Are new nurses adequately prepared? - page 5
:confused: As a nurse, I see more and more new grads who have little clinical experience and who are overwhelmed, more than I was and that was a lot. Many have had no more than 1 or 2 patients during... Read More
Dec 8, '02Originally posted by zacarias
Wow, what a thread!
I have also noticed that some nurses aren't so willing to help/show new people and this is annoying/distressing. Occasionally (unfortunately it can be a rarity), you can find a wonderful nurse who will teach you new things and understand that you're new at these things. I know they exist! I plan to be one of them when I have years of experience down the road!
Dec 8, '02Our program requires us to be CNA's first. We also start clinicals during the 1st term at a LTC facility taking care of pts. We don't do the meds at this time, but we are doing the assessments and writing the(including the meds, etc.) We move to acute care clinicals by the 2nd term and each term thereafter. We also have a post session lasting 3 weeks at the end of our first year. We have to take care of 4-5 pts./day during this session.
Dec 17, '02In our nursing lab at school, we learned basic procedures and practiced them, but we haven't gotten to do many on real patients.
As a new PN grad (yesterday was my last final), I don't feel prepared to go out and do many of the skills we learned.
Our instructors told us that after we're hired somewhere, we must insist that someone observe any skill that we haven't done before on a person. That makes me feel like a real PITA for the nurses with whom I'll be working.
"Um, could you come and watch me insert this foley, I've only straight cathed a female, and never a foley and never on a male."
"Uh, I've never suctioned someone, could you drop everything to help me..."
"Excuse me, but I've never done a tube feeding (trach care, colostomy bag change, straight cath, the list goes on...), I'm going to need some help"
I've been very fortunate that I've done quite a bit with a mentor at work, like sterile dressings, wet-to-dry dressings, observed many procedures. But I don't feel prepared to be on my own.
BTW, we were offered two caths in clinicals for our group of seven students. I volunteered for one and one other girl volunteered for the other, but most of our grads haven't even inserted a cath (and many didn't want the opportunity to try "Ewww, that's nasty"-- I say "then why do you want to be a nurse?"
Dec 17, '02[QUOTE]Originally posted by New CCU RN
As a new grad of a BSN program, I have to say I feel adequately prepared as a an RN. Granted I went straight for ICU so there was alot I needed to learn once I got there...and you know what ..we are all learning. That is just the way nursing and the medical field is.
My university focused on both theory and hands on experiences. However, they also felt that if you can learn how to be a quick, critical thinker even if you don;t know a skill, you will be better off. I truly believe this. Every hospital seems to have its own procedure/policy. It isn;t hard to learn how to insert a foley or an ng. It all comes with experience. However, nursing is more than skills. It is being able to critically think, to forsee patient outcomes.
This is how is changing. Personally, I'd rather be confident to question an order and know the rationale behind why the patient's care should be different than be the best at some skill. [/QUOTE
All the spouting theory in the world will not help if you do not know how to act on your observations.
Case in point: I grad. with a diploma and started a job with new BSN grad. One day, she had to give insulin to a pt. She came to me and said, "I never did this, I don't know how." I just looked t her and said, "In 4 years you never gave one insulin injection???"
She said, "Well, I know the theory behind it...I just never did it."
Theoretical knowledge is essential, but if you can't act on it, it really doesn't amount to much. There needs to be a sensible balance of both.
If you are going to go so far as to question an order, then if the doc gives you new orders, you need to be able to carry them out.
Not meant to flame anyone, but like I said, it's all about balance. Teaching kindergartners how to wash their hands may be fun, but it's not reality for most nurses. Giv these poor students some more practical clinical, so they are not so overwhlemed when they get out.
And I agree...I am much more afraid of newbies who "know it all."
Dec 17, '02Originally posted by mattsmom81
I'm an 'old' nurse and I believe the stories of mean old nurses are exaggerated...yeah sure there will be a few mean old nurses but there are some mean 'young' nurses as well, and mean docs, etc...
The point that today's staff nurses are overstressed is a valid one...a needy student or new grad may be perceived as one more responsibility in her day when she is already overtaxed. A little understanding here will take a student/new grad far.
Who would expect a new grad to 'know it all' as far as basic skills and theory...that would be a rididulous expectation. A willingness to learn and grow and a sense of personal responsibility in this area is what makes or breaks a new nurse, IME.
The student (and new grad) who always seems to look for the easy assignment with the least meds to look up and the least complexity will be 'slacker nurses'...the kind we all hate to work with.
Today's students would be wise to look at clinicals as their opportunity to 'get their hands dirty and get get their hands on every situation they can, IMHO, and see theory put into practice.
In my program (back in the dark ages) the STUDENT shared responsibility for hunting down and finding skills and situations in which to practice. My old diploma program made it clear IF we did not seek our own opportunities to learn, we would have to go 'on call' with the staff in off hours. Needless to say, we jumped in and found good experiences ourselves so we'd have our off time to ourselves.
Also I trained in a big teaching hospital where it was the norm to teach; everyone was in 'teaching mode'...see one, do one, teach one was the motto. This helped immensely...there were student docs and nurses of all levels and we were ALL learning...which reduced our panic...LOL!.
I don't believe seasoned staff nurses as a whole mind doing a little handholding with new grads...for awhile...but 'a little' and 'awhile' are the key words here.
Dec 18, '02I can teach patients and families to change a dressing, insert catheters, even hang IVs. I'm not teaching them to be nurses.
An interesting stat I heard in my (BS) program, but I don't know the source: clinically, ADN students are ahead of BS students at graduation; within a year, BS students are ahead.
Critical thinking. What should be done with the patient. What will help/ harm the patient. Most important aspects of nursing. "Skills" seem cool. They are mere details.
I've learned a lot of details, depended on the setting I was in. The details were somewhat difficult to learn when I was an inexperienced nurse. Now? Give me a couple of weeks. Anywhere.
Are we professionals or are we technicians. Techs know how to do something. Professionals know why.
Dec 18, '02I have just finished my first year, which included a practical experience 3 times a week for six weeks. I went into the med/surg ward scared to death because my previous learning placement did not require anything more than playing babysitter to some psych patients. I found the nurses were most helpful on my floor, although some co-students had the opposite...nurses who did not want students anywhere near them. I learned more in those six weeks, and was working with up to 3 patients at one time. The supervision we had was minimal, but in a sink or swim atmosphere, you learn to ask questions and if a nurse isn't able to help out, you find the nearest LPN as they are a wonderful resource of information and technical skills.
My lab experiences have been limited in my opinion and fragmented...instructors who refused to acknowledge other instructors ways of doing things and figure it is best to show you as a large group rather than in smaller ones. I would have gladly given up one of the touchy-feely courses that we were forced to endure for more lab time.
I realized very quickly just how overwhelming it will be when I do graduate and I am expected to be responsible for even more patients. I plan on taking every advantage of those with experience and the will to teach so that I am more of an asset than a hinderance on my first job.
Dec 18, '02When I was hospitalised post-partum, a student nurse (BSN, I think) was watching her preceptor prepare to insert my Foley. Since I'd already lost any modesty I might have once had, and since it already hurt like H--L down there, I asked the SN if she would like to practise on a 'worst-case scenario' (macerated, swollen, sutured post-baby) Foley patient. She ended up doing the insertion--and came back later in the day to thank me profusely. She'd never done an OB patient's Foley cath b/c hospital policy prohibited SN's from cathing conscious OB patients (unless the patient specifically allowed it).
So, I guess the moral 'o the story is, when you're on the pointy end of the needle, offer your arm (or meatus) to someone who could really use the practise.
Dec 18, '02I think there is some recognition in the health care field that nursing schools are inadequate. What is expected of a nurse is what physicians used to do many years ago, my mother retired from nursing in 1994, attended a hospital ADN program in 1950.
She said back then only physicians were allowed to take blood pressures! Now techs take them routinely. There is so much more knowledge and responsibility a nursing school cannot possibly teach it. The most they can do is prepare the students for the gawdawful shock one goes through in becoming a decent nurse. Many hospitals have recognized this and the nursing interships and externships are a godsend. I would advise any fresh graduate to solidify their knowledge and confidence in one of these, the commitment time you give up is well worth it, and seems to eliminate a lot of burnout on new nurses.
Dec 20, '02Not so long ago prior to doing my Nursing Degree, I was working as an Anaesthetic Tech. We had male orderlies back then who had the nysterious title of "Dressers". Their job was to da all the male catheterisations. Their training consisted of a cardboard box with a hole punched in it which was meant to represent the urethra! If you got the Foley in the hole, you passed. My thoughts on Nusring Education today, and there has been some discussion here in Australia, is that students in their final year should basically be employed in the hospital setting, under supervision so that they get a whole year of hands on experience
After Hours Nurse Manager
Dec 20, '02Originally posted by darius000
We had male orderlies back then who had the nysterious title of "Dressers". Their job was to da all the male catheterisations. Their training consisted of a cardboard box with a hole punched in it which was meant to represent the urethra! If you got the Foley in the hole, you passed. Patrick
After Hours Nurse Manager
Dec 20, '02I'm ex faculty in UK and USA. Left my faculty position two years ago to return to full time clinical nursing - where I can really teach new grads. The ADN program in which I taught replaced the acute care pediatric experience at an excellent hospital with loads of real nursing situations and helpful staff (many of the staff acted as part time clinical teachers for the college) with a community based pediatric course because the ADON did not rate pediatrics as a good experience. I think it is real med/surg with attitude - but who am I? A career nurse (peds and adults).
The real problem in the above situation is that many of the students (who admitted they did not want to continue to work pediatrics) stated it was the best acute care experience they had got in the whole of their training. Also some colleges are being squeezed out of the best acute care clinical placements based on how the college is perceived in the community.
I think we experienced RNs have to accept the reality of illprepared students, insist on high quality orientation/new grad programs/mentor relationships and do our bit to teach as we work. The newbies learn from something as simple as good examples right up to assisting them step by step with a complex procedure. But good teaching does take time, so real preceptors/mentors should have a slightly lower caseload, although I'm not sure how I feel yet about actual $ reimbursement. We should, however, get some recognition for quality teaching.
It appals me that students nurses can be taught in the USA by anyone with RN and a little experience (clinical teaching assistants). Even fully fledged instructors are not required to have a background or qualifications in education. Compare this with the UK where nurse teachers take a minimum of a one year full time course, plus supervised practice in education theory and practice. Food for thought.
Dec 21, '02I've worked peds and adult med-surg type settings. If you can do peds, you can do anything.
Again, hi-tech skills are cool. Monkeys can learn skills. Nurses are supposed to learn how to think. Too many schools graduate nurses who have not learned how to think. That is our problem. Now, schools teach students to pass tests, not how to be nurses. That, too, is our problem.
Though I find many such "nurses" on this board, I trully believe it is never too late to learn how to think, or how to be a true professional nurse.
I hope I am not wrong. It's discouraging sometimes.