Are new nurses adequately prepared?

  1. 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 clinicals. Many have told me that their nursing programs included role playing, seminars, and such events as teaching kindergarteners how to wash their hands as manditory clinical days. Is this a trend? Shouldn't there be more practical experience and teaching of critical skills, especially since patients are more acute? Many of the new nurses have never suctioned or used any of the complicated equipment common on the clinical floor. Would appreciate feedback.
    Also, I see experienced nurses who are less than helpful with new grads, taking the position that 'if I had to learn the hard way, so can you.' We all had to learn the hard way but we need to remember the acuity level of today's patients, the additional skills new grads must possess, and the increased stress levels. Have any of you observed any of the above?
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  2. 67 Comments

  3. by   Q.
    I believe the best practical training comes from ON THE JOB, versus a simulated skill lab with a rubber arm and red water. I started IVs on the rubber arm with a certain type catheter; this was NO USE to me when I started on my L&D unit with REAL arms and totally different equipment.

    I myself never suctioned a real patient; again, this was all simulated in a skills lab. Have I ever suctioned a real patient? Nope. Been a nurse for 5 years and the liklihood that I will ever is fairly low. I've been in obstetrics my entire life. Therefore from my perspective, I'm glad I didn't waste school time practicing a skill that I would never use, and is probably best learned on the floor anyway.
  4. by   MarcusKspn
    In our school we go over new skills in skill lab. Once we learned how to use the skill in the lab using dummies and each other we are allowed to practice the skill at our clinical sites. We always have to have our instructer or other Nurse with us to check us off and make sure we are competent to perform the skill without supervision.
  5. by   CMERN
    In my Nursing Program I would have to say the Cinical Lab as they called it was the most deficient waste of time. Why? it did not prepare us for what we encounter as "on the job" R.N.'s. Previuos to my college degree in Nursing years ago I had completed a CMA course which had a Lab componant that prepared me MORE for being an R.N. Than did my R.N. Program.... I agree Pt. acuity is high, stress levels are phenominal, . I could comprise a much more competent Lab Program than our program offered. Its a shame
  6. by   shannonRN
    i agree with susy...on the job training is way more helpful/useful than skills labs. i felt that there should have been more emphasis on the clinical portion rather than theory. i understand that theory is important and it needs to be in the curriculum in order to receive nln accrediation but spending more time discussing whether i am a parse person or not isn't as important as knowing the fundamentals of nursing. i was disappointed with my schooling (bsn). i want to further my nursing education but i felt that i needed the "on the job" training first.

    i think we all know experienced nurses who are less than helpful...to new nurses, to old nurses, to doctors, to patients, to patient's families.......some people are just mean. as for the "learning the hardway" mentality, i think a lot of the times nurses are frustrated with how little the new grad knows. i'm not saying that they should know everything...but knowing simple things like dressing changes or inserting a foley or ng. i also think that a new grad shouldn't be required to take a full load. they need to be oriented to the floor and their surroundings since there are so many specialities. give them a couple of days to observe and ask questions. i think that stress plays a role too. when a nurse can hardly find time to use the bathroom or eat during their shift, i doubt that they are going to want to take the extra time required to help that new nurse....jmho
  7. by   kimmicoobug
    I am a student and will graduate in June with my ADN. I like my program. We spend two days a week in the hospital setting for a full 8 hour shift. We get sent to various units. I was sent to Same day surgery this past week and to ER. As far as getting some experience doing particular skills, us students try to grab them when they come up. I was extremely excited two weeks ago when I inserted my first foley. I have never inserted an NG tube, but like I said, the opportunity has never come up. The materials in lab to do certain things are so obsolete as to what is used in the hospitals, that it is almost pointless to use them for practice.

    Most of the nurses are just great with us students. I think it could be because we could be their co-workers in 7 months.
  8. by   ohbet
    Theory,pathophysiology,knowing the reasons is as indispensible as on the job experience
  9. by   Tweety
    Everything I learned, I learned on the job. I took a four patient load during my clinicals by the end, but of course the RN was managing those patients as well.

    I think we need to allow new grads all the precepting they need. We need to allow them feelings of being overwhelmed, and support them when they are overwhelmed.

    I was thrown to the wolves and eaten alive at one place I worked when I was a relatively, though not quite new grad. I drowned many a time while the Charge Nurse and my coworkers ignored me.

    I am very very supportive of new grads and love working with them. Yes, they are unprepared and easily overwhelmed, but I'm here to teach them and support them.

    It's the one's who aren't overwhelmed, who think they know it all that scare me to death.
  10. by   Vsummer1
    None of my patients have needed anything but basic care. I have given 5 showers so far only because it was something available to do! Got the code browns... made a few beds... umm.. done assessments. But nothing they made us go through in lab has come my way. I truly HOPE I get to do SOMETHING soon. Granted, I am only first semester, but I am afraid if I don't get some real practice, I won't even remember how I did it on the dummy.

    They tell us that the NCLEX is the minimum required to be a nurse. Key word here is minimum. Well, that is fine but I NEED CLINICAL SKILLS! I don't want to be the new nurse who can't find the meatus on my female patient when I go to insert a foley because I have never done one before -- the lab dummy was pretty easy to find after 300 students have stretched out that rubber! Or who has never inserted the NG tube only dealt with tubes already inserted.

    So, if you get a new nurse like I will be, please remember it ISN'T MY FAULT that I never got the opportunity. I haven't missed one day of my clinicals yet (knock on wood) so it isn't as if I am the lazy one who knows how many hours I can miss and squeak by with.
  11. by   tlbw/tlc
    I, too, believe that on the job experience is the best way to learn, but it sure helps to at least be exposed to what you might see than to not have something mentioned at all. Nursing is so diversified that they have to cover as much as they can. However, my LVN school experience was such that our instructors were still having us do bed baths and bed changes in our last semester rather than concentrating on skills on the floor. One instructor did not like me so to punish me, she pulled me from all my observations and kept me on the floor so I would have to write care plans. It hurt my education because I am a very visual person -- so to have read it in a book and then gotten to see it would have been great reinforcement. Fortunately, the hospital I work at now is very big and will let me see things when the situation is right. I graduate as an ADN in December and my clinical experiences haven't been all that great to be honest. They (clinicals) were so horrible in LVN school that I don't force myself onto nurses when I am assigned to them. If they want to teach, I want to learn. If they don't want me around, I stay out of their way -- I work on the floor, too, so I'm very aware of how busy it is and how crazy it gets. Sadly, I get opportunities when and where I can and in bits and pieces. Nurses have a very difficult job and we SHOULD be supportive of each other--unfortunately, in most cases, it's not that way.
  12. 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 nursing school 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.
  13. by   psychonurse
    I for one know that if I hadn't been a CNA or LPN before I went back to school I would have had a definate awakening when I went to get my ADN degree. The most amount of patients that you had in clinical was 2...except for working in ICU I have never had that few patients on med/surg. The only reason that I got to do many of procedures is that I worked in the hospital as an RN and many of the staff nurses were willing to help me learn something. Like the first time I started an IV on a patient in the er...my clinical instructor was no where to be found but the IV therapy nurse was able to assist me.

    The only thing that I got to do many times was return flow enemas and that was not one of my favorite things to do... I think nursing students should be given a more realistic showing of nursing but they can't cause they would not be able to punch out 8-10 nursing care plans in one week. Once they get through school, not matter what part of nursing they are going into whether it be med/surg, ICU or ER, I still think that they should have one year of med/surg experience before they go into any other job. Gives you a more well rounded expereince of nursing...
  14. by   almostanurse
    Its hard because you have to take what comes to you. If you have pt that have feeding tubes, IV, JPs, NG, ect... then you learn those skills. Its been pointed out, we cant learn all that much from the lab, I mean you get the basic consept, but its not the same untell you really do it in a clinical setting. Myself, Ive never used suction, done trach care, never flushed a hep lock, never done a wet to dry dressing, lots of things Ive never done on a real person. If given the oppertunity I would love to, but what can you do? you can only take the pt given to you and hope you get to do some of these things in the long run. Im sure when you get all these new PN or RN on the floor, it might be a drag to have to go teach how to do "basic skills". but If I were a nurse with lots of experience and had a new PN or RN fresh out of school, and they came to me asking for help, I would rather help them and take the time to show them again, then to have them go in and say hay I did this on a dummy once, no sweat, lol:roll

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