I feel like nursing school didn't prepare me for work

vintagemother, BSN, CNA, LVN, RN · Mar 27, 2016

Timeis and Kristier, I'd like to reply to your comments in post #59.

My school tries very hard to teach us to become excellent new grad RNs. One of the ways that they do this is by expecting us to pass all meds and complete most of the daily charting for 4 pts by term 3.

I hate it!! In my opinion, I'm not learning how to do these things well, I'm learning how to do them in a manner that makes my school happy. For me, it's too much.

I recall I was taking on 3 pts at the beginning of term 3, because I wanted to. The floor nurses were satisfied with my work. I charted and passed meds according to facility policies. I was proud of myself, lol!

Then, I found out that my school expects us to write 6-13 page papers each week. I found out that most students who were getting good grades were doing the paperwork at the facility.

(My instructors are oblivious to the fact that students duck and dodge pt care to complete the school's paperwork)

Now that I understand that my grade is based on paperwork, I've had to change the way I do things at clinicals.

I think it's too much to expect all students to take my on almost a full pt load and do clinical paperwork.

Just my 2cents.

Kristiernbsn · Mar 27, 2016

Timeis and Kristier, I'd like to reply to your comments in post #59.
My school tries very hard to teach us to become excellent new grad RNs. One of the ways that they do this is by expecting us to pass all meds and complete most of the daily charting for 4 pts by term 3.
I hate it!! In my opinion, I'm not learning how to do these things well, I'm learning how to do them in a manner that makes my school happy. For me, it's too much.
I recall I was taking on 3 pts at the beginning of term 3, because I wanted to. The floor nurses were satisfied with my work. I charted and passed meds according to facility policies. I was proud of myself, lol!
Then, I found out that my school expects us to write 6-13 page papers each week. I found out that most students who were getting good grades were doing the paperwork at the facility.
(My instructors are oblivious to the fact that students duck and dodge pt care to complete the school's paperwork)
Now that I understand that my grade is based on paperwork, I've had to change the way I do things at clinicals.
I think it's too much to expect all students to take my on almost a full pt load and do clinical paperwork.
Just my 2cents.

Wait -- you're writing 6 papers per week? Or a 6-13 page paper per week?

We have to write a care plan on our one patient every week, and of course keep up with all the work in our didactic classes which are tough classes, but not paper-based. They're 80% tests, 20% class participation. I'm probably the only student who sees the value in care plans-- they make me think through the interventions and rationales which has been invaluable learning. Writing them isn't the same as studying ones that the hospital uses. As I stated, in answering the nursing instructor's question, what I see as important that I'm not getting, is SKILLS. I have started not one IV or a single catheter or even done a bladder scan on a patient, no matter how much I beg for the experience. I shadow the nurse who is assigned to my patient, but unless our patient needs a procedure, we aren't allowed to do it. If it's on another patient, even if it's with the nurse I'm shadowing, our instructor has to be there, and it's whoever she decides that gets it-- which is never me. And no, I don't do my paperwork at the hospital, I spend late nights and weekends doing my homework and care plans, which is why I have good grades. We aren't allowed to look at charts on any patient we aren't directly caring for, due to HIPAA rules the way our school interprets them. I do look for opportunities, for example I follow the wound care nurse when she's on our floor, and she has let me change dressings and take care of drains (in secret, my instructor would flip out!) and I have followed the medical team on floor rounds and listened to learn about the actual pathophys. I have rounded with every specialist who lets me, including respiratory therapy, PT, and OT. I just want skills.

RCLPN · Mar 27, 2016

Hang in there

RCLPN · Mar 27, 2016

YES I got my license 5 years ago and I felt like I learned 95% of my skills and knowledge on the job. I felt like nursing school prepared me for taking NCLEX, but not for working as an LVN. It took me probably 1 1/2 years and 2 jobs as a med nurse until I felt like I was proficient as an LVN. The sad thing is I felt like I had to make so many mistakes, and that is how I truly learned how to do things. Good luck girl, hang in there, you're not alone! :)

I totally can relate. I got my license 6 years ago. The first 2 years as a med nurse were awful. I made mistakes as well. I also think not being trained properly and the short orientation I went through set me up for failure.

RCLPN · Mar 27, 2016

Nursing SCHOOL is to gain KNOWLEDGE for TESTS...not a work-study kind of program. Not on-the-job training. That's why you get orientation when you get a job....AND you will still learn things most days of your career.

I know of other nurses as well as myself that were not given a proper orientation. Especially towards new grads. This just seta them up for failure

RCLPN · Mar 27, 2016

Nailed it!

RCLPN · Mar 27, 2016

I think a lot of the anxiety and self doubt that comes with being a new nurse can be due to the very short term orientations that some employers given to a nurse-even knowing that the nurse is a new grad.
Things have changed a lot since I've become an LPN. At that time, many LTC facilities wouldn't hire us unless we had experience, and many of us started out in a hospital. The typical orientation was 6 weeks full time with a preceptor. Now, most hospitals won't hire LPNs and the typical orientation for a new RN is 12 weeks-at least where I'm located (graduating from an RN program next week, I've done my research). As for typical LPN orientations in LTC facilities here- I trained (well, attempted to in the time and crappy staffing conditions that the place had) a new grad in the same amount of days that a seasoned LPN got with the facility-3 days- and then she would be on her own with no other licensed staff on site for guidance. I can tell you that if that was me when I first started I wouldn't have been able to do it. If a home health company were to 'train' for private duty it's typically a few hours with the nurse who has the patient that day when you meet the patient.
If if someone is lucky, they find a place that is willing to invest the time/money to help them adjust from the student to the assigned nurse role. With the competitive job market today though, those opportunities aren't as abundant as they were years ago.
Hang in there. You've made it this far and each day you will become more confident in your skills and critical thinking abilities. A little bit of fear is good- it can help keep you alert to what could be going on with a patient that overconfidence may miss.

Nailed it

sweetsthrnsass · Mar 27, 2016

I am a nursing instructor so I am very interested in knowing what parts of your job are making you feel unprepared.
While I do prepare my students to pass NCLEX I also want to make sure that they can care for patients safely.
I would like to use your specific feedback to make my clinical better for students.

Hi timeis!

So I'm going to be graduating in May from a BSN program. I just got a job in a 118 bed Level IV NICU, so that's an insane amount of stress as is. I don't feel prepared but I'm also not worried yet because I do pick up on skills quickly and am going to be at a fabulous teaching hospital.

My BIGGEST concern is that I literally have no idea how to chart or document. I've asked and asked but haven't been able to get a good answer. I have never worked with a nurse that even uses NANDA or makes their own care plans so asking them for help is pointless. Charting and documenting are something I highly recommend focusing on at the beginning of a new nursing cohort semester. I spend so much time making care plans but if I don't need this for my job, what's the point? My community health nurse professor didn't even know what NANDA was and didn't know we still had care plans.

I'm now in Transitions which supposedly prepares us to have a real job but that's a big fat joke. I'm taking two other classes along with this one that has 12 hour shifts. I have clinicals for three classes, exams, projects, assignments, plus my other obligations. How is this transitioning me to become a nurse? Except maybe teaching us how to survive on minimal sleep and a bag of chips.

I know none of this is your fault nor is it my professors, it's the program. But this is the perspective of my class at the very least. I hope something is helpful to you in better preparing your students!

And Happy Easter!!

Gem1984 · Mar 27, 2016

I am a nursing instructor so I am very interested in knowing what parts of your job are making you feel unprepared.
While I do prepare my students to pass NCLEX I also want to make sure that they can care for patients safely.
I would like to use your specific feedback to make my clinical better for students.

Well, I don't think it was really an instructor issue as it was a program issue. Most of my instructors were great. The problem was, as others have stated, the actual clinical setting. We had lost a few clinical sites and had more students than some of the sites allowed at time, so that meant shorter days so that they could split the group, or more time at one clinical site that didn't really allow us to do much but allowed more students at a time. We had clinical days that we spent in the lab, or with other departments where we were pretty much just shadowing. I got to do more during leadership because I was at obe of our hospital sites but when I say, more it didn't really include more skilled work, it was just less shadowing. I passed meds and got vital signs, along with assessments. No IV starts, foley insertions, trach care, nothing. None of my patients had much going on. I wasn't allowed to chart much, and the things I did, was just point and click. Not much complete sentence style documentation.

So with that being said now working as an LPN, I found it hard to chart, initially. In terms of skills, I feel really rusty, because I either only did things in lab or read about them. Just that overall comfortability, one gets when they have been able to "practice" something is not there, since I mostly shadowed nurses during clinicals.

At the end of the day, I know with time I will strengthen my skills and become a better nurse but with the stress of having a new job, being a new nurse, and then not feeling prepared it makes sone days harder than others.

So really I would say if you have good clinical sites that allow your students to take on more than one or two patients and to do more than just shadow, they should be fine. I would also suggest asking students reviewing common skills once per week, if the students have said they have had no chance to do certain things or only one chance, all the way up until graduation. There was so much learned in our fundamentals and first semester that we pretty much never looked back on, that I think would have helped. LPN school is just different in comparison to RN programs anyways because its typically a 12 month program compared to 2 or more years for RN.

Gem1984 · Mar 27, 2016

One thing I think that's different from clinicals and real world is the huge shift in number of patients one is responsible for. In my current clinicals setting, I have one patient. Capstone students get 2. The nurses on the floor where I am have 5 or more. I don't know what level Gem has graduated from (ADN or BSN) but in my BSN program, I'm competing with several other students for procedures, so I might never get to place a Foley or start an IV. And yes, I am very proactive and vocal about wanting the experience-- and I am a straight A student, I just always seem to be the one who hears "next time". So far, my patients haven't needed much of anything except a few meds and a backrub, so I have done very little. I have had lots of time to talk to them, though and I have learned a lot, but I am in my mid-50s, and I have worked in nursing as a LPN, so I have done a lot of the TLC stuff already. I need some skills! It's mostly luck that determines it, but a clinical instructor who plays favorites (like mine seems to do) can ruin your experience. Even in checkoffs, I got one kit to practice with, one to check off. Hardly enough to get to feel comfortable with it. I'm sure Gem can add to this. That's my views--Thanks so much for asking!

Im an LPN, but your program experience seems quite similar to mine.

timeis · Mar 28, 2016

Great point! Skills like INT IV insert and foley are very hard to come by. I definitely look for them. This semester only one student successfully performed an IV start while others tried several times. Only one straight cath this semester too. The materials are expensive. When I was in LPN school we used the hospital supplies to start them on each other. This hospital we cannot do that unfortunately.

sweetsthrnsass · Mar 28, 2016

Just to clarify, are you talking about practicing skills in a lab or real patients? I had so many opportunities to start IVs and insert foleys and then some on real patients and the hospitals in my area are already stretched thin with nursing students.