Quote from frogdog
Hi. I graduated 8 months ago from an accelerated BSN program. This is my second degree and second professional career. The problem I'm having is that, while I'm book smart, I lack clinical skills.
...what I'm realizing is, at least where I'm at, the job consist mostly of case management. I feel like I'm not getting any clinical skills. Some days I feel like I'm working fast food.
...I rarely put in an IV (done it only 4 times) or draw blood. ...some IV team nurses tell me they don't want the patient "poked too many times".... I've not put in any NG tubes, no caths on women, and there has been no training on reading the telemetry strips (in fact, none of the nurses on my floor know how to do this even though we are considered to have the most heart patients and we have tele monitors at the nurses station...tele is monitored down the hall by techs--emphasis mine[chris_at_lucas_RN]).
...I am now a little nervous about the fact that I haven't done a lot of things that students from community colleges get trained to do.
Any advice? I plan to keep my head up, have a good attitude and not be overtaken by insecurity.
...the sense of resentment I have experienced from some nurses who started out as CNAs and worked their way up to RNs or LPNs; I have felt, only from some, that they scoff at my lack of physical skills training. In fact, there is a long-standing belief that the nurses turned out into the community by the community college here are better trained than the nurses turned out by the university. ...one LPN that I have to cover, who has been a nurse for 15 years and who I absolutely respect in terms of her clinical judgment and skills, is extremely rude (actually, she's downright mean) to me. I've even asked her, if she wouldn't mind, to please share her knowledge and experience with me because I'd like to learn from her. She only glared in response.
Man, am I glad you wrote. This is the first time I have posted about my experiences as a new nurse (can someone please tell them that a GN doesn't have the RN yet, and once you have the RN, you are not a GN????)
I have read that nurses' first jobs are often pretty awful. And now I know why, at least I know what my experiences have been.
I started out on a tele floor. (I should say that this is my third degree, my second license, my second profession and, well, you get the picture.) I was assigned a coach who thought it was OK to reuse an IV cannula that had been tried on the patient five minutes before (by me), and laid on the bedside table since. Hello? Can we say "asepsis?" I never saw the woman do an assessment before giving meds. She never signed off on the strips on her patients (and when I went to do so and actually looked at the strips, she said, just sign here, here and here; the techs know what they are doing!). Oooookaaaaay......
Coach #2 I had only one day on my way to coach #3. I should mention that all three were foreign trained nurses (I'm not going to specify which foreign nation, not interested in getting flamed). #2 was demonstrating how to speed up my assessment paperwork (all on computer) by not looking at or touching a patient in the process. (Magic maybe?) The patient in question was a diabetic lady who had had an "optical stroke" (family's term). She was "legally blind." Her pupils were blown, irregular and did not respond to light. (I actually looked, with my little flashlight.) #2 efficiently typed in that the patient's pupils were 3mm and reacted briskly.
By that time all I knew was, I didn't want to be a nurse like that. The coaches (if you can call them that) continually pressured me to work faster. The educator (trained here) kept reassuring me that I had what it takes to be a good tele nurse, reminded me that I had done very well on the PBDS, etc. (Unfortunately she had had a "cardiac event" and was recovering from a stent placement at the time of the switcheroo.) The unit manager was educated in Canadian and Australian schools
(close enough to native US training in my book), and was an exceptional woman who warmly encouraged me to "have fun."
The day I made my decision to leave was a good one for me. I had had enough signs that the mixed signals and just plain bad nursing I was being "coached" to learn were nudging me rapidly toward burnout. The nurse manager cruised by, asked me how my day had been (she really was a lovely lady and I miss seeing her), and I told her frankly that "it bit," and that I did not think this was a good fit.
Long story short (we wish, eh?), in my exit interview, the nurse manager and the chief educator gently informed me that as a GN (grrr) I lacked the clinical skills to make it in a fast paced hospital
(not even just the unit, but the entire place, apparently), and further that (and I just love this) experienced nurses resent it when a novice tells them they are wrong
. Man, I wish I'd had the spine to tell them that--I never did. Kept my mouth shut except when specifically asked by the educator. (But for her cardiac event, I might still be there. Oh, well.)
I'm in a better spot now, more consistent with my previous (and current) profession. I'm getting wonderful feedback from my coaches: they think I am organized, accurate, competent. They think I've been a nurse "for years" and are shocked when they find I graduate in August and passed boards in September. Oh, yeah, and the job came with a raise in pay and better hours. (Ha!)
So, here's my advice. I think you are right on to take another spot in a place where you can get some experience. Maybe you'll find you are more welcomed there. The second job may become your primary one.
If you are to cover for an LVN who is rude to you, recall that as the RN, you clinically supervise
him/her. Part of your responsibility is to keep the team moving and flowing, and rudeness from a resentful underling interferes with good patient care. You might seek the support of your nurse manager--this is often the most diplomatic way of making a complaint. Paint the picture of your readiness to learn to supervise effectively, "I'm concerned that I am not meshing well with so-and-so; can you give me some cues for how to help him/her overcome the barriers between us?"
Don't worry about not knowing everything clinical. We just graduated. We aren't supposed to know everything, just enough to stay safe and keep our patients and colleagues safe. We are blank pages, ready to learn how nursing really works.
I also believe that your drive to hone your clinical skills will serve you well. Keep asking for help and support, ask the other nurses to let you do the caths, IV's, punctures, etc. They are often glad to teach! The techs might appreciate a nurse who respects their skills--take your lunch break sitting with them, let them teach you what PVC's look like, and bundle branch blocks, and junctional rhythms and pacers. See if your hospital has training courses on telemetry. You need that, if only to satisfy your own need to know
. (Funny, it's our license, I think it behooves us to really know
. But so many "experienced" nurses seem rather cavalier about that.)
As to degrees, you will find ADN's who resent BSN's and MSN's because they are booksmart but not clinically as good. BSN's look down on ADN's as not very polished. MSN's hopefully will be above that, but I've found some very, very arrogant ones, both on the floor and in the classroom.
Becoming nurses doesn't resolve our personality issues, and it does sound like some that you and I have come across in our short tenures as RN's prove that point. I'm for finding ways to get really good at this. You seem to, too.
Thanks for this thread! And your "plan" (above, in the truncated quote) is an excellent one. I'm adopting it as my own as well.
Good luck. Let's keep in touch here....