Nursing education today

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    I'm asking this to truely try to understand, not critisize,bash, or in any way demean students. I am a diploma graduate of 31 years. I don't understand why nursing education doesn't include more clinical experience. I can't imagine starting out the way new grads do today. I understand and appreciate the necessity of theory, but would it not be of significant value for that theory to be put into practice while in school on a much larger scale. Our students graduate having never cared for more than two patients. Is this the norm? Also, our nurses don't teach, the instructer must always be there for them to do anything new. Recently, a student had a patient on my assignment that went bad, the student and instructer walked away from the situation and it was mine alone to handle-I saw that as a terrific learning experience-what was that about?
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    I think for my ADN program we had up to three patients and were on the floor for the entire semester for 6 hour days with one hour post conference. I felt okay when I got out.

    renerian
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    Our ADN programs gives alot of clinical experience. From week 2 in the program we start 8 hr clinicals with 1 patient 1 day a week for the first semester. The second semester consists of 2-8 hr clinicals with 2-3 patients. Summer semester is Psych and we dont "take" patients but interact with all of them. This coming year in Pedi/OB will consist of one 12 hr clinical a week and MEd surg will be 2- 8 hour clinicals a week. That comes out to about 864 hours of clinical experience! Our theory consists of so much information. I do not believe we should learn those things in clinical but rather we should know the information beforehand so we are better able to understand. Also, if I were a patient I certainly wouldn't want someone doing something on me for the first time without someone present to guide them if they begin to make a mistake.
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    My program included ten 5-week rotations to different areas. Each week, we had two days on the floor Tues and Thur - 7a - 3p with a post conference. We had to go in the previous day to get our assignments, check the charts, make detailed care plans, and make med cards. There were about 8 in each rotation group with one instructor. We could only give meds, change dressings, etc when it was our turn with the instructor.
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    I'm in a BSN program, just finishing junior level. We've cared for 2 patients during med/surg clinicals. During senior level, we will work up to a full patient load (5 to 6 patients) by the end of the med/surg rotation. We are on the floor 7 hours a day with an hour post conference -- 3 days a week.

    I could be wrong...but I always thought the SBONs dictated how many clinical hours you must have before you could even sit for the NCLEX. ???? I can tell you that I still don't feel comfortable on the floor and can't do every possible clinical skill but I believe some of that comes with time.

    Oh, and about the instructor and student who walked away...ohmigosh!! Shame on both of them. Instructors (and students) should always be on the lookout for new learning experiences. If my instructor isn't looking, I am. No nurse or doctor has EVER said no when I've asked if I could watch or help with a procedure. Our instructor must be with us when we attempt a new procedure but we try and plot all this out at the beginning of the day and then prioritize when the schedule gets thrown out of wack.
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    We will get appx. 180 hrs of clinical experience, if i added this right.

    Receiving 20 hrs a week, crammed into 2 days. School begins Aug. 25th, first clinical day is Sept. 1st., and this continues until the last week in May.
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    I don't think ANY nursing program of today can match the old diploma programs of yesteryear in the way of clinical experience/time spent in the hospitals and other areas of RN practice.

    In those days, nursing students literally slept, breathed, ate, LIVED nursing. Many lived ON HOSPITAL GROUNDS, in dormitories and spent countless hours on the floors. The experiences today contain much more classroom time and less clinical time. This is due to many factors. Nurses today have much more autonomy than those of the past. We are expected to make many decisions previously deferred to doctors before. The legal climate certainly has changed, requiring nursing to be darn near all things to everyone with the threat of legal action hanging over each and every intervention we make on the job.

    I am in NO way putting down diploma programs in the past; could not be further from the truth. I think some of the most competent nurses I EVER met are grads of these almost-extinct programs. ( my aunt and grandmother among them). They hit the floor on graduation KNOWING the hospital inside and out. I just think changing, ever-expanding roles and attitudes have forced a change in nursing education, quite naturally. And I have talked to few nurses who, in being honest, felt they had NEARLY enough clinical hours upon graduation----myself included.

    I think nursing programs would do well to add clinical hours and less classroom time. A lot of what is covered in class can be covered in self-paced study and the like. JMO......and I am not suggesting spending more time putting in foleys and suctioning people, either. These tasks are such a small part of what RNs do day in and out. I am thinking spending time REALLY practicing team leading and working hand-in-hand with charge nurses, learning their roles. Also more time spent outside the hospital, in community health nursing, hospice nursing, home health nursing, school nursing, parish nursing. WE had so so much we could have covered! I wish I had. The first year was SO hard, not only learning my speciality, but being expected to learn to take charge of my OB floor within 3 lousy months.

    Oh well, I could go on and on. I do believe the OP has a great point. Nursing programs today (BSN/ADN) do NOT spend enough clinical hours doing what they will do. Cost and time constraints make it hard. No easy answers.
    Last edit by SmilingBluEyes on Aug 11, '03
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    A thought that I've had for twenty-some years: combine the best of both.

    Graduates of ADN and BSN programs should be required by law to complete a 0ne-year internship/residency at a hospital -based program. The content and oversight of the program should be from nursing educators and the state BON (NOT those gooffy hospital administrators or MD's). Limits should be placed on the number of hours per day and per week to prevent digressing to the days of student exploitation. One-month rotations in clinical areas (maternal/child, ER, ICU, OR, PAR, med-surg, peds, home health)
    This would allow the new graduate to solidify their newly aquired book knowledge and become really seasoned by working with experienced nurses.
    I am an idealist and I realize that there are few or no hospital administrators who would ever do anything nice like this to help new graduate nurses. Just an idea.
    Edward,IL
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    I teach in a BSN program & my clinicals are 7 hours with one hour post confernce for two days & then they do another rotation elsewhere to bring it all together. My students take 2 pt's each in ICU (which is the the max). They stay when the pt. goes bad unless there is a situation whereby the student is asked to leave, then we have discussion on the spot. When I was a student, I was in a CVOR rotation & the surgeon had a pt go bad, he lost his temper & I was ushered out but the crew because they didn't want me to be witness to his bad behavior (I still work with this doctor, many years later---the behavior is still the same). I was appreciative to the staff for sparing my feelings. I saw enough of the surgery to know was going on & know I didn't like CVOR, just not my cup of tea.
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    For months, I felt almost slighted in my BSN program that we were not receiving adequate clinical experience. While I still feel that I am not prepared to function as a nurse with a full load (just graduated), I am confident that I will eventually. The clinicals as most know them gave me some idea of skills, but with only 1-2 patients, it is hard to be exposed to very much. However, we did a senior practicum, where we were assigned a preceptor and worked his/her hours for 10 weeks. It was amazing how much I learned. I was in an ICU so I never went beyond 2 patients, but my friends on floors were expected to provide full nursing care for at least 4 patients. Our clinical instructors only stopped in to make sure all was well, leaving us one-on-one with a preceptor. I know other programs also use this method of learning, but several new nurses in the unit who had graduated from ADN programs were envious since they were never given the chance to learn like this.

    As for the theory part of nursing education - I agree that some of it is fluff. But nursing wants to call itself a profession and with that comes the need for a well-rounded education.

    Take what I have said with a grain of salt as I am new to nursing and never knew a time when new nurses had the experience that some of you did upon graduation. I am just trying to defend the education that I have received and thank all experienced nurses who have and will guide us new grads as we become the nurses of tomorrow.


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