New grad with no clinical skills

[malone2192]

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?

[blondy2061h, MSN, RN]

I graduated nursing school having never started an IV and only inserting one foley. No one wanted to let a student to it. Many of the hospitals I had clinicals at had policies against letting students start IVs.

That being said, emptying a foley and d/c'ing an IV are both extremely basic skills I can't imagine anyone having qualms about a student doing.

[lisamc1RN, LPN]

Well she knows how to d/c an IV and empty a foley now, and it didn't take that much time to teach her, right? :) Maybe it was her fault, maybe she didn't get the opportunity, or whatever, but these things are very fixable with patience from you and a little guidance. It sounds like she's not unwilling to learn, and this is a very good thing.

Does your facility have a list of skills new nurses are expected to come in already knowing how to do, or can they extend orientation if there is a need? I hope your new orientee proves to be a very motivated learner.

[sclpn]

I really think it's the quality of the NS program not the type of program. I went through the LPN at a local community college. we had a lot of clinical days but as other posters have said some nurses wouldn't let us touch their pts. I graduated without ever putting a foley in a real person. We had a few lab practices on a dummy then a check off in front of the instructor and that was it. Same with d/cing an IV, giving an IM, finger sticks etc. If my pts. had an order or needed the skill done then I had the opportunity but if my pt. only required PO meds then thats what my clinical day consisted off. Same thing going through the RN program. Never started an IV, changed a central line dressing....had lab practice on a dummy and then a check off with instructor and class moved on. Don't hold it againist her that her program was crappy...give her every chance to do skills that you can find. Thank God I had a wonderful preceptor who had lots of patience and who loved teaching.

Lynn

[malone2192]

Thank you all for such a variety of comments.

I had the opportunity to observe this nurse from a charge nurse position today. She oriented with a different nurse today. Again, she did a lot of observing. She is quite passive. With encouragement and assertiveness on both my end and the other RN, she stepped up and took some initiative. She did her first IM injections today.

I have to be honest, my facility got a little spoiled with the last couple of nurses that have joined us. We usually hire 1-2 new grads per year and have gotten some really good nurses. They WANT to learn and seek out the opportunities. This one will just need a lot more attention.

I, along with some other nurses', have individually discussed our concerns with our supervisor as well as the clinical educator. Time will tell as to how this situation will turn out.

It has been quite interesting to read the assumptions in several of the replies to this thread. ADN vs. BSN. The great debate continues. I have met and worked with countless nurses...from both different kinds of programs. In the end, we are all registered nurses. We all take the same test. The letters after our name shouldn't make a difference.

[Bortaz, MSN, 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! 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!

Quick! Everyone overreact!

[Bortaz, MSN, RN]

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.

Yeah, from what I understand, it isn't a very good program, and their NCLEX pass rates are dangerously low.

[GoldenFire5]

Well, I'm a new RN grad, although I was an LVN for a couple years. I have to say, I was a bit of a mess during my first couple days on the floor. I hadn't done clincials at this hospital, so the charting, policies, flow... EVERYTHING was new. I said a couple of stupid things. I dropped a pill on the floor (first for me). I almost put some foot cream on the wrong patient. And I was all thumbs with the IV pumps.

In my heart, I know I'm a strong nurse. I'm still getting up to speed with this new job. But those first couple days were just embarrassing. It's a combo of nerves and just learning the ropes, I think.

Perhaps your new grads will rise to the occasion if you give them a chance.