not enough clinical experience!!

Altered · Mar 8, 2009

I almost thought you were a friend I spoke to earlier tonight! Seems like us 2nd semester'ers all feel slightly overwhelmed at this point. I've been hearing more issues with instructors, to be honest, but I don't doubt I'll feel similarly at some point when I hit med-surg.

Last semester, I felt exactly as you are explaining. I think the change came through several means: 1) no pre-clinical paperwork for OB, 2) still needing to anticipate & prioritize patient care, 3) weekly journal assignment (have to pick 5 clinical outcome objectives w/ an example of how we met them AND have 3 goals for the following clinical)

At preconference, our instructor writes down our goals for the day. In post-conference, everyone discussed what we've learned (which is helpful since we have to include at least one example of critical thinking we used and one observed in another student).

If these things don't work for you, I always fall back on this: at AM report, after you tell your RN what you can and can't do, tell your RN specific learning experiences you'd like to observe. Tell other nurses as well, if you're permitted. And make a point of being able to verbalize the rational for Interventions r/t specific medical diagnoses.

Hang in there :specs:

ladymedik · Mar 9, 2009

Remember that at clinicals, they want you to do all A.M. care, plus meds and such. After clinicals, you won't be solely responsible for ALL the care. You will have techs or CNAs to delegate to so you can focus on meds or charting. Also, and I will probably make some enemies here, a 4 yr nursing program doesn't put much priority on actual day-to-day nursing. It is more focused on the managerial side. I work in an ER and we have had new grads from a BSN program, and they lack a lot of "hands-on" skills. Everyone is "new" at some point, I know. And we all had to learn. Just give yourself some credit. You will not be put out in the cold to fend for yourself. You will have a preceptor to guide you thru your hospital's SOP's. Just keep your patient's care as a priority and you can't go wrong.

Altered · Mar 10, 2009

Remember that at clinicals, they want you to do all A.M. care, plus meds and such. After clinicals, you won't be solely responsible for ALL the care. You will have techs or CNAs to delegate to so you can focus on meds or charting. Also, and I will probably make some enemies here, a 4 yr nursing program doesn't put much priority on actual day-to-day nursing. It is more focused on the managerial side. I work in an ER and we have had new grads from a BSN program, and they lack a lot of "hands-on" skills. Everyone is "new" at some point, I know. And we all had to learn. Just give yourself some credit. You will not be put out in the cold to fend for yourself. You will have a preceptor to guide you thru your hospital's SOP's. Just keep your patient's care as a priority and you can't go wrong.

Or you'll make some ADN friends

chevyv, BSN, RN · Mar 10, 2009

I think many of us feel unprepared leaving nursing school. I'm in an ADN program and am in my last semester doing some off site experience. Simply means that before preceptorship you spend 8 hrs in hospice, ER, and ICU. I finally got to start IV's on real people! I finally d/c'd a foley, never put one in though. I also did chest compressions during a code! My last semester and I finally have priming IV tubing down along with giving IV meds and pushes.

Your at a spot where you are getting into a routine that will last. Your priorities are meeting your pt and making sure every line and tube is in place and working properly (this is the first thing I do no matter what semester I'm in). I can't tell you how many times I've seen O2 set at the wrong number. Make sure they are running the right IV fluid. If not, check out why. Many times if a pt is just out of surgery, they will run whatever bag in and then start a different solution. I then do my head to toe assessment, including vital signs. This never changes (except during off site when the rn takes the lead). I chart right away. Before I enter the room, I always check the MAR, labs, reason their admitted, etc. At least you get your picture of them. Then I go in and begin.

When your checking your labs see if any coincide with the MAR. Are they getting potassium or magnesium? If so, you need to know what their recent lab value is before giving it (your instructor will probably ask you). Same if they are on coumadin or heparin. It's good to get your snapshot in place before entering the room. I will tell you that even though I do this, I'm still usually finding something that I missed.

You are not alone! This is the first semester that I feel I can handle myself and even though I feel like this, I know I have so much more to learn.

chevyv, BSN, RN · Mar 10, 2009

OH, you are just beginning to start to put everything together as far as connecting your care plan to your pt. Don't worry. I've heard that we do our real learning the first few years out of school.

nooneelse · Mar 10, 2009

to ladymedik: I totally agree what you are saying about the lack of "hands-on" skill for BSN program.. in fact, many of my classmate feel so too! we feel we don't know how to do much thing other than paper charting and make long careplan! lol =( but since I can't change the school.. is there ways I can help myself? I want to be more prepared.. and just wondering when you say hands on skill what are you referring to? do you mean like AM care? I only get clinical once a week, and school doesn't offer extra lab hours enough, actually.. not really at all. we need to schedule a time with our professor.. which is hard, since everyone's schedule is different. are there ways I could get some more practice of that?

and btw.. just want to say a BIG THANK U for all the replies, they really make me feel better!! :)

ladymedik · Mar 10, 2009

You could see if a near-by hospital has a mentorship, or a "ride-along" type thing. It will let you observe what "hands-on" things that will be required. I honestly cannot imagine going thru nursing school without some type of experience. I had 15 years of emergency medical services under my belt before I tried it. I applaud all of you jumping in as "virgins":wink2:. Hands-on things would include: getting a kid to swallow liquid meds without spitting them back in your face, a fecal disimpaction, holding previous kid still to get stitches, cleaning out a wound that looks like hamburger meat after a fall from a motorcycle, suctioning out the mouth of someone that needs to be intubated, but has just vomited up his dinner of collard greens and black-eyed peas. (Can you tell I'm from the south?) Of course this is extreme stuff, but I work in an ER and that is typical of things we have to do. Now if you get to do these things, I would think that you would feel like you had some clinical experience! As was stated earlier, most of your learning comes with OJT. You can't know how to handle things until you actually experience them. Don't get down yet, there's plenty of time for that.:chuckle