Are new nurses adequately prepared?

[RNGranny]

As a nurse, I see more and more new grads who have little clinical experience and who are overwhelmed, more than I was and that was a lot. Many have had no more than 1 or 2 patients during clinicals. Many have told me that their nursing programs included role playing, seminars, and such events as teaching kindergarteners how to wash their hands as manditory clinical days. Is this a trend? Shouldn't there be more practical experience and teaching of critical skills, especially since patients are more acute? Many of the new nurses have never suctioned or used any of the complicated equipment common on the clinical floor. Would appreciate feedback.

Also, I see experienced nurses who are less than helpful with new grads, taking the position that 'if I had to learn the hard way, so can you.' We all had to learn the hard way but we need to remember the acuity level of today's patients, the additional skills new grads must possess, and the increased stress levels. Have any of you observed any of the above?

[nursbee04]

I am a student nurse, and I do wish we had more time in a clinical setting. Anytime there is ANYTHING they will let me do in clinicals, I jump at the chance. I am so afraid that I will get out into "real nursing" and be clueless. A friend of my mom's (a nurse, of course) told me when I was accepted into nursing school: "Nursing school will teach you how a nurse should think and act, but nursing school does not teach you how to be a nurse. You learn that on your own." I am finding out how true this is.

PS - To all of you nurses that are understanding with student nurses, THANK YOU!! We know we're clueless and we can be annoying, but we are trying! To all of you that say learn it the hard way, THANK YOU TOO!! I realize that we need to think for ourselves as much as possible and not run to you before we assess things for ourselves. :)

[MishlB]

I think senior nurses forget they were once a new grad. We know we don't know it all, since most of it comes with practice and experience. Just give us a chance, and teach us what you can.

[MishlB]

Originally posted by Merry1

dddd dddddd I have survived 13 years of being a certifiable nursing assistant and I have seen/trained more new nurses that I care to think about! I am about to get paid for what I know when I graduate later this year:). Anyway, the nurses I see are book smart, can pass a paper test with no problem, but when they have to change thier first dressing or deal with someone going critical on them the newbies are at a loss without a clue in the world what to do for the most part( most forget the ABC's so fast it makes my head spin!!). I believe in more clinical experience and less book learning would do most newbies a world of good, being a CNA first should be a requirement and then we wouldn't have the newbies dropping out of nursing(after all the money on tuition and time in school) within 5 years of graduation. I spent 2 1/2 years on a step down unit and 1/2 med/surg and the experience I got there as a CNA can not even be touched by the clinical experiences I am supposed to be getting now. I worked with pts on nitro, lido drips, vents, head trauma, post-op.... anyone at high risk in other words. I had a group of nurses who were kind, paitent, and educators and what an education I got:)(even got paid for it!). That is how I learned to be a great nurse and how I teach others to be as good or better than I. To teach is to show love to one another.

Can I just say that even with experience as a CNA, being a nurse is very different. I think it's great that you have experience with patients of all kinds, but you are not ultimately responsible for them. In fact, you don't do for them what the nurses do. Don't be so quick to judge a new grad for their lack of knowledge. It takes time and practice. Everyone was new at one time, right?

[zacarias, ASN, RN]

Wow, what a thread!

I'm graduate in June from an ADN program here in WA. I totally feel unprepared for the real world of nursing. I have OB and public health next and only three more weeks of med/surg in the spring before I graduate.

I haven't done a lot of skills that I would have liked to have done. I try and let the nurses know that I'm willing to learn/do new things, but sometimes certain procedures never come up.

I have a new MA/nurse tech job that may afford me some opportunities to do some procedures, but a lot of the job isn't bedside, although I do my share.

I really want to be ready to enter the workforce come June, and so I'm doing all I can to get there.

I have also noticed that some nurses aren't so willing to help/show new people and this is annoying/distressing. Occasionally (unfortunately it can be a rarity), you can find a wonderful nurse who will teach you new things and understand that you're new at these things. I know they exist! I plan to be one of them when I have years of experience down the road!

Z

[2banurse]

Originally posted by zacarias

Wow, what a thread!

I have also noticed that some nurses aren't so willing to help/show new people and this is annoying/distressing. Occasionally (unfortunately it can be a rarity), you can find a wonderful nurse who will teach you new things and understand that you're new at these things. I know they exist! I plan to be one of them when I have years of experience down the road!

Z

B]I know they exist! I plan to be one of them![/b] - I think that all of us, both established nurses, student nurses and those that wish to be nurses should pledge to do just this.

Kris

[mspringer]

Our program requires us to be CNA's first. We also start clinicals during the 1st term at a LTC facility taking care of pts. We don't do the meds at this time, but we are doing the assessments and writing the care plans (including the meds, etc.) We move to acute care clinicals by the 2nd term and each term thereafter. We also have a post session lasting 3 weeks at the end of our first year. We have to take care of 4-5 pts./day during this session.

[mlolsonny]

In our nursing lab at school, we learned basic procedures and practiced them, but we haven't gotten to do many on real patients.

As a new PN grad (yesterday was my last final), I don't feel prepared to go out and do many of the skills we learned.

Our instructors told us that after we're hired somewhere, we must insist that someone observe any skill that we haven't done before on a person. That makes me feel like a real PITA for the nurses with whom I'll be working.

"Um, could you come and watch me insert this foley, I've only straight cathed a female, and never a foley and never on a male."

"Uh, I've never suctioned someone, could you drop everything to help me..."

"Excuse me, but I've never done a tube feeding (trach care, colostomy bag change, straight cath, the list goes on...), I'm going to need some help"

I've been very fortunate that I've done quite a bit with a mentor at work, like sterile dressings, wet-to-dry dressings, observed many procedures. But I don't feel prepared to be on my own.

BTW, we were offered two caths in clinicals for our group of seven students. I volunteered for one and one other girl volunteered for the other, but most of our grads haven't even inserted a cath (and many didn't want the opportunity to try "Ewww, that's nasty"-- I say "then why do you want to be a nurse?"

[fab4fan]

Originally posted by New CCU RN

As a new grad of a BSN program, I have to say I feel adequately prepared as a an RN. Granted I went straight for ICU so there was alot I needed to learn once I got there...and you know what ..we are all learning. That is just the way nursing and the medical field is.

My university focused on both theory and hands on experiences. However, they also felt that if you can learn how to be a quick, critical thinker even if you don;t know a skill, you will be better off. I truly believe this. Every hospital seems to have its own procedure/policy. It isn;t hard to learn how to insert a foley or an ng. It all comes with experience. However, nursing is more than skills. It is being able to critically think, to forsee patient outcomes.

This is how nursing school is changing. Personally, I'd rather be confident to question an order and know the rationale behind why the patient's care should be different than be the best at some skill. [/quote

All the spouting theory in the world will not help if you do not know how to act on your observations.

Case in point: I grad. with a diploma and started a job with new BSN grad. One day, she had to give insulin to a pt. She came to me and said, "I never did this, I don't know how." I just looked t her and said, "In 4 years you never gave one insulin injection???"

She said, "Well, I know the theory behind it...I just never did it."

Theoretical knowledge is essential, but if you can't act on it, it really doesn't amount to much. There needs to be a sensible balance of both.

If you are going to go so far as to question an order, then if the doc gives you new orders, you need to be able to carry them out.

Not meant to flame anyone, but like I said, it's all about balance. Teaching kindergartners how to wash their hands may be fun, but it's not reality for most nurses. Giv these poor students some more practical clinical, so they are not so overwhlemed when they get out.

And I agree...I am much more afraid of newbies who "know it all."

[MishlB]

Originally posted by mattsmom81

I'm an 'old' nurse and I believe the stories of mean old nurses are exaggerated...yeah sure there will be a few mean old nurses but there are some mean 'young' nurses as well, and mean docs, etc...

The point that today's staff nurses are overstressed is a valid one...a needy student or new grad may be perceived as one more responsibility in her day when she is already overtaxed. A little understanding here will take a student/new grad far.

Who would expect a new grad to 'know it all' as far as basic skills and theory...that would be a rididulous expectation. A willingness to learn and grow and a sense of personal responsibility in this area is what makes or breaks a new nurse, IME.

The student (and new grad) who always seems to look for the easy assignment with the least meds to look up and the least complexity will be 'slacker nurses'...the kind we all hate to work with.

Today's students would be wise to look at clinicals as their opportunity to 'get their hands dirty and get get their hands on every situation they can, IMHO, and see theory put into practice.

In my program (back in the dark ages) the STUDENT shared responsibility for hunting down and finding skills and situations in which to practice. My old diploma program made it clear IF we did not seek our own opportunities to learn, we would have to go 'on call' with the staff in off hours. Needless to say, we jumped in and found good experiences ourselves so we'd have our off time to ourselves.

Also I trained in a big teaching hospital where it was the norm to teach; everyone was in 'teaching mode'...see one, do one, teach one was the motto. This helped immensely...there were student docs and nurses of all levels and we were ALL learning...which reduced our panic...LOL!.

I don't believe seasoned staff nurses as a whole mind doing a little handholding with new grads...for awhile...but 'a little' and 'awhile' are the key words here.

Wish all thought like you!!!!! Good input....students must take responsibility at clinicals, (I am one), to make the best of the little time we have before being fully responsible!!!!!!!!!

[abrenrn]

I can teach patients and families to change a dressing, insert catheters, even hang IVs. I'm not teaching them to be nurses.

An interesting stat I heard in my (BS) program, but I don't know the source: clinically, ADN students are ahead of BS students at graduation; within a year, BS students are ahead.

Critical thinking. What should be done with the patient. What will help/ harm the patient. Most important aspects of nursing. "Skills" seem cool. They are mere details.

I've learned a lot of details, depended on the setting I was in. The details were somewhat difficult to learn when I was an inexperienced nurse. Now? Give me a couple of weeks. Anywhere.

Are we professionals or are we technicians. Techs know how to do something. Professionals know why.

[tazzyjo]

I have just finished my first year, which included a practical experience 3 times a week for six weeks. I went into the med/surg ward scared to death because my previous learning placement did not require anything more than playing babysitter to some psych patients. I found the nurses were most helpful on my floor, although some co-students had the opposite...nurses who did not want students anywhere near them. I learned more in those six weeks, and was working with up to 3 patients at one time. The supervision we had was minimal, but in a sink or swim atmosphere, you learn to ask questions and if a nurse isn't able to help out, you find the nearest LPN as they are a wonderful resource of information and technical skills.

My lab experiences have been limited in my opinion and fragmented...instructors who refused to acknowledge other instructors ways of doing things and figure it is best to show you as a large group rather than in smaller ones. I would have gladly given up one of the touchy-feely courses that we were forced to endure for more lab time.

I realized very quickly just how overwhelming it will be when I do graduate and I am expected to be responsible for even more patients. I plan on taking every advantage of those with experience and the will to teach so that I am more of an asset than a hinderance on my first job.

[RN2B2005]

When I was hospitalised post-partum, a student nurse (BSN, I think) was watching her preceptor prepare to insert my Foley. Since I'd already lost any modesty I might have once had, and since it already hurt like H--L down there, I asked the SN if she would like to practise on a 'worst-case scenario' (macerated, swollen, sutured post-baby) Foley patient. She ended up doing the insertion--and came back later in the day to thank me profusely. She'd never done an OB patient's Foley cath b/c hospital policy prohibited SN's from cathing conscious OB patients (unless the patient specifically allowed it).

So, I guess the moral 'o the story is, when you're on the pointy end of the needle, offer your arm (or meatus) to someone who could really use the practise.