New grad with no clinical skills

  1. 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?
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    About malone2192

    Joined: Aug '09; Posts: 13; Likes: 3
    Charge Nurse
    Specialty: 15 year(s) of experience in Rural Healthcare, AIDS, Hospice, UR, LTC


  3. by   stelon
    I feel bad that her instructors have not properly prepared her. I finish my LVN program at the end of the year and they've drilled everything into our heads through hands on experience.

    We've all done tons of skills and they've also placed a major emphasis on critical thinking. I hope she manages to get through this mess her school has put her in and becomes a great nurse.
  4. by   LoveMyDaughters
    Wow. I am currently in RN school now and we have LOADS of clinical hours. (Not too mention lots of class/lab time as well).

    I can't imagine graduating and not having any clinical time. I believe her school did her a huge disservice.
  5. by   lalalalexi
    I know that at my nursing school (an ADN program) skills were really hit hard. We had to pass competencies (instructor watching as we performed skills on dummies) and also had to do the skills in clinical in order to pass the class. After a while, most skills became automatic. I never imagined other nursing students not doing this until I started working at a hospital as a tech during my second year in school. A few nurses were hired the same time as me and so we all oriented to the floor together. One girl talked about how nervous she was to do an IM injection because she had never done one. And another girl said she only started an IV once and never had more than one patient at a time. I was shocked, to say the least. Both of these girls came from different BSN programs. The thing that really got me is, this hospital is trying to go all-BSN nurses and when I graduated, I wasn't able to get a position there. Now, I understand nursing is a lot more than just performing skills and tasks, and critical thinking is so vital, but how will these nurses have the time to think critically about anything if they are so caught up muddling through skills they are afraid to perform?

    Anyway OP, I totally see where you're coming from. I think some nursing programs are great and others I wonder how any of the students pass the NCLEX at all. And even though I would have hated it, I think maybe there should be a skills component to passing boards.
  6. by   JomoNurse
    NS is nothing like the real world. Take a few extra minutes to reorient this N-E-W nurse to some pretty basic nursing skills. It's easy to forget to do these things if you aren't doing them 3x a week at work, every week.
  7. by   Bortaz, RN
    Some of it may be the school, but some if it may be the nurse herself. In my ADN program, I sought out opportunities to do procedures (or to observe them till I could do them myself), but I had many, many classmates who would purposely avoid getting in there and doing something. We were encouraged to seek out skills practice, but a lot didn't.

    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.
  8. by   amiro31
    I can see why she is excited about d/c-ing her first IV. I can say that I used to shy away from nursing clinicals. I would watch people perform them, then go read about them. I would love to give PO meds, but terrified of IV's (this was 2 years ago). I figured that when i graduated i would do nursing for 60+ years and learn it then so why not enjoy college now (I had the college mindset and my friends were going out bla..bla.bla). I now work in an ICU and needless to say, i've learnt to put in foley's, start IVs. I really think that the clinical part of nursing school taught me 20% of what i needed to learn for my job. The theory was right on...but seriously, when do you really get a textbook patient in practice? they usually have more stuff going on....she will eventually figure it out with your help. just direct her more towards the policies of your hospital and take time to show her. let her know that she always has RESOURCES...and PLEASE don't look at her like she's stupid (it might be obvious to you, but not to her). Bottom line, she will probably need more than 8 weeks of orientation.
  9. by   sleepyRN2
    i dunno know where this student graduated from, but i am an el camino college nursing student, 4th sem (yay) and the tasks you've listed are things i've done, plus more. tsk tsk tsk. lol. yay ECC!
  10. by   MisterSimba
    I recently finished my first semester of nursing school, and have done all the skills you mentioned, except for discontinuing an IV. We haven't done IV's yet - that starts second semester, when we also go from having one patient to having two. All I can say is having a good clinical instructor is worth her (or his) weight in gold! Mine was amazing!!!

    I'm in an accelerated second-degree BSN program, but I think many (if not most) ADN programs are just as good, and much less expensive.

    A question to all the seasoned nurses out there: what is the point of all the APA papers? I feel like all they do is take away time that I could use to study or read my textbooks!
  11. by   cardiacmadeline
    Did this nurse graduate from a 2 year or 4 year? I am assuming a 4 year. I have a BSN and when I graduated, I started with 3 other ADN nurses. I looked like a complete idiot compared to them. I had hardly any clinical experience--1st semester cardiac floor - 2nd semester a small rural hospital on med surg floor- 3rd semester community clinical-4th semester gen surgical floor with a terrible preceptor. That's it, that was all of my clinical experience. I felt my instructors were more focused on their research than teaching and that the nursing school had more interest in the advanced nursing programs. But, I did graduate with some knowledge of nursing skills, but it was nothing compared to my ADN coworkers. I think my nursing program was a joke, and supposedly it is an excellent program at a well known school.
  12. by   wee_oneRN
    d/c'd first IV? and never emptied a foley bag? I don't see how that could be possible. I just spent countless hours inserting foleys, working with iv's etc.. I wonder if this was a private school that the new grad came from? I have heard some bad stories of private schools jumping on the 'shortage' bandwagon without properly preparing students. There is a school here that is being sued by the students that cannot pass their boards. This is a huge burden on you and other preceptors. Best wishes from a jobless recent grad in CA
  13. by   sleepyRN2
    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.
    Last edit by sleepyRN2 on Aug 27, '09
  14. by   naun
    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.
    Last edit by naun on Aug 27, '09