No IV Practice / Little hands-on practice in clinicals - page 3

by SlyFoxRN 8,674 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


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    When I started my nursing program, I didn't have any direct patient care experience besides passing out water and snacks on the floor. It was uncomfortable. Yes, having CNA experience would have been great, but that isn't the path in life that I took. Does an MD need to be an MA before practicing medicine? I don't think an RN needs to be a CNA to practice nursing. Getting acclimated to the patient care environment might take longer, but 10 years down the road, it won't matter whether you've had CNA experience or not.

    The amount of hands-on experience your school can provide varies greatly (depending on practicum site rules, clinical instructors, preceptors, type of unit). My med/surg facility and clinical instructor made it clear that I was not to perform venipuncture on human beings, which is now (as a new grad) a skill that I'm nervous about. BUT I WILL LEARN IT. EVERY NURSE DOES!

    Just focus on getting the most out of all your experiences. Jump in and ask if you could do a wound dressing change or watch a foley insertion. Even after a very hands-on rotation, I believe every nursing student has a long list of skills they are proficient at but not confident about. Oh, and learn the meds, even if you're not allowed to give them --- physically giving them is the easy part, learning how to do it safely is the more important step.
    Hoosier69 likes this.
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    grntea, you are excellent!!

    Quote from grntea
    this 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.
    MissH1967 likes this.
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    Quote from shortnorthstudent
    Every clinical experience is going to be a bit different. Hopefully you will get some good rotations over the rest of your education.

    One thing to keep in mind is that skills are easy to teach. Many hospitals will have slightly different guidelines for skills. While you will most certainly perform many of these skills as a nurse, they are simply teachable skills. They can be picked up and perfected over time. The most important part of your education is the assessment and critical thinking that you are learning. That is what makes an RN a unique individual in the healthcare system.
    Skills may be easy to *teach* but they are not always easy to learn. There is no replacement for consistent practice and the confidence to adapt skills to the situation at hand. To me, your post reads, "You will learn on the job." Yes, that is indeed very true but there is a limit. I would expect a new grad nurse to hone basic skills like IV sticks and gain experience in all the quirky, imperfect situations one has to perform them (like on a thrashing, demented and dehydrated patient). But would it be desirable to have a nurse who has to learn IV sticks from the ground up? No. And judging from the tight job market for new grads, many hospitals have the same sentiment.

    Assessment is nothing without intervention. A is only one letter in ADPIE. It's just as important to do a thorough head-to-toe as it is to know what to do, then do it well.

    I believe the OP's schooling is not conducive to this but, sadly, not the exception among nursing schools nowadays.
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    "
    [color=#333333]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...."

    [color=#333333]i disagree completely. you don't need to be a cna first to be a good rn. it's like saying you have to be a pizza delivery person before you can own a restaurant, one skill is barely related to the other. it's time and money to become a cna, why make students who have the drive and ability to go right into a nursing program take a cna course and work as a cna first? the same goes triple for lpn. that's a 1.5 year community college degree, why on earth make qualified students waste 1.5 years of their life and an unknown amount of money to get a different degree where they are very few jobs to begin with? most rn's were never a cna or an lpn and do just fine.
    [color=#333333]
    myelin likes this.
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    Quote from IceGuy
    It sounds like this is a common problem, but classroom based information is still given in most programs. 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...
    GIGANTIC SIGH! This issue has been addressed about a trillion times on this site and what you are about to find out is that there are differing opinions about what constitutes appropriate training for nursing students.

    Lots and lots of folks here will tell you it should all be skills. They will be supported by nursing students who's teachers (mostly ADN school in my experience from reading here) told them that's what nursing is.

    Lots of other folks will tell you its all about the critical thinking skills.

    Here's what I think: You will find that the collection of skills that you think are so important are likely not even reserved to practice as an RN in your state. EMTs, paramedics, CNAs, LPNs all do these precious skills of yours and it really doesn't matter. (In the teaching hospitals, MDs must be checked off on a certain number of peripheral ivs, lab draws and foleys. Skills they consider not so complex and easy to grasp.) You will also find that even if you learned them in nursing school, it will not be until you do them after school on a routine basis and in the context of providing care under your own license to your own patient will it matter much.

    Most of these amazing skills everyone raves about can be learned in ten minutes flat and are taught on the regular to other types of personnel that didn't spend time and money in nursing skill.

    In terms of patho and critical thinking, you will find that this is the "skill" most often reserved to you. You are the link between patient and doc. (I personally don't find many CNAs calling the MD.) The MD will be listening to your assessment and even maybe asking you what you think the clinical picture is for this patient. This is the stuff you must learn in school but that's just IMHO.
    Hoosier69, SopranoKris, and RicRock like this.
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    This has been a great thread with so many anxiety-relieving thoughts and opinions. I won't graduate for another 14 months and I am already freaking out about caring for patients on my own and my lack of technical skills. I definitely think I need to work on my therapeutic skills.

    I have so much appreciation to those here who impart their wisdom.
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    Once you're hired, you can ask to spend like 5 hours in the ED doing nothing but sticks. They'll appreciate it and you'll get plenty of exposure
    melmarie23 likes this.
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    I think most nursing students worry they aren't going to be proficient with the "hands-on" skills once they graduate. Luckily, no one is expecting you to be! Yeah, we've all dealt with the crochety old nurse that doesn't want to show you how to do something then yells at you when you don't know how to do it. But grumpy people are a part of life, and most nurses are more than happy to answer questions or help you out if you need it. Never be afraid to ask questions or be worried you're going to look dumb if you don't know how to do something. I'd much prefer to work with a new nurse with lots of "dumb" questions than with one that thought they knew everything.

    As far as school goes, it may help to keep a list of skills you want to accomplish and go over it with your preceptor/instructor. My school was touch-and-go when it came to teaching me skills and it was kind of up to the students to throw themselves out there in order to get experiences. It all depends on the nurse you are shadowing. Sometimes you get a surly one that couldn't care less whether you learn anything or not, but keep your eye out for the great ones that actually *want* to teach you things. I'll never forget the nurse I worked with in day surgery that asked me what I wanted to learn that day. When I told her we had been learning IVs in lab but I'd never gotten a chance to do one on an actual person, she brought me to the nurses station and announced "This is my student and she wants to learn IV inserts today! Anyone who needs an IV start, come find me and we'll do it for you!" The floor was grateful for the help and I was grateful for the experience.

    Also, it helps to keep an ear out for opportunities that other nurses on the floor can provide. No one says you have to stick to your nurse like glue, especially if you have a, um, less-than-helpful one. If you see the blood bank drop off some blood, grab the nurse that picks it up and ask her if you can watch her hang it. Heard about a patient that's going south? See if you can tag along as they (hopefully!) transfer him to the ICU. Don't get in the way, but wait until things have quieted down a little on the floor and ask all the questions you had along the way.

    I know it's easier said than done in these situations. I remember the stress and anxiety of nursing school and feeling like I didn't know bupkus when I graduated. But you will learn it eventually, and as long as keeping your patients safe is your #1 priority, you'll do fine!
    Hoosier69 and melmarie23 like this.
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    I have being doing pre-reqs for the nursing program of a local community college. I will start actual nursing classes this fall. One of the pre-reqs was to get your NA 1 license. My adviser said one of the reasons they started requiring it was because they only accept 25 students a year, and they always had some that later dropped out because they didn't realize that part of their job was to wipe butts, make beds, clean vomit, etc...When a student eventually dropped out, the school could not fill that open spot. Our NA 1 clinical was at a nursing home. My school also decided to give a extra points towards being accepted into the nursing program if you earned your NA II, which I did. During that class, my RN teacher told us how she learned to do blood draws (in a break room with fellow classmates sticking each other.) I decided that I would take a phlebotomy course. I am so glad I did, because I have learned of the damage you can do when you don't know what you are doing. These side classes have cost me some extra money, but I feel they will help me in the long run in feeling more confident in what I am doing during my nursing classes. If I can land a part-time job at the hospital as a tech it will help me get my foot in the door.
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    pretty common. I never put an IV in until I started working in a NICU. In the NICU nurses did all their own IV's so we were very encouraged to just start doing them. Now I work in a peds cardiac ICU and I would say almost all the nurses who were new grads within the past 5 years have no idea how to place an IV, they all use the hospitals IV team (or me when they learn I know how to put IV's in!)


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