Got my first ever RN job, need advice afraid I forgot all my clinical skills.

Published

I just scored my first RN job after many months of trying (Yeah!!!). :D

I am about to start a 12-16 week paid new grad internship/orientation to the hospital and the unit in about a week. I am nervous and excited. Having finally gotten a job which involved a lot of time (months) and effort of interviews and applications and a lot of gas and miles, I feel I can finally call myself a real nurse. It was all worth it in the end, I am getting a great position in a awesome unit at a great hospital. Now the next challenge I have to overcome is all the time that has past from my last clinical until now.

I finished my ADN at the end of 2014, took and passed the RN-CLEX in summer 2015 (which I wrote about in another post on allnurses), and started and am enrolled in as a full-time student to an accredited online RN-BSN program, and I will be graduating this year. However there is no clinical component to the online school, and now it has been over a year since I have practiced any clinical skills. I have orientation next week and am so worried they will say I am incompetent or fire me for not knowing some of the basics. I remember a lot like VS, 3 checks, and 5 rights etc, but not all the lab values, and I was not ever very good with actual people lung and heart sounds in school (now the ones you practice on the dummies were easy), also no IV fluids to hang at home to practice on etc.

So has anyone ever experienced anything like this, and what is your advice? I was going to watch some clinical skill videos on you tube to refresh some, but other than that I don't know what else to do. Any advice/help would be appreciated. Also any encouraging stories of how you overcame a similar situation would be great for a stressed out new grad RN like me.

Up Vote Up Vote ×

Get a good stethoscope and practise your assessments and vitals on family members. Also get a nursing handbook/notebook specific for the area you are going into and review. Carry with you to work and dont be afraid to refer to it and ask tons of questions. Once you start orienting a lot of this will come back to you. Just always remember to speak up when you don't know something and keep your ABCs in mind for the patients' safety

Up Vote Up Vote ×

I went to a fancy brand-name accelerated in-person BSN program, and I basically had zero hospital skills when I graduated. I had never once placed an IV...some people got a chance in clinicals, some didn't...I had done one Foley, I had never worked an IV pump outside of lab, didn't know how to hook up or manage a chest tube, etc. I don't think I even gave an IM injection. (I have a whole separate rant about how BSN programs are so eager to make us "nurse leaders" that they fail to prepare us in any way to be actual nurses - save that for another day).

Anyway, for better or worse, the hospitals are accustomed to getting new grads who don't know how to do anything. Watch the YouTube videos if you like, and definitely pay very close attention and write yourself notes every day as you're learning on the job. It's going to be very stressful for a few months. There will be some people in your new-grad orientation group who seem to know so much and be so much more confident than you. Maybe they had great clinicals or a more hands-on program. But four or six months later, you're basically all going to be at the same level - don't let it freak you out.

My first job was in a level I trauma center and I was TERRIFIED. On top of my lack of clinical skills, I have the worst visual-spatial abilities of anyone I've ever known - watching me try to figure out how to put things together, or open a package, or whatever, is painful. You can imagine in that environment, the learning curve was brutal. But I got through it, and so can you!

Up Vote Up Vote ×
I went to a fancy brand-name accelerated in-person BSN program, and I basically had zero hospital skills when I graduated. I had never once placed an IV...some people got a chance in clinicals, some didn't...I had done one Foley, I had never worked an IV pump outside of lab, didn't know how to hook up or manage a chest tube, etc. I don't think I even gave an IM injection. (I have a whole separate rant about how BSN programs are so eager to make us "nurse leaders" that they fail to prepare us in any way to be actual nurses - save that for another day).

Anyway, for better or worse, the hospitals are accustomed to getting new grads who don't know how to do anything. Watch the YouTube videos if you like, and definitely pay very close attention and write yourself notes every day as you're learning on the job. It's going to be very stressful for a few months. There will be some people in your new-grad orientation group who seem to know so much and be so much more confident than you. Maybe they had great clinicals or a more hands-on program. But four or six months later, you're basically all going to be at the same level - don't let it freak you out.

My first job was in a level I trauma center and I was TERRIFIED. On top of my lack of clinical skills, I have the worst visual-spatial abilities of anyone I've ever known - watching me try to figure out how to put things together, or open a package, or whatever, is painful. You can imagine in that environment, the learning curve was brutal. But I got through it, and so can you!

Well that sucks. I went to a no name 2 year school for my ADN. Our clinicals in my opinion sucked because of lack of exposure to real sick people being that most of our time was spent at a critical access hospital with maybe 10 patients on a good day. We did have some experience with real medical/surgical cases though limited. However, i did a few IV's, a foley, and IV antibiotics. Nothing crazy like piggy-backed lines and y sites that I do now in ICU trying to manage compatible meds etc. I spoke up. I was pretty loud about wanting to do things. I guess it benefited me as i got experience. When other people didn't get to do anything. I know of such people in my class.. So maybe class size made a difference for you? Mine was 13.

Regardless the learning curve is always huge no matter how prepared you think you are. Especially off orientation. The first year ALWAYS is terrifying.

Up Vote Up Vote ×

"Quote from laflaca

My first job was in a level I trauma center and I was TERRIFIED. On top of my lack of clinical skills, I have the worst visual-spatial abilities of anyone I've ever known - watching me try to figure out how to put things together, or open a package, or whatever, is painful. You can imagine in that environment, the learning curve was brutal. But I got through it, and so can you!

Yes I have some problems with opening and assembling too. :D Sincerely Thank YOU so much for sharing your experience. I have hope that I too will overcome.

Up Vote Up Vote ×

dnptobe20 Thanks I ordered a oncology book, and I found my old clinical skills CD-Rom. I feel more confident as I am watching, although I know doing and watching are different things. Thank you for the advice:up:

Up Vote Up Vote ×

Okay so I have been finding some good advice on site. For further clarification can anyone explain what a brain sheet is and is there a template? I never heard of anything like this before and it seems like a good tool I would like to utilize?

Up Vote Up Vote ×

You will be checked off on skills as you have the opportunity to practice them. Practice at home with the basics like sterile field. Run through the steps with your preceptor before attempting the skill and before going in the room. Most important of all, be confident when you go in the room! You'll be ok.

Up Vote Up Vote ×
I went to a fancy brand-name accelerated in-person BSN program, and I basically had zero hospital skills when I graduated. I had never once placed an IV...some people got a chance in clinicals, some didn't...I had done one Foley, I had never worked an IV pump outside of lab, didn't know how to hook up or manage a chest tube, etc. I don't think I even gave an IM injection. (I have a whole separate rant about how BSN programs are so eager to make us "nurse leaders" that they fail to prepare us in any way to be actual nurses - save that for another day).

Anyway, for better or worse, the hospitals are accustomed to getting new grads who don't know how to do anything. Watch the YouTube videos if you like, and definitely pay very close attention and write yourself notes every day as you're learning on the job. It's going to be very stressful for a few months. There will be some people in your new-grad orientation group who seem to know so much and be so much more confident than you. Maybe they had great clinicals or a more hands-on program. But four or six months later, you're basically all going to be at the same level - don't let it freak you out.

My first job was in a level I trauma center and I was TERRIFIED. On top of my lack of clinical skills, I have the worst visual-spatial abilities of anyone I've ever known - watching me try to figure out how to put things together, or open a package, or whatever, is painful. You can imagine in that environment, the learning curve was brutal. But I got through it, and so can you!

Sorry to jack the thread lol but I feel like a fumbling idiot in m ed surg clinical bc i have the same visual spatial problem. I also got a job as a tech last month, no previous experience, and the amount of wires and near stumbles and patients i can't figure out which way to turn and prop up btwn clinical and work is baffling! Lol! I struggle so much with the positioning of my body and the patients' bodies. I had to go to skills help before clinicals even started because i was messing up even on dummies. :/ book smart but a hot fumbling mess lol. Glad t o hear you were able to get through it.

Up Vote Up Vote ×

A big Thank YOU to LightMyFire, RN, William2, Laflaca, Dnptobe20, and Aspiringnursedd for your responses.

Other things I would appreciate a response to are:

I am focusing on reviewing the steps but most importantly the why of assessment and what to do if things are outside of normal. I am also focusing on the basics but essentials like safety, infection control, med administration etc. I have a few days left before I start orientation is there any thing else I should spend my time reviewing?

:sarcastic:I wish I had asked more about orientation which probably would have eliminated a lot of my anxiety. Can anyone relate? Also should I tell my preceptor/s that I have not had clinical in a year, or would that be seen negatively. I was honest with my employer and they do know how long it has been since I have had clinical. I am just not sure if this is passed onto my preceptor, or if it matters in how they will orient me. What do you think?

Up Vote Up Vote ×
Specializes in Psych, Corrections, Med-Surg, Ambulatory.
Okay so I have been finding some good advice on site. For further clarification can anyone explain what a brain sheet is and is there a template? I never heard of anything like this before and it seems like a good tool I would like to utilize?

It just means worksheet. If you don't find a template, it's easy to make your own. Each line has room for your pt's name, and other pertinent data. Then you use it to plan your care, prioritize needs, keep a to-do list. It's just a way of keeping yourself organized, so people refer to it as their "brain". Your preceptors will help you with this.

Up Vote Up Vote ×
Specializes in nursing education.

Here is an example of a brain sheet. My PM clinical students like this one a lot. There are a lot of variations on this. The units usually have examples too. Find one you like, or create your own, to organize and prioritize your shift.

PM Clinical Report Form.doc

Up Vote Up Vote ×
+ Join the Discussion