Experienced nurses: what was YOUR training like?

[SubSippi]

I frequently see comments on this site about new grads not being adequately prepared in school, along with comments about new grad training being grossly inadequate these days. I am very curious about how things have changed over the years.

The unit I work on is critical care/tele. We have six patients per nurse most days, but can go up to seven, and on our floor, the charge nurses also have patients. The CNAs have 12 patients each. We take patients who are on long term vents, and get the ICU/IMU overflow. I have a theory that to open up an ICU bed, they don't send us the most stable patient, but someone who has DNR orders. Because I never get an ICU transfer who isn't DNR (but that's for another thread).

Anyway, I got six weeks of training before I was on my own, which was definitely not enough. I'm lucky enough to work in an environment where the experienced nurses are very nurturing and patient, as well as good teachers, so I didn't feel as "thrown to the wolves" as other new grads have. My question is, if I had gotten this job a decade ago (or two, three, or four decades), what kind of training would I have received? Would it have been the same, or would I have gotten more before I was working on my own?

I'd also love to hear from any experienced nurses about the kind of training they got for their first jobs in different settings. Did you feel like it was adequate? Did you feel like your nursing school did a better job at preparing you to start your first job that nursing schools do today, and if so, what do you think the differences are?

[Ruby Vee, BSN]

I have a BSN, graduated in the late 70s. We had about six hours of clinical time a week, and when I started my first job I definitely was not ready to "hit the ground running." I struggled with everything. Didn't know how to get a patient weighed even! The RNs on my unit were too busy to do any precepting, so I had none. The hospital had it's own diploma school, and I was the first BSN they'd ever hired. Neither side had any idea how ill prepared I was! I learned how to pass meds, assess wounds, change dressings, place an NG tube and a Foley from the LPNs on my floor. They were awesome! The NAs taught me how to bathe a patient, do vital signs, change beds, empty Foleys, etc. They were awesome, too. From the RNs, I learned how to hang blood, start IVs and give IV medication . . . I was afraid of them.

My husband graduated from a diploma program in the early 80s. He got 20-30 hours of clinical a week, and before he graduated was running charge on a Med Surg floor. He already knew all that stuff I had to learn before he graduated, and when he started his first job at the hospital where he trained, he was a known quantity and a competent nurse.

I suspect more of today's new grads are in my position rather than DH's. It's too bad that the diploma programs are all gone now; those diploma nurses learned so much more than we did in the BSN program!

[Rose_Queen, BSN, MSN, RN]

Nursing school in no way whatsoever prepared me for my career as an OR nurse. However, I had an excellent orientation program. It consisted of 6 months working one-on-one with a preceptor as well as classroom learning. That was followed by 3 months where two orientees would be on their own in the room but have an experienced nurse available for backup. Classes weren't restricted to two; the max a nurse could be responsible for during the 3 month solo period was limited to 2. So if there were 5 orientees, there would have to be 3 free experienced nurses. At that point, we were staffed adequately to provide that.

Now, it's a totally different world. New nurses to the unit get all of 12 weeks orientation. 9 months cut down to 12 weeks. It still has me shaking my head and wondering why, as most of the newer nurses who got short-changed in orientation are the ones leaving within a year. I'm also concerned when it comes to patient care- someone that new, who is still learning how to do things in the OR, being on call with emergencies rolling in the door where experience truly can make a difference. It's kind of scary, and makes me never want to have to be a patient- in the OR or in the hospital in general, as the same is happening in all units.

[ChristineN, BSN, RN]

Like Ruby's husband I graduated from a diploma program, having approx 24hrs/week of clinical. Prior to graduating I was taking care of 5 pts independently on a med-surg floor. However this wasn't in the 70's or '80's, but in 2008 when I graduated. I took a job on a pediatric unit, and had 3 months of orientation, as well as participating in my hospital's nurse residency program. When I came off of orientation I was competently caring for my pts, and received many compliments from management, pts, and coworkers. I never felt like my schooling or my hospital left me ill prepared

[SwansonRN]

Just finished my BSN around two years ago. I felt very prepared to pass the NCLEX, but not as ready clinically. Luckily I had an internship and a preceptorship while I was still in school where I more or less learned the absolute basics: how to assess and pass meds. Otherwise clinicals were bed baths and trying to stay out of everyone's way. The program I was hired into once I graduated was 6 months with an intense didactic portion including classes, projects, and online modules. I owe the majority of what I know and how I work to that and shadowing nurses on my floor. Nursing school was just the foundation.

Edit: oops missed the part of the title that said "experienced nurses" lol

[CrossCountryRN2008]

ADN programs generally have more clinical less research thank BSN programs. I started in rehab sub acute with less than 2 weeks training. Tried corrections got 1 week. Finally got into med surf years later got 6 weeks as experienced. New grads here get more

[TiffyRN, BSN, PhD]

ADN grad from 1992 here. I had about 12hrs/week training during clinicals. As a new grad it was standard to get 6 weeks with the first week being all classroom (with maybe half of that nursing oriented). It was nothing close to enough. My charge nurse and my best friend (an LPN) protected my patients while I learned how to be a decent nurse. A year in, I'm charge. Seriously? Funny thing is that after getting 9 years experience I go to a new field (NICU) and they give me 12 weeks! Granted, there were huge differences but still, 12 weeks! What I wouldn't have given for 12 weeks as a new grad.

[HouTx, BSN, MSN, EdD]

Like Ruby, graduated in the late 70's... (LVN-BSN). I had LOTS of clinical training/exposure in my college-hour LVN program. BSN required specific numbers of clinical experiences (# IV starts, m & f caths, dressing changes, NG insertion, etc) in order to meet requirements for graduation. If you didn't get them done during your regular clinicals (2 full shifts per week), you were expected to arrange additional clinical time with an approved preceptor. As students, we started IVs & dropped NGs on one another (srsly!!)

I began in a Trauma/Neuro ICU - no 'residency' 1 week official orientation .... and LOVED it so much, it became my chosen specialty.

I'm not claiming any sense of superiority - today's environment & list of 'duties' is very different than the old days. I admire and esteem today's nurses - they're Rock Stars!!!

[HeatherGurl84]

I wish more experienced nurses were understanding when it does come to today's new grads. I graduated with my BSN in 2010 and the course felt truly "book" not "skill" based. We were not allowed to start IVs or draw blood in clinical time, that was mainly reserved for staying out of people's way. We mainly could do baths, run & get things for a patient, and observe other nurses. In some places, nurses looked at students as a bother, not as someone who wants to learn.

This really hurt when I started my first job on a busy med-surg unit. Walk into the unit and first thing a LPNs says is "let's see how long you last." I could ask for help and be told "NO" to my face, was even called STUPID to my face in front of a group of nurses when I wasn't sure about the answer to a question. I was asked if I even went to nursing school by one nurse when asking about a lab result. I was eventually let go within 5 weeks and told by the nurse manager "that I wasn't a good nurse." I left crying and with a major inferiority complex.

I am now rebuilding and beginning a new job this month, while being terrified that other nurses will treat me the same way. Nurses must remember that everyone was NEW at one point in their career. Nurses deserve support, not public shame or criticism when they don't know or need to ask. Yes I graduated with my BSN, but that doesn't make me feel smarter than anyone. I WANT an accepting learning environment.

Now I know that some preceptorship get students who scare them to death or don't want to listen. There are always a few in the bunch. Then there are those who think they know everything.....SCARY. They will end up making a major mistake somewhere. I want to ask questions and learn....it isn't fair to get your head bitten off.

Respect is key.