[jjjoy]

Originally Posted by november551

don't worry, you'll have TONS of time to practice everything else from the point that you graduate until you retire. seriously.

Very true, but what's the point of a student training period if it isn't to train in what you'll actually be doing for 80% of your working day?

And in regard to those long detailed care plans, they ARE a great learning tool for see how different systems and pathologies and medications interact. However, most nurses work in real-time and deal with what's going on NOW. So while students should get some practice in putting all the pieces together, I think students ALSO need to practice and learn how to deal with what's right before them.

In the "real world" they won't know what their patients' diagnoses and status' will be before they receive shift report, nor have several hours to look up the pathophys, treatments, etc. And there's no realistic way for students to get the chance to do a comprehensive care plan on every possible type of patient they are likely to come across after graduation. Many schools don't teach students how to function WITHOUT such extensive pre-planning or without knowing a patient's full history and course of illness to present.

[Morettia2]

Originally Posted by ranaazha

What causes the night nurses to get out so late? Are the day nurses asking too many questions / expecting too much of your shift? I work days and report lasts anywhere from 20-45 mins depending on how much has gone on that days (a couple orders vs. 20) and the nurse to whom you're giving report (some want the basics and will find the rest out for themselves, whereas others want every bloody detail).

As for report, during my final semester, we had 12 precepting shifts where we did the full 12 hr shift with our preceptor. Once the preceptor was comfortable with us, they would encourage (some more than others) to give report and maybe fill in the details we missed. This was a great learning opportunity because, I agree, report is tough! Even while I was precepting as a NG I found it difficult, mostly because it's frustrating (a) to adapt your personal reporting style to the several other styles that nurses have and (b) my preceptor would do so much for me and NOT tell me about it UNTIL report, so I often felt like a donkey's rear...

Nursing school, by far and away, will NEVER be enough preparation for the real world of nursing. I'm convinced it's just simply not possible. If you're lucky, though, you'll work with some understanding people who are willing to help ease you through the transition process. While I've met a few rotten apples (those nurses that are just plain mean!), most are very helpful. I even have one who HATED reporting off/on with me, who I get along with great now.

There is a light at the end of the tunnel, though!

Day shift gives the worst report at the hosp. I work at. I ask the relvant questions but we NOC shift always end up with the worst report. And yes most of the nurses in the morning are asking questions that takes a blink of an eye to look up. It drives me nust to no end sometimes when I am there for an hour and a half post shift giving report and falling alseep driving home and some even have the nerve tpo call me at home and ask me like 1000 more questions ..one day I say well I do this at night LOOK IN THE CHART and don't boehter me unless it's life or death and don;t call and ask me what the NS is set at look at the doctors orders and I wrote it in the care plan in the bedside..open you eyes..no offense to day shift it's only like this at my hosp..

[ranaazha]

Originally Posted by Morettia2

Day shift gives the worst report at the hosp. I work at. I ask the relvant questions but we NOC shift always end up with the worst report. And yes most of the nurses in the morning are asking questions that takes a blink of an eye to look up. It drives me nust to no end sometimes when I am there for an hour and a half post shift giving report and falling alseep driving home and some even have the nerve tpo call me at home and ask me like 1000 more questions ..one day I say well I do this at night LOOK IN THE CHART and don't boehter me unless it's life or death and don;t call and ask me what the NS is set at look at the doctors orders and I wrote it in the care plan in the bedside..open you eyes..no offense to day shift it's only like this at my hosp..

That's does sound pretty insane -- esp. to be called at home for the rate of NS! Wha??? Is there some intervention that mgmt or charges can take in these situations? It just sounds... weird.

As I said, I've had to adapt to different nurses' reporting style / some days being more difficult than others, but if you're dealing with this on a regular basis, then it sounds like a problem that needs some fixing.

Good luck!

[nurse educate]

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.

And there you go!! You just saw the big picture, and prioritized!!!

As my old boss used to say, there's a method to our madness!! In order to prioritize, you need to grasp the 'big picture'. How can you decide who is your priority until you have given everyone a quick once-over? How can you decide who needs to be seen first, who can wait, etc?

Yes, the falling patient DOES come before flipping through the chart. I NEVER condone flipping through a chart to get the full history before checking patients (but that's just me). I have students sitting at the station knee-deep in the chart, and haven't even checked to see if the patient is there, let alone alive. I will ask them if they need to know all that info before walking in, assessing and taking VS? As an RN, you do not have time for that. You rely on a good report to get the quick version of the pertinent history. As a student, this is where the primary RN comes in...ask for a quick report. I know all nurses are not receptive to students, but if you show the initiative and ask for infor, most of them will oblige.

It takes time, no one expects you to grasp this overnight (or at least no one should). If they do, they really needed to be reminded thay they too were once a new grad, in the exact position you were in. If someoen does not like your style of report, ask them "what am I leaving out? Am I giving you too much unimportant info?".

[nurse educate]

Originally Posted by 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, and for me being in the ED, how to assess patients, what questions to ask, etc.

OMG!! I NEVER heard a student say this!! I'm sooo glad you saw the point. I did see your point beyond that as well (if you didn't have the patient). Sadly, there is nothing we can do about that

[nurse educate]

Originally Posted by Hopefull2009

I am almost finished my second year...these are my only skills that I have actually PRACTICED.

bedpans
bath
changing linens
vitals
2 shots

That's it.

Here is my EXACT point of this thread.

So tell me, what did you do for two years, since you did NOT do all the skills? Please tell me you learned something. Do you know how to assess, chart, I&0, teach, discharge, wound care, caring for more than one patient? Please tell me you did something else

The only thing that really concerns me that I do not see on your list is IV meds. Did the rest of your class do more than this? If they did, then you should have spoken up to your CI and told him/her that you needed to do some of the things not on this list. Although I try to keep a list, it is very difficult to keep track of who has done what, so I ask my students every couple of weeks, 'who still needs an NG, IVPB,?'. Because even by the time you get to second year clinical, your CI will not want to hear that you never did an IV.

[nurse educate]

Originally Posted by jjjoy

Many schools don't teach students how to function WITHOUT such extensive pre-planning or without knowing a patient's full history and course of illness to present.

I went to the school where I teach. When I was a student, we got our assigment the day before, and had tome to look up the meds and the disease process. We did not have to have a CP ready, but needed to at least know what the Dx meant and know the meds.

Somewhere along the line, they stopped doing this. Now the student goes in cold, more like real life. They still need to know their meds before they pass them. Personally, I will let things slide about the meds, and will tell them, "let's give it, then come back to me with the answer when we're done". Not all the time, depends on the med and what the issue is. And they do need to figure out what the Dx means. At this point, a good # of them carry a PDA, and some still have the old'fashioned med dicionaries with them. This is real life. After 13 yrs of nursing, I do not know every med or disease, so I have to look things up as I go along.


Just curious Joy: are you still a student?

[Morettia2]

Originally Posted by ranaazha

That's does sound pretty insane -- esp. to be called at home for the rate of NS! Wha??? Is there some intervention that mgmt or charges can take in these situations? It just sounds... weird.

As I said, I've had to adapt to different nurses' reporting style / some days being more difficult than others, but if you're dealing with this on a regular basis, then it sounds like a problem that needs some fixing.

Good luck!

yea tell me about it

[Educator1234]

Educators must stop minimizing the importance of "skills"! Yes.. you need to prioritize assessment-critical thinking skills, but this minimization has lowered the standards of nursing practice. I see it every day as a hopsital orientation coordinator. We spend countless hours training nurses " skills". I am not refering to hospital specific equipment either...
In the current hospital environment struggling with multi-drug resistant diseases, medication errors and sophisticated equipment nurses need to have at least basic skill preparation out of nursing school. You would not hear of a surgeon learning his "skills" later!!! It is important to patient safety and to the profession.

[oldiebutgoodie]

Originally Posted by Educator1234

Educators must stop minimizing the importance of "skills"! Yes.. you need to prioritize assessment-critical thinking skills, but this minimization has lowered the standards of nursing practice. I see it every day as a hopsital orientation coordinator. We spend countless hours training nurses " skills". I am not refering to hospital specific equipment either...
In the current hospital environment struggling with multi-drug resistant diseases, medication errors and sophisticated equipment nurses need to have at least basic skill preparation out of nursing school. You would not hear of a surgeon learning his "skills" later!!! It is important to patient safety and to the profession.

Oh, thank goodness! The voice of reason! It seems that only you, Educator1234, and jjjoy agree with me on the importance of skills. I am quite distressed that everyone else on this thread thinks that skills are something a monkey can be trained to do.

Learning skills actually has a theoretical basis. I'm sure you are familiar with Maslow's Hierarchy of needs? Well, I think that new nurses also have a similar hierarchy, starting with learning the "ways of the hospital", and skills, and progressing to critical thinking and the "big picture".

Pat Benner also explored these issures in her "Novice to Expert" research. New nurses tend to progress through phases, beginning with anxiety over skills and progressing eventually to a more developed sense of the big picture.

Bandura's Self-Efficacy theory also touches on this.

"The most effective way of creating a strong sense of efficacy is through mastery experiences. Successes build a robust belief in one's personal efficacy. Failures undermine it, especially if failures occur before a sense of efficacy is firmly established."

(from http://www.des.emory.edu/mfp/BanEncy.html)

And in the realm of common sense, haven't you heard of the saying, "You have to walk before you can run"?

Medical schools teach skills, why don't nursing schools? I am a wound and ostomy nurse, and have had some students lately who are pitifully grateful that I let them change some dressings and change ostomy pouches. While learning these skills, however, we are also discussing assessment and theory behind the wound, reason for the ostomy, etc. A recent student (who would be graduating in a few weeks) did not know how to do a moist saline gauze dressing in a patient.

The students who come to our hospital stand around and read the chart ad nauseum. They are so grateful for some real life practice.

This is not to say that nursing schools create task-oriented drones. Obviously, critical thinking is an important and essential skill. But it seems like nursing school concentrates on 95% critical thinking, 5% skills. Nursing education has lost its way. But by teaching more skills, we can accelerate the student's progress through the novice phase, as well as increase their confidence level.

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!

And in terms of full disclosure, I am 54, went to nursing school at a highly regarded BSN program when I was 49, and was pretty clueless when I got out. I am now in an MSN program, and plan on helping my students acquire some skills when I begin to teach.

Oldiebutgoodie