New grad with no clinical skills

Nurses General Nursing

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I oriented a new graduate nurse today and was absolutely flabergasted. She graduated in May and passed her boards easily in July of this year. This nurse somehow got through nursing school observing but not performing anything. She was so proud of herself for dc'ing her first IV today. She had never emptied a foley bag, drawn up medication from a vial, done a blood sugar....the list goes on.

She is slated for up to 8 weeks of orientation to the facility. This is difficult because its really not orientation to the facility she needs right now. She needs hands on nursing skills. I've been out of school for quite a while but I vividly remember the HOURS/WEEKS/MONTHS spent in clincals. Are nursing schools skimping on clinicals? Are they more worried about their stats on passing the boards--and producing nurses that are book smart and not clinically savvy?

I graduated from an ADN program. In my experience how much hands on you received during clinical was dependent upon: 1). How assertive you were in seeking out experiences 2). How supportive your instructor was in helping/mentoring/encouraging you to seek experiences and advocating for you 3). How supportive the nursing staff was on the floor in which you had clinical. I had clinical shifts in which I hardly got any experience and it was largely dependent upon the nurse I happened to end up with. I experienced many nurses who couldn't be bothered. In those cases, I made the best of the situation and often called in my instructor to help out - but she had 9 other students to look after. It seemed to make all the difference in the world which nurse you ended up with. If you had a nurse who was interested in mentoring/teaching - it was a good clinical day. If you had a nurse who was disinterested in you - you were basically hosed for that shift. I think that the majority of our students got their experiences working as interns - they had more access to opportunities. Unfortunately not of all of us could take intern positions during school.

It is hard to imagine that the new grad had absolutely no experiences, but it is not inconceivable that she may have had limited experiences. I definitely feel like I did not get enough education and practice with skills at my NS program.

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As a newly licensed LPN, there were certain skills that I never got the chance to do in clinicals, such as inserting a foley, trach care, suctioning, or anything involving TPN, for instance. On the other hand, I did some skills, such as d/cing an IV, that many of my classmates didn't get to do.

However, I know many nurses who never got to do a lot of nursing skills until after they started at their first job. Everyone's clinical experience is going to be different based on what's available in the clinical setting. (Though I never heard of observation-only clinicals.)

Also, this thread brings up other questions: what specific clinical skills should all new nursing grads be able to perform? Should nurses have some sort of documentation to give to potential employers showing exactly what skills they did in clinicals? Should hospitals or LTCFs not hire someone who hasn't done certain skills in clinicals?

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Specializes in Pediatrics.

Like others have said, it can depend on the school but also the student. I go to a community college and I will be starting my 2nd year. My first year we had a small starter class in the summer to teach us the basic skills (CNA) so first term we could do something in clinical. We get 5 hours of lab every week, were you pratice and practice some more then tested on skills once you pass the test you can perform the skills in clinical. We would get 12 hours a week of clinical time for 6 weeks each term.

Even being in LTC there was opportunity to do skills, but you had to seek them out. In my third term while 3/4 of my cohort was in the hospital setting for clinicals my group was at a SNF. One day the wound care nurse came on the floor she was taking care of my patients roommate, she let me watch as cleaned the wound she then let me follow her to her next 3 wound patients that were on the floor. Our clinical instructor would seek out skills for us and encourage us to look for skills to do whether they were a patient or not.

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I oriented a new graduate nurse today and was absolutely flabergasted. She graduated in May and passed her boards easily in July of this year. This nurse somehow got through nursing school observing but not performing anything. She was so proud of herself for dc'ing her first IV today. She had never emptied a foley bag, drawn up medication from a vial, done a blood sugar....the list goes on.

She is slated for up to 8 weeks of orientation to the facility. This is difficult because its really not orientation to the facility she needs right now. She needs hands on nursing skills. I've been out of school for quite a while but I vividly remember the HOURS/WEEKS/MONTHS spent in clincals. Are nursing schools skimping on clinicals? Are they more worried about their stats on passing the boards--and producing nurses that are book smart and not clinically savvy?

I know that time is important in training/orienting nurses to a unit, and being able to perform tasks/skills quickly and proficiently is a big part of that.

It's difficult to understand how someone got thru school without at least doing some of those things.

All-in-all, it's easier and quicker to teach most people physical skills than to instill a knowledge base and critical thinking.

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Specializes in Med/Surg, Ortho, ASC.

"APA papers are great tools. you may not see the importance of it right now but later on it might just help you, especially when you go into higher and higher education (MSN/Phd). you see a paper in APA format is the accepted and required format needed when disseminating information r/t your profession and ultimately to your colleagues. it is important because you belong in a profession that requires professionalism. Hence, any information or concepts that you usurp or "corrupt" in your paper must be open for your colleagues for some kind of validation, i.e. the APA format papers are professional papers (i.e. APA) which are open to peer review. Peer reviewed papers are important in one's profession because this becomes the bread and butter of the said profession; in this case, nursing. for example, one would refrain oneself from using a nursing procedure especially if it has not been exhaustively tested & tried; however, you can check peer review papers (APA) for information regarding that nursing procedure. hence, all that statistical data, original or meta-analysis, the peer review papers (APA) go through that task for you. only really good APA papers of substance get to be published, the rest die a quick death. now, you see how it strengthens one's profession, and its importance to all in the said profession. "

I'm thoroughly confused....is this posted in the wrong thread?

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Specializes in L & D, Med-Surge, Dialysis.

The New Graduate need encouragement! Let give room for improvement. Rome is not build in a day!!:icon_roll

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my apologies to you, roser13. that (APA comment) is a reply to mistersimba who gave his own thoughts regarding New Grad w/no Skills AND at the same time posed a different question concerning APA (direct roser13: read mistersimba's thoughts). i'm not sure whether that question was rhetorical, but i answered it since i thought of it as important. and i posted it here since he raised the APA subject here. it would be inappropriate of me to post it elsewhere when it was posted here, as well. anyway, we'll just think of it as a question w/in a question however irrelevant to the main topic of new grad w/no skills; however, relevant in that it is a part of a super topic: nursing.:)

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Specializes in NICU.

I agree that it may be this particular nurse, rather than the school she attended. I attend a private university that is known in our state for having a wonderful nursing program. I agree with this assessment, however a lot of it has to do with my attitudes. I am entering my 4th and final term of the program, and so far have had 6 clinicals (one more to come this semester). I have actively sought out oppurtunities to perform skills while in these clinicals, and as a result I have placed foleys, started IV's, done dressing changes, given plenty of meds of every type, and observed procedures, such as cath lab procedures and endoscopies that nurses assist with. However, I have observed other students in my program doing their absolute best to avoid doing ANYTHING to an actual patient. Luckily, for the most part all of our clinical instructors have been very good about encouraging students when it is needed, and therefore even the most squeamish and frightened of us, in the end, has done at least a little. It is sad to think that without some very supportive clinical instructors though, these students would manage to graduate without practicing any real skills in the hospital setting. Of course we have to practice everything in the lab, and then test before a teacher in orderr to validate skills, but it's just not the same thing as doing it 'for real'.

Hopefully, with a bit of good, supportive, leadership on your part, this nurse will gain confidence and quickly catch up to your expectations.

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I went to LPN school in a small town, we did all the skills the nurse was saying the new grad had not done, It was back in the late 80's but I'm shocked this Nurse had not even dumped a cath bag or done an accu check. !! Didn't they have a check off list for skills in school?

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this is really bad for her..coz nursing means well equipped in practical work.. i wonder how she passed her practical exams....i m also in d last year of my bsn..but we were so excited during our first year to learn quickly nd doing work efficiently..

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we currently each have a personal check off list in our nursing program. it has become invaluable to have one, because it keeps one on the ball, q semester, as to which of the skills were completed and those that need to be completed.

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Unfortunately, I can see how it happened. I am a graduate of a 14 month accelerated BSN program, and we did not get as much clinical time as the regular 4 year students got. When I graduated I had few skills down well. It left me at a disadvantage in some ways, but I was able to quickly learn in a small hospital with low acuity patients. If I had stepped into a busy ER or other specialty unit, I'd have been sunk.

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