Not Enough Clinical Experience

  1. 0 Please a kind hearted nurse student-- Someone weigh in with your advice or experience that could help!! I am in an accelerated RN program and in my final quarter. I graduate at the end of the year and know I don't have enough clinical experience under my belt. My school messed up and lost its positon in clinical rotation scheduling-- so instead of doing clinical work in a hospital we ended up in a nursing home for med/ surg clinical! Nothing but passing meds! I have NOT started an IV on a real person, or completed many skills other nursing students typically do, like wound packing. I am a licensed CNA and work as a PCT and imaging assistant at 2 different hospitals. I graduated from a med asst trade school, so I can draw blood and do injections. But when it comes to using all the different devices, parts, etc., I don't know what I will do. I live in fear of ending up with a cranky preceptor and being found out that I am all thumbs with ports stopcocks... I see all these different things stacked in the supply room of the Med Surg floor and I am TOTALLY lost! I feel like I have a big secret that I am afraid someone will find out... My Maternal Health clinical (moved back, after Peds!) will be in a clinic and I don't expect to see action there, either. My Peds clinical is at a hospital and we are not allowed to TOUCH the children! The good news I did get some experience with critical care and also rehab, with brain injury patients... but NOT the fast paced world of Med Surg! Is this more common than I think? Anyone? HELP!! Thank you from the bottom of my heart. I promise I will Z"pass it on" when I become a nurse mentor myself.:heartbeat signed, b33again
  2. Visit  b33again profile page

    About b33again

    b33again has '0.5' year(s) of experience and specializes in 'pacu'. From 'SF, CA US'; Joined Aug '11; Posts: 9; Likes: 3.

    16 Comments so far...

  3. Visit  anonymousstudent profile page
    1
    We have a lot of experience in hospitals and all I feel like I do is assessment, assessment, assessment, and more freaking assessment. Sometimes I give a BATH! Wow. I have passed lots of meds, but the more skill based things I haven't gotten to do. My CI a few quarters ago told me not to worry about it because when you become a nurse hospitals do lots of training. I sure hope she's right. I would love a chance to place an IV or heck, even a Foley, but so far no luck.
    futurernfarmer likes this.
  4. Visit  b33again profile page
    0
    I am so glad you responded-- it's great to know I am not alone. I am hearing that many hospitals will teach in the new grad programs, so we shouldn't worry.. haha but we do, we are overachievers! Thanks for posting and I will keep you informed... b33again.
  5. Visit  ashleyisawesome profile page
    1
    all of our clincals are in hospitals and it is rare that we get to do a good skill... im finishing my last semester before our specialties, and ive only been able to do one foley (because there just happen to not be any foley insertions when were on the floor :/), ive hung a decent amount of ivs, but its because i seek them out.. some people in my class have not hung one yet, ive changed two picc line dressings, but other than that ive just done meds, assessments, charting and BATHS. haha. i think youll be fine, you will get a lot more experience in preceptorship, and when you graduate they dont expect you to have mastered everything, thats why they have lengthy orientations for new grads...

    my best advice is when you are at clinical in the hospital take every chance you can to do things you havent done yet... make a list of skills you want to practice and see if the nurses on the floor will let you do them, even if its not your patient, as long as your clinical instructors okay with it.. and they usually are. good luck!
    going2BaNurse2014 likes this.
  6. Visit  Elisheval profile page
    4
    I'm giving this post a *bump*--- I think it's really important! I hear so often on Allnurses about students who say they do so much, it sounds like they are performing open heart surgery single handed When in the real world, most of us get as far as a bed bath and thats it.
    futurernfarmer, sandyfeet, jjjoy, and 1 other like this.
  7. Visit  NSGstudent12 profile page
    0
    I didn't get to do much in my clinicals until our pull outs started. On my surgery pull out i did my first cath and IV while the patient was out. Thank goodness bc it made it sooo much less nerve racking! ha
  8. Visit  b33again profile page
    0
    Hi everyone, I had to laugh about all the bath comments. It looks like I could be more assertive in letting nurses know I would like to assist... and Elisheval is right, it's like we are amongst neurosurgeons, the way fellow students brag... My clinical group is rather large and greedy, so I will just have to elbow my way in. Thank you to all who replied! :bowingpur
  9. Visit  ParkerBC,MSN,RN profile page
    0
    I don’t think there is a nursing student that can honestly say he/she performed every task learned in the lab while on the floor. I had a Geriatrics course in my program. So, we did a clinical rotation at a long-term care facility. I found it interesting. You deal with a patient population who is experiencing multiple chronic conditions. In fact, I would venture to say you learned a lot about pharmacology in that rotation given that the residents often times have multiple drugs. If you are on the skilled unit side of LTC, there are opportunities for practice skills, wound dressings and tube feedings for example.
    You’re not going to know everything when you get out. Even if you started three IV’s successfully in your clinical doesn’t make you an expert. Take one day at a time and welcome the learning opportunities that come that day. If there is an opportunity during one of your clinical to perform a skill that you have not done yet, let the instructor know. If you can’t perform it, ask if you can watch the other student or nurse perform the skill.
  10. Visit  jjjoy profile page
    1
    It's frustrating enough to get minimal quality intensive clinical experience as a student; it irritates me even more when given the assurance "no one expects you to be able to do all that" and "don't worry, they'll teach you" but at least half the time, colleagues and supervisors of new grads toss out "you've never done what?!" "how did you graduate?!" "you're not picking this up fast enough" (within just a few days or weeks).

    I'm sure it's different everywhere but that doesn't seem an unsual experience - unfortunately!

    What to do about it? Be persistent, and more persistent, during clinicals to get as much exposure and practice as possible. You may have to be just this side of obnoxious to really maximize your experience. "Round" on each other's patients as students so that you can see as much as possible. Even if you aren't *doing" as much as you'd like, assessment is a big part of nursing and the more you see first hand (eg various symptomatology, wounds, skin conditions, etc) the more you have to draw upon in the future. Presenting on each other's patients is also a good way to help nail down meds, diagnostics, lab values, etc ... stuff that may not be directly tested on in NCLEX-style tests but that will be useful to draw upon in future practice.

    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.
    futurernfarmer likes this.
  11. Visit  CBsMommy profile page
    0
    I felt this same way so I decided to go for a Nurse Extern position. Are there any hospitals within driving distance that offer such a position? I've been able to see and do so much more having this position than in my time on the floors during clinicals! I've placed more IVs and Foleys than I can count, I've got to do some dressing changes with wound vacs, got to see/touch chest tubes, G-tubes, etc. I've not done everything and in no way am I an expert but I was able to experience more than most of my classmates. Plus I got great tips from the nurses I was working with and got to work a lot on time management skills.

    And, since this is my last semester before graduation, I am going to hand my CI a list of stuff that I would like to work on. I know a lot of other students want IVs and foleys and since I'm already comfortable with that, I wouldn't mind trading those out for things like feeding tubes and other stuff.

    Just a thought. Good luck to you and yes, most hospitals do train new grads but the more hands on experience you have now, the easier it will be to transition!
  12. Visit  GrnTea profile page
    0
    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.

    in your first year of practice you'll have plenty of time to do "stuff." what you need to remember is that "stuff" is not nursing, not the core of it, not the part that will carry you through the lifelong learning we call a nursing career.

    if you think some people will hassle you for not having done "stuff," then ask your preceptor to put the word out that you want practice. believe me, foleys and dropping ng tubes and iv starts and wound packing will come out of the walls. meanwhile, just expect that you will get some snide remarks, and remember that they are about as important as the fact that you have to park waaay the ehll out in the back forty of the parking lot. which is to say, a pia but not really related to what you're doing here.
  13. Visit  CBsMommy profile page
    1
    Quote from grntea
    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.

    in your first year of practice you'll have plenty of time to do "stuff." what you need to remember is that "stuff" is not nursing, not the core of it, not the part that will carry you through the lifelong learning we call a nursing career.

    if you think some people will hassle you for not having done "stuff," then ask your preceptor to put the word out that you want practice. believe me, foleys and dropping ng tubes and iv starts and wound packing will come out of the walls. meanwhile, just expect that you will get some snide remarks, and remember that they are about as important as the fact that you have to park waaay the ehll out in the back forty of the parking lot. which is to say, a pia but not really related to what you're doing here.
    i am in an as program and did get a full semester of psych (complete with many hours/days at our state mental institution - in the acute ward) as well as a full semester of peds/ob.

    and, while i do agree with you that skills are not everything that a nurse does (far from it), i would rather master as many skills as i can now so that i can concentrate on my "critical thinking" and time management piece and becoming the very best nurse that i can be for my patients.
    ORnurseCT likes this.
  14. Visit  jjjoy profile page
    0
    Quote from grntea
    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.
    Last edit by jjjoy on Aug 7, '11


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