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 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 think it depends on persone, on her own consciousness:nurse:

_______________

Life is good!

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I definately think 8 weeks of orientation is going to be a little short . . . can she work as a tech for 3 months and then orient to the unit? I know where she's coming from though . . . I went to a BSN program and worked as a secretary/aide/tech part-time during nursing school. I was appalled during my second med-surg rotation that my clinical instructor (THE INSTRUCTOR) had never seen a small-bore feeding tube or a Perma-cath before . . . and didn't know how to program an IV pump. We spent so much time doing care plans that a lot of the technical stuff got ignored. We have a similar issue at my hospital regarding IVs; I'm an ICU nurse and we get called all the time to start lines on the medical floors. Frequently the primary nurse has not even attempted it. We all miss lines sometimes, but one night I had to do four on the same 21 bed unit! I think that should be a competency built into orientation . . . I know that I was not permitted to work (or be paid) as a tech until I was able to get 3/5 IV starts, which I think is a reasonable target.

In short, clinical time is WAY too short in BSN programs - look at med students in their 4th year, they stay overnight with the residents and learn a ton because they're in house all the time . . . how can you glean that much info from 2 6-hour shifts a week in clinicals?

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Specializes in Hospice.

I just graduated from LPN school in April. I don't know what it's like everywhere else but here nursing schools are popping up everywhere - and these schools are fighting for clinical locations. When a school is finally let into a facility for clinicals they are often sharing the facility with another school and limited on the number of patients they can take care of. In these situations you may or may not have a patient that has a foley or an IV or... (fill in the blank). I learned quickly that if I wanted a chance to perform a certain skill I needed to make my desire known to my instructor. I had to learn to be assertive and make MY needs known - something I hadn't been used to doing. Not everybody in my class was able to do that. Some were just lazy and didn't care to try. I haven't emptied a foley bag but I'm pretty sure I could if I tried. Even though I'm IV certified I have never DCd an IV (on a real person anyway - just the fake one in lab). BUT... not doing any fingersticks??? I don't understand that one.

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I definately think 8 weeks of orientation is going to be a little short . . . can she work as a tech for 3 months and then orient to the unit? I know where she's coming from though . . . I went to a BSN program and worked as a secretary/aide/tech part-time during nursing school. I was appalled during my second med-surg rotation that my clinical instructor (THE INSTRUCTOR) had never seen a small-bore feeding tube or a Perma-cath before . . . and didn't know how to program an IV pump. We spent so much time doing care plans that a lot of the technical stuff got ignored. We have a similar issue at my hospital regarding IVs; I'm an ICU nurse and we get called all the time to start lines on the medical floors. Frequently the primary nurse has not even attempted it. We all miss lines sometimes, but one night I had to do four on the same 21 bed unit! I think that should be a competency built into orientation . . . I know that I was not permitted to work (or be paid) as a tech until I was able to get 3/5 IV starts, which I think is a reasonable target.

In short, clinical time is WAY too short in BSN programs - look at med students in their 4th year, they stay overnight with the residents and learn a ton because they're in house all the time . . . how can you glean that much info from 2 6-hour shifts a week in clinicals?

Although we learn to do it, we generally don't start IV's on my floor. Pt's usually come from ED or ICU with lines in place so we get very little practice at it - the only time they're required is when one goes bad, and that's not really very often. If you were the pt would you want me, a nurse with very little practice at starting IV's, or a phlebotomist or ICU nurse to start your IV?

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My school has emphasized clinical hours and skills, but it just depends on where you end up. Some hospitals are better than others in terms of "letting" students do things. I've worked with some nurses who didn't want a student to touch their patient with a ten foot pole - one CNA didn't want students bathing her patients! Come on!

I did my first blood sugar reading this semester, and I'm graduating in two weeks. Most hospitals I did clinicals at either had policies that didn't allow students to do them, or the machines required a passcode. I love doing skills and was eager to get new ones under my belt - but when it takes me three times as long as a seasoned nurse to put in a Foley for the first time, who is going to stand there and supervise me? My instructor has 5 or 6 other students. The nurses are way overworked as it is. Luckily this semester I was at an institution with a heavy focus on nursing education, and the nurses took the time to step aside so that I could do skills even though they could do them twice as fast. But that's a lot to ask.

Skills are important (never emptying a foley bag, bzuh???), but so are other things. You can teach someone how to do a blood glucose check in two minutes. Dealing with wide gaps in nursing knowledge or poor critical thinking skills is a lot stickier. If she actually *has* observed skills many times before, she should be ready to do them herself without much teaching.

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Specializes in Surgery, Tele, OB, Peds,ED-True Float RN.

Ok... you all can stop making this post an opportunity for the "ADN's" to put down the "BSN's". Give it up already! :banghead: Do you have to put others down to make yourselves feel good??I had an awesome BN program, with wonderful instructors and tons of clinical time. I would not have gotten through my clinicals or preceptorships without being able to complete these skills. I have worked with crappy ADN nurses, but also with crappy BSN nurses. There are some great nursing programs out there, BSN and ADN (and some not so good ones). Stop making blanket statements (AND THIS GOES BOTH WAYS) about a program that you haven't completed, not to mention the differences between BSN programs themselves!

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Specializes in LTC.

Sometimes it depends..when I was in school I asked to do things and my instructor told me I needed to learn x frist...well that's all I *did* In med surg rotation was to learn x so when I graduated I had very little experience...

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Specializes in Med-Tele, Internal Med PCU.

As a new grad, I am with the others. Either she frequently "went to the restroom" and/or her clinical instructors failed her.

While I didn't have the opportunity to insert a Foley (male student-female pt X 4) we did do it on a sym-man during skills development in 1st semester. I also had never given an IM injection, or started an IV on a real patient. We did IV practice 3-4 different times on practice arms, and injections obviously were a check off.

Emptying a Foley is part of measuring I/O there was no escaping it for 3/4 of my patients. D/Cing an IV was part of discharging/transferring and I did 8-10 of them. Now, we typically had 1 pt per week, the last 2-3 weeks my CIs assigned us 2+ each with 1 student being "charge", everyone got 1 week as charge and 2 weeks with 2+ pts.

My biggest deficiency is meds and protocols, but that's my fault for trying to do ED right out of school.

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Specializes in Community Health, Med-Surg, Home Health.

This is nothing new. I graduated from the first LPN program my community college offered. Because this was a new program, they did not have enough clinical instructors and the director had to hire whoever she could. Most of these CIs had other jobs and would arrive late and wanted to leave early to be at work the following day. Then, many times, clinical was cancelled at the last minute. Also, some of the clinical instructors did not want to break their necks to supervise us, so, we only had one patient at a time and if there wasn't anyone around that needed IV care, then, that sucked for us.

I always believed that the diploma programs were better because the ones in my area (from what I was told), had weeks of clinicals a time and made sure that both, skills and critical thinking happened. They increased the number of patients each semester, so, many of them were prepared to take a full load soon after graduation.

I blame the schools because while it is important to ensure that they obtain students with great grades, pounding them with theories about Nightingale do nothing for us in the real world when we are expected to perform.

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Specializes in Cardiac.
By contrast, I have spoken to nurses on the floor who were very surprised that we, as ADN students, were allowed to do far more than the local BSN program allowed their students to do. I eventually spoke to several students in the BSN program, and they told me they weren't even allowed to pass meds till their last semester of clinicals, and were discouraged from doing foleys, IV sticks, etc.

What??? I graduate from a BSN program in ~9 wks and this was definitely not the case. We passed meds during our very first day of our first clinical. We started IVs whenever there was an opportunity in which to do so. I've inserted foleys about a million times as a PCT and twice that amount as a nursing student.

Maybe the emphasis shouldn't be placed on what type of program (BSN, ADN) these new grads are coming from but rather the quality of the program and the diligence of the nursing students/clinical instructors.

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Specializes in Cardiac.
Ok... you all can stop making this post an opportunity for the "ADN's" to put down the "BSN's". Give it up already! :banghead: Do you have to put others down to make yourselves feel good??I had an awesome BN program, with wonderful instructors and tons of clinical time. I would not have gotten through my clinicals or preceptorships without being able to complete these skills. I have worked with crappy ADN nurses, but also with crappy BSN nurses. There are some great nursing programs out there, BSN and ADN (and some not so good ones). Stop making blanket statements (AND THIS GOES BOTH WAYS) about a program that you haven't completed, not to mention the differences between BSN programs themselves!

Thank you!!! I can always sense when a thread is going to head in that ugly (BSN vs. ADN) direction...

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What??? I graduate from a BSN program in ~9 wks and this was definitely not the case. We passed meds during our very first day of our first clinical. We started IVs whenever there was an opportunity in which to do so. I've inserted foleys about a million times as a PCT and twice that amount as a nursing student.

Maybe the emphasis shouldn't be placed on what type of program (BSN, ADN) these new grads are coming from but rather the quality of the program and the diligence of the nursing students/clinical instructors.

We passed meds our first or second clinical day, and with my first Pt, I managed to drop the PO pain med on the floor while putting it in the little cup. My clinical instructor and the staff RN had to waste it. They were kind enough not to verbalize their thoughts.

Hey, at least I didn't try to pick it up and give it...............like I would have at home!:chuckle

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