Am I crazy, because this seems VERY WRONG...

[Fannie'sMom, BSN, RN]

Hello friends,

I need some honest opinions from people outside my circle, as all of my fellow students share my same opinion and all the faculty blow sunshine up my you know what, when I even hint that the situation isn't right. So here is the deal...

Me: Adult senior student in BSN program at local university

Preceived problem/issue: Clinical assignments

History:

Fall semester junior year - 10 wks clinical mostly focused on CNA duties w/some assessment

Spring semester junior year- 7 wks med/surg where I passed meds 3 times, then 7 wks mental health where I observed patients (not shadowing nurses) in different settings (eating disorders, adolescence, geriatrics, etc)

Fall semester 2011 -

14 wks med/surg at a nursing home, where I (a BSN student) shadow an LPN whose primary duties is to administer medications to 30-45 patients in their 8 hours shift.

*LPN's, please don't be offended or turn this thread into an arguement of LPN's vs BSN"s. I fully appreciate that I can learn a lot from an LPN and these people bust their A** all day, every day. My issue is that my university placed me in a clinical situation where I am shadowing a nurse who 98 % of the time is handing out PO meds to long term residents, who are primarily stable (because they take 17 meds 3 times a day...OMG).

Community clinical-public health nursing- 7 wks at a local health dept whose budget has been desimated, so we spend our time watching CD's, observing employees in the Lead Poisoning program, or shadowing health inspectors. One was lucky enough to do an at home visit w/an actual nurse meeting w/an at risk mother.

My feelings- I am ANGRY. My primary complaint is that I feel like I am paying a ton of money to learn how to do everyone elses job. My mental health clinical taught me the job of behavioral health specialist (the counselors), my current med/surg clinical is teaching me what it is like to be a full-time CNA (as when I am done assessing and medicating my patient I answer call lights all day, as there are never enough CNA's to help the residents and my community clinical, where I am learning the jobs of health inspector and other misc health dept personnel.

The final thing I will say is I appreciate that all of these people are part of the health care team and I need to have an understanding of what they do, but I have a finite amount of time to learn NURSING, and it feels like I am learning anything but. While I think every student nurse would do well to be exposed to a nursing home setting, I am spending the greatest chunk of my clinical experience there, while my classmates in other clinical groups are one on one w/ICU nurses, in IV clinics, and in hospitals with acute patients, experiencing hospital nursing.

Am I wrong? Should I believe my instructors who give me the party line of "it's a good opportunity to learn____" fill in the blank. I feel like the clinical portion of this nursing program is substandard and I keep getting sunshine in an attempt to deflect the fact that I am in fact right. Please tell me what you think, as I am about to lose it!

Thank you inadvance for your response.

[tothepointeLVN, LVN]

In order to get good learning experiences you have to hustle sometime. But you would be surprised at how much of nursing involves little snippets of other specialities

At my school we also had a case of the haves and haves not each semester. Sometimes we would be in an acute hospital while others were rotting in a nursing home. Though sometimes it would be we were limited to what we could do in the acute hospital vs the students who could do more in the Sub acute.

Find out who does the clinical assignments at your school and schmooze. At my school the A students got their pick of assignments mainly because they were losing a lot of clinical sites due to bad behaviour.

Your not even halfway through all your clinicals yet. It takes time to get exposed to some skills. I did more skills at a sub acute than I did at the acute hospitals. Lots of vents and trachs and gt's and IV's and wound care.

Also some skill your not going to get to do unless you patient needs it. Sure its nice to practice CPR in person but your patient has to code to do it.

The most important skill your EVER learn in nursing is not the one your think. It's not IVs, its not Foleys. It's ASSESSMENT and you can practice this no matter where you are.

Get your steth and go and listen to every patient in the NH heart and lung sounds.

[Bruce_Wayne, ASN, RN]

You can learn from any situation, what is important is your outlook.

I was having a candid discussion with some nurse friends of mine and the consensus was that nursing school does no teach you every thing you'll ever need to know about being a nurse. Nursing school teaches you what you need to know to pass the NCLEX and to be a NEW nurse.

A lot of your actual learning and experience will come from on the job training. That's why orientation for brand new nurses takes so long and many places are hesitant to give those positions out willy nilly, because they're a huge investment on the part of the health care provider.

[JROregon, ASN, BSN, RN]

I'm a second year ADN student and our clinicals are set up differently. We do a 3 week rotation in a continuing care facility but spend most of the time in acute care. We were also very limited in what we could do the first year. Kind of frustrating. Now that I've had a chance to practice IV skills on patients I've come to the realization that all these skills can be learned by doing them a couple of times, but the thinking that goes on and the critical thinking about what is going on with the patient is what takes the 2 years. I agree with the posters above that you will learn the most in your first year on the job.

I will be honest with you and say that I might be really bored in a long term care facility if I had to observe someone passing out meds and I would try to make the most out of the situation as possible. Yes, listen to those hearts, they are going to have all the weird dysrhythmias that you are learning about. They are also documented so you'll know what you are listening to.

[xtxrn, ASN, RN]

ADN from 1985 here :)

I'd be mortified. We spent a DAY observing LTC (and I ended up working in several LTCs, and loved it- I'm not dissing LTC ) . We had a quarter of psych. We started giving meds the first day of the second week. IVs came later in the second year.

THIS is the reason that you're getting passed up for jobs as a new grad. THIS is why they have to do preceptorships/internships now (we NEVER had them; I'd never heard of them until I moved back here - IL, from TX- and after 17 years was put on a 5-6 week orientation... I do best by "doing", not chasing someone around. My preceptor was great, though- and saw immediately that I'd ask if I had questions.

It is SO frustrating to keep hearing this from you guys - but helps me understand what's going on when some of the questions are asked that a lot of us "oldies" take for granted- we didn't have the same frame of reference that is so common now :hug:

Yeah- you're going to have to get creative. I'm wondering if some of the instructors who didn't spend a lot of time on the "floor" just don't KNOW how to teach it- because they're not comfortable with it either (IDK this- but seems to be a possible reason; not all instructors, but those "never do bedside" sorts ).

[dudette10, MSN, RN]

Your first clinical rotation and your mental health rotation sound all right.

Your senior year is another story all together. I agree with you that your senior placements leave a lot to be desired.

The community health placement really confuses me. You weren't even shadowing nurses, were you?

[Vershonda]

What you fail to realize is that another nurses license is on the line when you are in clinicals; therefore, passing meds and shadowing an LPN is what you will do. You need to get what you can get out of every clinical situation and quite complaining about what you are not getting. Too many Nursing Students complain about what is going on in school without taking into account that you are a student. In no profession are you taught everything that you will do on the job, you learn it on the job. Learn what is being taught in the classroom and in clinicals which is to mastered the concept of Critical Thinking for when you actually start working as a Nurse under your own license.

[tothepointeLVN, LVN]

Also you have to weigh in the fact that schools compete for clinical sites and money is involved in the form of donations from the school. My LVN scored good clinical sites through that system AND being willing to make their students do clinicals from 4pm-12midnight.

Your school may not be willing to do that.

[anonymousstudent]

What you fail to realize is that another nurses license is on the line when you are in clinicals; therefore, passing meds and shadowing an LPN is what you will do. You need to get what you can get out of every clinical situation and quite complaining about what you are not getting. Too many Nursing Students complain about what is going on in school without taking into account that you are a student. In no profession are you taught everything that you will do on the job, you learn it on the job. Learn what is being taught in the classroom and in clinicals which is to mastered the concept of Critical Thinking for when you actually start working as a Nurse under your own license.

Oh, this response makes me very, very sad. Look, the OP is going to be a nurse in what, 6 months? Maybe 7, she said she's a senior. Is it even rational to throw a person with absolutely NO experience into a hospital or LTC facility and expect them to be a good nurse? Or heck, even a safe nurse? Theory is not going to cut it. You don't walk into a patient's room and get 4 multiple choice questions on their chest for how to proceed. None of us want to know everything or experience everything. But before many of us went to nursing school we completed required courses comparable to CNA work. We can wipe butts. We can give baths. We can do it. And we will routinely prove that in nursing school, and be thrown to the wolves when we leave because we've never had any chance to do any real skills or get any experiences. My clinical experiences haven't been quite so dull, but close. It's horrible. I'm scared for when I leave school. I need a skill set that I absolutely cannot obtain. I'm told it didn't used to be like that. I'm told that through the hospital based diploma programs and some of the older modeled ADN/BSN programs they actually got nurses ready to work the floor when they left. This makes me want to puke. Which I will get the opportunity to show you I can clean up. But push some Zofran to help you? Nope.

[Cessna172]

14 weeks med surg at a nursing home is not med/surg. Why are you placed in a nursing home anyway? You need actual clinical hospital experience, of course that's my opionion, but you just don't get the same learning environment in LTC. Hope things improve for you.

[Rhody34]

This seems very surprising to me... I'm in my third semester (out of 4) from an ADN program at a CC. Our clinical breakdown is this.

Semester 1:

5 weeks @ Nursing Home- pt care, assessment, PO, SC, IM meds

10 weeks @ Hospital- med surg, pt care, assessments, charting, PO,SC,IM meds

Semester 2:

15 weeks @ Hospital- med surg, pt care, assessments, charting, PO, SC, IM, IV meds (every shift to 2-3 pts.)

Semester 3 (current semester):

5 weeks @ psychiatric hospital- assessments, charting

10 weeks (2, 5 week rotations at different hospital placements)- med surg, pt care, assessments, charting, delegating, all meds

Semester 4:

7 weeks pediatric

7 weeks woman and baby

I would be SOOO upset with you clinical rotations. I feel like that wouldnt prepare me at all. Sorry youre experiencing that. I guess looking on the bright side is youll have your BSN, where as I'll still need to do my RN to BSN. So youll at least have a leg up there. Good luck! Seems kinda crumby!

[tothepointeLVN, LVN]

Can I ask. Is this a private for profit school?