HELP! Newly RN, poor clinical background, where do i start


Please help me, I'm a foreign graduate and I recently passed the NCLEX. yayy i'm an RN but...

I really feel so incompetent because I'm positive I have poor clinical background.

I have no idea, what to do on field, i mean we did one return demonstration per skill that's it and that was two years ago on my 2nd year, 3rd and 4th year were nonsensical clinical duties. we didn't even do staffing. i know shame on us but that's behind now i want to know what i can do to solve my incompetence

modesty aside, i want to say, i study good, i remember almost everything for a short time, but for me to remember and act like it's second nature to me the way real RNs have instincts and gut feelings i have to repeat studying it over and over. and that's okay

Anyway, I want to know, which skills do I have to know as a starting nurse in US, the most important ones.

What would I be expected to know wound vac, all kinds of medication administration, assessment everything, insert foley caths ?? Please help me, I am dying of anxiety.

How do i start on the field, i'm afraid, something will come up with the patient and i won't even recognize it?

which concept in Nursing is the most helpful?

I am willing to study.

P.S. Please don't make me feel badder by putting in your two cents about how terrible my educational training is. I already know about that. I grasp what they could give. I couldn't afford a better school. I know that I passed and it wasn't luck, I can study good.

I would greatly appreciate and forever be indebted to helpful RNs who would give me specific areas to focus on, and give me a bird's eyeview of what nursing is really all about starting your shift, the common denominator in all areas, what is expected of a new nurse ergo easing my transition as a really clueless RN

and will you please any threads that might be helpful to me if you know some?

Please help me help me help me, I am really really anxious and upset and going nuts and stuck and scared to death and ready to grasp whatever you could help me with. I need to work good so I could provide for my mom and dad and my siblings. Your help would help me save our lives.


diane227, LPN, RN

1,941 Posts

Specializes in Management, Emergency, Psych, Med Surg. Has 32 years experience.

I would take a refresher course if I were you. That may help you feel more on track, especially if it has been two years since you have practiced some of your skills.

Specializes in ER, Perioperative. Has 10 years experience.

If you are a new grad or haven't worked as an RN before, most hospitals will put you on some kind of orientation or precepting.

No one gets out of nursing school with good clinical skills -- unless they were a medic in the military before or were previously a phlebotomist or medical assistant.

If you get orientation, you will probably receive instruction specific to the institution and unit where you are hired. For example, if you have to draw blood or start IVs, they will make you attend hospital-based classes on drawing blood, proper procedure, order of the draw, etc.

Precepting is working with an experienced RN. Usually you will do both -- orientation classes *and* precepting. While you are precepting, tell each of your preceptors (if you have more than one) about your lack of clinical skills. They are used to this. Tell them that you need to observe for a few days before you start trying to draw blood and start IVs.

I can't tell you what you will need to know because it depends where you get hired and what you'll be doing. Nursing home care is different from in-patient hospital nursing. ICU nursing is different from med-surg.

Wherever you go, you will be oriented and trained. STAY ON ORIENTATION AS LONG AS POSSIBLE. Many units and hospitals will want you to come off orientation early if you show good progress, but you shouldn't do it unless you are very confident. You *need* that time with another experienced nurse, even though at the end of it, she will probably be reading magazines because you are doing all the work because you *can*.

There is a big gap between the "book-learning" of nursing school and "real world" nursing. It is tough but it is do-able. Try to get hired at a hospital or facility that orients/precepts new grads for a MINIMUM of 16 weeks. Six months would be better, but let's not reach for the moon.


989 Posts

Start on a med/surg unit - you will be fine.

roser13, ASN, RN

6,504 Posts

Specializes in Med/Surg, Ortho, ASC. Has 17 years experience.

I agree that you should not worry so much about lack of clinical skills. Any unit that you start on will train you to their specific procedures in their own way. I'm sure that there are many other new grads who are more or less in the same situation as you, either due to the passing of time or less than perfect clinical experience.

I would caution you to be careful in an interview situation. Try not to mention any of your concerns. If you're like me, when you get anxious, you tend to blurt out your feelings:lol2:! Take deep breaths and remember that you are not the first new grad (nor will you by any means be the last) to worry about being ready for your new challenges.

canesdukegirl, BSN, RN

8 Articles; 2,543 Posts

Specializes in Trauma Surgery, Nursing Management. Has 14 years experience.

You may not have as poor a clinical background as you think. Your anxiety is through the roof though. Take a deep breath....and another....ok. Now let's get down to business:

1. Know that you will have an orientation to the hospital that you will be working in. They will show you the equipment that is commonly used on the units. They will have a one on one workshop in order for you to master each piece of equipment. This will be done before you even get to the unit. You will be introduced to Plum or Abbot Pumps, you will be shown how to properly apply and release restraints. You will know how to run blood sugars. You will also be in a computer class to learn how to put in orders and read orders.

2. When you get to your unit, you will be paired with an experienced nurse. They will not let you work on your own until both you and your preceptor are comfortable with your knowledge and performance. Take a small notebook with you and write down the things that you learn. You may think that you will remember, but you will be not only in "hospital shock", but will more than likely also be in "culture shock". You will suffer from brain overload. Each day when you go home, take out your notebook and review what you learned. Take your textbook out and compare that to your notes. Add any additional notes from your text to your notebook. Typically, adults need to see/hear/write the same thing 3 times in order for it to be committed to memory.

3. When you are on the unit, take a good look at the MARs for your patients. You will see a pattern of the most commonly used drugs for med/surg patients. Write them down and then take your drug book and study them when you go home.

4. ASK QUESTIONS. No matter how silly you feel asking, it is the safety of your patients that should be forefront in your mind, not how dumb you feel asking the question. Other nurses will respect you for asking.

5. Getting the "gut feeling of nursing" as you describe comes with time. There is nothing that will serve as a catalyst. Experience takes time, and it will come to you. When you are learning, the KEY is not to panic. You may think that you are not catching on quickly enough, but it is easy to let anxiety take a firm grip on your mind that will surely cloud and stunt your learning. Take it easy on yourself. If you weren't bright enough to be a nurse, you would have failed the NCLEX. You have already proven that you have what it takes to be a nurse.

6. Do NOT bring any anxiety with you to an interview. Do NOT say that you are lacking in clinical skills. You will be trained, so let this thought leave your mind. Go into your interview dressed professionally and bring a copy of your resume with you. Smile, be confident and hold your head high. You have the credentials, the education and now you must have the confidence.

I would suggest applying for a position in a med/surg floor. This will be a wonderful building block for you. It can be crazy and hectic, but that just comes with the territory of nursing. If you want to study more, focus on the med/surg portion of your text. This is a great basis for most nursing.

Take some of that anxiety away! What do you enjoy doing on your time off? Have some fun-you deserve it! You must MUST release that anxiety, because that is your biggest hurdle.

Good luck to you! I hope that you are able to land a job without too much time passing. Where are you applying? The job markets are variable right now, so get those resumes out!


239 Posts

In Arizona one of the community colleges is now offering a Nursing Continuing Education Track of courses that are targeted towards the new-grad student. The course design allows students to take a core group of classes that are based upon the new-grad orientations programs in the valley and include QSEN competencies of quality and safety. Students may also choose a specialty track (like OB or Critical Care) to get training in an area they have a specific interest in pursuing.

Maybe your area offers something similar?


15 Posts

hey yeah! there are some really good posts clinical (and I am not a foreigner) was weak too, I thought. Your clinicals don't make you proficient, they just introduce you to the skills. That is why hospitals want experienced staff, and that just takes time and practice. Please don't worry--well, worry some, because that will keep you learning, but we don't come out of nursing school perfect nurses. I'll keep you in my prayers, and I know you will be a great nurse.


65 Posts

Has 2 years experience.

willowRN, I agree with the previous posters. I would also encourage you to address your anxiety issues with your doctor. Anxiety can have a negative impact on your ability to focus, memory issues, etc., but it is treatable. Congratulations on passing your NCLEX. I hope that you will find nursing to be a satisfying career. I think it's a very honorable thing that you are doing to help support your parents and siblings. Best wishes to you and welcome to the world of nursing.:nurse:

canesdukegirl, BSN, RN

8 Articles; 2,543 Posts

Specializes in Trauma Surgery, Nursing Management. Has 14 years experience.

Oh, and Willow, I forgot...:hug:big hugs to you, sweetheart!


65 Posts

Has 1 years experience.

Don't feel bad, I think most new grads feel the same way, unless you went to the best school in the world and have faced every clinical situation ever, so that would be impossible. You will be quicker once you have experience and you start getting the hang of things. Pay close attention on orientation and don't feel bad asking too many questions. Good luck!


78 Posts

Hi willowRN,

I can sense what you're going through, as I am a new grad myself who started working. I wish every health care facility that is willing to hires new grads would also offer a solid orientation-- this is not true at the moment.

*Protect yourself (PPE when necessary) even when the health care facility may be pressuring you to do otherwise in order to be more cost efficient.

*Introduce yourself and maintain a straight face. Therapeutic communication was something I took for granted in school but is now useful in practice.

*Check name, another identifier (DOB, MRN, etc), and allergies. Finding out allergies is especially important because most of our job will involve drug administration or some kind of physical task that *may* cause an allergic rxn. With the breakthrough of hospital computer systems, there will be a quicker way to screen for potential allergic rxn and drugs but for now, it will still take some investigation on our part.

*Sterility vs clean-- Sterile procedures will take a little more time for organization and set up the first few times.

*Always document.

*Verbal orders. be assertive. if the providers don't put it in, you don't do it. (unless its an emergency... but this is still a grey area...)

*Don't let anyone rush you or compromise safety (many experienced nurses have reiterated this)

*try to learn the same skill from different people to gain perspective.

These principles apply to almost every situation. I am having a difficult time too during my first year but I think this is just part of the process of developing as a nurse. growing pains!