Do you feel you were adequately prepared to practice nursing when you graduated? - page 5

Do you feel you were adequately prepared to practice nursing when you graduated from nursing school? Give us your opinion, comments or suggestions by posting a reply to this message. Please include... Read More

  1. by   swmn
    Prepared, yes, ready no. I will try to explain. I graduated from a hospital based diploma program in 1996. I continued working in the computer field through school, my only experiences in patient care before my first shift were from nursing school clinicals. I went into nursing because my computer customers were more interesting than their computer problems.
    I walked into my first shift knowing I _could_ do everything I was going to require of my CNAs, and my LPN; and was confident in my ability to cover the allied nursing sub-specialties (PT, OT, RT, speech, etc) on 11-7 shift. On the fourth of ten scheduled nights of orientation my preceptor was a no-call / no-show. I assumed charge on 120 neuro stepdown and LTC beds with 1 LPN and 5 CNAs that night and loved it. My preceptor was never heard from again. My DON came in early the next morning, and asked why I had not called her for help. I explained honestly that I had not required any help, but if I had I would have called her. She was beaming before she was done interviewing the rest of the 11-7 staff.

    As a deeply people oriented person, I do have to accept some of the credit for my success; but vast credit is due as well to the faculty of the Ellis Hospital School of Nursing in Schenectady, New York. Besides requiring we be able to give a better bed bath than any CNA, my class knew, without exception, that even though we could do all the things we were going to delegate, as RNs we posess a body of knowledge and scope of practice unique in patient care. I knew I could do some things better than my people were doing them, but I had to delegate so I could do the stuff only I could do.
    I also learned how to look stuff up. I carried a bag to work every night that would just barely qualify as carry-on baggage. Besides spare clean whites and an extra stethoscope I had three textbooks and a couple handbooks in there. My drug book was always out whenever I was passing meds, I believe looking something up is the sign of a concientious professional, not an admission of weakness. My staff quickly decided mine was a rational point of view. If there was not time to look something up, 911 was a phone call away for me.

    One thing I learned in the business world that I wish was in my nursing curriculum: Constructive delegation. As RNs we all have to delegate, but none of my nursing instructors taught me to delegate constructively.
    For me it is a three step process. 1. I have to decide what my minimum standards are. 2. I have to communicate and delegate those standards clearly to someone capable of carrying them out. 3. (this is the hard one) I have to stand back and give them space to exceed my expectations.

    I got my minuimum standards down to four rules for my CNA's on third shift.
    1. I require the vital signs I ask for by 2400 sharp. They must be measured accurately and charted promptly.
    2. Scheduled rounds must start sometime between 5 minutes early and exactly on time.
    3. Call bells must be answered immediately. I am talking five rings on the annunciator, not five minutes.
    4. When you are off the floor, someone needs to know where you will be, and someone needs to know they are covering your call bells.

    As long as four of those things wre happening, I was sweet as pie and found a legitimate reason to give every staff member under me a meaningful compliment every shift. Cross the line, and you are going home, now, off the clock. I would prefer to work short staffed then babysit. You are required to report to the DON's office during normal business hours tommorrow. I will write you up between now and then, and you will be permitted to tell your side of the story to her. You are not to report for work on my time until I have the DON's personal assurance you are capable of meeting the minimal standards of your certificate and this facility. Collect your things and leave the building immediately. Here is 35 cents to call your ride (I kept some change in the carry-on sized bag). There are both a payphone and a place to wait out of the weather at the convenience store across the street. Wherever possible I would close with a compliment, "I hope to see you tommorrow night. You are capable of outstanding work and have a good rapport with patients x, y and z."

    This has turned into another long answer to short question. The shorter version is my diploma program was excellent preparation for bedside nursing, but it was the interpersonal skills from my business background that gave me wings. We all test our limits, it's the nature of the beast. _Enforced_ limits tend to be obeyed.

    I have yet to meet any RN, from diploma right up through PhD FAAN who has learned to delegate or communicate with co-workers in a nursing program. Those of us that do it learned it somewhere else. I have identified two common traits.
    One is infectious optimism. Unspoken rule number five on my floor is if you are being paid to be here, you have to smile. The way to get that to happen is smile most of the time, and usually sooner rather than later people start smiling back.
    The other seems to be applying the nursing process to 'healthy' co-workers, ancillary staff and self, beyond applying the nursing process to 'sick' patients. Even with the small number of diagnoses available, we posess an extrodinarily powerful tool for improving professional and interpersonal relationships. Off the cuff I am willing to bet more than half of your problem children are feeling powerless. What can you do to empower them so they can do a better job for you and your patients?

    Off my soap box,
    Scott
  2. by   swmn
    Prepared, yes, ready no. I will try to explain. I graduated from a hospital based diploma program in 1996. I continued working in the computer field through school, my only experiences in patient care before my first shift were from nursing school clinicals. I went into nursing because my computer customers were more interesting than their computer problems.
    I walked into my first shift knowing I _could_ do everything I was going to require of my CNAs, and my LPN; and was confident in my ability to cover the allied nursing sub-specialties (PT, OT, RT, speech, etc) on 11-7 shift. On the fourth of ten scheduled nights of orientation my preceptor was a no-call / no-show. I assumed charge on 120 neuro stepdown and LTC beds with 1 LPN and 5 CNAs that night and loved it. My preceptor was never heard from again. My DON came in early the next morning, and asked why I had not called her for help. I explained honestly that I had not required any help, but if I had I would have called her. She was beaming before she was done interviewing the rest of the 11-7 staff.

    As a deeply people oriented person, I do have to accept some of the credit for my success; but vast credit is due as well to the faculty of the Ellis Hospital School of Nursing in Schenectady, New York. Besides requiring we be able to give a better bed bath than any CNA, my class knew, without exception, that even though we could do all the things we were going to delegate, as RNs we posess a body of knowledge and scope of practice unique in patient care. I knew I could do some things better than my people were doing them, but I had to delegate so I could do the stuff only I could do.
    I also learned how to look stuff up. I carried a bag to work every night that would just barely qualify as carry-on baggage. Besides spare clean whites and an extra stethoscope I had three textbooks and a couple handbooks in there. My drug book was always out whenever I was passing meds, I believe looking something up is the sign of a concientious professional, not an admission of weakness. My staff quickly decided mine was a rational point of view. If there was not time to look something up, 911 was a phone call away for me.

    One thing I learned in the business world that I wish was in my nursing curriculum: Constructive delegation. As RNs we all have to delegate, but none of my nursing instructors taught me to delegate constructively.
    For me it is a three step process. 1. I have to decide what my minimum standards are. 2. I have to communicate and delegate those standards clearly to someone capable of carrying them out. 3. (this is the hard one) I have to stand back and give them space to exceed my expectations.

    I got my minuimum standards down to four rules for my CNA's on third shift.
    1. I require the vital signs I ask for by 2400 sharp. They must be measured accurately and charted promptly.
    2. Scheduled rounds must start sometime between 5 minutes early and exactly on time.
    3. Call bells must be answered immediately. I am talking five rings on the annunciator, not five minutes.
    4. When you are off the floor, someone needs to know where you will be, and someone needs to know they are covering your call bells.

    As long as four of those things wre happening, I was sweet as pie and found a legitimate reason to give every staff member under me a meaningful compliment every shift. Cross the line, and you are going home, now, off the clock. I would prefer to work short staffed then babysit. You are required to report to the DON's office during normal business hours tommorrow. I will write you up between now and then, and you will be permitted to tell your side of the story to her. You are not to report for work on my time until I have the DON's personal assurance you are capable of meeting the minimal standards of your certificate and this facility. Collect your things and leave the building immediately. Here is 35 cents to call your ride (I kept some change in the carry-on sized bag). There are both a payphone and a place to wait out of the weather at the convenience store across the street. Wherever possible I would close with a compliment, "I hope to see you tommorrow night. You are capable of outstanding work and have a good rapport with patients x, y and z."

    This has turned into another long answer to short question. The shorter version is my diploma program was excellent preparation for bedside nursing, but it was the interpersonal skills from my business background that gave me wings. We all test our limits, it's the nature of the beast. _Enforced_ limits tend to be obeyed.

    I have yet to meet any RN, from diploma right up through PhD FAAN who has learned to delegate or communicate with co-workers in a nursing program. Those of us that do it learned it somewhere else. I have identified two common traits.
    One is infectious optimism. Unspoken rule number five on my floor is if you are being paid to be here, you have to smile. The way to get that to happen is smile most of the time, and usually sooner rather than later people start smiling back.
    The other seems to be applying the nursing process to 'healthy' co-workers, ancillary staff and self, beyond applying the nursing process to 'sick' patients. Even with the small number of diagnoses available, we posess an extrodinarily powerful tool for improving professional and interpersonal relationships. Off the cuff I am willing to bet more than half of your problem children are feeling powerless. What can you do to empower them so they can do a better job for you and your patients?

    Off my soap box,
    Scott
  3. by   hollykate
    Interesting Scott,
    I graduated in May from a state univ in NC. We had a class called leadership- which was advanced med surg with a twist- we all took turns being "in charge" and making assignments/delegating activities to our Student colleagues. I Learned so much more about motivation and how to communitcate iwht others so that things actually get done. SO yes, there are some nursing programs that attempt to teach it.
    As far as being prepared for reality- well, having been an Adie, I pretty much had an idea of what reality was for nursing. I have had a great job in an ICU since I got my liscence. I was recently recruited by the "other" level one trauma center (STICU)in my area- so will be leaving for better working conditions and a little more cash (They sure seemed to think I was ready). I feel I was prepared and ready, but of course, there were still a few things to learn, but since we as nurses go to inservices almost everyweek- guess we are all learning the new stuff all the time.
  4. by   TXERRN
    I feel that my ADN program prepared me adequately. Too much time in nursing school is spent on care plans and more time should be spent on making sure nurses are able to handle their organizational skills, time management skills and working under pressure so that in the real world of nursing they are a little more prepared. My mother is a nurse and prepared me for the reality of nursing, so I was fortunate to know what to expect, but too many of my colleagues were not.
    I am currently receiving my BSN and have learned nothing new that will help me in becoming a better nurse. It's mostly the same fluff and unrealistic objectives from the first go around. All of the community health and pro-health stuff is great, but who really has time to do it in real practice? I sure don't in the ER.
  5. by   Mijourney
    Hi. As a diploma grad, I felt I received good ground knowledge of bedside nursing practice. As a BSN grad, I received a good understanding of community health concepts of patient care. Being a nursing assistant before going to nursing school at least gave me an idea of what type patients I would work with and some of the complexities of their care.

    What I was not prepared for was the adverse effect that the medical industrial complex would have on my ability to deliver good, safe, quality care to my patients.

    I did not learn the overwhelmingly heavy impact the government, the AHA, AMA, MCOs, private insurors, licensing and accrediting agencies and other entities would have on my nursing practice.

    I really did not have an understanding that profit would reign king in a life and death situation.
  6. by   dazedandconfused
    I can say with all my heart that I was not prepared when I graduated. I have my BSN from a VA university. With three years of books and little clinical experience, I graduated. If it were not for the LPNs that took me under their wing at my first job, I would not have made it through. And I thanked them for it everyday that I worked with them. If I had have of the experience they have I would be a better nurse. I have seven years out and still have a lot to learn.
  7. by   lita1857
    VERY! attended a 3yr hospital diploma program that required you also at the local community collge for your AAS degree. You went to clinical and worked the floors along side the nurses as students w/instructors precepting(and every nurse you came in contact with)7-3:30pm, classes in anatomy/microbiology etc taught by college staff during the evening. Blocks of teaching in one area like pediatrics then psych etc. broken up during first 2yrs, in the 3rd year legal aspects/charge nurse responsibilities/supervisory/precepting.They also STRONGLY recommended working 1st year on med/surg floor-best advice I took, you definitely learn organizational skills/prioritizing that will last a life time.Besides all the other issues in other posts to make people want to go into nursing...how about programs that produce nurses that can hit the job with confidence/skills/knowledge and EXPERIENCE! Radical thought huh?
  8. by   Greystorm
    I graduated from an in hospital program in 1990. During the course of my training I had the opportunity to spend the majority of my time in the clinical setting. This allowed me the chance to develope the skills required to be an effective member of the team upon graduation.

    Now that I've been in practice for the last decade I can see the difference that has developed in the nurses that graduate today versus those from my era.

    It seems as if the nursing schools today want to develope nurses to be administrators not clinicians. The emphasis is all wrong. Train the nursing students to care for patients and develope clinical skills, not prepare fancy careplans and write research papers. Sure these things have their place, but those shouldn't be the primary focus.

    Just my opinion.
  9. by   daisie
    I graduated in 1999 from Hartsville Career Center as an LPN. It is a one year program. I learned to be a CNA. I learned to be an LPN when I got my nursing job. The experienced nurses in the facility where I work taught me how to be a nurse.

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