Are Student Nurses Prepared for "Real Life?'

nerdtonurse?, BSN, RN · Jul 22, 2008

I'm an LPN, and I will tell you what I told my preceptor on the first day: "I feel like an overqualified CNA" -- until I actually worked the floor, and realized I wasn't even that qualified. I divide my education into two piles:

--learn to pass the boards; I have yet to do anything with dietary/nutrition other than order NPO or not, but I had a whole class on it.

--learn to be a good nurse. -- that's the patho book and the lab test manual I bought that my teachers said I didn't need. It's more important for me to know things like a positive d-dimer with someone who has a chronic inflammatory disease process is very different situation from a positive d-dimer with someone with SOB, chest pain, and a history of diminished mobility. Never on a test, but it's saved my backside on the job.

Nurseandwife · Jul 22, 2008

I start nursing school the end of Aug and this scares me. I am afraid I will not be prepared but more than that shouldn't the experianced nurses help you learn. My mom has been a nurse for 17 yrs and she has already told me that I have to work in a hospital for at least a year to learn what I didn't in school but she didn't tell me that the other nurses were going to be mean to me because I am new like satie up there! This scares me even more!

cherex74369 · Jul 22, 2008

15 years ago, I was not prepared for the "REAL" life, either. And ther's NO WAY one could ever be prepared for this profession as it is truly a "HANDS ON, JUST DIVE IN THERE!" job. BUT...... I was taught by my ADN program instructors certain basic, common sense skills.

These were things like,

**"If you don't know something.....FOR PETE's SAKE.....ASK SOMEBODY!!!"

**"NEVER assume anything(the old 'A-s-s out of u-and-me story')"

**"CYA all the way with your charting, because if it wasn't charted... It wasn't done!!!" (This one has saved my ass more than anything, because, unfortunatley, some physicians have a penchance (sp?) for "witch hunts" and would like nothing better than to have someone else's paycheck end, particularly if their OWN is on the line!)

**"REMEMBER....the patient doesn't want to be here any more than we do. Most folks don't want to be sickly and couped up in a hospital room"

The new students that I am having come through on rotations are seriously lacking in the basic social skills such as "Respect your elders and senior staff!!!" The "I-know-it-all-already" attitude makes my brain go into a BLOODY RAGE!!! :banghead:

I came out of my little ADN program SCARED S*%TLESS!!!! I had so many (what I felt were stupid) questions of my mentors that I thought they would all just love to kick my butt!! But as I got into nursing further, I realized there were NO stupid questions, just stupid people who chose NOT to ask the questions and blunder about on their own, causing more grief for themselves and certainly for the patient. I realized the seasoned nurses who were there at my workplace were a never-ending fountain of information and wealth of skills just waiting to be tapped into. All one had to do was ask them.

I sound like some old fogey "These young whippersanppers ain't got a clue, so damn disrespectful and smart-allecky", but that's the flow of the river I'm feeling nowadays, unfortunately.

How to change it? Who knows. Maybe it should've started with their parenting (MY fav saying is "They're 15 years past a good ass-whoopin'!), maybe society created this, maybe the fast-paced, cattle-through-a-chute health care system created it. But, if anything I could give as a pearl of wisdom to the new ones it would be this.......

Know yourself, your limitations, your knowledge base. Don't try to go beyond it on your own.SLOW DOWN!!! Patients will not die on you (well-l-l-... MOST of them!! Sorry...a little dark 'nursey' humor) if their 9o'clock meds are given right on the dot. Find someone with a little more experience the their name and ASK, ASK, ASK them to help you sort things out and problem-solve. We "old nurses" have that "Mothering/Teaching" instinct planted in us and would like nothing better than to share our love for what we do with all of you!:heartbeat:heartbeat:heartbeat

PEBBLES1 · Jul 22, 2008

don't be scared, although I did have a few bad clinical experiences, I did learn something believe it or not. I learned, if I am a nurse preceptor, I no how not to act. Also, their are some good nurses who will show you and let you do everything. good luck in nursing school

sallers · Jul 22, 2008

Hi everyone

I am an English student in my third year with one year to go. I agree that theory seems to be the main focus with little relevance to hands on practice and I donot study the biology course until I am in year 4. This has to some degree been a disadvantage as I struggle with the workings of the body. On the plus side I have alot of hands on experience with our mentors encouraging us to take charge of our patients while they oversee us. In England we have to take extended courses after we qualify for I'vs and the giving of controlled drugs etc. I have come across some students who have never had a hospital placement in 3 years and have been only in nursing homes so donot have the basic skills to bed bath patients!

LaneRN · Jul 23, 2008

I can not really answer this question being that I am just starting school. but we have a simulation lab that is located in the hospital We were informed that we would practice here and would see things that we might not otherwise get to see if we were just doing clinical rotation alone. But our clinicals start the first semester we are in school so I feel that the more hands on you do the more at ease I will feel. I am already a CMA, as well as a CNA, as a CMA we are allowed to draw up meds and give injections and what you have described is a very scary thought because even when I was in MA school a mistake like that even during drug thearpy class would have gotten my butt chewed out. But I think you are never fully prepared until you are on your own we are all still learning everyday and I guess some nurses that have been doing it for awhile will agree with me. But a mistake like that, really does need to be reported to the instructor that this nurse had. So that maybe this can be addressed in future classes. I know that as far as drug caculations at the beginning of our second semester we will have three chances to get drug caculations right on a test and if we do not we will not be able to go to clinicals and the possibility of being dismissed from the program itself. I am really looking forward to finishing school and becoming a nurse and I know that I will not be perfect and will still have lots to learn when I get out but again this is just plain crazy

FromNH2VAwherenext · Jul 23, 2008

I went to nursing school at a prestigious university; however, I think the way we were taught in clinicals is no way to learn... here's your 1 pt now go give him/her bed/bath/ADLs then draw up meds and don't forget to do some patient education (and document everything). It was OK for the 1st semester; however, I would think that by the last semester, we'd be taking care of a group of pts routinely... that wasn't the case.

I had about 6 clinical days where I actually felt like a nurse and my preceptor actually let me do my thing -- assessments; accepting transfers; hand-offs; calling residents; meds and I was STRESSED! She actually let me delegate to Nsg Assistants, too! We had a workbook for prioritization and delegation for our last semester; yet we weren't able to delegate to Nsg Assistants -- something's wrong!

I realize that critical thinking will get you way ahead in the world rather than learning skills... however, with the nurse/pt ratios climbing and pts with several co-morbidities, it's necessary to learn the fine art of nursing -- prioritization and delegation. :nurse:

I am somewhat terrified of working my first RN job -- start 8/11. I only have a 6 week orientation :bugeyes: . So, I beg of the more "seasoned" nurses who may be preceptors and charge nurses -- be easy on us, ok? Wellll, let me clarify -- have patience :chuckle! We'll get the IV and Foley insertions eventually. Please be willing to share your tidbits and pearls of wisdom with us about the ART of nursing -- I know the science. :redbeathe

solneeshka, BSN, RN · Jul 26, 2008

Well put, BRAVO!

It really is the truth that nursing school just prepares us to be trainees. It teaches us the lingo and the general principles, but what we're required to learn for school just doesn't jibe well with what you really need to know on the floor. That's how school always is, though. In my previous life in finance, it took months on the job before I really even figured out what it was that I was doing for a living (as in, what my role was in the big picture of the company). This is why GNs have orientation! I'm working with a preceptor right now on an externship and have learned more (and definitely done more) in one week that I have in my previous semesters of clinicals combined. The problem is that nursing schools are rated based on what percentage of students who sit for the boards pass; if they want to be highly rated, then they have no choice but to teach to the boards. The problem is the boards; if they reflected more information about more common nursing issues, rather than bringing in all kinds of questions from as broad a range as they seem to be able to think of, then nursing school and clinicals would be designed to reflect more real-world experiences.

As for the units of insulin issue, that's a newbie mistake that anyone could make. It may have been the first time she was drawing up insulin and got nervous. (You remember what it's like to be nervous about nursing care, right?) That's why the unlicensed students are required to have all their meds double-checked by their licensed instructor or nurse before administering them. It's precisely because mistakes like that happen (even by nurses) that all insulin has to be double-checked by another nurse, even if a nurse is adminstering it. The good news is that she will probably never make that mistake again!

As for our program, if the techs know there is a student on a patient that day, they don't even go in the room. We do all the ADLs plus all the nursing care, and we're up to four patients by the time we graduate, which in this area is more than even GNs take. The problem that I know we face is that we're so busy/worried during our shift about accumulating all the data we need to do our paperwork that it definitely interferes with the quality of our care. I only have to turn in a once-weekly summary of what I've done for this externship (minimal paperwork) and as a result, my clinical time has been tons more valuable both for me and for my patients because I'm actually doing things.

Cut the students some slack and be a nurse who will teach them instead of one who sighs at the sight of them! Take a few minutes to work with us and we can relieve you of hours of your work. Please all you nurses, pay attention to where students are in their program and don't expect more of them than is realistic. From our first day on the floor, first semester, we had nurses who didn't even assess their patients if we were assigned to them. That's just not safe! At that point, no one knows what they're doing! I would shake just taking a blood pressure! The more patient you are with us, the sooner we will gain confidence and the fewer stupid mistakes we will make.

pinkTLC · Jul 26, 2008

Jee! That's a nice question to ask and ponder about. I hope clinical instructors can give comments too. Haha! :chuckle

:thnkg:I think i myself is not very much prepared. Not that my school has the fault,it's just that i think no one can ever be prepared enough to be a staff nurse in a hospital without the experience perse. Every fresh grad who'll enter the REAL life would probably have the fear and thought of "am I prepared?" But hey, I may not be prepared enough to say the I won't be commiting nonsense stupid mistakes :yldhdbng:(hoping i won't kill a patient,,, just kidding!), I can be prepared enough as training goes by, as I gain new experiences... maybe at the end of a day I can proudly say to myself that I'll be ready when I'll be ready. Tomorrow's another day, how about giving it a chance. Who knows, you might be a great nurse...after all! :grad:

LaneRN · Jul 27, 2008

I totally agree with you just because we are in nursing school does not mean that we know everything already there are even nurses who have been on the job for years if they tell the truth that will say that they learn something new everyday. So be patient with us just remember you were a new nurse once upon a time and I can bet you that the nurses on the floor where you worked felt the exact same way that you feel about the nursing students as well as the new nurses. We all make mistakes and I know that this was a dangerous one but we should all double check our meds as well as have someone else check them so that costly mistakes to patients are not made I bet that there is not a nurse out there that has not made some type of mistake in their carrer some just may be worse than others and I will agree that I bet she will be more careful next time and I do agree that it was a very bad mistalke that could have harmed a patient but all of the expereinced nurses just need to have patience and help oiut those that are just starting instead of just leaving us to do it on our own until we are experienced enough I agree that when my friend started clinicals the nurses on the floor just left the student nurses to care of the patients they were assigned to without checking on them to make sure that they were okay. They were just starting out with less than two days in the program I think this is sort of careless on the nurses part who was responsible for the patients that the student nurse had and I asked where wwas the instructors thanks god I am not doing clinicals there are going to the school she went to. I jusst feel that everyone needs to work together and if a student nurse is not sure of something that they do need to ask the nurse for help or the instructor because we are just begining our carrers and will need the help of others and mistalkes like this can harm others as well as make others very nervous around you.

beachbum3 · Jul 27, 2008

15 years ago, I was not prepared for the "REAL" life, either. And ther's NO WAY one could ever be prepared for this profession as it is truly a "HANDS ON, JUST DIVE IN THERE!" job. BUT...... I was taught by my ADN program instructors certain basic, common sense skills.
These were things like,
**"If you don't know something.....FOR PETE's SAKE.....ASK SOMEBODY!!!"
**"NEVER assume anything(the old 'A-s-s out of u-and-me story')"
**"CYA all the way with your charting, because if it wasn't charted... It wasn't done!!!" (This one has saved my ass more than anything, because, unfortunatley, some physicians have a penchance (sp?) for "witch hunts" and would like nothing better than to have someone else's paycheck end, particularly if their OWN is on the line!)
**"REMEMBER....the patient doesn't want to be here any more than we do. Most folks don't want to be sickly and couped up in a hospital room"
The new students that I am having come through on rotations are seriously lacking in the basic social skills such as "Respect your elders and senior staff!!!" The "I-know-it-all-already" attitude makes my brain go into a BLOODY RAGE!!!
I came out of my little ADN program SCARED S*%TLESS!!!! I had so many (what I felt were stupid) questions of my mentors that I thought they would all just love to kick my butt!! But as I got into nursing further, I realized there were NO stupid questions, just stupid people who chose NOT to ask the questions and blunder about on their own, causing more grief for themselves and certainly for the patient. I realized the seasoned nurses who were there at my workplace were a never-ending fountain of information and wealth of skills just waiting to be tapped into. All one had to do was ask them.
I sound like some old fogey "These young whippersanppers ain't got a clue, so damn disrespectful and smart-allecky", but that's the flow of the river I'm feeling nowadays, unfortunately.
How to change it? Who knows. Maybe it should've started with their parenting (MY fav saying is "They're 15 years past a good ass-whoopin'!), maybe society created this, maybe the fast-paced, cattle-through-a-chute health care system created it. But, if anything I could give as a pearl of wisdom to the new ones it would be this.......
Know yourself, your limitations, your knowledge base. Don't try to go beyond it on your own.SLOW DOWN!!! Patients will not die on you (well-l-l-... MOST of them!! Sorry...a little dark 'nursey' humor) if their 9o'clock meds are given right on the dot. Find someone with a little more experience the their name and ASK, ASK, ASK them to help you sort things out and problem-solve. We "old nurses" have that "Mothering/Teaching" instinct planted in us and would like nothing better than to share our love for what we do with all of you!:heartbeat:heartbeat:heartbeat

Thank you!!! I start as a new grad on Monday and I am SCARED TO DEATH. I was starting to feel like there is something wrong with me for feeling this way and feeling like I don't know a thing! Glad to know my questions will be welcomed and that more experienced nurses won't look down on me for not knowing it all when I walk in the door. Thank you!!

Katie82, RN · Jul 27, 2008

Many of the student nurses I have encountered lately appear to be ill-prepared for the real world.What is going on? What are these students being taught and prepared for? Ex: Student drawing up 5 cc of insulin thinking it's 5 units. What are they doing????

I witnessed this same error once by an "experienced" nurse who had floated from psych to our floor. Drew up insulin to flush a lock. Luckily,I was sitting at the desk checking orders and he was working at a med cart nearby. But to answer your question, no, they are not prepared. Can't possibly get enough clinical experience. But then, neither are teachers, lawyers, pilots, and of course, doctors. Skill and competence come with experience, that's the "real world".