Not Enough Clinical Experience

jjjoy, LPN · Aug 7, 2011

please, please remember that what we call in the ed biz "psychomotor skills," the things you do with your hands, can be done by anyone with enough practice. hell, we teach lay people how to do peritoneal dialysis at home or suction tracheostomies. but the understanding of why some things are as they are is something you get in better education: more science, more sociology, more psychology, more history, a basic statistics class, exposure to more clinical settings (i doubt if you'll get a full semester in peds, psych, ob, or any public health at all in any as program) give you the insight to ask better questions and make better decisions.

heck, by that logic, why be so impressed with just about any skill or service out there? the majority of services provided in the world can be done by anyone with enough practice, can't they? much of the intense competition to get into nursing school, medical school, law school etc has more to do with not enough teaching resources or strategic limits of entry to the field, not a lack of qualified applicants.

a couple of psych and soc courses could bring any lay person up to speed with the psych/soc aspect of rn education. most any life science major will have taken more science courses than that required by most nursing programs. i came to my nursing program with a strong background in psych, soc, life science in general and human biology specifically so i didn't get much more out of the nursing program in those aspects.

clinical exposure? that's definitely a benefit of a nursing program, but my bsn program had just 5 measely weeks (2 days/week) in each different clinical setting. it was a great introduction to the spectrum of nursing care but by no means prepared us to actually take on full rn responsibilities in those arenas.

yes, nursing is *more* than just psychomotor skills, but let's not diminish the value of such psychomotor skills. anyone can learn to change the motor oil on their car, just like anyone can learn to insert a foley or start an iv. but i'd expect a *professional* mechanic to bring to their work the experience of already having changed oil on many different cars, to have more than just a barely passing exposure to the variations in oil change procedures on the most common cars out there, and to recognize problems that may otherwise have gone unnoticed. and as a licensed nurse myself, i had hoped to bring more of this type of competence in basic psychomotor nursing skills in most common situations - not everything and not in every situation, but more rather than less. but as a student in my program, we had few opportunities as students to do much of anything besides pass oral meds and take unrealistically long and involved health histories and physical assessments.

nurseprnRN, BSN, RN · Aug 8, 2011

you misunderstand me and i am sorry i didn't make myself clearer.

of course the oil changes of our bedside care, like bed baths, aren't only oil changes-- they are filled with the opportunity to observe, assess more deeply, intervene, engage the patient in conversation about home, understanding medications, treatment plan, and so much more. this is why rns should be doing them, and why care situations should be staffed so they can. of course anyone can do a psychomotor skill, with training; that was exactly my point. i believe the op's original concern was that s/he hadn't had "enough clinical experience" in those sorts of things. i was trying to explain that nursing is so much more than tasks, and that s/he will be proficient in tasks soon enough, whether or not s/he had the chance to do them as a student or not.

i am sorry you only got ten clinical days per area in your bsn program. we did three days per week for three years in mine; full semesters (not quarters) in medical nursing, surgical nursing, psych, public health, ob, and pedi. and even with all that, the list of "stuff" i never had occasion to do as a student was a long one. but it all came out in the wash at the end of a year or so, and i had seen enough and learned enough by then that i was ready to have those hands-on experiences backed by a good theoretical framework. i stand by my assertion that new grads need worry less about not having sunk half a dozen ng tubes as students (or even one), and more about how to be ready to keep learning for a professional lifetime.

futurernfarmer · Aug 13, 2011

I'm sure you see a lot as PCT and asst, but I know when I was working as a PCT, I was so busy with my job responsibilities that I had little time to find out anything beyond what I needed to know as a PCT; so student clinical time for me was best used focusing on issues beyond basic care. I'm very grateful for my nsg asst experience as I never would've learned so many 'tricks-of-the-trade' or gotten as comfortable with basic patient care just on student clinical time.

:redpinkhe

I can second this. I work on an abd tx floor, and I rarely get a chance to sit down and chart, let alone ask my RNs to let me watch them do skills or answer questions or explain things to me. I'm starting to think HUC (unit secretary) might have been a better job to familiarize myself with the daily routine, get comfortable with MD/pharmacy/other calls, have time to ask RNs questions, etc. Maybe I can cross-train... Either way, PCT-ing has been a great experience to feel more comfortable with clinicals, just not being a nurse exactly. I am now proficient in MANY drains, giving baths, and linen changes such as for pts on bedrest (it took a while taking lead from RNs and experienced PCTs), which is more than I could say in clinical last semester. So hopefully in my last two semesters of clinical, I will breeze through those aide skills and have the time and energy to pester the RNs to let me do/watch their skills. :nurse:

jjjoy, LPN · Aug 15, 2011

I agree that a unit secretary job, depending on the facility and exact job description, could be *very* useful for someone going into nursing. It's not hands on clinical care, but the exposure to the floor routine, calls to and from physicians and other departments, and familiarity with meds and dosages if doing order entry could really be priceless.

jjjoy, LPN · Aug 15, 2011

i was trying to explain that nursing is so much more than tasks, and that s/he will be proficient in tasks soon enough, whether or not s/he had the chance to do them as a student or not. and even with all that, the list of "stuff" i never had occasion to do as a student was a long one. but it all came out in the wash at the end of a year or so, and i had seen enough and learned enough by then that i was ready to have those hands-on experiences backed by a good theoretical framework.

i think we do mostly agree! : )

since i am personally much stronger in analysis than in application, i just tend to find the advice "oh, you'll pick that up in no time; don't worry about it!" frustrating. especially when faced so often by the expectations of colleagues and employers that one *should* already know this and have done that. it's not my experience to hear "oh, of course you wouldn't know that/have done that yet!" more like an exasperated huff and "what are they teaching in schools these days" comment. since i'm not a quick study in regard to *feeling* competent in psychomotor skills, i tend to feel threatened by implications that i may not be meeting expectations. here are these experienced nurses who seem to expect that i should have more comfort and familiarity with a whole plethora of skills, and i not only haven't done a couple of them, but i've only done one or two of them, once or twice, ever... am i supposed to stay in that position in good faith when i know that it will take another six months to a year to really have the skills to fill my job role? that during that time, my colleagues will be burdened by my lack of experience and not only be burdened by it, but huff every time until i do finally get up to speed... i know, i need a thicker skin. : )

yes, a working nurse is likely to get this kind of experience within their first six months to a year. but i think it's a shame and a bit backwards for the newbie to have to not get that kind of experience until after they have the license and have been hired into a position that is really for someone who *already* has that kind of experience. the first six months, the newbie isn't only learning the specific job they are doing, they may be getting their first real exposure to . if nursing school only ensures that graduates are *ready to learn* to practice nursing, as opposed to *ready to practice* nursing, then a formal transition step between nursing school graduate and ready-to-hire rn would seem to be necessary - like residency for physicians.

i do see the many dilemmas with that model. i just also see many dilemmas with the current system. i don't think there are any easy answers, especially when one must factor in limited resources.