Failing the next Generation of grads - page 3
Hi there, After 5 years as a nursing student ( I failed a clinical and had to repeat a year) I am looking back at what was and what will be for the "caring" profession. What I have witnessed... Read More
Mar 14, '02Just as a personal opinion, if I had had more clinical time to practice nursing, my stress load would have been GREATLY reduced and I could have concentrated more confidently on the theory. As it was, my BSN program only offered 14 days a semester for 4 semesters. I would have done ANYTHING for an internship, or residency, or independent study program that would have given me more opportunity to learn hands on nursing under the guidance of an instructor. Those options were unavailable at the time, and my instructors waved away concerns by stating the skills can be learned later and the theory will take you farther. That didn't do much for my anxiety or self-confidence. Not to mention that upon graduation, no hospital in the state would hire new grads since they had been in layoffs for 3 years. I enjoyed my classes, but I would have even stayed for an extra semester to get the experience if it was available. Some people just need more time to grow up I suppose!
Mar 15, '02So you only had 54 days of clinical when you graduated? That is RIDICULOUS!!! MY BSN had us in clinical a lot more than that!
Mar 15, '02Fergus, your program does sound alot different than mine. Ours had clinical for 2 days a week for 4 semesters. We started our many of our clinical days having a conference with the instructor and other students, presenting what we had learned from textbooks about our patient's illness. By the time we got to the floor, the nurse assigned to that pt had already gotten report, assessed the pt, and maybe done meds, and was busy with her other pts. We would end up doing the bed baths, doing a med pass with the instructor, wasting alot of time, then doing long notes which the instructor read and critiqued before we left. We usually stayed about 7 hours, including lunch. Often, the floor RN assigned to the pt was too busy to teach us how to do skills. The instructor supervised EVERY student med pass, which ate up most of her time.
Mar 15, '02I graduated from a 2 year ADN program that was actually 4 years by the time you did the 2 years of sciences (including 1 year each of chemistry and A & P) required before admission to the program. The entire 4 years was 15-18 credit hours per quarter.
For every hour of theory you got 2-4 hours of clinical, when you walked on the floor for clinical you were expected to know the patho/phys-and NOT just the stuff on the little pre printed cards...by the final 2 quarters we did an 8 hour day of theory and 4 (8) hour days on the floor a week-all med-surg...by the last 4 weeks of the final term you had to be able to carry 4 patients, on your own, with a precept to double check your meds...the instructor came by a couple of times a shift and checked documentation.
The class I graduated with placed #1 in the state on the boards, with every grad passing and all within the top 20% in the state.
I may not have known much about the 'psychological' aspects of Nursing but I could sure guess the blood gasses on a pink puffer based on their color, VS and O2 liter flow.
Mar 15, '02These are all very excellent posts.
I remember my days as I new grad; I graduated from a BSN program without every having started an IV on a real person. Some of my classmates did - they got a rotation to the GI lab and spent all day starting HUNDREDS of IVs. I have to say I liked the variety of clinicals that my school offered, but you weren't always lucky to get them. Frankly, there just weren't enough nursing instructors. And, as this original post stated, Masters prepared nurses who are prepared to teach, are also in short supply. The nursing shortage effects every aspect of nursing - not just the floors.
As far as clinical skills vs theory. Fergus is right; as a student you are obsessed with the skill-learning because this is what "defines" a nurse in mostly the public eyes, as well as some nurse's eyes too. But what we forget about, I think, is that nursing has been defined as an art and a science. The science piece has taken the forefront lately because health care in general has evolved to being highly technical; as a result, nursing had to become technical as well. But where is the best place to learn this? The floors. The hospital. Isn't it part of OUR obligation as working nurses to mentor and teach the new ones? Isn't that how Medical Education works? Perhaps if there wasn't such as shortage, teaching new grads wouldn't be seen as such a burden. Nowadays we are expecting new grads to be up and running, to fill the staffing holes, not really thinking about their needs of being mentored properly. It's a darn shame, and that's where I think we are failing our next generation: not in the schools, but on the floors.
There is way too much information about nursing that has to be crammed into 4 years. Even now, in my Master's program, there is information about nursing that I was never exposed to in the BSN program, simply because there wasn't enough time. The best place to learn about Watson, et al is in the classroom. The best place to learn skills are from experienced nurses on the floor. You can't learn Watson on the floor. You can't learn research on the floor; and when it's time you APPLY research, you are lost because you never had it before. Much of nursing can be automatic, and as time goes on, it becomes more automatic and if the basis of nursing was never laid in the classroom, we are simply robots - and nursing has then lost what makes in an art.
That is my opinion.
P.S. Having graduated school never starting an IV, I learned it on the floor and now am proficient in it. I learned it from a very skilled nurse on my OB floor. She certainly didn't teach me about nursing theory and research. But I feel I need BOTH to have the potential to be an excellent nurse.Last edit by Susy K on Mar 15, '02
Mar 15, '02That's crazy grouchy. Our program had us on the floor two days a week during the regular semesteer (8 hour shifts where we did primary nursing for 2-5 clients and occasional team leading), but then we had consolidated practicum where we worked full time (36-48hours a week for 4-6 weeks during the summer) and another consolidated practicum in our final semester (we only had 2 weeks of classroom time that semester and it was all about skills and assessments and pathophys).
I COMPLETELY AGREE WITH SUZY!!! It is our job to help new grads. We tend to be very hard on them because they are easy targets and that has to stop. The funny thing is I was talking to my aunt who's a nurse and she said that older nurses were talking about the poor quality of new grads when she was in school too (and that was in the sixties!).
Mar 15, '02I personally don't see anyone being 'hard' on new grads. I do see some resentment of young nurses with huge egos and attitude...I guess the schools propogate this today but I don't know for sure.
As mentors we take on an extra assignment above and beyond our already mountainous assignment...can you get that? We wonder why this mentorship is necessary. Don't you think it is the job of the NURSING SCHOOL to train you as a competent, entry level nurse? I do! Does anyone else out there feel like me here? Why should I feel so obligated to do for you what your school has not? The needs and demands of new grads today is unlike any I've encountered, and why is this? Does anyone else think our poor nursing schools have any responsibility at all here?
What new grads see as being'eaten alive' is quite simply a reflection of multiple problems in our profession today. The fact that nursing schools are putting out poorer and poorer products through the generations is abhorant and we should be angry about this instead of blaming 'grouchy old nurses' and resorting to elitism. JMHO as usual.
Peace (and I'm pulling my 'grouchy ol' nurse ' claws back in now)
Mar 15, '02Mattsmom -
I CAN get that you are taking on a new grad to mentor on top of your huge assignment. I have done it. I have also not orientated a new grad properly AT ALL because we were just do damn busy. As a unit and as a preceptor, we failed her, I think. We were concerned with getting tasks DONE, rather than actually teaching her tried and true techniques about this or not.
There is such a shortage that we are fully expecting our grads to fill the holes - and that is not fair.
Do you honestly think a new grad is going to be proficient in all aspects of technical care and skills? I am an experienced nurse and I am not. I would need orientation again to an NG tube, to a drain, to dressing changes. I have the basic knowledge, but would need guidance. I don't know these things - how can you expect a new grad to?
Physicians are taught in this manner - probably because they don't have empty staffing holes to worry about. WE DO. And that's what we view new grads as; not as young nurses who need further education on the floor, where many of your purport that "true" learning takes place, but as another member to staff so you can finally have your vacation granted. How can you argue that real learning occurs on the job, but then not offer the opportunity to your new grads, or feel resentment that you have to educate them? It sounds contradictory to me.
While you have a valid concern about staffing and you deserve your vacation to be granted, I also see it as how the nursing shortage is effecting how we teach our young nurses.Last edit by Susy K on Mar 15, '02
Mar 15, '02Yes, in fact I do think a new grad should be competent in the performance of basic nursing procedures, PLUS critical thinking skills, both of which are neglected in most of today's nursing schools IME.
You have proven my point. If you would need reorientation to insert an NG or change a dressing, I do wonder at the calibre of your nursing education, dear. And I'm sorry if this sounds harsh, but YES I was a competent, basic practitioner upon graduation as were most diploma nurses of my generation. My school made SURE I was!
Your comments suggest failure of staff nurses when new grads do not do well, and again I must beg to differ.
We shall have to agree to disagree.
Mar 15, '02Mattsmom,
I see what you are saying (the skills I would need reorientation to) but I have been an obstetrical nurse for 4 years and never did a lick of Medical/Surgical after school. After time, the skills are lost. That's what I mean. I have a foundation, but not proficiency. I can't.
I feel that is comparable to a new grad perhaps having all the experience in the world at doing injections, etc, but simply didn't get to master NG tubing, etc.
You could have a valid point in the schools; they may not be able to keep up with the advancing technologies of medicine. ?? I don't know.
Perhaps schools need to be revamped, but I think part of this is the nursing shortage - hitting availability of instructors to provide quality education. But I still think as professional, experienced nurses, we have an obligation to the new grads that we are not fulfilling.
Mar 15, '02I agree nursing schools are partly to blame mattsmom, I just don't think they are that different today than 30 years ago. My aunt is proof of that. The new grads are never as good as the older grad classes . I would argue that we are hard on the newbies and students. I think a lot of us are so stressed that it is easy for us to take out our frustration on the students, rather than dealing with what was really frustrating us (like poor staffing, increasing workloads,etc). Even now, a lot of my colleagues (and I admit, I do it too occasionally as I get as stressed and catty as the next nurse) enjoy putting down the education students receive and pointing out how much better their program prepared them and generally pointing out anything a student or new grad does wrong. Even if we all agree that nursing schools should be better preparing their grads, I don't get why we take that out on the new grad, they didn't get to choose how their program runs.
I don't think any school can truly prepare a student to go from novice to expert overnight. While in school they have the benefit of a preceptor or an instructor all the time, then they are thrown to the wolves the day they graduate. I don't think a new grad can be expected to be an expert nurse day one out of school. I don't think that's super useful to us as a profession either.
The mentorship programs I like are when experienced nurses CHOOSE to become involved and it is NOT in addition to their already hairy workload. It eases the transition for the new grad and gives the new grad a chance to benefit from and learn from an expert nurse. It made me feel more at home on my unit and decreased my stress because I knew that I had someone to talk to if things were going bad. I still keep in touch with my mentor almost five years later. She is the most amazing role model for me, and I can't tell you how much she shaped my practice as a nurse. Some hospitals here are instituting mentorship programs because it has been shown to increase retention levels by an amazing amount. Whatever we feel about , we do need to keep new grads in the workforce.
Mar 15, '02Whenever I worked as a preceptor of new grads, the first thing I would tell them is to stay as close to me as you did your former Nursing Instructors! Even on very busy days when the shift work was hectic, I made certain that the new grad I was precepting didn't miss a beat. If I pulled meds from the med cart, she/he had to have their eyeballs glued to what I was doing. If I did dressing and wound care, they had better be close enough to do it themselves on those busy days. When doctor's orders were written, every order transcribed from the patient's records to the MAR sheets by me was also closely witnessed by the new grads being precepted by me. When report was given, they were right there hearing every word, and did walking rounds with me and the off-going or on-coming nurse. Their little legs didn't miss a beat...no siree! We learn by listening, hearing, copying, and then applying all of the above. First we scoot, next we crawl, then comes pulling up on one's two feet, and then we walk. Once your legs are walking, they better be walking on my heels and picking up everything. Sometimes those hectic days are so hectic, the new grad wants to stop and cry. Well, so do I, but we keep on pushing on until "break time"...whatever the heck that may consist of. I would tell them to cry later when the day was done, but until that time there was no time to cry!
Mar 16, '02I have worked in an ICU setting for almost five years. As one of the more senior staffers,I have been involved in preceptoring new staff members during their orientation period, and I also perform the charge role on a frequent basis. The BN program in our area is so deficient in basic nursing skills that one of the RN/BNs I was preceptoring, even after more than a year of employment with our facility, had NEVER d/c'd a foley. My time with this nurse came at the end of her clinical experience capping off a post-basic critical care course. A second RN/BN now working in our unit poses problems for me when I am in charge, because despite the facts that she has a degree, has been out of school for five years and is now a clinical instructor at the local university, is only capable of caring for the most stable of our patients. She has almost no time-management ability, and is often very behind on scheduled meds and treatments. Her lack of organizational ability impacts on the rest of us because she is never ready to take her breaks when she should be. As well, she isn't yet able to function independently and requires help with many routine tasks. I find it a little frightening to know that she is a clinical instructor for our next crop of grad nurses, who graduate woefully unprepared for the reality of providing bedside care.