graduate in 3 months & I don't know anything?

[stewiegriffin]

I'm in my final semester of an ASN program, 12 weeks from graduation, & I feel like I don't know anything.

I've given 3 shots, done 1 dressing change, d/c'd 2 IV's & that's about it.

I've given no IV pushes or piggybacks, not put in or d/c'd a foley, never tried to start an IV, no NG experience.

I get totally overwelmed when I have multiple patients. If my patient needs a lot of my time, then I run out of time on my computer charting. If I take time to do my charting correctly, then I don't have enough time with my patient's chart to get the info I need to do my homework later. As soon as I sit down to chart, my instructor or a floor nurse shows up & says let's go do such and such. It ends up taking 4 or 5 different tries to chart on one patient & I always worry that I'm leaving something out. And that's not even including giving meds, because we aren't giving meds this semester. I'd never get anything done if I was passing meds, too.

I've never watched a nurse do an assessment on a patient. I'd love to know if there's a better routine than the way I do it. I'd love to follow a nurse for a whole shift and maybe get some time-management & organization tips.

My grades are fantastic & my paperwork always gets top marks. My APA format is flawless. Unfortunately, none of that is going to keep my patients alive.

Is it normal to feel this way this close to graduation? Shouldn't things be falling into place by now? Maybe this is a sign that I'm in way over my head & I'm just not going to get any better.

[avahnel, ASN, RN]

I have heard on this site that we will learn more in our first year as a nurse, than in the whole time we were in school. In school we have to do every thing by the book, and in the real world that is not always the case, so maybe when you are practicing it will be easier just because you will be able to do things the way you do them best, not the way others want it done. I would talk to your clinical instructor about your "lack of experience" or just make yourself a little more assertive when new experiences come up. I have asked all of the nurses that I have worked with if I can join them in thier assessment of the patients. If you have a nice nurse, she will talk about breath sounds, bowel sounds ect with you. You can ask to shadow a nurse also. I wish you the best!!

[shoegalRN, RN]

This is the way I look at it:

I am also graduating from a BSN program in May. I learned more while I was a Nurse Intern than I ever did in clinical.

I try to focus on graduating and passing NCLEX. I figure the "real" learning will start once I become a nurse. I figure I will get all the hands on training that I never got in nursing school. I look at as on the job training.

This is why I don't see anything wrong with new grads going into specialty areas. I, however, need a foundation before I specialize, so I will be starting on a Telemetry/Pulmonary floor.

[redtshirt]

We're in a job where we will never stop learning. Opportunities dont always arise when your a student and theres always someone you can ask if youre unsure. ( i feel the exact same as you!)

[NurseLoveJoy88, ASN, RN]

I think you need to take charge of your situation. You are three months away you should of done alot more. The things you said you have never done, I done all of that in my first semester of NS.

When I go to clinicals I take charge ! I know what I can and can't do, based on what we went over, so I use that in my advantage. I march to the RN staff nurse, politetly and with confidence and tell her that I'm responsibe for : Meds, IV's, piggy backs, head to toe assessments, dressing changes, and etc.

I also document everything, and f/u with her to remind her what procedures I've done and will get to. Ofcourse I have my instructor with me every step of the way to look over things, but I'm the one doing it all. I work too hard, and pay too much to go to nursing school to hardly get any hands on experience. Some students are perfectly okay with not getting any experience at clinicals, I'm not !

So use the rest of your three months and take charge at clinicals ! Good luck with that.

[PEBBLES1]

What you are feeling is very normal. I just graduated last month and I still feel that way. Relax and give yourself credit, you know more than you think. Good luck to you and you will be fine.

[stewiegriffin]

Believe me, assertiveness has never been a problem for me.

All the floor nurses know what we students can & can't do.

I've never had a floor nurse deny me a learning experience or cut me out on a procedure I needed to do.

The problem is, you can only work with your own patients & you can only do things that are ordered for those patients.

I can't cath my patient just for practice. I've yet to have a patient offer to let me drop a NG on them just to help me out. I can't do a dressing change on another student's patient just because my patient doesn't need one.

We're only allowed to work with the patients that our instructor assigns us to. We can't even answer a call light on another patient because we didn't do rounds with their nurse or look at their chart.

My biggest problem is finding time to chart my assessments & peruse my charts for the homework I'll be doing that night.

I feel like most of my time is spent doing bed baths, feeding patients, & making beds and, of course, helping the other students do the same with their patients.

The Techs on the floor are told that nursing students do 100% care for their patients, so you can't even ask them for a hand with lifting. If it's a 2 person job, you have to find another nursing student who happens to be free.

I feel like my time is being spent doing tasks that I've done for years (patient bath, feeding, bed making) and I'm rushing through the things that I need the most practice on.

I'm just really frustrated right now!

[hypocaffeinemia, BSN, RN]

I'm the same distance from graduation as you.

My question, and I apologize for it's frankness: What have you been doing at clinicals?

Here in Texas, our allotted and necessary hours of clinical time is pretty minimal, but even in the time I've had I've done everything on your list a dozen to dozens of times. This likely isn't your fault, but you don't seem to be receiving many learning opportunities at clinicals. We've had days where we were sent to the OR or pre-op just to practice foleys and IV starts (and pre-op assessments), for instance.

And IV medications: I haven't had a patient yet that wasn't on IV antibiotic piggybacks or without some sort of IVP med. How have you avoided this?

[stewiegriffin]

No need to apologize. It does seem ridiculous, doesn't it?

As far as meds go, our instructor has decided that we aren't passing any meds this semester. Apparently, the hospital's electronic RX system is too difficult to handle with students in tow. We rarely passed meds last semester because the hospital was just getting the new system up and running.

When we observe somewhere, we are doing just that: observing. You have to have your instructor present to do anything. There aren't enough instructors to follow us to our observation experiences. Our instructors have to stay put on the assigned floor with the other students.

Obviously, I've done tons of assessments, baths, feedings, etc.

I've just been unlucky in my patient assignments. I seem to catch patients who are almost recovered. The foley &/or NG has already come out.

Don't those patients ever think about my needs?

[hypocaffeinemia, BSN, RN]

I'd argue that 'observation' shouldn't count as clinical time. Yes, it's a valid learning experience, but it's essentially the same as shadowing. Clinicals are there to prepare us to be competent providers upon graduation. How can you competently administer IV medications if your instructor disallows you from doing this? Heck, we do IV medications, barring narcotics, independently this semester in my program.

Have you been in more acute areas like ICU or ER where you will frequently have opportunities to insert or DC IVs, Foleys, and NGs? Why not?

When you graduate you may want to consider writing a letter with your concerns to the dean/department head.

[chevyv, BSN, RN]

Observing isn't always a bad thing, especially this close to finishing. I too will graduate in May and haven't done many things. I've never even had the chance to d/c a foley! I've done some IV tubing prep, but have never gotten the chance to start an IV. I did do a blood draw off a PICC. I've never started a foley either.

I have seen students forget to ask the pt to spell their last name or give a dob before giving a med (they did compare the mar to the med and bring up pt wrist band and med by elelctonic emar). These students were kicked out of their last clinical.

I start my last clinical tomorrow and am scared to death! The hospital has a new all electronic computer system that the full timers are familar with. I'm part time so the instructor flew through it because the rest are ok with it. I don't even know how to chart on the stupid thing, let alone find my information for my care plan! I haven't slept in 2 days because I'm so worried. Although I feel as though I know nothing, I also feel like I won't make it through this last clinical. I have the instuctor who is the devil himself and am so stressed my goal is to fly under the radar and get my experience with my first nursing job.

This is not how I wanted my last clinical to go. I had dreams of gaining condficence and feeling able to ask any questions. Now, I'm afraid I'll hear "What, you should have had that before." I'm so disappointed but have no tears left. I'll have 2 pts and be responsible for all cares. Hope nobody goes south on me, I may not realize it!

[NurseLoveJoy88, ASN, RN]

Believe me, assertiveness has never been a problem for me.

All the floor nurses know what we students can & can't do.

I've never had a floor nurse deny me a learning experience or cut me out on a procedure I needed to do.

The problem is, you can only work with your own patients & you can only do things that are ordered for those patients.

I can't cath my patient just for practice. I've yet to have a patient offer to let me drop a NG on them just to help me out. I can't do a dressing change on another student's patient just because my patient doesn't need one.

We're only allowed to work with the patients that our instructor assigns us to. We can't even answer a call light on another patient because we didn't do rounds with their nurse or look at their chart.

My biggest problem is finding time to chart my assessments & peruse my charts for the homework I'll be doing that night.

I feel like most of my time is spent doing bed baths, feeding patients, & making beds and, of course, helping the other students do the same with their patients.

The Techs on the floor are told that nursing students do 100% care for their patients, so you can't even ask them for a hand with lifting. If it's a 2 person job, you have to find another nursing student who happens to be free.

I feel like my time is being spent doing tasks that I've done for years (patient bath, feeding, bed making) and I'm rushing through the things that I need the most practice on.

I'm just really frustrated right now!

Wow, I'm sorry. I can totally see why you are fustrated. My program is so different. During the first half of the semester we focused on assessments, bed baths, ADLs, feeding and etc. So there fore when we moved on to the second half, we focused more Meds, treatments, and etc. We still do the total care, however we can delegate to techs to help c- patients' ADLs as needed. We can't learn it all and do it all, thats why my program is set up like that. Yes, nurses should always lend a hand to help a tech, however it has to be done on the nurse's free time from giving meds, treatments, charting and etc.

So far as doing things on other patients, why not ? As long as the nurse is present or your instructor and you have permission. I was constantly doing procedures( non - meds) for patients other than my own. As a nursing class we stuck toghether and worked toghether. If one student didn't have a diabetic patient, the instructor would let the other student check the BGL and give insulin the next time on the diabetic patient they didn't have. I don't blame you, its the way the program is set up. And the med system at one hospital required an additonal 4 hour training, but it was totally worth it !

Well, like others said you made it this far and in the work force you will gain all the experience you need.