New graduates with no clinical skills.

soxgirl2008 · Sep 26, 2012

I am a pre-nursing student and I am currently taking Intro to Nursing. One of my assignments was to interview an RN. One of the questions I had to ask was what advice you would give to students or new graduate nurses. I spoke to a nurse at a local hospital and she said she would tell all students to get out there and get as much clinical experience/skills as possible - to not just sit back, but to get out there and find something that needed to be done and do it to practice the skills and get the experience. She has noticed that new grads do not have the skills they are supposed to have, even on simple things like starting an IV. I thought that was great adivce. She said that it seems like new grads "have no idea what they are doing". I wonder if this is normal accross the board. Could it be that people are going into nursing just for the paycheck and aren't really interested in learning? What is your opinion? Do you agree or disgree? What would be your advice?

I don't think it has anything to do with not being interested in learning. Yes, you learn skills in nursing school but you don't get a chance to practice them enough to the point that when you start as a new grad you are completely comfortable doing those skills. I know nurses who never started IVs until they became nurses. They learned how to start IVs on dummies in nursing school, but while you are in clinical the only way the students got to start a real IV was if their patient just happened to need one at that time, and in a lot of cases the chances of your patient just happening to need an IV put in while you are there is slim. They can't let you start an IV on patients just for the learning experience if the patient doesn't need an IV. Same with foleys.

As a new grad you aren't going to be comfortable with all your skills right away. My advice would be for nursing students to look for nurse interns positions while they are in school. At the hospital I work at many of our nurse interns have said the only chance they've had to really practice a lot of their skills on real people was while working at the hospital.

maracuya · Oct 19, 2012

Thank you soxgirl2008 for your advice, I honelsty had not thought of the fact that we'll be practicing on dummies. I'm sure it is very different. I will certainly keep your advice in mind.

jennaroo · Oct 19, 2012

Mind you I am a pre nursing student....starting pre reqs in spring actually......anyhow what you said about some people going into nursing for money could be true, but I cant help but wonder (keep in mind this is just from listening to friends of mine experiences) but it seems to be a HUGE trend that clinicals have become an issue of job shopping.......seems there are more times than not when nurses that the students are assigned to during clinicals are to busy to teach or allow the students to have hands on experience because her/his pt load is to heavy......so the student leaves after a whole day of just following the nurse around but has not got to actually do anything......kinda hard to learn skills when you cannot do them......I have heard of these nurses telling the students they like it better when an experienced LPN comes in for clinicals because she can at least help and not sit back and watch......well as a student without this training or someone willing to take the time to give the hands on I'm affraid thats all a student can do.......this seems to also be a trend in sims lab.....instructor says it takes to long to allow each student to practice on the dummy so you explain the steps to the provcedure in the lab instead......wonder if the schools meant for this to be done this way when they set these expensive labs up?

I am crossing my fingers I can get as much hands on as possible when I start clinicals. You know on the show Grey's Anat.....how all the intern dr's come in droolig for procedures ect lol thats how a nursing student should be while training......we have to pay for this education and they charge us as much as possible so I want to suck as much from them back in return by ensuring that I walk away a capable nurse with a basic knowledge and an attitude that there is room to grow and improve.......whew lol sorry babling now

DalekRN · Sep 8, 2013

Really?? Of COURSE new grads don't have skills... They're new! That's what orientation and the first year is for. You graduate with just enough info to be able to start to learn the specific skill set needed for a first job. Of course new grads arent great at IVs, foleys, doing fundal checks, hanging iv bags etc. Those take practice, the amount of practice which only a job could provide. I don't expect any of the students I precept for leadership to know any of that stuff. I just expect a willingness to be on their feet, talk to patients, practice and learn. That nurse should be ashamed and think back for five seconds on his or her first year on the job and remember how many skills they had to learn after school. Grr...

SquishyRN, BSN, RN · Sep 8, 2013

\ said:

Really?? Of COURSE new grads don't have skills... They're new! That's what orientation and the first year is for. You graduate with just enough info to be able to start to learn the specific skill set needed for a first job. Of course new grads arent great at IVs foleys, doing fundal checks, hanging IV bags etc. Those take practice, the amount of practice which only a job could provide. I don't expect any of the students I precept for leadership to know any of that stuff. I just expect a willingness to be on their feet, talk to patients, practice and learn. That nurse should be ashamed and think back for five seconds on his or her first year on the job and remember how many skills they had to learn after school. Grr...

I don't believe in this at all. Orientation should not be where nurses learn their basic skills. Orientation should be where new nurses become oriented to their setting and develop unit specific skills, not basic ones. Yes, it takes time for nurses to develop the skills they need to be competent on the floor, but their first job isn't where they should be acquiring these skills. New grads being ill-prepared for independence on the floor is a large part of why employers don't like hiring new grads. It's not the fault of new grads. These things should be learned in school, not on the job. Clinicals are inadequate as they are. I'm a big proponent of nursing residencies and apprenticeships and only hope that those will be the wave of the future in nursing education.

DalekRN · Sep 8, 2013

I don't believe in this at all. Orientation should not be where nurses learn their basic skills. Orientation should be where new nurses become oriented to their setting and develop unit specific skills, not basic ones. Yes, it takes time for nurses to develop the skills they need to be competent on the floor, but their first job isn't where they should be acquiring these skills. New grads being ill-prepared for independence on the floor is a large part of why employers don't like hiring new grads. It's not the fault of new grads. These things should be learned in school, not on the job. Clinicals are inadequate as they are. I'm a big proponent of nursing residencies and apprenticeships and only hope that those will be the wave of the future in nursing education.

As long as this ^^^ is an attitude existing in the healthcare setting, new grads will continue going home crying and burnt out and leave the profession. You can learn the steps for skills in school, like for skill checkoffs, but mastery is in repetition and adequate repetition is available only at a job. That's not debatable.

schnookimz · Sep 8, 2013

In my entire time in nursing school, I was never once at a hospital where I was allowed to start an IV. The hospitals in this area simply don't allow it because of the risks, so I would love to know where the experience is supposed to come from?

LadyFree28, BSN, LPN, RN · Sep 8, 2013

I don't believe in this at all. Orientation should not be where nurses learn their basic skills. Orientation should be where new nurses become oriented to their setting and develop unit specific skills, not basic ones. Yes, it takes time for nurses to develop the skills they need to be competent on the floor, but their first job isn't where they should be acquiring these skills. New grads being ill-prepared for independence on the floor is a large part of why employers don't like hiring new grads. It's not the fault of new grads. These things should be learned in school, not on the job. Clinicals are inadequate as they are. I'm a big proponent of nursing residencies and apprenticeships and only hope that those will be the wave of the future in nursing education.

No, it's not the fault of the new grads, or the schools, hospitals are not always "kind" enough to let nursings students get great opportunities. If more hospitals were willing to let new grads in regardless of GPA get into apprenticeships and residencies, and have transition to practice agreements with local schools, then that can help, but if hey are not going to allow students enough access to become comfortable, then what are new grads going to do???

The hospitals and other facilities have to be on the same page as the nursing programs... :yes:

SquishyRN, BSN, RN · Sep 8, 2013

\ said:

As long as this ^^^ is an attitude existing in the healthcare setting new grads will continue going home crying and burnt out and leave the profession. You can learn the steps for skills in school, like for skill checkoffs, but mastery is in repetition and adequate repetition is available only at a job. That's not debatable.

I believe you are misunderstanding me. I absolutely agree with you in that mastery is in repetition. But what I am arguing is that one's job is not where that repetition should begin to take place. If residencies and apprenticeships were the standard prior to licensure, instead of the limited clinicals that nursing education currently provided, new grads would have received more of that repetition while still a student, not a fully-licensed nurse. We should not just accept the status quo in nursing education by adopting an "of course" attitude towards new grads not receiving adequate training to be relatively independent on the floor. Nursing education needs to change, but that takes time. However, in the meantime, I don't believe new grads should be chastised by other nurses for having been failed by current nursing education either, but that varies among individual nurses -- you'll always have your nurses that scoff at new grads for not having enough skills and nurses that welcome the opportunity to teach.

\ said:

No it's not the fault of the new grads, or the schools, hospitals are not always "kind" enough to let nursings students get great opportunities. If more hospitals were willing to let new grads in regardless of GPA get into apprenticeships and residencies, and have transition to practice agreements with local schools, then that can help, but if hey are not going to allow students enough access to become comfortable, then what are new grads going to do??? The hospitals and other facilities have to be on the same page as the nursing programs...

Yes to the last statement. We as a profession need to be on the same page with facilities and schools. We need to be able to convince facilities that it would be far more beneficial for them to train new grads properly in residencies than continue to use the sink or swim approach that leads to so much burn out. Of course this takes time to do on a grand scale, but it's a goal worth going for to further the profession overall.

EDIT: Fixed spacing issues since I'm on my phone.

Stephalump · Sep 8, 2013

No, it's not the fault of the new grads, or the schools, hospitals are not always "kind" enough to let nursings students get great opportunities. If more hospitals were willing to let new grads in regardless of GPA get into apprenticeships and residencies, and have transition to practice agreements with local schools, then that can help, but if hey are not going to allow students enough access to become comfortable, then what are new grads going to do???
The hospitals and other facilities have to be on the same page as the nursing programs...

My hospitals have been very accommodating, but STILL, I can only get so much experience doing ten 12 hour clinicals per semester, especially when you consider that we don't learn every skill in the very beginning.

I learned how to put in an NG tube during my first semester...in October 2012 or so. I finally got to do one in February of 2013 - four months after my last practice. And I haven't done one since. Maybe I will before graduation, maybe not. But when it comes time for me to start working, I'm sure I'll have completely forgotten how to do the whole thing.

I wholeheartedly agree with the need for residencies across the board for transitioning from nursing school into the field. I think it's a change that's desperately needed. The system is flooding new grads into the market and those new grads are less and less prepared. My program has to fight to keep the clinical locations we've had for YEARS thanks to new programs opening and old programs expanding. The nearest RN to mine is an hour away. Why am I fighting for spots at the hospital next door to my school?

Mandatory residences would slow the rate at which schools would be able to accept and graduate students. That freaks out the "shortage" fear mongers and infuriates the money makers, so it's going to be an uphill battle. But it needs to happen.

Satori77, ADN · Sep 8, 2013

Part of the problem is nursing schools popping up all over the place like diploma mills, spitting out new grads every few months. Many of these large for-profit institutions care more about money than producing well-rounded nursing professionals. I've lost count how many are in my state. If you want a better clinical experience, make sure to research the schools you are interested in going to. You will never get enough experience. I doubt any new grad feels 100% prepared when they go out into the real world. But you have to make due with the experiences you are allotted in school. When opportunities arise to learn a new skill, take it. Show an interest, even if it is not a floor or specialty you are interested in. If the nurse you are paired with needs to do do something, ask if you can help.