Are new grads prepared for the bedside?

Nurses General Nursing

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In doing some research, I've found very little in regards to how well prepared new grads are by their nursing programs for actual bedside care. Stereotype says that ADNs are better prepared than BSNs because of concentration on clinical vs theory. Of course, I'm sure it varies widely by program?

How are the new grads in your facility and area? Do they seem fairly well prepared, or do they take a lot of time and effort orienting? What are nursing programs missing?

I'm also doing a couple of surveys that take about 3 minutes to complete, just to gather data. (I'm not a nurse academic. I actually take care of sick people). One is for new nurses, and the other is for experienced nurses who are working with today's new grads.

Survey of new nurse graduates (1 year or less experience as an RN) (New nurses, less than one year)

Survey of experienced nurses (2+ years) on the preparedness of new nurse graduates. (Experienced nurses, over 2 years)

Specializes in Med-Surg, NICU.

I went to a BSN program and had a full semester of preceptorship in which I, under a registered nurse with a minimum of two years of experience, took care of a full patient load on a med-surg unit. I felt prepared, but still wasn't great with certain skills (foleys and IVs).

Some skills take time to learn and become proficient. I was able to pass the NCLEX with 75 questions on the first try and knew just enough not to harm someone ;)

2.5 years in, I'm still learning, but I am getting more comfortable.

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I graduated from a direct entry program, and we were doing skills right away in our clinical sites (for the BSN portion of the program). I agree that our senior preceptorship was the best way to learn, as we basically took an assignment every shift and were expected to be "the nurse" with those 1 or 2 patients that we had (of course with our preceptor). They also started bedside rounding at that time and we were expected to present the patient in rounds with the team from the first week on. However, my floor that I did my preceptorship on was very used to students and new grads. I was hired on that floor after graduation and the transition was great, we had 3 months of orientation. It wasn't in any way easy but the support was definitely there to help you succeed in that first crazy year.

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My program did not adequately prepare me for bedside nursing. I wasn't even taught how to chart medication administration on a MAR, although I distinctly remember a clinical instructor criticizing me for dropping something. More than once, precepting nurses at my clinical sites specifically mentioned that they were giving extra attention and going around the "rules" (not to allow the students to do certain things) because they knew that we were being inadequately educated. Now why would more than one practicing nurse find it necessary to bring that up? Because it was true? Yes.

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Specializes in ICU / Urgent Care.

Honestly I don't think anything can prepare someone for the soul-crushing realities of bedside nursing, you just have to experience it and be purged by the fire fueled strictly by obliterated hopes and dreams.

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Specializes in Med/Surg, ICU, ER, Peds ER-CPEN.

My biggest frustration is that I have had some hit the unit with the mentality that they are instantly better than someone because they have a BSN, most don't even realize their preceptors are primarily ADN nurses because we are the ones with the most experience on the unit. I also get frustrated when they start applying to NP programs before they even finish their orientation and learn how to BE a nurse.

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Terrified! Absolutely terrified my first night as an LPN in a LTC facility. Two months after passing the NCLEX-PN, and only 3 weeks of orientation, I, alone, was placed in charge of the 11-7 shift of a floor with about 45 permanent residents and short term rehab patients (the night supervisor only came out the office to do 6am med pass).

In the first 3 months I operated feeding pumps, cleaned and dressed their stomas, administered IV saline for hydration, administered IV antibiotics, cleaned and dressed stage 4 ulcers with tunneling, fought to keep airway open on resident with an allergic reaction presenting with a swollen tongue that nearly filled her mouth, given nitro tablets to residents clenching their chest, digitally remove feces from an impacted resident, clean catches with a straight catheter, insert Foley catheter, gather culture sample from a wound, administer TPN, while waiting for EMTs tend to an elderly woman with osteoporosis who fell and had fractured ribs, clean and monitor external fixator on tibia, assess the progress of wound care & pneumonia care & upper respiratory infection care & urinary tract infection care, intervene to raise oxygen saturation when below 90% (I know, I did kinda go on; a small pet peeve of mine - LPNs are real nurses; night shift has same situations as day; but, that's another post).

My clinicals were not in a hospital but convalescent and rehab facilities; and, yes, I felt adequately prepared for the bedside. The terrifying part was that I now was on my own and the sheer number of residents/patients under my charge (though I must say my night supervisor gladly answered any questions I asked and was a great support and guide).

I felt prepared because, as another poster shared, my clinicals (3 days per week, 6:30am - 12:30pm) had plenty of assessments - assessing those who had pneumonia, uti, uri, on antibiotics, cellulitis, renal failure, heart failure, respiratory failure. We looked at lab values from blood work to correlate them to diagnosis, medications, and treatments. There was time to do some Foley insertions, suture removal, glucose test, bladder scan, med pass, charting, and progress notes; but, the main focus was assessment.

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Specializes in psych.
My biggest frustration is that I have had some hit the unit with the mentality that they are instantly better than someone because they have a BSN, most don't even realize their preceptors are primarily ADN nurses because we are the ones with the most experience on the unit. I also get frustrated when they start applying to NP programs before they even finish their orientation and learn how to BE a nurse.

^^ This!! I'm a ADN nurse and I'm training the newer nurses now and they all they seem to care about is who has a BSN and who doesn't. They are also looking to jump ship ASAP to become NP's.

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correction/clarification:

the night supervisor only came out the office to do 6am med pass on wing 2 of the facility (while I did 6am med pass on wing 1 and rehab wing)

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Specializes in CVICU, MICU, Burn ICU.
Terrified! Absolutely terrified my first night as an LPN in a LTC facility. Two months after passing the NCLEX-PN, and only 3 weeks of orientation, I, alone, was placed in charge of the 11-7 shift of a floor with about 45 permanent residents and short term rehab patients (the night supervisor only came out the office to do 6am med pass).

In the first 3 months I operated feeding pumps, cleaned and dressed their stomas, administered IV saline for hydration, administered IV antibiotics, cleaned and dressed stage 4 ulcers with tunneling, fought to keep airway open on resident with an allergic reaction presenting with a swollen tongue that nearly filled her mouth, given nitro tablets to residents clenching their chest, digitally remove feces from an impacted resident, clean catches with a straight catheter, insert Foley catheter, gather culture sample from a wound, administer TPN, while waiting for EMTs tend to an elderly woman with osteoporosis who fell and had fractured ribs, clean and monitor external fixator on tibia, assess the progress of wound care & pneumonia care & upper respiratory infection care & urinary tract infection care, intervene to raise oxygen saturation when below 90% (I know, I did kinda go on; a small pet peeve of mine - LPNs are real nurses; night shift has same situations as day; but, that's another post).

My clinicals were not in a hospital but convalescent and rehab facilities; and, yes, I felt adequately prepared for the bedside. The terrifying part was that I now was on my own and the sheer number of residents/patients under my charge (though I must say my night supervisor gladly answered any questions I asked and was a great support and guide).

I felt prepared because, as another poster shared, my clinicals (3 days per week, 6:30am - 12:30pm) had plenty of assessments - assessing those who had pneumonia, uti, uri, on antibiotics, cellulitis, renal failure, heart failure, respiratory failure. We looked at lab values from blood work to correlate them to diagnosis, medications, and treatments. There was time to do some Foley insertions, suture removal, glucose test, bladder scan, med pass, charting, and progress notes; but, the main focus was assessment.

I enjoyed this post so much, I almost forgot what the topic was about! Just want to say... you are the bomb. I hope you are working towards your RN -- not because you are not already a "real nurse" but because it will open many more doors for someone like you (I almost get the feeling you LIKE what you do!;)) . The world needs nurses like you!

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By The time I have completed nursing school, I will have had over three years experience as a CNA. Would you say that that would improve my bedside nursing?

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Specializes in Medical-Surgical/Float Pool/Stepdown.
By The time I have completed nursing school, I will have had over three years experience as a CNA. Would you say that that would improve my bedside nursing?

Yes and no. You will not be as scared to provide basic care needs and interact with patients that many of your new nurse peers will be. Being a nurse is also words different than being a CNA and you won't understand until you're there in the thick of it. I personally also found that I had an even harder time developing time management skills because I was trying to do everything for all of my patients instead of delegating when I needed to whereas I found that my peers that did not have any CNA experience had less challenges with.

I also had awesome hands-on clinical experiences from the very beginning of nursing school because I went to a well regarded ADN community college that practically fed our new grades to the areas largest employer that is a Level I/Teaching/Magnet/etc hospital that let us do pretty much everything that was available to learn there. We had rotations with full patient loads on every floor with built in clinical times set aside for areas like ED/OR/Cath lab/CVICU/SICU...even following a lactation consultant, a Diabetes APN, and going to One Day Surgery for IV start experience.

Needless to say that I felt prepared to start as a new grad and to hold my head above water (however barely) with the sink or swim trauma floor I started on...drowning...getting resuscitated...repeat...until I got enough experience. I am thankful for the foundation I received in school but it's not really compareable to being on your own without a safety net.

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I graduated May 2016, struggled with the BRN and NCLEX for about a year before finally getting my license, and could not make it through my first job's orientation. Just resigned (bowed out gracefully to avoid being terminated), I felt totally unprepared for my first job, but OTOH my managers said they lose about 1/3 to 1/2 of their orientees and the floor is very hard. Came on here today to make a thread about it actually. Writing this post made me realize I need to word my OP carefully before I post it.

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