what are your clinicals like senior year?

[MidnyteRaine]

Hi everyone, I don't post much, but I desperately needed a break from school work. My eyes feel like they're going to dry up and fall out of my head from all the reading, I'm sure some of you can relate! I'm in my senior year now, very very happy about that, but I'm a bit disapointed with my college's program for senior year, especially with clinicals. I wondered how yours' compared with mine.

This semester I have clinicals for 2 courses, Peds and Med/Surg III. There are a total of 11 clinical days for Med/Surg, 6 of them are observational experiences (PACU, OR, ER, Cardiac Cath Lab, Express Admissions Unit, etc) where we can do procedures we were checked off on, but can't give any meds. The other 5 days are on the floor. Since we're using new hospitals, the first day in each hospital we only get 1 patient. Then we advance to 2 patients, but we don't give meds everyday. There are about 6 ppl in the clinical group, and only half give meds on any given day. We already worked our way up to 2 pt.'s last semester, and will continue to take only 2 this semester, doing both the aide and nurse's job. It just doesn't seem like we'll be getting much experience, especially with meds (we're just starting to give IV meds this semester too and giving meds 6 times over a month and a half isn't enough to get comfortable doing so).

Clinicals for Peds is similar, one to two patients, when we have 1 pt. we always give meds, but we don't always give meds when we have 2 patients. Here we have about 6 real days on the floor and 5 observational experiences (PICU, NICU, Perinatal Unit, manning the phones for Project Child hotline, etc).

My class will be graduating in one year and it's scary to think in January, with one semester to go, we'll have only got up to 2 patients at a time. It seems a bit ridiculous. I love my instructors, but I'm beginning to dislike my BSN program and respect the diploma programs that are out there. Sure, I'll know about Leadership issues, historical figures in nursing history, but the diploma grads will be more comfortable on the floor! We have the highest NCLEX pass rate in a BSN program in the area, but I'd gladly switch that in exchange for feeling competent when I graduate! I'll stop before I switch into ranting mode :) Is anyone else's program like this or is my program suckier than I realized? Geez, this turned out to be a small book, sorry about that! Hope everyone's first weeks are going well!

Ashley

[Altra, BSN, RN]

Hello MidnyteRaine, I do have some thoughts about your question, but I'd probably end up writing a novel ... gotta go get dinner, then I'll be back.

Welcome to allnurses.com! :)

[Altra, BSN, RN]

Hello from the other side of PA

I think the first thing to remember is that we're probably not going to feel competent when we graduate. After reading these boards for about a year now, and talking with other nurses and new grads from my program, I have yet to read/hear anyone say that they graduated and really felt competent right away. I've accepted the fact that it may be a year before I go to work without a knot in my stomach. I've also had the opportunity to observe some of a new grad's orientation when I was assigned to a certain unit where she was orienting, and that has made me acutely aware of how important it will be for me to ask careful questions about orientation when I'm doing my first job search, which I'll begin doing in about 5 months.

Is it possible to ask your instructors if you can beef up your pt. assignments? If you successfully manage 2 pts. one week, can you ask to possibly be assigned 3 for the following week? This is just my personal experience, but I found that going from 2 to 3 patients made things much more real. Also, do you know anyone who is a recent graduate from your school, who you could talk to about how they made the transition from student to GN to RN?

As far as how clinicals work at my school, this is how it goes: during our 3rd semester we have med-surg for a full 15 weeks - comparable to med-surg I & II at many schools. Each of those weeks except the last one we have 2 clinical days (full 8-hr. days), for a total of 28. Four of those days are observational - 2 days with a home health nurse, 1 day in ortho rehab, and 1 day in the OR. The 2nd day in the OR we scrubbed in for cases if we wished to. Two other days were spent in outpatient surgery - not really just observational since we did do pt. care, but not with a typical pt. assignment either. For the remaining 14 days we rotated through 3-5 different units, including telemetry. We gave all meds including IV meds except those being given through a PICC line. We had 2 pts. most days, sometimes 3, and just 1 pt. for one day during the week we were to do our complete health assessment assignment.

Our final year is 8 weeks of each of 4 specialties: peds, L&D, psych/MH, and critical care. Two clinical days each week. We are assigned only 1 pt. at a time in psych & critical care, 2 in peds, and 1 mom/1 baby in L&D. The final 6 weeks of our program is doing our preceptorship and taking the nursing leadership/trends course. We're paired with our preceptor and work their schedule - whatever it might be - 36 or 40 hours/week with their full pt. load of 4-6. The first 2 weeks we're joined at the hip with our preceptor, but over the last month we're to assume responsibility for everything, with guidance. This is clearly the time to "put it all together."

During med-surg, when I thought I would rather get hit by a truck than write one more **** med card, I started to daydream of the day when I'd be an RN, and not have my patient care responsibilities accompanied by countless pages of written assignments that keep me up until 2am. I wouldn't have to go get my instructor for everything. I'd have keys - oooh, the power! (ha ha!) But I think I'm going to miss the safety net of having instructors to go to.

BTW, if you haven't browsed there yet, there is a great thread in the graduate nurse forum. I forget the exact title of the thread, but it's Tales of a New RN. Great reading.

Good luck to you! Hope some of this has helped. We'll get through this ... :)

[manna, BSN, RN]

Did you have the chance to do an externship?

I'm just a junior, but in my BSN our senior level rotations are Advanced Med Surg, ICU, Community, Psych and a preceptorship of our choice.

[dianacs]

We have had community and now senior practicum.

[MidnyteRaine]

MLOS, you suggested something so simple that I had to laugh that I didn't think of it first --> asking the professor if I could take a 3rd patient. I'll do that if it seems like there's time...I think we only take 2 because it's too crazy for the professor to supervise meds and treatments if we'd take more than two pts. I'll have to see if it seems like the professor would have time and be willing to let me have another pt.

Manna, yeah, I did have an externship in med/surg over the summer, it was an excellent experience and I loved it, I even signed on to work there after graduation. During the externship I was up to 3 patients...granted I felt a little disorganized and flustered sometimes, but I know I can definantly do it. So going to 2 patients seems like a step backwards : )

Thanks to everyone who answered....I just can't wait until nursing school is over with, lol. Of course I know that during the first few months of working I'll be wanting to retreat back into the safety of nursing school :chuckle Good luck everyone with school this year!