Soon to graduate and still don't know what I'm doing

[greyL]

My graduation will be in April. I only have my public health clinical and my preceptorship left. Even though graduation is near, I still don't feel confident in my skills. I've had the chance to do an IV twice, and I screwed up both times, I've never had to cath a female, I've never had to put in an NG-tube... I feel like my clinical experience is severely lacking, and it's not because I'm not being proactive about getting to do things at the hospital. I'm usually the one that does things that no one wants to do. So far, I've given 5 suppositories and I've helped with an enema. Most of my classmates have never even given a suppository. Why? Because they don't want to do it. They think it's gross though I don't know why. It's just people's butts. If there was poo involved then they wouldn't be needing a suppository... >_>

Is this normal? Have others graduated without much hands on experience? My mom is an RN and I asked her about it and she said that she didn't get much hands on experience in school either and that she learned everything after she was hired by a hospital. That doesn't seem right to me.

I still have my preceptorship left, but what is that exactly? It's extremely difficult to get any information from people at school.

[JBMmom, MSN, NP]

I agree that working on thinking should be more the focus than skills, but for me, being comfortable with the skills has made me much more able to focus on the thinking. I'm in my third semester and I feel like other than starting IVs or inserting an NG tube, I've been exposed to most things that I would have wanted. I've done about half a dozen caths, plenty of IV meds, NG tube meds, PEG tube feedings, IMs, dressing changes- including central lines, and now we're working on the big picture. We're now taking three patients, getting and giving report, sometimes administering all scheduled meds on two patients (depending on how many of us are on the floor). We're learning to prioritize and get things done, and I'm starting to put the big picture together. No matter what there will be a learning curve when I start practicing, but I feel better knowing that the task stuff isn't all that intimidating to me anymore. I feel for those that have had a clinical experience that didn't provide the skills they want, but I'm sure you'll be fine when you're out there.

[ashleyisawesome, BSN, RN]

Nursing school prepares you to pass the NCLEX. Diploma programs taught you bedside nursing, but those don't exist anymore. So you learn on the job or through direct patient care experience working alongside RNs.

My occupational experience complimented my clinical experience quite nicely.

they still exist, im attending one right now. oldest one in the country actually! my advice to the OP would be to try to get a tech job in a hospital. many of them allow techs to do blood draws and insert foley caths, and just having extra exposure to the hospital environment will make you more comfortable as a nurse when you graduate.

[delabeaux, MSN]

Wow... ya'll went to my nursing school... I graduate and December and am only semi-confident thanks to my month-long preceptorship. Other than that, in my two years I have NEVER been with a nurse one on one.

This is why no one wants new grads. Employers realize colleges teach $hit and they are tired of having to teach what the schools failed to do.

Perhaps the schools will pull their head out of whatever location it is in to realize what is going on... perhaps students need to quit enrolling before they'll get it.

Who knows when people will realize that THERE IS NO NURSING SHORTAGE!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!1

[ImThatGuy, BSN, RN]

Clinicals I've had don't make me feel under prepared. Rather, they make me feel like the entirety of nursing could be OJT. I just made the assumption prior to school that nursing school was more in-depth than what it actually is. I'm kind of disappointed.

[KimberlyRN89, BSN, RN]

There's still quite a few diploma programs in PA, VA, and I think there is one in DE. I think nationwide there are fewer than 100 left.

Anyways, I feel like everyone else Passing the NCLEX seems to be these school's #1 concern, not hands-on skills! We addressed this concern to some of our instructors, and they just shrugged & said "That's how it was for us in nursing school too"..ugh!

I know that this is a HUGE heated topic, but I think ADN programs do a better job with providing their students with clinical experience. I'm in a BSN program & it seems they just focus more so on theory. That's just my 2 cents

[MN-Nurse, ASN, RN]

I only learned about diploma programs recently. If I had known that those existed, I would have tried to look for one because there are still a few out there. Why are they dying out? Diploma programs make a lot more sense to me.

Even though the students put in a lot of hours working for the facility and they put out very well trained nurses, they were still prohibitively expensive for hospitals to run. Especially when boards and bean counters started closely examining revenue and cost streams.

I think federal funding for diploma programs makes a lot more sense than federal school loans to for-profit colleges, but thats not what happened.

One of my old bosses noted she had like 80 hours training as a charge nurse while in school.

[nurseprnRN, BSN, RN]

"is this normal? have others graduated without much hands on experience? my mom is an rn and i asked her about it and she said that she didn't get much hands on experience in school either and that she learned everything after she was hired by a hospital. that doesn't seem right to me."

it is exactly right, and i'll tell you why: because since florence was a probie (look it up), there has never been a way to teach every nursing student every psychomotor skill in the book while in school. worse, most students think that tasks/skills are all there is, and that's why they feel incompetent at the end of their education. i am here to tell you that your education is primarily there to get you to safe entry-level practice (which it is, believe it or not, even if you have never done some tasks), but more importantly, to teach you how to keep studying and learning to hone your professional craft.

i never cathed anyone, had a chance to start an iv, or sunk an ng tube as a student-- the opportunity just never arose. didn't stop me from doing every single one, with guidance from more experienced nurses, within a week of starting my first job, in a pacu. they're just tasks. we teach lay people how to do tasks all the time.

studies show that new grads may start out at different levels on the psychomotor skill thing-- true, the old diploma schools did use students as staff five days a week, and so they got a lot of that hands-on thing that you think you need to envy. but tasks are not nursing. again, we teach tasks to lay people all the time, but that doesn't make them nurses, now, does it?

by the end of the first year of practice, new grads with better educations pulled ahead of diploma grads in basic knowledge, skills, autonomy, and decreased errors. yep. true that. i am not starting the bsn-entry-to-practice thrash (knock yourself out if you want to, but leave me out of it this time, my position is clear). fact is, though, that better education makes better teachers, better architects, better chemists, better engineers, and better nurses.

so although i am sure your faculty told you never to say "don't worry" to a patient, because it invalidates their feelings, i will say, "you don't have any reason to worry" about this issue. all the nurses you will work with started out as, well, new grads. some will be butt-heads about your lack of experience; ignore them, once you pull out the kernel of truth in their complaints. keep on learning, and you'll be fine. really. trust me on this one: your faculty wouldn't let you out the door with a degree in hand if they didn't think you could be a nurse. go with that.