Are we sacrificing hands on patient care for academics?

Ayvah, RN · Oct 30, 2010

I did not get much out of my clinicals. They were mainly in 4 hour chunks, which we had 2 patients and spent the time doing the med pass, vitals, baths, call lights, and careplans. While I learned about med passes, it would have been much more helpful to have full-day clinicals where we would get more of the 'whole picture' experience and have an opportunity to participate in solving problems/exercise critical thinking. I learned far more in my full-shift nurse externship than I did in my clinicals. Skills like IVs are not that big of a deal, because that comes in time but problem solving experience is a critical component that was missing in my school.

snazzy-jazzy, BSN, RN · Oct 30, 2010

I don't think any amount of clinical hours will prepare me for real life nursing when I graduate, because being a student on the floor is different to being totally responsible and on your own. Your program does seem really low in hours though, I have 16 hours a week, then in my final year I do a total of 800 hours with preceptors on the wards. I can understand why you are concerned, though as others have said these clinical skills you will manage to pick up in real life nursing.

Orange Tree · Oct 30, 2010

Opening up a medication and handing it to a patient is the easy part....it's knowing everything behind it, in front of it, and all around it that's more difficult and important. Don't worry about the "brick-laying" part of the job too much....you'll learn tasks very quickly when you hit the floor.

CuriousMe · Oct 30, 2010

I agree that it sounds like an issue for your program (and the other's in your area from your response).

I'll have between 1,300 and 1,400 clinical hours before I graduate from my BS program. We were administering meds with our instructor during the first year, in the second and third year, we can give all meds except IVP and narcotics without an instructor or our RN (this is a three year program). By the second year, we're taking at least two patients by ourselves and we spend the last 6 months of our program working one-on-one with an RN 25 - 30 hours a week.

mb1949 · Oct 30, 2010

We had 10 hours of clinicals a week, plus simulation lab, and 2 med passes a semester, 4 if you needed additional practice, not enough in my view, I did a two year AAS-RN program. I wish I had gone to an ADN program, my friend attended one, gave meds every clinical day, did foleys, IV etc. I changed dressing on CVL once, although we did tons of trach care and tube feedings, etc. I still would have liked more practical experienced, but like the OP my class all passed NCLEX on first try, my program is very rough in the book learning department, I know a lot, but am concerned about clinical practice

RevolutioN2013 · Oct 30, 2010

I know a lot of people knock diploma programs, but my best friend is an FNP and came through one. We both had BS in other fields. Anyhoo, I will have 8 hours of clinical per week in semesters 1 and 2 and 16 hours clinical per week in semesters 3 -5. I am told that when you come out of this program you are truly ready to hit the floor and be an RN and I feel this is important for me. I would not have the confidence to even attempt the job without that sort of experience beforehand. I apply in December!

SummitRN, BSN, RN · Oct 30, 2010

that sounds like a program problem. I did over 700 hours of 1 on 1 with a nurse preceptor. By the end i took on a full pt load. I think some programs are better than others but i definately felt prepared. I would given your feedback to your program.

Do you mean that you have a clinical faculty member 1 on 1 for 700 hours or that you rotate to a facility and are paired up with any given staff nurse for 700 hours? Either way, that sounds like a great way to do it!

My BSN program sends people with 1:4 and 1:6 for faculty:student and then pairs us off with staff nurses for the first ~700 hours while the faculty float from student to student, but the last 120 hours are 1:1 with clinical faculty.

I think the issue is deeper than just hours. If schools are not respected enough to go to a good facility or have staff nurses trust them to participate much in care, then clinicals are just observation sessions or simply mundane. 17 hours into my clinical life, I ran into a student from a nearby for-profit BSN program in her senior practicum. She was ecstatic because this was her "only clinical that isn't in a nursing home."

shoegalRN, RN · Oct 30, 2010

Nursing school teaches you how to pass NCLEX on the first try. End of story.

They figure you will eventually learn to be a nurse, once you actually start working as a nurse.

This is why so many students have a very hard time transitioning from nursing school to the real world of nursing.

And to top if off, most of the nursing instructors havent been at the bedside since Florence Nightengale, so they tend to paint nursing with rainbows and unicorns. Students come out of nursing school not at all prepared how to deal with conflict, patients, family members, doctors, and other nurses.

This is why I believe most new grads leave the bedside after the first year of nursing.

Something is wrong with the system!

chinacatSN · Oct 30, 2010

That's...odd. I'm only my first year, first semester of NS and we're in clinicals for 2 days a week, 6 hrs each time. It's only been the first week of clinicals and everyone has passed meds so far. I've also been able to remove an NG tube and I went to dialysis with my patient and learned all about the process, the machines, and listened to a fistula in a patient's leg - and it was only the 2nd day! If you haven't even passed meds yet - which is something you will probably have to do every day as a nurse - I would say that your program isn't top notch. The NCLEX pass rate is all good and wonderful, but that doesn't mean diddly when you have to go out into the world and work as a nurse. If you get a med error because you've never actually passed meds, your patient isn't going to care that you were a 4.0 student and passed NCLEX with flying colors.

If I were you, I would set up a time to have a one-on-one conversation with your instructor and explain to her what you are feeling. Tell her that you NEED to pass meds. If she won't help you out, go over her head. It's your life and your license that may be on the line in the future.

llg, PhD, RN · Oct 30, 2010

Nursing school teaches you how to pass NCLEX on the first try. End of story.

What you describe is a bad nursing school. There are GOOD nursing schools. But unfortunately, most students don't pick their school based on the quality of the school. They pick the school that is the most convenient and/or cheapest for them.

If you want to go to a GOOD school ... you need to consider the quality of the education they provide as more important than the convenience and expense when you pick your school.

(And it's not just about money. Sometimes, cheap schools are good and expensive ones are bad.)

Fiona59 · Oct 30, 2010

I'm not surprised. It seems as the academics increase the hands on time decrease.

I trained about a decade ago. Half my course was spent on the units. By the end of our surgical rotation we had to be able to care for a minimum of three patients by ourself under the supervision of the assigned nurse that worked on the unit. We did full shifts, days and evening.

To graduate we had to work a unit full time as unpaid staff undersupervision for four weeks.

Everyone in my class passed the national exam. We all knew that the shifts could suck, nobody had rose coloured glasses.

Now, the academic have increased at the PN college I attended. The new students feel that they should do less hands on and they are superior to the classes from pre-2005. They had a terrible surprise to find out the LPNs preceptoring them on my unit had four university degrees on top of their PN Certificate. Because pre-2002 there weren't advanced placement programmes for holders of "other" degrees in my area, there were 1200 applicants for every 100 seats in nursing school. People did what they had to do to earn a living.

To expect previous generations of nurses NOT to be able to critically think because they weren't educated to the BScN level is wrong. We all have to be able to think, look at the prospective outcomes, weigh the options.

Time has to be spent in the nursing trenches to learn the skills of our job. To expect working staff to hold the hand of a new grad and teach and mentor their basic skills is wrong. Orientation is meant to be used to learn how the facility operates and finesse any skills you (the new employee) feels unsure of. It's not a time to learn what should have been part of a basic education.

CuriousMe · Oct 30, 2010

To expect previous generations of nurses NOT to be able to critically think because they weren't educated to the BScN level is wrong. We all have to be able to think, look at the prospective outcomes, weigh the options.
Time has to be spent in the nursing trenches to learn the skills of our job. To expect working staff to hold the hand of a new grad and teach and mentor their basic skills is wrong. Orientation is meant to be used to learn how the facility operates and finesse any skills you (the new employee) feels unsure of. It's not a time to learn what should have been part of a basic education.

I wonder if you're replying to the right thread? No one expressed an expectation that "previous generations of nurses (are) NOT to be able to critically think because they weren't educated to the BScN level"