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!
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.
Yes you already know in advance whats funky about them so you can learn what things look like in a safe environment. You'll learn what a brittle diabetic looks like, lots of things. Just keep your eyes out and always be trying to learn. A lot of the resident's love it when you assess them. It makes them feel like they are being looked after. If you REALLY feel your not learning or have exhausted all avenues then give back to your patients. I spent a lot of downtime painting old ladies nails. I don't regret a second of that.
There are ways of doing. Ways of knowing and ways of being.
You have to learn and practice all of them. You'll be a good nurse I can tell but instead of getting angry at something you probably have no control over use it to expand your knowledge in whatever way you can.
I totally feel you. I have a rant on another thread about my clinical rotations. We are in a hospital but we're stuck on a floor that gets nothing but hospice patients and those with lung issues: COPD, cancer, bronchitis, etc. BORING. And our instructor seems to be under the impression that we are CNA students. The difference in our hospital is that we aren't understaffed with CNAs. Instead, we have Jabba The Hut, whose breath reeks, sitting on her fat *** getting paid while the REGISTERED NURSE students are doing her bedbaths and whatever.
I will be a registered nurse in less than 7 months. I need to know how to do REGISTERED NURSE skills. I need to be shadowing a nurse. I did get to do that once but it was a new grad, totally overwhelmed with her 8-10 patient load every day, and hating being a nurse. Not very useful...
Every time this topic comes up someone has to say "You're not above doing CNA skills". I know that, so save it. I am fully aware that I will be responsible for many or all the same duties that a CNA has. I get that. However, I've been a CNA since 1995, I think I've got that.
My school isn't a private for profit. Its a community college.
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.
and this is the reason I am so happy with my choice to attend a nursing college that is part of the hospital. We do all our clinical rotations IN the hospital. And we hit the floor running from week one.
and this is the reason I am so happy with my choice to attend a nursing college that is part of the hospital. We do all our clinical rotations IN the hospital. And we hit the floor running from week one.
Thank you for starting this thread. You raise a very good. The quality of the clinical experiences provided by a school is important. The better schools offer better-quality clinical experiences.
Unfortunately, many prospective students fail to consider that as they choose a nursing program. They look at the convenience of attending the school (schedules, length of program, availability of financial aid, etc. ) ...but never investigate the clinicals offered by the school.
We should all be talking about this more -- and making sure prosective students are told to investigate the clinicals before choosing a school.
Perhaps you could slow down your progression through school a bit -- and get a job as a nursing assistant at a local hospital. The right job might help you develop your skills and help you to get a job after graduation -- and be better prepared for that job. I wish you the best of luck.
and its times like these i am so happy i chose a diploma program.
i do feel you are being a bit snooty about having to answer call lights and do "CNA duties".. sorry to tell you but nurses, yes even BSNs, have to answer call lights, give bed baths, change dirty briefs. all CNA duties are nursing duties, they are just duties that are allowed to be delegated.
with that being said, it does sound like you are getting a lame clinical experience. i see barely any hands-on experience. shadowing is ok every once and a while, but you really should be on the floor (acute, LTC, or whatever) practicing basic skills. by the end of my first semester i had given meds (PO, IVP, SQ, Peg tube), inserted and d/ced a foley, enemas, several picc line dressing changes, and probably some other things i cant remember.
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 ).
It is much more likely, from the sound of the post, that the school has too many students for the availability of clinic sites. There are areas with WAY too many nursing programs, and too few sites. The instructor should give you guidance if you are in an area with less opportunity to practice skills. Ex- what would you assess for when giving this patient's 17 meds? How do you know they are/aren't working from your assessment? Also, my students have placed foleys, given IM injections, performed wound care, etc at LTC in addition to med pass.
Schools need to lower the faculty student ratio in clinical. It takes twice as long to work closely with a brand new fundamentals student, and to encorage them to talk through the rationale of their actions vs. just doing it myself. Yet schools regularly assign ten or more students per instructor.
Since none of the current state of affairs will change overnight, I would be proactive. How many clinical hours does your program have vs other local schools? If there is a disparity, why? Look for every opportunity where you currently are: full assessments, understand all patho & meds. Learn time management and how to plan your care in each area.
Thank you for starting this thread. You raise a very good. The quality of the clinical experiences provided by a school is important. The better schools offer better-quality clinical experiences.
Unfortunately, many prospective students fail to consider that as they choose a nursing program. They look at the convenience of attending the school (schedules, length of program, availability of financial aid, etc. ) ...but never investigate the clinicals offered by the school.
We should all be talking about this more -- and making sure prosective students are told to investigate the clinicals before choosing a school.
Perhaps you could slow down your progression through school a bit -- and get a job as a nursing assistant at a local hospital. The right job might help you develop your skills and help you to get a job after graduation -- and be better prepared for that job. I wish you the best of luck.
llg, GREAT plan. I will start a new thread on questions to ask a prospective program.
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).
In my case, I think that is exactly what is going on. My instructor has only been out of school for 3 years and to hear him tell it, he is super nurse. I'm becoming more and more suspicious of his claims of experience.
Sounds very similar to my BSN program. When you get to the final semester, where you are to be "functioning" as a graduate nurse would, don't be surprised when you are handed a sheet of paper listing the eight "functions" of a graduate nurse that you are not to even consider performing. Your preceptor will be handed the same list of restrictions. A great learning environment.
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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. 
).
tothepointeLVN, LVN
2,246 Posts
Yes you already know in advance whats funky about them so you can learn what things look like in a safe environment. You'll learn what a brittle diabetic looks like, lots of things. Just keep your eyes out and always be trying to learn. A lot of the resident's love it when you assess them. It makes them feel like they are being looked after. If you REALLY feel your not learning or have exhausted all avenues then give back to your patients. I spent a lot of downtime painting old ladies nails. I don't regret a second of that.
There are ways of doing. Ways of knowing and ways of being.
You have to learn and practice all of them. You'll be a good nurse I can tell but instead of getting angry at something you probably have no control over use it to expand your knowledge in whatever way you can.