Clinicals, really not prep for real world?

[RNnewbie2014]

I am about to enter my third semester of nursing school in August, and I will be in OB/PEDS. I am so nervous about my final last semester because I really have not done "that" much in clinicals? I have maybe gave meds once!!! I have given one insulin shot, and one lovenox shot. I have taken out one central line, and attempted to insert one IV. I have not even really hung an IV bag!! I have yet to insert an NG tube either!! Mostly, I have done baths baths and more baths!! Not that I mind that, it's just really? I feel like I am going to be murdered when I get a job because I have hardly done any of my skills. Oh yeah forgot one, foley cath!! I am so scared.. Someone give me reassurance? I have tried to apply for summer jobs and have not had any luck and this is really the only time I can get a tech job. Encouragment? Word of advice anyone?

[caughtbuckinoff]

Deep breath here. What you (and many other students) call "skills" are not skills, they're tasks. We teach those to lay people every day-- how to access their own IV ports, how to run their own peritoneal dialyses, how to suction their kids on home vents; your average junkies are better at phlebotomy than ER nurses ... does that make them nurses? No, it does not.

The reason students focus on those is mostly, in my opinion, because there is that checklist in learning lab you have to get completed. Sure, you probably did them in school. Don't believe the people who tell you they did all those "skills" on patients in school when we went to school with Florence. I promise you that no nursing unit on which you will work will expect you do be proficient at IVs or venipuncture, complex dressing changes, various tubes and wires, sinking Salem sumps, and a host of other stuff; they expect to teach you. And I promise you that one day of hanging IV antibiotic piggybacks will teach you pretty much all you need to know about spiking IV bags.

Believe me, a year after you have been at work you're not going to find any of this stuff that exciting in the least. :)

And I know you won't believe me when I say this, but these tasks are far and away not even the most important things to get out of your nursing education. What you need to learn, and I'll bet you have if you think about it, is how to think through a problem, how to say, "I don't know but I'll find out," how to look things up, how to ask questions like, "Why did you make that decision? How did you prioritize that?" and how to begin to empathize with the pickle your patients have found themselves in being in hospital rooms instead of their own homes so you can really listen to them. All new grads learn tasks eventually, but alas not all of then learn these, the most important things. Nobody expects you to be expert at them either, but they have a right to expect you to be a competent beginner at them, and I'll bet you are.

Look around you. Look around here, even :: peering through the screen back at me :: ::. Every single RN who graduated from any kind of basic nursing program has much more to learn than s/he can even imagine. Really. We all did. We all do. I've been out of my basic program for mumblemumble years and I learn new things every week still. If you have learned to keep learning, then you will be fine. Honest.

Love this. You always have something intelligent and rational to say. Thanks for helping to get all of us noobs through it, grntea.

[Maladroit, BSN, RN]

Focus on the things you CAN practice like assessment, documenting (or how you would document), communicating with your patients, and helping other nurses. Just jump in there and seem interested, stand in the doorway and watch what other nurses do - for better or worse - you will learn a lot that way. Skills will be taught and picked up quickly and ever institution does them differently, so don't worry too much about that yet. Assess and develop those skills to know when something isn't right and what you'd do to fix it.

[s.marie333, ASN, RN]

I'm sorry you haven't had a lot of experience. My friend just graduated from a BSN program and said that she wasn't allowed to do anything but baths and changing linens. I think it's crazy how different some programs are compared to others. I am in an ASN program (about to start my 5th and final semester in August). I have done countless IV's, hung IV meds and fluids, have done a few foleys (male and female), and pass medications with my RN that I am assigned to at every clinical day. In each new semester, we had to pass medications with our instructor one time and do a head to toe assessment with them present, and after they checked us off, we were free to go with an RN. I do everything the RN does, and even document my assessments in the computer with her watching over me.

I am sure it is a scary feeling not feeling prepared in your skills for a future job, but the hospital staff know that you are a new nurse and you will get plenty of opportunity to do skills on the job. Critical thinking is more important than any skill, because that is what is going to tell you what you actually need to do with your patient. My instructor told us this: "You can teach anyone off the street to pass meds or do an IV, but the difference in being a nurse is being able to assess a situation and use critical thinking to come up with a solution."