Are new grads prepared for the bedside?

[Robert.CFRN]

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)

[Purple_roses]

I would imagine the length and thoroughness of actual job orientation makes a big difference in preparedness. At hospital A, a new grad on med surg may be promised a 10 week orientation and wind up taking 6 to 8 patients by week 2 because the hospital sucks, while hospital B may extend the promised 10 week orientation if it's needed and add patients onto the new nurse's load based on the nurse's individual readiness.

In order for nursing school to shoot us out with guns blazing, ready to go right off the bat, nursing school would need to take at least an extra year or two in my opinion.

[Purple_roses]

^^^ So much of this. When I was in school, it was common to hear, "well you'll get this experience in your first year of nursing." It was more theory and teaching to the NCLEX during instruction time ...

... and while I had 1450 hours of clinical time ...some hospitals had policies that didn't want students to do xyz, and our school also established policies in place. Students and their clinical instructors were often navigating through a clinical mine field of "can do's" versus "can do not's." So no, I didn't feel prepared.

I think an entire skill check off should be done with receiving negative feedback constructively ... it can be done on those skill days each semester lol ("great job with setting up that Alaris pump ..." "... Now, I noticed how ...").

This is it! Schools maintain accreditation based on NCLEX pass rates and not job performance. You nailed it.

[Ruby Vee, BSN]

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?

To the extent that you will already know the basics of how to talk to patients and families, how to position the patient, the most efficient/neat way to clean up poop, what to say when you don't know the answer to the patient's question (and it won't be "I'll ask the nurse"), beginning time management, etc. -- yes, it will help. It will put you ahead of the new grads who don't have CNA experience, for sure. As your preceptor, I'd trust you to do accurate I & Os, deliver meal trays and set them up for the patient, gather supplies for clean-ups, morning care, etc. and any other CNA tasks things. But you will not have a clear idea of the full scope of a nurse's responsibilities. Your time management will change because suddenly you will have all of these OTHER things to do that you didn't have and probably didn't even register as a CNA.

Nursing priorities and time management will be different. You'll have to learn assessment skills, how to ferret out the nuggets from a chart full of excess documentation (to please risk managers and "nurse leaders"), what to say when you call the doctor and when you need to call them -- and thousands of other things that nurses have to do. You'll have to learn to delegate and follow up appropriately. Which meds are compatible in an IV line and when (and why) to hold that insulin dose.

CNA experience helps, to be sure. I wish I had had some -- my first year of nursing was rough because I had to learn all of the CNA stuff at the same time I was learning the nurse stuff.

[Thanksforthedonuts, BSN, RN]

I had 650+ hours of clinical time as an ADN student. From what I have heard, 4 year BSN students do not have anywhere near that many hours. Need to ask some of the ABSN students. I know that ADN students seem to be, in general, better at time management. Have no idea why.

I think that is more program specific. I went through a traditional BSN program and had WELL over 1000 hours... well over. I stopped counting at 1000.

[Not_A_Hat_Person, RN]

I got an ADN in 2008. Clinical sites ran the gamut from a noted teaching hospital to a nursing home so bad we stopped going there, and they shut down not long after. If you weren't really aggressive about doing procedures, at a facility that allowed students to do procedures, you spent the entire shift doing vital signs, feeding, ambulating, and bathing. Students could only give meds with the clinical instructor present, so we gave meds once or twice per six-week rotation.

I would have loved to do a summer preceptorship, and I applied for a few (including one at the hospital where I was an ER volunteer), but I didn't get in. I was also unable to land a job as a Nurse Tech or CNA (nursing students are supposed to be able to challenge the CNA exam, but my advisor refused to tell me how).

I graduated feeling like a CNA who gave meds. When I finally found a job, in Assisted Living, I had a rough time for a while. I had been taught that asking questions about unfamiliar things was good, but once I got out into the real world, it was often met with "What do you mean you don't know how to do that?"

[sistasoul]

I was not prepared at all. In clinical rotations you had at most two patients and you did not have to deal with doctors, family members, PT, dietary, respiratory, MRI, cat scan, admissions, discharges, phone calls, etc. In no way are new grads prepared.