No IV Practice / Little hands-on practice in clinicals
3Mar 22, '12 by SlyFoxRNHello 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??
2Mar 23, '12 by Esme12, BSN, RN Senior ModeratorFor the programs now a days.......yes. That is why so many hospitals are not hiring new grads until they receive some sort of residency program (hopefully paid for by another hospital).
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1Mar 23, '12 by shortnorthstudentEvery 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.
2Mar 23, '12 by Ashley, PICU RNWhat you are describing isn't really outside the norm of modern nursing school. When a school is "highly regarded" it usually means they have a good NCLEX pass rate. Since the NCLEX is a didactic test, many schools focus on the didactic information. Since yours is a 1 year program, your school has very little time to give you all the information that you need for NCLEX, so of course that's where the focus is. In a longer program you would probably find there is more emphasis on clinical skills. Unfortunately many of these accelerated programs are teaching you the book information and leaving it up to your first hospital job to teach you the skills.
I'd encourage you to learn as much as you can from clinicals. Some of the most important experience you can get is not performing the individual skills (which you can practice in the lab) but performing assessments, identifying abnormal data, recognizing various lung, heart and bowel sounds, learning what presentation and symptoms to expect for various diseases/complications and critically thinking about what to do with all the information and how to base your care of the patient around it.
You don't have to do the wound care to learn the s/s of infection, what a healthy wound looks like vs a non-healing or infected wound, and what you would want to assess and report about the wound. See what I mean?
Seek learning experiences outside of the hospital, if possible. Volunteer at an immunization clinic to get practice with shots.
As far as IV's and blood draws, there are a great number of nursing programs that don't include any practice or teaching about how to insert IV's or draw blood. Most hospitals don't allow students to do either of these things because the hospital requires special certification. You'll learn this skill on the job, like most of the new grads are doing now.
1Mar 23, '12 by LemonIndiscretion, BSNYou may do a lot more next year, especially because it's an accelerated program. I'm in a traditional bsn program and I didn't start doing a lot of injections, dressings, feeding tubes, IV meds etc. until this past year which was my junior year. At this point we each give all our patients meds and treatments each clinical day. Have you had medical surgical nursing? That's when we really started doing more injections and dressing changes. I don't feel like I am good at anything but I do feel a little more confident, especially with injections and meds. I work at a group home too, which may be why I feel comfortable around meds and dressings because I've been giving meds there for 6 years.
I don't know what state you live in but in my area, there are a lot of Student Nurse Internships that you can apply for after taking at least one semester of medsurg. I just applied to 3 of them. I've heard some are better than others and by participating in one you have a better chance of getting a job after you graduate.
I hope you get to do more and feel more comfortable over the next year. Good luck!
0Mar 23, '12 by LemonIndiscretion, BSNThey have a flu clinic that my school participates in and they offer the opportunity for students to basically give injections all day, I highly recommend this experience if your school offers it. You volunteer and its not for credits or anything but its worth your time!
0Mar 23, '12 by emcadamsyou may want to think of doing a short phlebotomy program at a community college or career school. I took a CNA course, and the career school I took it at had a phlebotomy program that involved 100 live sticks. So I guess you have to stick 100 people before you get your phlebotomy cert. They also give other students $100 toward their cost of program for being stuck by the phlebotomy class.
1Mar 23, '12 by DamaskI got my BSN via the accelerated route and felt the same way...until the last semester when I had practicum. If you have a practicum, you'll get a LOT of experience there! Many of the skills turned out to be the easy to learn once you have done them a few times. However, I still haven't had the opportunity to do a few. I think assessment takes the most time to learn, imho. Each time I do it I get a little better. Like Ashley said, you can also use the time to work on critical thinking skills.
Even if you don't get a chance to do technical skills during clinicals, spend the day understanding EVERYTHING you can about patient labs/medications/assessment data and trying to integrate it with what you know. A few clinical instructors brought out equipment for us to practice with, too. You can ask about that. We didn't get much lab time so sometimes the instructor would let us play with an IV pump for a while. A nursing instructor was the one who taught me blood draws (more than halfway through) and I had no trouble doing them thereafter.
From what I am hearing most people in our group got hired fairly quickly. I was just hired this week after looking for a month. Many of the floors my former classmates are working on have binders and workbooks for them to continue training and learn about floor specific concerns.
I never went through a residency program, but the hospitals here do have very thorough orientations. It's practically "school...continued." You'll learn fast. If you aren't the type to learn quickly...you wouldn't be halfway through already. I remember! Six weeks for a class and a test almost every week with multiple papers due and clinicals? Sheesh!Last edit by Damask on Mar 23, '12 : Reason: More readable
0Mar 23, '12 by silverbat, ASN, RNThis 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....
3Mar 23, '12 by brillohead, ADN, RNEarly 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!"
In some facilities, floor nurses rarely insert IV catheters -- there is an "IV team" that does all of that. What they need is floor nurses who know how to care for that IV line.
Do you know (and follow) the "scrub the hub" concept? Do you know what meds you can push fast and which have to be pushed over time? Do you know which meds are compatible and which will crystallize in the line? Can you recognize the signs of phlebitis or infiltration? Do you know what adverse effects to be on the lookout for after you push certain meds?
Those are the things that I am concentrating on. If I am in a situation down the road where I'm going to be inserting IVs regularly, I know I'll be able to shadow an experienced poker and learn from an expert.