these impossible ideas. Hope I didn't bore too many of you out there! : )

[Dragonnurse1]

Kiringat the big duh's you will get easily enough like a patient coming thru triage with a 42 o2 sat - 38 by blood gas. chest white out and she is chf patient. That you will get. It is the more sutle patients. The ones that got off the bus at 1 am with dumb or weird complaints. Or the muchousen (sp?) syndrome. Sure the patients will tell you one story and the ED MD another - patients lie - it is a known fact.

Your ER md can be a big help just do not let him yank your chain. I worked with one of the least liked ER docs and I enjoyed it. He expected you to do your job - he wanted me to dress a burn patient and said do this, no do this, not that way and I finally said "well if you make up your damn mind I will finish this" the pt started laughing and He never gave me any grief.

Remember this one little thing you have 2 ears and one mouth so you can listen twice as much AND if you have team nursing follow someone that has gobs of experience. And vent, if something is making you crazy find someone who will listen, other nurses on your shift might want to vent to. Keeps you sane

[booshieRN]

Dear Nurse Educator,
Skills take time to acquire, and , as with many things, the more practice you have, the better you become at skills.
Assessment may come easier to some. Definitely problem-solving, time-management, and organization are important. Also. listening to the patient is very important. They have been dealing with thier medications and disease processes longer than we have, and they know thier bodies. It is also a sign of respect.
I don't know anyone who has been "counseled" regarding not performing skills correctly. It will come with time.
The best advice I can give to students is to ask for help with any skill that you are not comfortable with. Never risk someone's health and safety if you are unsure. Give yourself time to grow into your new role. Be patient with yourself.
While ther are many excellent nursing schools, nothing can prepare you for the reality of the floor except the floor itself!!
I would suggest encouraged your calss to perform case studies, work in groups to try to have them practice some real-life scenarioes..i.e. listen to taped report...practice taking off orders, or ask them what orders they would expect for a specific dx..and why. We did this in my last semester of nursing school and it helped tremendously.
GOOD luck to all nursing students BELIEVE in yourself !