Colleges spitting out new nurse without any training?

shoegalRN, RN · Oct 28, 2009

I think half of my class would kill for that kind of experience. The very few extern positions I have been able to find in our community are not only unpaid, but open only to people that already work at that hospital/facility.
I don't know very many people that can afford to take an unpaid externship when they graduate and have student loan payments due.
Even CNA/STNA/PCT jobs are becoming really hard to come by here and all they are allowed to do is beds, bath's, bathroom, and call lights.

Even though I was a nurse intern, I got PAID tech pay. I was PRN/as needed and the job worked around my school schedule.

fulzgold · Oct 29, 2009

What is a DSD?

Dry sterile dressing! Bandaid!

foreverLaur · Nov 23, 2009

The nursing school I'm going to go (hopefully) to has you learn a lot of stuff in lab. You have 3 tries to pass the skill and if you can't, you are out of the program. Then you are able to do the skill in clinicals and each skill has to be done, seen, and documented so many times by your clinical instructor.

The school also has a human patient simulation lab that we go to 1 day a week.

I also work as a nurse aide at a hospital and it has helped me out SO much. I'm already familiar with the hospital environment, I've seen the job that nurses do day in and day out, I know how to insert/remove foleys, do dry wound dressing changes, vitals, accu checks, etc. Luckily I work on a post-op floor for the most part, so the vast majority of my patients are UAL which makes my job much easier!

All my patients I research. I look up their history, see why they are hear, and see what medications they are on. I look up the medications I'm not familiar with and try to figure out why they are on that particular medication.

Prior to last week, I didn't realize the substantial relationship between the kidneys and blood pressure. I had a patient with a kidney mass on a calcium channel blocker. I did a lot of research and learned a lot!

I also let the student nurses secretly practice starting IVs on me a lot so I've learned a lot of the tips and tricks so hopefully that will help when the daunting task of learning IVs starts.

Hopefully it will pay off in nursing school!

On a side note, the nursing students that come through my hospital don't have to come in on their own time and get patient hx, etc. The instructor finds the patients for the students, and provides the information for the students to learn beforehand. Then they get report from the RN upon arrival and do patient care all day.

want2banurse35 · Nov 24, 2009

I know when I went through LPN school clinicals were a joke. The nurses on the units we went to really were not very receptive to us. It was a good day if we got to pass some PO meds. Other than that, it was CNA work all day. It didn't help matters that the hospital where we did clinicals wouldn't hire LPNs. As far as this particular nurse not knowing the steps of a BS check or insulin injection...In my LPN clinicals, we weren't allowed to check blood sugars as it was a "lab value"(the CNAs who worked there could do it, but we, as nursing students weren't allowed ), and our instructor specifically told us, if we didn't check the blood sugar ourselves, we couldn't give insulin. Absolutely ridiculous. I definitely not making excuses for this person, however, b/c these things could've been learned in the lab.[/quote']
I have had several friends of mine from different RN nursing programs say that nurses werent receptive as well. A few off them even said that the nurses barely let them do anything but CNA work. Some said the nurses were flat out rude to them. I think people need to try to work together because they were new nurses at one time. I know they are busy but if you have the help why not utilize it.

Up2nogood RN, RN · Nov 24, 2009

I also work as a nurse aide at a hospital and it has helped me out SO much. I'm already familiar with the hospital environment, I've seen the job that nurses do day in and day out, I know how to insert/remove foleys, do dry wound dressing changes, vitals, accu checks, etc. Luckily I work on a post-op floor for the most part, so the vast majority of my patients are UAL which makes my job much easier!

Aides can insert foleys?

foreverLaur · Nov 24, 2009

Yes, if we have the proper training.

Katie5 · Nov 24, 2009

Dry sterile dressing! Bandaid!

In my opinion, maybe I'm wrong.But the way you responded, with the exclamation point suggests you're being sarcastic. But if I'm correct,(which I hope I am), it's because of attitudes like this, that make some new nurses hesitate to ask questions.

My patients come first so I'll still ask questions. So whomever gives me sarcasm can shove it up where the sun doesn't shine!

dannyc12 · Nov 24, 2009

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?

Great points. I've got some classmates who never worked in healthcare and plan to never work in healthcare until they graduate. They have a lot of trouble at clinicals. In the limited time we have at clinical sites, it is probably very difficult to become proficient enough at any new skill to be able to practice it on the job right away. Our teachers assign so much clinical paperwork that we spend a good chunk of our time writing as opposed to treating.

I've met some very good nurses who retrained after layoffs in one or two-year programs. I would wager their first employer and first co-workers had to have a lot of patience.

I had a very nice moment recently when I was assisting a resident at breakfast and a family member (who is an RN) of another resident saw my student ID and asked me, "Where are you going to school?" I told her and she said, "Great! I really notice when I orient people from there they are trained well! Better than students from the four year programs. That made me feel a little better. Hope my untrained schoolmates get good fast!

canigraduate · Nov 24, 2009

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

Ouch!

eyknough · Nov 24, 2009

I hear ya. I remember check-offs for nursing procedures, and they were tough to pass. It's amazingly easy to break sterile technique!

But anyway, I just wanted to mention something that one of my clinical instructors told our group on more than one occasion. She said that we nurses are not paid for our technical skills, we are paid to use our brains. So following that logic, if someone's having trouble with inserting an NG tube or foley, there's always someone else who can help out and get 'er done.

I think she was noticing how much we were focusing on procedures, and being able to 'do' nursing things, which was taking a lot of time away from learning the enormous amount of information we need to know to be a nurse.

But of course I also notice the eye-rolling when ever we students try to dive in to our knowledge of medicine and physiology while at clinical. After all, don't the blood sugars need to be checked, oh and mrs. jones needs to be in the shower, too.

Just remember, while we are students it's a different game. We spend so much time writing every lab value down and trying to gain insight as to the best way to care for a certain patient. After all, we students will be writing numerous care plans and drawing up tons of concept maps. So we're there for a little different purpose than to do the crap work so the staff nurses don't have to deal with it.

We're learning.

Also, we've been lead to expect a certain amount of orientation and training at each specific site. Perhaps we're just burnt out from more than 2 years of full-on mind-steaming theory work. But if we made it through nursing school (at least in Michigan), then we're probably worthy of your time and effort. We ain't no dummies.

lol

CNA's can insert foleys? The way we're taught in Michigan is that a task can not be delegated to a UAP if it in invasive. Although we can delegate other nursing takss based on inservicing and trusting that the UAP can do it adequately. After all, if we delegate a nursing task, and the UAP botches it and gives the patient a mean UTI, it's not going to be the UAP who gets in trouble..... Because inserting a foley in a hospital or institutional setting is a nursing task.

nursemike, ASN, RN · Nov 24, 2009

When I was in school, I hated careplans. Mostly because I was bad at them. But the one thing my instructors did give me credit for was that I always really tried to individualize them to the actual patient. I ended up barely passing them, but I have to admit I did learn a good deal from the #$%^&&**) things.

Lately, my facility has been putting a lot of emphasis on a daily plan of care. (Sounds suspiciously like a careplan, to me...) We are supposed to document a daily plan of care, then evaluate whether it was met, and if not, why. The plan is to be initiated on dayshift, or on admission, then evaluated on nightshift. So, yay, I only have to do one if I admit someone.

So, many nights, when the time comes to evaluate whether goals were met, the plan of care is one word: safety. Sometimes: "safety, pain mgt." Pretty easy to evaluate. Thing is, the nurses who are doing this are usually strong, smart, experienced nurses who provide excellent care. It's just that they are so busy providing excellent care that they don't have a lot of time to chart careplans. But I'm following these nurses and know they're doing stuff that would make my clinical instructors weep tears of joy. And when I do an admission plan of care, what I chart isn't much better. I may suggest that we not put a post-op crani in a double with a GI bleed, but I rarely chart anything about risk of infection.

What does this have to do with the OP? School and real life are two different worlds. As noted, school is very much oriented to NCLEX, and to some extent, it must be. If you don't pass NCLEX, it doesn't matter how good you are at IVs.

I went to a very well-reputed ASN program. Did I hit the floor a competent nurse? No way. Did I learn anything? 4.5 years later, I'm still occassionally amazed when I need to know something and something I learned in school pops into my brain. Other times, I may need to confer with a coworker. Now and then, a more experienced coworker asks my advice, and sometimes I even know what to tell them. After a lot of struggling, I'm a decent, reasonably competent nurse. I credit my school for giving me a foundation to build on, but at least as much credit is due the more experienced nurses I've worked with who taught me how to actually do this stuff. They could have been--and probably were--amazed at how much I didn't know, but any doubts I had as to whether I could do this job came from me. Frankly, my biggest criticism of my mentors is that "You're doing fine," is nice to here, but doesn't help me learn a lot. Telling me what I'm doing wrong is less fun to hear, but a lot more instructive. Now that I'm in a position to do some mentoring, myself, I try to remember that. And while I do feel the OP's pain, it is what it is. You can rant all you want about how unprepared new nurses are, but the question remains, what are you doing about it? You can watch nurse after nurse fail to cut it, or you can do what my mentors did: teach, encourage, repeat as needed.

foreverLaur · Nov 24, 2009

CNA's can insert foleys? The way we're taught in Michigan is that a task can not be delegated to a UAP if it in invasive. Although we can delegate other nursing takss based on inservicing and trusting that the UAP can do it adequately. After all, if we delegate a nursing task, and the UAP botches it and gives the patient a mean UTI, it's not going to be the UAP who gets in trouble..... Because inserting a foley in a hospital or institutional setting is a nursing task.

My official job title is "multi-skilled tech." My hospital doesn't really have nurse aids much anymore. We do foleys, dry wound dressing changes, blood draws, ekgs, and typical nurse aide duties. We have to have been trained officially in a school setting to perform all the tasks and have proof prior to being hired for the job.