No IV Practice / Little hands-on practice in clinicals

[SlyFoxRN]

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 well. One thing that is starting to worry me however is what I perceive as a big gap between the didactic and our clinical component. Clinicals, quite frankly, kind of suck. Mainly we just shadow nurses, very little hands on. The only hands on stuff I've done (after 4 months of clinicals now) is remove an IV catheter, take vitals, do an assessment, and give out a few medications. We can only give out medications if our clinical instructor is with us, and with 6-9 students per instructor, we are lucky to give out medications once per rotation. I've given one shot - a vaccine. We're not allowed to do anything with IV's at all - we won't have ever inserted an IV or practiced a blood draw when we graduate aside from a 20 minute lab dedicated to it (we stuck a dummy arm once). I just feel like when I graduate I will be totally incompetent and it's scaring me a little. Anyone have a similar situation?

The odd thing is, my program is supposedly very well regarded. We are ranked highly as far as nursing programs go, and hospitals in the area prefer our grads over any other school around. I don't understand what I'm missing here. Is it common for nurses to have little hands on practice before graduation??

[Wrench Party]

I'm in a traditional program and my clinical experience this semester has been great- one of the benefits of

going at a slower pace is there is more time to learn everything. In the middle of my 3rd semester, and

we've done trach care, hung blood from the bank and IVs, done wound care, put in and d/c'd Foleys, and now we're learning

ostomy care.

I also make it a point to offer to be a runner for the nurse I'm working under- that strategy got me extra

experience with passing meds, setting up a PCA pump, hanging IVs, doing IV flushes and d/c'ing them, and doing wound care.

I try to make up for all the extra hassle I caused her by being a pain in her butt.

[dudette10, MSN, RN]

My opinion: The typical hands-on skills can be learned fairly easily, and even if you spend hours upon hours in a skills lab at school, you need practice on real people, which may not happen in clinicals. I think learning skills in nursing school is a highly overrated endeavor.

I've been working a little more than 6 months. There is a particular skill that I had to perform last night. I didn't know how to do it. Three of the four nurses I was working with have more than 15 years experience. NONE of them knew how to do it. We called a nurse from another floor to come show us. I performed the task under the teaching nurse's direction, while the other nurses watched and asked questions.

THAT is true teamwork, and no nurse would survive without it.

For those who gasp and clutch their pearls because a new grad doesn't know how to do something, I'm quite sure feeling of superiority brings immense satisfaction, hiding under the mask of shock and disappointment. There are EXPERIENCED nurses who are courageous enough to change specialties that don't know how to do certain skills.

Everyone brings up the IV insertion skill, as if that is the Valhalla of nursing skill. If a 10-year experienced nurse in LTC takes an acute care job, there's a pretty good chance that her IV skills would be limited. Experienced OR circulating nurses can do their jobs with ease--and a floor nurse would be lost in that environment--but inserting an IV? Unless they rotate to pre-op, outpatient, or PACU, very little IV experience to speak of. Gasp and clutch your pearls at that.

[dudette10, MSN, RN]

Why do we even have accelerated programs? Jobs are scarce anyway. Do we need people who are rushed through a bare bones program...

I have posted many times on what an ABSN program really is. Accelerated because the first 60 hours of general education are not part of the ABSN program. Accelerated because there are no significant school breaks.

There is nothing "accelerated" in the knowledge gained. You must take at least 60 hours of nursing coursework in an ABSN program. I did four semesters of an ABSN program in 17 months with no summer break. ADNs at the most popular community colleges take four semesters in their program in 21 months with a summer break!

What's more is that the local ADN programs have classes included in their nursing programs that were required pre-reqs in my ABSN program.

All one has to do to understand program requirements is google the various programs in the area and look at the coursework required. Every site I have ever visited has that information on a site page. I am clearly talking about programs in my area.

On this site, I have never made condescending remarks about ADN programs or ADN-educated nurses. I have, however, defended BSN programs and those universally-hated "fluff" courses which are, by regulation, required in the BSN programs in my state. I just wish others would research facts about the programs before making uninformed remarks about them.

[dudette10, MSN, RN]

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).

In my state, nursing students are not allowed, by regulation, to do venipuncture, hang blood, and transcribe MD orders. Only licensed nurses can. (Of course, phlebs can do venipuncture, but I'm talking about the nursing profession...)

I'm not sure if a clinical instructor or primary nurse would even allow a student to place an IV on a thrashing, demented, and dehydrated patient in those states that allow it. That is setting a student who barely knows how to use the equipment up for failure--and ultimately a HUGE waste of precious time.

[melmarie23, MSN, RN]

a lot of nursing schools in my state do not practice IV starts either. Its considered "on the job training." I had an IV skills class in two hospitals I was hired at after graduating. For one hospital, I never even had a chance to put those skills to use. I was on a floor (acute rehab) where if they had access, it was a PICC line, which was maintained by IV therapy. When I got hired into L&D, I was fully trained and now do starts regularly. Also, in this particular hospital, only certain units are allowed to start their own IV's (ED, ICU, L&D, tele)....the rest of the hospital, the IV team comes and does the starts. Its hospital policy. So I dont find it all that strange that your nursing program isnt training you on IV starts.

[Vespertinas]

In my facility, it is frowned upon to use the IV team as your first line for IV starts.

[ImThatGuy, BSN, RN]

Nursing school clinical rotations do seem like a horribly mismanaged affair. To me, it would make more sense to complete all of the didactic and laboratory components and then move on to a clinical rotation at the end of the semester (say, the last two to three weeks). By doing that, you'd be able to integrate everything you covered in that semester, assuming the patient load allowed for it, and you wouldn't be skipping back and forth between "Yeah, we covered that, but we didn't cover this. I don't know what that guy's disease/medicine/intervention is." I think it's stupid.

I also think the last semester of the program should have a more intern-oriented clinical whereby you show up, do the job, and leave under the guidance of a staff nurse. Stepping into the clinical environment periodically doesn't allow you the probability of encountering a patient that's going to require a lot of interventions. However, being there everyday for a prolonged period does. I say this not even liking clinicals. I'm all about the cognitive process and deciding what to do. I couldn't care less about the hands on part. There isn't one technical "skill" or procedure that I have any eagerness to engage in simply because I'm not a hands on kind of guy. I'd rather stand in the corner, make a decision, and have someone else do it, but I still think nursing school would enjoy marked improvement by following my model.