Is my (50K) BSN worthless?

Nurses General Nursing

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Long, sad story. I graduated from BSN program as a second-career nurse in December, 2017. Passed NCLEX in 75 questions in Feb. of 2018; secured first job in ICU at a Level I trauma unit in a residency program summer 2018. Was asked to leave program after 2.5 months on that job, with management saying that ICU is too difficult for a new grad nurse. Took psych job at small, poorly run standalone facility and worked 50+ hours/week, was assaulted, had 20+ patients at times. Was offered and accepted dream job at a highly reputable rehab hospital in the specialty I've always wanted. Did not make it through orientation here either. Manager and one of the preceptors stated that maybe I'm just not cut out for floor nursing.

I came into this job with almost no bedside experience. I arrived for 6:30 a.m. shift at 6:00 a.m. every day. I lived, ate and breathed this job, spending all non-working time reading about disease pathophysiology, watching YouTube videos on suctioning and IVs (just to name two, there are many skills with which I had no experience) designing shift report form and tightening up med pass procedure. For many of these, I actually acted out the processes just to get some muscle memory. All to no avail. One preceptor remarked that I was "passionate" and "the most hard-working person I ever met," but, something just wasn't "clicking" and I wasn't "making connections." She also said that she loved my inquisitive nature, hinting maybe I should try research.

Here's my question. Are there really some people who just can't do bedside nursing? I don't want to appear as bitter arrogant, but, come on, this isn't rocket science. This most recent dismissal happened a week ago and I'm working hard to gain some perspective and insight. I would definitely look to other areas of nursing, but it seems most want at least 1-3 years bedside experience. Where do I go if I can't manage that?

Any guidance would be much appreciated.

Specializes in Clinical Research, Outpt Women's Health.

Public Health Nursing?

I did my ADN at a CC decades ago, and our clinicals were 95% observation, or shadowing. In no way were we caring for patients.

The hospital used to hire RN students as nurse's aides. I did this one summer and then 1 or 2 evenings a week. It helped somewhat.

I knew I wasn't going to like the bedside, and I didn't. I did it just long enough to get the basic hang of it, then went into home care.

Home care then was a completely different animal than it is now.

On 10/10/2019 at 1:29 PM, boxofrain said:

5. YES. I had every day planned in advance, but the things I mention above reared their ugly heads. Additionally, I'd get sucked into a patient room (say to take them to the bathroom) and end up spending 15-20 minutes there since they couldn't be left alone.

6. I probably do lack confidence, but I never hesitated. I always asked to do the things I needed work on. For example, I let the PCTs know that I wanted to do all of the lift transfers or all of the straight caths just to get the experience.

You clearly have the drive to be a good nurse and it sounds like a good work ethic. From these responses, it looks like maybe you need to "work smart" instead of "work hard" going forward.

One of the hardest things for me to do was learn NOT do everything for patients. It's not that I feel I'm above a toileting a patient or doing a lift transfer. It's that unlicensed staff CAN do those things but they CAN'T do the other things that require an RN (check results, call doctors, give meds, etc.). If I have time, I actually love to do patient care, but now I try to wait until after my first med pass is done and the pressure to be "on time" lets up. I need to know I have the time available before I start a time-intensive task that can be delegated.

It's easy to get sucked into a patient's room, and it's happened to me many times; let's face it - no one wants to say no to a patient who asks to go to the bathroom. What I started to do is to call my aide on the phone or just push the call light which rings through to the aide. I let him/her know that this patient needs to use the bathroom. Then even if I get the patient up, I know someone will be there to relieve me, wait with the patient, and get him/her back to bed safely.

Doing all of the lift transfers, while a good way to practice a skill, is probably not something you have time for. You are the RN, and you need to delegate. It's hard. I know my CNAs are better at lift transfers than I am. They're also faster at EKGs because they do them all the time. If I need something STAT and the aide is not available, I CAN do those things, but it's not a priority for me to practice them over and over when I have things to do that the CNAs can't do.

Now you are the RN, not a student. Yes, you are learning things, but your primary goal is not to learn. Your primary goal is to see the patients' needs are being met. Doing all the straight caths on the floor just to get the practice is a student nurse mindset. As an RN, if you're off doing all the straight caths, that means you're probably not doing other things that your patients need you to be doing. The longer you're there, the more straight caths and lift transfers you'll do; you don't have to go looking for those opportunities - they'll come to you.

1 Votes
7 hours ago, turtlesRcool said:

One of the hardest things for me to do was learn NOT do everything for patients. It's not that I feel I'm above a toileting a patient or doing a lift transfer. It's that unlicensed staff CAN do those things but they CAN'T do the other things that require an RN (check results, call doctors, give meds, etc.). If I have time, I actually love to do patient care, but now I try to wait until after my first med pass is done and the pressure to be "on time" lets up. I need to know I have the time available before I start a time-intensive task that can be delegated.

I tried to delegate and was told that I wasn't helping the PCTs enough, so I went back to doing all the patient care myself. I really felt like I could not get a break at this facility. Every move I made was wrong...

2 hours ago, boxofrain said:

I tried to delegate and was told that I wasn't helping the PCTs enough, so I went back to doing all the patient care myself. I really felt like I could not get a break at this facility. Every move I made was wrong...

If you're doing all the patient care, what are the PCTs doing? I mean, I help, but I don't take over patient care or I'd never get anything else done.

If I do something that is usually part of their routine, I chart it and give them a heads up so they don't duplicate it. Like I usually do a full set of vitals in the morning because most people need cardiac meds and I need to check HR and BP anyway. So by checking temp and pulse ox while I'm there, I eliminate the need for the PCTs to do a set on my patients until the afternoon. It builds goodwill and gives the aides back some time to do other things. If I'm with the aide for a two-person transfer to the commode, I'll make sure to chart the output so the PCT doesn't have to later. Little things like that can take some of the pressure off the aides but without the time-suck that comes with doing the bulk of personal care myself.

Specializes in Psychiatric and Mental Health NP (PMHNP).
On 10/14/2019 at 3:50 AM, Wuzzie said:

You do realize that skills are not taught in a vacuum?

Yes, and thank you for proving my point. A nurse can be the best at skills, but still not be a good nurse.

Specializes in Psychiatric and Mental Health NP (PMHNP).
On 10/13/2019 at 9:07 PM, Susie2310 said:

Number of clinical hours and number of patients is not a complete measure by itself. One could have a relatively large number of clinical hours but it is important how much of that clinical time is spent providing actual hands on bedside nursing care under the supervision of one's clinical instructor/preceptor and also what types of nursing activities are performed.

I doubt that anyone would disagree that no-one is 100% prepared coming fresh out of school and that isn't the focus of this discussion.

Those "skills" are a lot more than just step-by-step actions; many require considerable knowledge of not just the procedure but relevant aspects of the patient's medical condition, involve significant clinical decision making to perform correctly and safely, and incorporate using the Nursing Process.

1. I am simply responding to previous posts that suggest that current RN grads are somehow less prepared than in the past. I also responded that at least at my school, RN students had complete responsibility for caring for up to 6 patients at a time. It wasn't shadowing.

2. With regard to skills, I agree and thank you for reinforcing my point. Skills alone do not a good RN make

Specializes in Psychiatric and Mental Health NP (PMHNP).
On 10/13/2019 at 9:41 PM, MunoRN said:

It's not the number of clinical hours that varies, that's fairly standardized, it's the rate of progression that occurs.

Some programs expect their students be taking a full load with a preceptor only observing them by graduation, some programs have students only taking a portion of a regular patient load.

At least in my area, this a result of differences in the ratio of students to clinical opportunities between ADN and BSN programs. The main BSN program has it's own affiliated medical center which as almost twice as many beds as the hospital the ADN program uses, but the BSN program has just over 10 times as many students. As a result, while the ADN students are paired 1:1 with a precepting nurse at their clinical rotations and are starting to provide care 'independently' in their first year of the program, the BSN students are 8 students to 1 preceptor for most of their first year and don't get anywhere near as much opportunity to progress to becoming and independently practicing nurse.

As far as skills go, it's actually a completely different issue than skills. Knowing how to place a foley or start an IV is an extremely small part of learning how to manage multiple competing patient priorities and needs through hands on experience.

I agree with you. My issue are the the blanket statements on this forum by some posters that basically new RN grads all suck.

When I was an RN student, and then an NP student, I made the mistake of reading this forum. It caused me a lot of needless anxiety.

A lot of the comments on this forum, not just on this thread, are akin to the old codger proclaiming, "When I was a young 'un, I had to walk 5 miles to school each way in my bare feet, over a bed of hot coals. blah blah."

Based on many comments I have read on this forum, I could update this to: "When I was a new grad RN, I knew EVERYTHING the minute I started my first job. I could manage 12 patients, insert a catheter and start an IV simultaneously with juggling 3 juggling balls, and I never ever made a mistake or needed to ask a question."

We should be supportive of new grad nurses, not constantly run them down.

2 Votes
28 minutes ago, FullGlass said:

Yes, and thank you for proving my point. A nurse can be the best at skills, but still not be a good nurse.

It doesn't prove anything at all other than you didn't grasp what I was saying.

2 Votes
Specializes in Psychiatric and Mental Health NP (PMHNP).
1 hour ago, Wuzzie said:

It doesn't prove anything at all other than you didn't grasp what I was saying.

What are you saying? That a nurse who is great at skills but sucks at everything else is a great nurse?

Some people struggle with the physical mechanics of skills. That is what I am addressing. I was one of those people. I certainly understood everything else, but I was slow to learn skills and needed extra practice. Yes, I understood the context. Such people need extra time and practice or they may pursue an RN position that doesn't require those skills.

Let me tell you a little story: My first semester of nursing school I was paired with 2 idiots who had been CNAs or "techs" prior to nursing school in a lab class to learn skills. Well, they already knew how to perform some of those skills, while I was a slow learner in that regard. They endlessly mocked me and tried to make my time in the lab a living hell. Given that they were very young and also acting like they were about 12 years old, they were shocked that I stood up to them, complained, and they ended up being strongly reprimanded. They ended up not doing very well in school, and also ended up not having many friends because of their bad attitude. BTW - I ended up being quite good at skills - it just took me longer to get there.

So don't assume someone who struggles with skills doesn't understand context. And just because a nurse is good at skills doesn't make them a good nurse.

Wow that’s quite a leap there and not one bit accurate. It’s pretty presumptuous of you to put words in my mouth. When you’re ready to have a calm dialogue minus the accusations and histrionics let me know.

Specializes in Psychiatric and Mental Health NP (PMHNP).
36 minutes ago, Wuzzie said:

Wow that’s quite a leap there and not one bit accurate. It’s pretty presumptuous of you to put words in my mouth. When you’re ready to have a calm dialogue minus the accusations and histrionics let me know.

So what are you trying to say? Please clarify.

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