Is it possible that the shortened RN training causes more anxiety for new grads

Harrychandler · May 17, 2011

So when you say you had 5 pts all by yourself a few questions
1/ Were you carefully supervised and mentored by a preceptor?
2/ Did you preceptor gradually build you up to 5 or were you just thrown straight in?
3/ What were your responsibilities?
4/ Do you feel your preceptor gave you the support you needed
What jobs have you applied too and how have you presented the skills you acquired during your work experience

Hello,

My 1st clinical rotation was in a LTC facility and I only had 1 pt. We learned the basics and did not give meds. 2nd clinical was med/surg with one patient at 1st then when the students were ready, we got a second pt. Students were responsible for all nursing care including meds. 3rd clinical was med/surg again and we started out with 2 pts and ended with 3 or 4 depending on the students skill level. Then I did an OB and psychiatric inpatient rotation. These 2 were just following the nurse around and observing. Then I did a pediatric ER rotation for 2 weekends and had a total of 3 pts. on one shift-total responsibilty and the same with the adult ER rotation but I got lucky and only got 1 pt everytime. Then we went to a school and sat with the nurse for one day. Then med/surg again with 3 pts and ended with 5. During all these rotations we had 1 instructor with us and the nurses at the facilities were mostly great and very helpfull. Only a few used to dissapear and not help us.

Now for the last rotation. Before we started we were tested on all the skills learned in the labs and had to pass the last test and the ATIs before we could do the last clinical. We were assigned 5 pts the first day and had total responsibility of the pts. There was only one instructor and my group had 6 people. We did not get an official preceptor but the nurses who worked at the hospital were very helpful and so were the CNAs. I learned a lot.

I applied to hundreds of jobs and only received 2 interviews. One at a hospital and the job I work at now. The interviewer at the hospital told me clinical rotations do not count as experience even after I explained how rigorous my rotations had been. The Homecare agency I work for now did not seem to care either way. They hire new grads all the time.

Julia19701 · May 17, 2011

A lot of what I have been reading is why some colleges are requiring new nursing students to get their CNA first. You work with pts and deal with family members & other employees BEFORE you become a nurse. There are several things that are beyond the scope of a CNA. Several nurses I have worked with will allow nursing students to observe them perform things like folley insertion or IV insertion. I know that observation is no substitute for the real thing but it is something. I don't think that a thing in the world can ever be a substitute for hands on experience though.

jlgn125 · May 17, 2011

I am a new grad. I had 6 weeks orientation. I am so glad to hear I am not the only one feeling so woefully unprepared for the real world--can anyone say roxanol, ativan and atropine--I would have loved some education on that and I know this is going to sound funny but how about s/sx of death and dying and how to use those meds wisely. I have felt so uncertain at times, at others I am ok. I have been working for 2 and half months and I haven't felt nauseous for a month now. My heart rate and anxiety is higher than it has ever been and I wish I had an off switch sometimes so I could stop thinking about my night when I am at home. On the funny side I have lost 12lbs, lol. I am on the 10pm-6am shift in a LTCF and I am the only nurse on the floor with 3 cna's. my census averages 56. I obviously don't see everyone but I have plenty to keep me busy, pts that are up, paper work, a med pass that has to be started by 430 the absolute latest, dealing with being a supervisor of sorts for the first time in my life, break??? what's that. I am 40 and just starting in this business and I have a total new found respect for nurses. I wish I had maybe went for the one diploma program that is offered in my state but I had to work too. I like nursing I just wish I had had more time to be with someone. I didn't get a preceptor but I was trained by a bunch of good nurses so I am blessed with that. I wish i couldn't say this but I am glad I am not alone. Thanks for listening. Good luck to all of you starting out. I am determined to make it (most days, lol) and hope you will too. :nurse:

DoGoodThenGo · May 18, 2011

Wow, thanks for the history lesson! It's always really, really interesting for me to hear about how the field of nursing has evolved, and continues to evolve. I wish they taught us THAT in school. :) It's pretty fascinating, actually, especially when you consider how it relates to the whole capitalism vs. socialism debate, religious affiliations and business decisions, and the current economic climate.

Depending upon what source you wish to believe and or time in history, there always has been a shortage of nurses in the United States. To answer for this the federal government came up with various methods to address the problem.

Title III - The Health Ammendment Act of 1955

The Nurse Training Act of 1964 (expired in 1984 but funded again by Congress)

Title VIII (created by the above ammending the Public Health Service Act) authorized:

1- grants to assist in the construction of teaching facilities

2 - grants to defray costs of special projects to strrengthen nurse education programs.

3- formula payment to schoos of nursing, and

4- extension of professional nurse traineeships

In addition there are or were other forms of funding floating around for nursing from:

The National Institutes of Health

The Medicare Program (reimburses hospitals for costs (under certain strict conditions) for the education of nurses (RN and LVN/LPN), that is to say running a diploma nursing program.

Since the end of WWII there has been a gradual shift in funds for nursing education from the federal government to state and local governments. This has has followed the switch from diploma programs as the primary means of educating nurses in this country to colleges and universities.

Each time the Nurse Training Act expries and has to be renewed/funding by Congress the battle lines are drawn and often priorites change in terms of where the money will go. The governement being what it is, everyone and their mother has an opinion as to what is needed for the future of the nursing profession, hence where large parts of the pie will go.

Under "ObamaCare" several hospitals will be selected to receive funding via Medicare for the traning of advanced practice nurses. However best as one can research there is scant or nil federal funding for the orientation of newly licensed nurses.

By the way, due to the pretty much elimination of hospital based nursing programs in the United States, only a handfull of states (N and PA were two) with remaining programs get a bulk of the funding from Medicare's funding. Oh there is Texas as well for it's LVN programs.

okchug · May 29, 2011

to the post who had "5 patients" on their own....

We were not even allowed (by facility) to give meds, do procedures, etc. without direct supervision of the RN or clinical instructor. On the oncology floor, we could not enter the rooms without an RN!

While I question the practice of giving a student 5 patients on their own, a little more reality would have been helpful.

SpEdtacular, MSN, RN, EMT-P · May 29, 2011

OP Great topic! I find it very interesting that different programs have such different requirements.

I was a paramedic prior to becoming an RN and there was tons of clinical. We were required to do 500 hours in the ED, 500 hours on the truck, rotations in the cath lab (observing), OR, ICU, med/surg floors, etc., we had to do skills a certain amount of times e.g. 100 IVs, 20 intubations in order to finish the program, and then we took the national registry test which consists of a written and practical exam. When I started working I did three orientation shifts and was on my own.

I went to Excelsior for my RN and they have practical exam you must pass to graduate. For the most part I felt very comfortable when I started nursing although I know I've still got a long way to go. It seems like teaching to pass exams has become the norm in America which is really too bad.

CompleteUnknown · May 29, 2011

It's possible but it's also possible that people are individuals and thrive differently in situations.
On nursing school, we can't entirely put the blame on them in having anxiety-filled graduates- they truly can only do so much.
I mean for the students to totally understand the magnitude of responsibilties in nursing, then they would have to have the patient load all by themselves( and we know there's a fat chance of that happening).
We have to take things in our stride and be ready to be absorbent and learn as much as we can at any given point in time.
Nursing school provides the education, students have got to be proactive too in their learning.

This is a great discussion with lots of thoughtful posts.

I'm a product of the old hospital based training where the student nurse was employed by the hospital, and paid both when we were working on the floor and when we were in lectures. On any given shift, there would likely be a mixture of first year, second year, third year students, and RNs. The mix depended on the type of floor and the acuity of the patients. We didn't go to OR, ICU or the ED until we were in second or third year, for example.

As a beginning first year student nurse after our initial period of lectures and visits to the ward to practise bed bathing and vital signs on real patients (after learning on ourselves or the mannequin), we would be responsible mainly for bathing, turning, bedpans, skin care, feeding, TPR and BP, pretty much the general 'basic nursing care' type of thing and as we progressed we were given increasing amounts of responsibility. Our 'book learning' was reinforced by constant exposure to patients. Even as clueless first years, or slightly less clueless second years, we SAW what happens to patients with x condition, what happens when y goes wrong, what happens when z isn't addressed and how to respond to a complication or emergency long before we were the ones who actually had to do this ourselves.

In time, we WERE the ones who had to do it ourselves. It would start with being 'in charge' while the RN was on a meal break so for half an hour or so we were responsible for everything. While we prayed that nothing would go wrong, it often did, and we were expected to deal with it. By the time we were ready to be left in charge, we could deal with most things, and we knew how to get help quickly if we needed it. The RNs were expected to help us with our education and skills, and while there were some 'evil witches', for the most part they were very good with this.

When we were in third year, the RN would often say 'okay, you be the RN this shift, I'll be the third year', and this was how the shift would go unless we got out of our depth in which case the RN was right there to take over. Or if we were almost ready to graduate, the RN might divide the ward in two and we'd take half the patients and 'be' the RN for those patients. The RNs knew the capabilities (or otherwise!) of the students they were working with and would push the timid ones into doing things when this was needed, and would watch closely and correct or take over if necessary. They also weren't above showing the overconfident ones that overconfidence is dangerous, and would allow students to get into a certain amount of difficulty before 'rescuing' them.

I remember when I was on my first surgical ward, the RN asked me how a particular patient's wound site was. I didn't know. I'd been too busy with other very sick patients to even think of it, I hardly knew I should have done it, the patient had seemed fine. The RN said "So, your patient had surgery today yet you haven't even looked at their dressing? What if the wound has been bleeding for hours?" I knew I'd messed up and practically ran up the corridor to check the wound. It was fine and when I told the RN that, she said "Oh, good", with a half smile on her face. It wasn't until later I realised that she'd checked it several times herself but wanted to teach me a lesson. These days some would call that 'eating your young' but it didn't seem that way to me then, and it still doesn't. I never forgot to assess a post-op patient's wound after that.

Yes, hospital stays were longer and the acuity was lower. But very sick patients were still very sick. There were still patients on the ward that should have been in ICU. There was no rapid response or code teams. There weren't many IV pumps, mostly we had to count drops, and every time the patient moved their arm the rate would change. We mixed all our own drips and all the medications were given out of 'stock' bottles. Patients still had complications and emergencies. It's not like the student nurses of the time were somehow protected from the realities of very sick patients with complex needs.

These sort of programs weren't easy. If we failed an exam along the way, we were out. If we didn't have the required number of a multitude of skills checked off, we couldn't graduate. We learned about evidence based practice (although it may not have been called that at the time) and we had to prove we could think as well as do. Along the way, about half of my class either dropped out or had to leave because they failed an exam.

While it's true that much has changed and this sort of nursing education has fallen out of favour, I think we've thrown the baby out with the bathwater. The very fact that patients are sicker today and there is so much to know and so many skills to master would seem to me to be an argument FOR some sort of apprenticeship system or period of supervised practice before the RN licence is granted, not an argument against this idea. I feel so sorry for new nurses today, they are expected by the hospital to be able to perform at the same level as an experienced nurse without having had the opportunity to gain enough clinical experience to do so.

SpEdtacular, MSN, RN, EMT-P · May 29, 2011

@CompleteUnknown The paramedic course I took was similar (didn't get paid though :mad: ). When we learned a skill we were expected to start using it immediately which was great because actually doing the skill gave you that psychomotor memory. I've found that when you are taught/try to learn a skill from a book it just doesn't sink in.

pockunit, ADN, RN · May 30, 2011

I'm afraid many nursing programs seem aimed at one goal: passing the boards. The expectation seems to be that you'll learn what you need to know on the floor, and right now, in school, you just need to learn the minimum competency to be safe and therefore pass the NCLEX.

I'm sure it's not the same in all programs, but while I understand that my teachers are good and want us to be good nurses, the unstated theme is "This is what you need to pass. Later on you'll learn the "real" nursing skills."

Maybe I'm just jaded, though.

pockunit, ADN, RN · May 30, 2011

Very good point, Multic...
I suppose I should feel lucky that (I don't think) there are any online-only RN programs. Because academia thinks technology can do EVERYTHING. This is an age that values quantity and expedience over quality time spent. There is no substitute for spending time doing something with your hands. You can't simulate that.

When my grandmother was a nurse, pts didn't automatically go for cxr to r/o pneumonia. Nurses could tell when someone had it by their breathing. When she broke her hip and was in rehab, she kept telling the nurses that her roommate had pneumonia and they kept blowing her off. Four days later, hey! pt is dxd with pneumonia.

It's like docs not doing physical exams anymore. There is a subtle skill to seeing and hearing what the body has to say and that just isn't taught anymore. I hope I get to work with a nurse who's going to retire soon and who can teach me the mad skills we just don't get any more.