No IV Practice / Little hands-on practice in clinicals - page 2
by SlyFoxRN | 8,786 Views | 42 Comments
Hello all, I am half way finished with my 1 year accelerated BSN program, and so far I like it for the most part. Our classes have been really interesting and in depth regarding disease processes, etc. and I'm doing quite... Read More
- 0Mar 23, '12 by MN-NurseQuote from IceGuyOne of the perils of an accelerated program.I don't understand what I'm missing here. Is it common for nurses to have little hands on practice before graduation??
The best way to get hands experience with patients is to have a job involving direct patient care while you are in school. You will get plenty enough facility specific IV and med pass experience during your first days on the job.
It is so easy to spot the new grads who never worked in healthcare. I know a few posters on allnurses like to say working in healthcare doesn't matter, but it does. Many of my classmates spent their clinical time just getting acclimated to even being in a hosptial setting. They had nothing to build on so they were starting from scratch. It makes a difference.
I recently took report from a BSN grad who has been working for 6 months. She never worked in healthcare previously. Her dependent patients were a mess, their rooms were a mess, power cords, IV lines, and O2 lines hoplelessly tangled, no ADL supplies in the room, and they are rarely repositioned. I/O and weight data is often missed.
The new RNs with good experience as aides have no problem completing these very basic aspects of care.
I thought my two year ADN program was plenty accelerated. I can't imagine what those one year 2nd degree BSN programs are like,
- 0Mar 23, '12 by RicRockQuote from brilloheadEvery year our School has meetings with the local hospitals and the hospitals tell our instructors the same thing.Early in my program an instructor told our class that the nursing managers in the facilities around here said, "We can teach them to put in an IV -- we need YOU to teach them how to THINK!"
They've went so far as to even claim that they could teach a monkey to start an IV, which is not something I'd volunteer for!
Most of my classmates were concerned about the lack of opportunities to perform procedures but most times those things require practice to become skilled in and there is no way you'd have enough clinical time to feel fully comfortable with them anyway.
- 0Mar 23, '12 by tothepointeLVNQuote from mds1I'm up for that idea. Once your eyes are open they can never be shut again and that's a good thing. Can you believe before I started LVN I had NEVER been inside a nursing home and probably spent 5 mins on a med/surg floor visiting in the prior 10 years. My only frame of reference was the ER.This is one reason I truly believe that everyone should be a CNA PRIOR to learning to become an LPN or any level of RN degree, and that someone going for an RN degree( ANY degree) MUST be a practicing LPN prior to acceptance in ANY RN program. I think it should even be a part of their programs, like any other pre-requisite.....Just my thoughts....
I kinda feel in some ways the same as the OP. Our school paid for our IV certification class as a reward for passing the HESI the first time. So I'm "IV certified" with 3 live sticks total. 2 on the same person. I can't apply anywhere that needs the certification because they assume your competent. I've even though about taking a phlebotomy course.
- 0Mar 23, '12 by SlyFoxRNIt sounds like this is a common problem, but classroom based information is still given in most programs. I guess my big concern is that it seems we're not even being given that. My program seems to be intent on trying to get nurses to go on to be NPs, and I almost feel like this BSN program is nothing more than a pre-NP program. We're being taught very little when it comes to the skills required to be a successful floor/staff nurse. For example, our classes are broken into areas (peds, women's health, psychiatry, etc) like most nursing programs. In each one, however, we mostly just learn the diseases and disease processes that most effect each group. When we get to management, it's mainly which drugs are prescribed, how they work, and what procedures are done, and how they work. This is important, yes, but only if I also know how to GIVE the medication. I could tell you all about why methotrexate is given for cancer (as well as ectopic pregnancy), exactly how it works (right down to a cellcular level) when to prescribe it, etc. If you asked me to give it to someone I'd give a blank stare - where does it go? Is it IM? IV? If IV, how long is pushed? I have no idea. I feel like I am being prepped to prescribe/diagnose (aka: be an NP) more than I'm learning to be a floor nurse. I appreciate knowing exactly WHY physiologically my patient is exhibiting certain symptoms, but I honestly feel a little upset sometimes when I have no idea how to prime an IV tubing to help relieve them...
I just keep telling myself I can pick up skills easy once I go into new grad orientation at my first job...but then I wonder if I'm going to look like an idiot once in orientation. I wonder if I'm going to be given simple tasks and have no idea how to do them...
- 0Mar 23, '12 by mikala3We were told in school that anyone can teach you a "task", but that you need to practice critical thinking in nursing school over all else. I also did not get much experience in IV's, never gave blood, only did skills on the medical maniquins. But I passed the nclex in 75 questions.
- 0Mar 23, '12 by DamaskQuote from IceGuyI can see why you're worried.It sounds like this is a common problem, but classroom based information is still given in most programs. I guess my big concern is that it seems we're not even being given that. My program seems to be intent on trying to get nurses to go on to be NPs, and I almost feel like this BSN program is nothing more than a pre-NP program.
Have you brought your concerns up to the school? Can you write down what skills you want to practice by the end of each clinical? Do they have you write journals with goals? Maybe if you tell your instructor you want to do such and such task, he or she can look for opportunities for you to perform it. Nurses on the floor used to approach our instructors all the time when they had a task to perform.
Priming an IV tube is pretty easy, but we didn't learn to do it until a little over halfway through school. Maybe ask the director of the program when you get to do these things. I think we had to be "released" to perform various tasks after the relevant lectures. Our syllabus actually listed the tasks out week by week.
Do you have a practicum with a preceptor and everything?
Being a CNA before/during nursing school is a great idea. Those who were were miles ahead. I wish I had been. By the time I decided I wanted to, I found out we were considered too close to graduation. My program did require healthcare experience, and I was a volunteer. (Still am!) Being a CNA would have been better, though.
- 19Mar 23, '12 by GrnTea, BSN, MSN, RNthis isn't even a new thing. when i graduated in 19smumblemumble, i had never put an iv into anyone, never put a foley into anyone, and never done a lot of that lab check-off "stuff." the opportunities just didn't present themselves, and we were in clinical 24 hours a week. by the time i had been in my new job six weeks, i'd done all of that and more.
see, it's really common for students to fixate on that "stuff." it's easy to understand why they confuse what nurses do with what nurses are, because they have that big list of lab check-offs and all. somebody romps into the cafeteria and says, "i got to sink an ng tube," and everyone is green with envy. ask a student what s/he knows about nursing and you'll often get a task-oriented list: "i can give shots, put in a catheter, change a wound dressing..." some poster above noted that we could teach iv therapy to a monkey. well, maybe not, but we teach lay people how to do home hemodialysis, suction tracheostomies, administer tube feeds, plug in home antibiotics into a portacath, and all sorts of "stuff," but does that make them nurses? no, of course it doesn't.
with fewer clinical placement opportunities, nursing programs are often not able to guarantee you will have hands-on practice in "stuff" before you graduate. trust me when i say this: it does not matter. within a year after starting your first job you will have had plenty of time to practice "stuff."
(someone suggested being a cna, but that won't assuage your yen to "give shots and start ivs" at all.)
once upon a time i had students on an oncology floor. i had one who was an experienced cna, who i found in the nursing station at 0900 reading (at least it was the ajn). i said, "why aren't you with your patient?" and she replied, "he's all done up." this is cna-speak for bathed, bed changed, and breakfasted. and now worthy of being left alone for more important tasks. i said, "get back in there and sit with him, and don't come out until it's time to find me for meds." she came out around noon almost in tears. seems this poor man had a horrible diagnosis and nobody, but nobody, had had the time to just sit with him and let him talk about his fears, his family, the whole thing, just get it off his chest. she told me that now she understood the difference between what nurses did with their hands and what nurses were.
you can too. once you know that, the "stuff" will suddenly have much less prominence in your thinking.
do not stress over being "incompetent" as a new grad. all new grads are, by definition, incompetent, but it's not because they haven't "done stuff." it's because they are in the baby-step situation of learning how to be nurses. you'll all learn "stuff" in good time, nobody reasonably intelligent expects you to know it all at graduation (and do not believe the ones who roll their eyes at you and say they knew it all-- they lie). eyes on the prize, all, and you will learn that the lab check-off "stuff" is not the prize you think it is now.
- 0Mar 23, '12 by ParvulusPuellaThat doesn't sound unusual. We never learned how to start IVs or draw blood in school. And we were never able to hang any sort of cardiac drips or blood in clinical, those had to be done by a nurse with a license. We were allowed to watch, and of course we practiced the procedures in lab. A lot of the hospitals in the area have dedicated IV teams who place IVs if they aren't done in the ED, and have phlebotomists for lab draws. If the hospital doesn't have an IV team, and the staff nurses are to start them, it's covered in clinical orientation.
- 0Mar 23, '12 by mindlorThank you for the words of wisdom/encouragement GrnTea. I graduate in a few weeks and the skills issue has been weighing on my mind. I have put in a foley, I have dropped an NG, I have done complex dressing changes, started an IV, and lots of other things. However, I have done these things very few times. What I have worked on a lot is my therapeuric communications skills and I feel really good about that. So all in all I think I am in pretty good shape
One more test, one more, final, end of program test, then Pinning, then NCLEX, hopefully RN before Memorial Day
Then maybe all those comments from other people who reply to my posts wont be able to use the "your only a student" barb LOL.
However, I clearly understand that once I have the RN is when the real learning begins....