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!
Sounds like my school. 16 months and I will be done with my BSN. My clinicals are crappy. I gave 3 meds, 2 baths and answered call lights. We had to fill out a 5-10 page paper on the diagnoses, and list ALL meds. On tuesday afternoon and it all is to be COMPLETE by wednesday 0600, or we are "clinically unprepared" and can't pass meds until that is done. Then she calls our school and tells our clinical cordinator that the school is not preparing us for clinical rotations. REALLY????? This is an LPN-BSN program. She is not teaching students that have no clinical background. I pass meds to 28 people ALL DAY! Then we are told to "think like an RN" and not told HOW. I missed a learning opportunity to see a GI scope and see a blocked bile duct because I was giving a shower. Clinical instructor's response? "That's life," WHAT?? Good thing I understand GI a little better now by reading the book (sarcasm) since watching that procedure could have made things much easier to understand! And since I am a visual learner, that's life?
We are told to "think like an RN, you are going to be seen as the leaders when you apply for a job with a BSN..." Really? How do I do that? I am an LPN and I need to know how to transition from that into the RN role. Telling me to do it isn't gonna get you or me anywhere.
Yes, we know answering call lights and giving baths are going to be part of the job but, really, watching the nurses in the hospital.....most of them don't. So don't tell me I can learn something from answering call lights and giving baths. Cuz I bet YOU don't do it either. And yes, we are students. But we are also nurses, and we are PAYING to learn the skills needed to be an RN with a bachelor's degree. Being used as a CNA to give the CNA's and nurses a break is NOT what we are paying for.
Our clinical cordinator called me to see how things were going and I explained to her the situation. And I told her I guess my expectations of what I am SUPPOSED to learn in clinicals are set too high.
Specializes in PICU, NICU, SICU, CCU, ER, RN Paralegal.
I'm one of those old diploma nurses, who graduated in 1971. We used to complain about all the "free labor" we were giving the hospital when we were in school, but we did everything. In my senior year they would designate 2 of us as the charge nurse. This wasn't only for clinicals, this was when we were working extra as nursing assistants. Scary? Yes. Did I learn a lot? Heck yes! When I graduated, there was no orientation other than hospital personnel issues. And, we were prepared for that. Over the years I have seen a sharp decline in new grads who have any clinical skills at all. I once worked in an NICU with a new grad who had completed 3 months of orientation. She actually asked me how to tell if her patient was breathing. I went straight to the Head Nurse of the unit and suggested some Well Baby time for this person. This was supposed to be my back-up? No way!
Specializes in Gerontology, Case Management, Pediatrics.
I understand your frustrations with your clinical experiences. I am from the "old school" diploma program through a hospital. We worked full 8 hour shifts in each clinical setting and not just day shift lol And I had a 6 week orientation program in my first job. I understand this is no longer the case.
It might seem like following a med pass is not a good learning experience, but...did you know that this med pass needs to be completed within a certain time frame? Did you know certain drugs have parameters, like taking a pulse with Dig, checking an INR with Coumadin, what is the blood level for the pt on Phenobarb? While you are following this nurse, ask questions..like why is the patient receiving this med, have you noted any side effects, what are the state regs regarding a med pass in this setting?
Bring a list of questions with you each day. Be curious.
Look up the meds you see being passed-a great opportunity to learn what type of meds geriatric patients receive. Do you see any potential issues? SNFs also have pharmacist reviewers who review patient files to ensure there are no interactions or problems. See if you are able to review this report for the unit you are on-a great learning tool. When I worked in LTC, I learned a great deal from my pharmacist reviewer. With her help, we were able to reduce doses or eliminate completely for many of our residents because as we know livers do not detoxify the body as well as we age.
Review the care plan for the patient-see if you can help identify any problems that are not addressed or whether any of the goals are being met. Then you can discuss this with your instructior and brainstorm how to improve the patient outcomes.
You can practicing assessing patients also..review your findings with the RN to see if you are on target.
One thing I learned through the years, is that complaining did not achieve much, except the person complaining was ignored. Remember to come with a solution when you see a problem.
Good luck to you and your fellow students. Don't give up :-)
Specializes in Hospice, Case Mgt., RN Consultant, ICU.
Reading these posts explains a lot. I feel really grateful to have graduated from a three year hospital school of nursing diploma program. The hospital was across the street from the nurses residence. Yes, we students lived in the residence and did not have the situation so many have of commuting from home to school. We were immersed in the nursing education process. Our hospital was a teaching hospital similiar to the Cook County hospital one used to watch on ER. So we had all the various specialities of acute care such as OB, GYN, ortho, GU, etc. as well as Med-Surg. We also had clinics. Students rotated through all the clinical areas. Our psych rotation was three months in length and the psych hospital was also just across the street. As Seniors we had the experience of being the Charge Nurse.
I don't understand totally what some mean by 'CNA duties' - sounds like fundamentals of nursing. I don't understand why some nursing students seem to have an aversion to bedside nursing. But we have all been around those nurses who seem to think they are too good for hands on nursing.
It really does seem like some students are being cheated out of the clinical experience you should be getting and are paying dearly for something you are not getting. I do take exception to the comment about hospice being boring. Most hospice patients are cared for in their homes and you will find these patients to have a wide range of medical conditions. Plus you have the added impact that they are dying and all that adds to the situation for the patient and their loved ones.
I wish all of today's nursing students the best. It does seem there are a lot of issues with the programs being offered today!
As a new nurse, I remember talking with my aunt who graduated from a hospital based program. She had training that related directly to working in the hospital. They were working there, all the time, doing the job. They went from their training directly to working for the hospital. She seemed to have had a better experience than I did in my nursing school program (they were in the trenches together and they had to work together). We need the same thing for new grads.
The OP didn't say if she was already doing a LPN-BSN or a full 4 year BSN but you older RN's need to understand.......if we are LPN's doing a BSN program, we have to be working as a LPN to be in the program. That means: we do VS, we do toilet people, we do answer call lights. THAT is what we are frustrated about!! We are adult learners doing an ADULT BSN program. We are already working as LPN's and we don't need to do VS, toilet people, give showers, and just answer call lights during a clinical rotation. We need to be with the RN so we can LEARN. I can do a med pass to your 4-6 people with my eyes closed. A 4-6-8 person med pass is NOTHING to us if we work in LTC and do it EVERY DAY!! Yes, we know there is a certain time frame in which to give meds. Can you give meds to 28-30 people in 2 hours??? I can, because I DO.
I had 2 patients at the end of my med/surg rotation. I had my ADL's AND assessments done and charted before the RN even completed her first one! Trust me when I say having 4-8 patients to me is nothing. I think my time management/prioritization skills are so strong that they may hinder me in the future, because I don't feel like I am learning how to prioritize care to 2-4 critically sick patients. Sure, I can read that in the book, but to help me understand it better, I need to see it being done. How can we learn that if we are doing VS and showers, and answering call lights?
Strange but this was my expereince as a BSN student in 1978! Looking back to my own clinicals, I'm not sure ANY experiences in nursing school can prepare you to work as a nurse. I can also tell you that any time I've had students do clinicals on units I've managed (psych, neuro, rehab) it's been mostly "look but don't touch". It's unfortunate but I believe it's the norm and not the exception. Count on looking for a good internship program and start applying well before you graduate because this is probably your best chance at breaking into a clinical specialty. Good luck, and remember - we didn't choose nursing - it called to us.
Strange but this was my expereince as a BSN student in 1978! Looking back to my own clinicals, I'm not sure ANY experiences in nursing school can prepare you to work as a nurse. I can also tell you that any time I've had students do clinicals on units I've managed (psych, neuro, rehab) it's been mostly "look but don't touch". It's unfortunate but I believe it's the norm and not the exception. Count on looking for a good internship program and start applying well before you graduate because this is probably your best chance at breaking into a clinical specialty. Good luck, and remember - we didn't choose nursing - it called to us.
Unfortunately, you are right, I think it is the norm. A lot of the new BSN grads hired at my facility said the same thing. And you do learn a lot on the job faster than in the clinical setting. We were told to just do what we were told and don't gripe about it. Wish there were more hospital nursing programs. But, a few more months in the trenches and then off to try to get a job doing what my passion is!! (And then more time in the trenches, LOL!!)
Specializes in Community & Mental Health, Sp Ed nursing.
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.
I cannot emphasize this enough. Listen to hearts, this setting is were you'll get some interesting variations. Same goes for lungs. Take BP's and if they are willing practice taking BP's on a leg. What about all those meds? What do they do, what are they for, what are their SE's. When a doc comes in to do their rounds, ask if you can follow them around. Review a patient's file and look at their blood work, do you see the correlation.
Even if you can't do this, just by asking shows your interest in wanting to learn everything. Geri is an important sub specialty, so much so, specialty leadership programs are being developed.
Specializes in Med/surg,orthopedics,emergency room,.
Okay everyone please do not feed me to the wolves for my response! Dear Am I crazy, what exactly were you expecting from your clinical rotations? Just because you're an"Adult senior student " was that suppose to make a difference? In order to be a well rounded NURSE yes, you do have to learn everyone's role in patient care, so you DON't become a nurse who looks down at LPNs and CNAs because YOU are holding the clipboard!!! What did you think nursing is? Another point to consider that was touched upon is the fact when you do your clinicals you are working under someone elses license> I don't know about anyone else but as far as I'm concerned, my license is my bread and butter, and I will not put it in jeopardy for anything or anyone.
If you felt short changed in some area, could you not have extended your clinical time in that area? Could you not volunteer to get a good feel of that particular module? Could you not have gone to your preceptor, counselor, or instructor and said you needed a little more time in one area or another? I understand your financial and time constraints, but at some point in time you hvae to speak up and say, something about your own education, afterall YOU are paying for it!
Just because you are a "BSN student" that doesn't mean that you shouldn't know all levels of nursing. Some of my best teachers were paramedics,emts,and LPNs. To be honest, I have taught many RNs things they didn't know, or couldn't do, so please do not turn your nose up because you had to "shadow an LPN whose primary duties is to administer medications to 30-45 patients in their 8 hours shift". Keep your mind open! Grasp all the "little things" that each area has to offer! Ask questions be involved, and remember your attitude and what you take away from every situation is what's important.
I'm am LPN so never have lived ur life or walked in your shoes. AND I'M NOT TALKING ABOUT EVERY BSN PROGRAM IN THE WORLD. I work with several BSN nurses from MA. that felt the same way you do. These are the people who did the 4 yrs straight thru. and not a 2 yr program 1st. They felt they were way cheated out of major clinical skills that even I as an LPN got. Just so that u know ur not alone. I worked with one my last week of LPN school 23 yrs ago and it's funny I remember this as she was also a student in her last wk of school. The RN came to get her as they were going to push Lasix on a Pt. Not only had she never pushed Lasix she admitted she had never pushed any drug in 4 yrs. I remember at 19 thinking there had to be something wrong with this back then.
You are missing a lot if you don't get to experience critical care, trauma, cv, neuro, general icu stuff, ER. Critical care is all about assessment and thinking. You also should see peds, labor and delivery, post postpartum, nursery, cath lab, surgeries, mental heath... It's important to see which kind of nursing your interested in, not to mention just sheer exposure, even if the stuff your doing wouldnt take a RN license to do. I was in Houston area, so maybe I was just lucky.
As a new nurse, I remember talking with my aunt who graduated from a hospital based program. She had training that related directly to working in the hospital. They were working there, all the time, doing the job. They went from their training directly to working for the hospital. She seemed to have had a better experience than I did in my nursing school program (they were in the trenches together and they had to work together). We need the same thing for new grads.
SE_BSN_RN, BSN
805 Posts
Sounds like my school. 16 months and I will be done with my BSN. My clinicals are crappy. I gave 3 meds, 2 baths and answered call lights. We had to fill out a 5-10 page paper on the diagnoses, and list ALL meds. On tuesday afternoon and it all is to be COMPLETE by wednesday 0600, or we are "clinically unprepared" and can't pass meds until that is done. Then she calls our school and tells our clinical cordinator that the school is not preparing us for clinical rotations. REALLY????? This is an LPN-BSN program. She is not teaching students that have no clinical background. I pass meds to 28 people ALL DAY! Then we are told to "think like an RN" and not told HOW. I missed a learning opportunity to see a GI scope and see a blocked bile duct because I was giving a shower. Clinical instructor's response? "That's life," WHAT?? Good thing I understand GI a little better now by reading the book (sarcasm) since watching that procedure could have made things much easier to understand! And since I am a visual learner, that's life?
We are told to "think like an RN, you are going to be seen as the leaders when you apply for a job with a BSN..." Really? How do I do that? I am an LPN and I need to know how to transition from that into the RN role. Telling me to do it isn't gonna get you or me anywhere.
Yes, we know answering call lights and giving baths are going to be part of the job but, really, watching the nurses in the hospital.....most of them don't. So don't tell me I can learn something from answering call lights and giving baths. Cuz I bet YOU don't do it either. And yes, we are students. But we are also nurses, and we are PAYING to learn the skills needed to be an RN with a bachelor's degree. Being used as a CNA to give the CNA's and nurses a break is NOT what we are paying for.
Our clinical cordinator called me to see how things were going and I explained to her the situation. And I told her I guess my expectations of what I am SUPPOSED to learn in clinicals are set too high.