What didnt you do in school?

CT Pixie, BSN, RN · Apr 21, 2013

During school clinical rotations I never had the chance to...
1. Insert a Foley catheter
2. Start a peripheral IV
3. Insert a NG tube (I've still never done this in my 7 years of bedside nursing)
4. Irrigate an indwelling urinary catheter
5. Perform a real head-to-toe assessment
6. Apply a wound vac
7. Flush a PICC or central line
8. Administer blood
9. Perform intraosseous infusions (Still never done this)
10. Assess for livor mortis or rigor mortis
The ones I listed are the top ten, but there's still so much I never learned in nursing school. My nursing programs (LVN and RN) focused on passing NCLEX and not much else.

Never performed a real head-to-toe assessment? Really?? During LPN schooling we had to do a head to toe assessment as a check off in the skills lab, we also had to do them on patients with the instructor in the room. We even had one instructor who would quietly follow behind after you gave your head to toe assessment to her and go back and do her own to make sure you hadn't made things up.

Inserting a straight cath was something we all got to do because there was a resident who had an order for a straight cath every ?? hours (the time frame escapes me). Because we stayed that that facility and the same floor for the duration of clinicals, everyone of us was able to perform this skill. We also got to do close to 120 IM flu vaccines d/t being at the facility at the time they were being given.

8-10 are the only things I've never done during my LPN or RN schooling. However I was able to do #10 during my time as an EMT.

Tait, MSN, RN · Apr 21, 2013

It's sad that some basic skills aren't bring taught anymore. I figure it has more to do with the clinical sites not allowing it?? Shoot we practiced injections and the alike on each other...

It isn't that they aren't being taught, they just aren't cropping up in clinicals. I believe this is why there will be a shift to increasing hands on clinical time via a residency type program as the nursing community comes together on exactly what school needs to incorporate. While I was in school I never saw an actual delivery of a child, however my Filipino counterparts had to camp in wards until they saw 30+! My mother-in-law, a diploma RN, also had to camp out.

I never inserted a foley, but did so within a few weeks of starting my first job.

Never dropped an NG but did several in my first year.

I knew how to do it, I had practiced it, I had been taught, so when the time came I walked through it outside a patient room with a senior co-worker, then went in and did it on the patient as though I done 100 of them before.

For the OP: Understand why they are done, practice your skills on the dummy, and then have confidence and move forward with a co-worker at your side!

Tait

Esme12, ASN, BSN, RN · Apr 21, 2013

I'm getting close to graduation, and theres SO many things I've never done on a live patient! Stuff like, foley, IV's, injections, (all I really have done is some minor wound care and hygiene stuff) It makes me nervous, but hopefully I'll be blessed with a great orientation....SO.... What types of things had you never done on a live person til after you were licensed and working?
Have you precepted a new grad and been surprised at the skills they hadn't had much practice with?

I am concerned for you....what school is this? LPN or RN?

This is what concerns me in nursing education these days....and why hospitals don't want new grads.....they have to teach them too much.

I went to college YEARS ago and we had extensive clinical experience. We need to return to the basics and teach our nurses to be nurses.

BeenThereDoneThat74, MSN, RN · Apr 21, 2013

I went to college YEARS ago and we had extensive clinical experience. We need to return to the basics and teach our nurses to be nurses.

I did too, and my experience was different than what many are sharing here. I think there are a lot of factors that are contributing to this:

-clinical sites aren't as willing to let the students do all of these skills. Fortunately, mine is.

-clinical instructors not willing to take on the skills that come their way.

-Either they don't fell comfortable doing it with their students (because maybe their skill level is lacking)

- they don't feel like doing it with them

- timing: Heparin is given at my clinical site at 2pm (TID). Clinical ends at 2pm. I will post conference before, then have 2 or 3 students give the heparin, then we leave.

Or we give it at 1, then wrap up for the day. Not everyone does this.

- or just not enough time. Do you have any idea how long it takes to perform a skill with a student? Much longer than it does for a practicing nurse. You need to go over the skill with them (to make sure they don't mess up in the room), gather the supplies. Then, it will easily take twice as long for the student to perform the skill. YES, it is the instructors job, but when you have to divide your time among multiple students and have committed to passing meds on a certain number already, it may not be in the cards to "drop everything" if an opportunity do insert a foley comes around (at 10am). If you ask the nurse if the patient can wait, they may not be willing to hold it for you (because maybe it CAN'T wait). The instructor needs to balance the workload for the good of the group.

-clinical groups (at least in my areas) have gotten bigger over the years. More students = less individual time for each student.

- no opportunity for some skills. Where we go, RNs don't drop NG tubes. I only did this skill many years after NS, when I started working in Peds. There is rarely a foley opportunity that comes our way. And Ever an IM injection.

As others stated, anyone can learn a skill. The main focus tends to be on thinking and managing. I know that students need to hone their skills, but they also need to figure out how to think, problem solve and prioritize.

I often ask my students to think about what makes a good nurse. Do you think patients say "that nurse hung the best IV ever" or are they more likely to say "that nurse recognized that my mother was in distress, and knew exactly what to do"?

brownbook · Apr 21, 2013

You tube is great for educational videos. Of course use your nursing knowledge from lectures and book learning to assess the techniques you see on you tube.

duckyluck111 · Apr 21, 2013

As a student, I can tell you that that this education is much more about observing, practicing out-of-date techniques on mannequins and making sure we pass the NCLEX so the schools pass rates stay high.

duckyluck111 · Apr 21, 2013

You tube is great for educational videos. Of course use your nursing knowledge from lectures and book learning to assess the techniques you see on you tube.

I agree. You tube is great, but can you imagine approaching a patient and saying "I've never done this but I saw it on You Tube"

CT Pixie, BSN, RN · Apr 21, 2013

I go to a school that is connected to the hospital (literally and figuratively). The hospital administration, nurse managers, staff nurses and instructors are more than willing to allow students do anything and everything that falls under the SOP of the RN (within reason, there are some times under the SOP of the RN that you obviously wouldn't have a student do). I don't know if that's because its a teaching hospital, if they trust our college and have a good relationship w/my school, or a combo of both.

I'm just greatful my school makes us hit the floor running bascially from day one. If you haven't done something b/c your patient didn't require it, the instructor will hunt down a patient that does, get the needed ok's from NM and staff nurse and we do it w/the other patient. Our instructors have told us to write down a list of things you have never done that you'd like to or things you have done maybe once or twice but would like to do again. They do what they can to meet all your 'goals' for that clinical rotation.

Julesmama28 · Apr 21, 2013

Wow. I feel really lucky to be at the school I am after reading this! I'm in level two of a a 5 semester BSN program. Level one we were taught to do assessments, give oral meds and injections. I was able to do an assessment with each patient and multiple lovenox, insulin, and flu shots. This semester we were able to do (with our instructor present) IV push and IVPB meds, foleys, IV insertion, hang fluids, NG tubes, etc. I think the only thing we aren't allowed to do is BGs but that's hospital policy- weird but true. I have done 3 IVs, multiple blood draws, 2 foleys and one straight cath, so many injections I don't remember how many, no NG, (that doesn't seem too common to even have a patient with one though.) Each clinical we took at least one patient as our own and passed all meds, did assessments and other care for them. Great learning experiences!

Palliative Care, DNP · Apr 21, 2013

In school I never inserted a foley, NG tube, an IV, provided wound care, or suctioned a trach. We were told that patients were not our test dummies as students. So what did I learn in the ADN program? I was a glorified CNA for the whole 2 years of the program. When I hit the floor for my 1st job I was eaten alive by experienced RNs that assumed I would have all of these skills. My first year was HELL! I went straight on to the RN to BSN program. Now am in a BSN to DNP program and have no plan on looking back! There is a reason so many new nurses are ready to jump ship. These programs are churning us out with the ability to pass the NCLEX but not actually do the job of the floor nurse. We are completely unprepared for that reality and then picked apart until we all but break. Instead of taking the time to teach new nurses how to do things correctly and safely it seems it must be easier to tear them down. I have since saved a few new RNs from preceptors that were trying to make them quit and told everyone how they would never be good nurses. Know what? They are great nurses now because they had critical thinking all that was needed was some hands on training. I believe we can teach each other hands on it should be the thinking skills we question.

Twinmom06, ASN, APN · Apr 21, 2013

a lot depends on the clinical instructor...I've done plenty of foley caths (in fact I work as a student nurse aide and the nurses come get me to do foleys and straight caths...) I dropped an NG tube during my ICU rotation (guy was newly admitted and vented and as we were rolling him to clean him he started to vomit - nurse handed ME the NG tube and said "make sure you rotate it through the turbinates in the nose - I nearly crapped my pants!)...I've d/c'ed foleys and IV's...a few of my classmates drew labs during ICU (as my clinical instructor says - what happens behind the curtain stays behind the curtain) and suctioned both ET and trachs and did trach care, changed ties, changed cannula's....hung IV's, IVPB's and done pushes and flushes...plenty of sub q heparin, lovenox and insulin, as well as IM flu shot clinics, IM iron and B12 shots as well...

one of our local schools lost their accreditation last week - NCLEX rates too low (they were on probation for several years) and their clinical are observation only - no hands on...the local hospitals don't generally hire their new grads, they hire us because we're so hands on (ADN program)....

melizerd, ASN, RN · Apr 21, 2013

During school clinical rotations I never had the chance to...
1. Insert a Foley catheter
2. Start a peripheral IV
3. Insert a NG tube (I've still never done this in my 7 years of bedside nursing)
4. Irrigate an indwelling urinary catheter
5. Perform a real head-to-toe assessment
6. Apply a wound vac
7. Flush a PICC or central line
8. Administer blood
9. Perform intraosseous infusions (Still never done this)
10. Assess for livor mortis or rigor mortis
The ones I listed are the top ten, but there's still so much I never learned in nursing school. My nursing programs (LVN and RN) focused on passing NCLEX and not much else.

Wow really? 8-10 are the only ones I haven't done. I've still got one semester to go too, and I'm in an ADN program.

Blood won't happened because its not allowed but I've been there with the two RNs while they did it and did the vitals and 15 min sitting with the patient.

A head to toe is done every week takes me about 10 min at the beginning of clinical.