Colleges spitting out new nurse without any training?

[fulzgold]

Has anyone else noticed the new nurses aren't getting much training? Has anyone else oriented a new nurse, very recently, and wondered how in the world they passed their state boards? The healthcare facility I work at has had numerous "baby nurses" come on board recently. Not one of them could cut the job. If they didn't quit on their own, they ended up getting terminated.I was trying to orient a new one a week ago. It became clear very quickly she knew absolutley nothing. I had to take her through all the steps of blood sugar checks, insulin injections, she didn't know how to apply a DSD. It was like I was her clinical instructor. She went to a reputable college for her LPN, so i just don't get it. I asked her what she did in clinicals and she said "Well, all we really did was CNA stuff". She said she had worked in a factory and got laid off and the unemployment office hooked her up with some retraining. WT?

[jjjoy, LPN]

One last comment here...

My classmates and I expressed concern over our lack of confidence in our clinical abilities (in a program at a reputable uni). Our instructors assured us again and again that no one cared if we as new grads had never started an IV or only had placed one foley in two years and that we'd "quickly learn on the job" all else that we'd need to successful.

Well, that seems to be true enough... either you "quickly learn on the job"... or you don't. Then you quit or are let go.

[Oz2]

My clinical skills are definitely lacking, but I can give one h*** of a PowerPoint presentation!

My nursing education was definitely NOT what I was expecting when I forked out that $30,000.

[tokidoki7, ASN, RN]

I'm all for it, too. Unfortunately, there often aren't many internship available out there so only a few people can take advantage of them. Some also may promise a lot of learning but end up being mostly bed baths and enemas. Some NA jobs also are quite limited in activities and the workload too heavy to allow the student to learn much beyond their job. I agree that it's usually better than no experience but it may only go far in helping a new grad be prepared to work as a licensed nurse.

I agree. I'm a nursing assistant on a large med/surg floor. Seems like the perfect place to learn, but so many of the nursing assistants have quit. I can get up to 15 patients with half them bed-ridden. There are good days and then there are bad days.

I'm in my first semester of nursing school and clinical is just whatever. It really depends on the nurse I'm working with. Some nurses like to teach and give me an opportunity to learn a skill hands on. Other nurses are too "busy" and just think I'm a fill-in nursing assistant. They don't want to be bothered with teaching or explaining.

[**All Heart RN**]

1) Passing the NCLEX has very little to do with one's clinical abilities.

2) Many schools focus primarily on students NCLEX pass rate and meeting the criteria to be legitimate schools. Meeting that criteria does not assure that students get a strong clinical foundation. There are liability issues, overworked nurses who don't want to deal with students, CI's who don't work to assure maximum opportunities, and more. Even if a student must thoroughly prepare the night before, most learning won't be available for quick recall and application until there's been a good deal of repeated experience working in real time. Plus, much of the night before prep work may include trying to create one's nursing care plan to fit whatever varying expectations each CI may have. For some, that may mean hours digging around for how to acceptably word the nursing diagnoses, interventions, and goals.

You absolutely nailed it! Your response was my entire experience in nursing school. We were required to go to the hospital, on our own time, the day before, compile a bunch of data re: our patients and then went home and spent about 6 hours trying to piece together care plans to fit each CI's preference.

In addition, I think clinical experiences are what each student/Clinical Instructor makes of it. It is the student's responsibility to "jump in" and be open to being an active learner/"doer" on the floor. It's also the clinical instructor's responsibility to provide various learning opportunities for students during clinical.

Out of all of my clinical experiences there was one CI who will always remain memorable to me...she went over and beyond any other instructor (i.e., drilled us on pathophys, drilled us on meds, and when she found a pt that had something interesting going on, she tried to pull as many students in the room as possible).

To the OP: In addition to what's been said above, I feel that what you're finding is also a result of Nursing becoming a fallback career for people who have been "victims" of this economy. It's almost like people from all backgrounds (cops, factory workers, lawyers, sanitation workers, mechanics) who have fallen on hard times have decided, "Hey, what the heck, I'll go to school for a little while and become a nurse!" And then, of course, there all of the schools/tech colleges who realize what's going on and they're cashing in on it.

[Music in My Heart]

Wow, you're all making me think more and more highly of my school (DEMSN/CNL, no less).

Done a bunch of IVs, a few Foleys, wound care, injections, blood sugars and insulin all the time, lots of enoxaparin, assessments galore, full patient care for 3 pts by the end, all meds, IV push, passed meds galore... pretty much everything. The only thing that we didn't do was blood.

[BmoreCRNP]

It all depends on the school you go to. When I was in nursing school, our clinicals sucked, both in the lab and in the facilities. One of the problems was the concern for liability. Patients had to sign a release allowing a student to do any procedures on them. Many patients refused to let us place foleys or put in IVs. They were just too scared that we would damage them. I think the only skills I got to do on a real patient while in school were give IM injections, change dressings, and remove staples. That's it! The first time I did a foley or inserted and IV was on the job. I personally believe that foreign trained nurses have somewhat of an edge. They may not have the same theory, but they do a lot more hands on skills in their training. For example, my Filipino co-workers told me that they were required to deliver a baby themselves, & assist with a surgical procedure among other things.

[SunnyAndrsn]

Well, this was more of my experience, during the last two years. LPN 2007, RN 2008.

back in the day when I was in school (1985) when we had clinicals we had to go to the hospital on our own time get full hx, meds and know them,dx have 3 care plans and be at report the morning of and while at clinical we did patient care not more school paperwork. Now I have never seen a student do that with in the last couple of years it like the politically correct has taken over and you cant make me do something on my time I may be wrong but thats what I see

[SunnyAndrsn]

Not all of us were able to attempt IVs, but this was what we did too...

Lots of hands on care...we were doing blood sugars, foleys, and insulin our first semester. I did a number of TB skin tests my first clinical as well.

Full head to toe, demonstrated for our instructor on a pt. each semester as well.

Some facilities would not allow students to do IV push meds, some did. I did sterile dressing changes, pulled drains, hung lots of IV meds. Like you, we couldn't do blood.

Wow, you're all making me think more and more highly of my school (DEMSN/CNL, no less).

Done a bunch of IVs, a few Foleys, wound care, injections, blood sugars and insulin all the time, lots of enoxaparin, assessments galore, full patient care for 3 pts by the end, all meds, IV push, passed meds galore... pretty much everything. The only thing that we didn't do was blood.

[cabanaboy]

back in the day when I was in school (1985) when we had clinicals we had to go to the hospital on our own time get full hx, meds and know them,dx have 3 care plans and be at report the morning of and while at clinical we did patient care not more school paperwork. Now I have never seen a student do that with in the last couple of years it like the politically correct has taken over and you cant make me do something on my time I may be wrong but thats what I see

Did they teach how to write coherent sentences back "in the day"?

[Lucky0220]

I find it quite interesting that a previous poster in this thread who stated that because of her wonderful education, she came to the floor and barely had to ask for help. In another thread just about a week ago, she was so stressed from getting her "butt kicked" every night and never getting any help, that she was about to "quit nursing"!

I don't think that we should judge a new nurse's performance on the floor by her/his clinical experiences in school. Students are not to blame if their school, clinical instructor, or the sites they went to, provided poor clinical experiences. I, too, did mostly CNA work during clinicals. My school focused on didactic and NCLEX prep.

Luckily, my practicum, at the end, where you work one on one with a nurse from the facility, provided me some opportunities to insert foleys and attempt IV insertions, as well as glucose checks. Nontheless, I was still totally unprepared for life on a med surg floor.

I am thankful for the patient preceptors and helpful co-workers I have.

[lindarn]

I just have one question- do other health care professionals (PT, OT, SP, Pharmacists), have the same problem? Programs that are only intersted in passing scores on licensing exams? Students graduating not knowing how to do anything?

I guess the reason is that these programs ALL REQUIRE a mandatory 6 month to one year PAID internship, to teach the technical skills. Cuts down on sticker shock after graduation. They also have a lot lower attrition rate after graduation. Food for thought. And they ALL have a higher level of entry into practice. JMHO and my NY $0.02.

Lindarn, RN, BSN, CCRN

Spokane, Washington

[CuriousMe]

back in the day when I was in school (1985) when we had clinicals we had to go to the hospital on our own time get full hx, meds and know them,dx have 3 care plans and be at report the morning of and while at clinical we did patient care not more school paperwork. Now I have never seen a student do that with in the last couple of years it like the politically correct has taken over and you cant make me do something on my time I may be wrong but thats what I see

That's what we do now. Need to go in the afternoon before to get PT info from chart.... & need to have all the info incl. 3 nursing dx, (highlighting the priority Dx), interventions for each Dx, all their Hx, all their Lab values, patho explanations for any values outside normal limits and med info (including standard dosage, MOA, whether the prescribed dose is within limits, contraindications, life threatening AE's as well as common SE's, and any IV info like dilution, other meds it can't be given with, etc).

If you don't have all of the above in the AM, then you're sent home.

It's a 3 year BSN program, with clinicals starting from week 2 of the program. By the 3rd term of our first year, we were able to start IV's, insert foley's, hang IV's, give meds, IM, subQ, IV push, and obviously PO. The only thing we can't do until next term is hang blood.

As far as spending our time in clincal's strictly as CNA's, we're told to be very clear with our RN and CNA for the day what care we will and won't be performing....so, it's not up to the RN or CNA, it's up to us. (other than days with special projects, it's usually total care of our patients....not CNA for the floor).

Now, since I'm only in my second year, I can't speak to how prepared I'll be once I'm a new graduate....but I do know that if I'm not prepared, it will be my fault and not my program's.