Is my (50K) BSN worthless?

[boxofrain]

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.

[Wuzzie]

“I will say that my ABSN clinical instructors said they felt the ADN (2 year RNprograms) did a better job of teaching skills than most BSN programs. However, skills are only one part of being an RN. Many hospitals will now only hire BSN RNs, so I'm not trying to stir up a debate here. “

This was your statement. It’s pretty clear by the last part what your meaning was. It seems from what you said that you are of the opinion that ADN programs are better at teaching skills at the expense of other important aspects of nursing. I was simply pointing out that ADN/Diploma programs do not just teach skills. Heck an above average monkey could probably be taught some of the things we do. ADN/Diploma nurses are also taught the theory, physiology, pathology, EBP and critical thinking associated with the skills they are learning just like BSN students. The structure of ADN/Diploma programs and perhaps their smaller size often permits more actual hands-on time with patients which likely explains what your instructors observed not an absence of a thorough education. You’re right, it’s not just technical skill that makes a good nurse anymore than it is excellent academic aptitude or the right personality. It is the entire package. The educational format one chooses matters not. That doesn’t mean if you suck at IVs you aren’t a good nurse or if you are technically skilled you’re lacking in a more broad knowledge base. It means we each bring certain strengths and weaknesses to the table and hopefully we are able to find a place that both celebrates and stretches us as the nurses we are.

[FullGlass, BSN, MSN, NP]

1 hour ago, Wuzzie said:

“I will say that my ABSN clinical instructors said they felt the ADN (2 year RNprograms) did a better job of teaching skills than most BSN programs. However, skills are only one part of being an RN. Many hospitals will now only hire BSN RNs, so I'm not trying to stir up a debate here. “

This was your statement. It’s pretty clear by the last part what your meaning was. It seems from what you said that you are of the opinion that ADN programs are better at teaching skills at the expense of other important aspects of nursing. I was simply pointing out that ADN/Diploma programs do not just teach skills. Heck an above average monkey could probably be taught some of the things we do. ADN/Diploma nurses are also taught the theory, physiology, pathology, EBP and critical thinking associated with the skills they are learning just like BSN students. The structure of ADN/Diploma programs and perhaps their smaller size often permits more actual hands-on time with patients which likely explains what your instructors observed not an absence of a thorough education. You’re right, it’s not just technical skill that makes a good nurse anymore than it is excellent academic aptitude or the right personality. It is the entire package. The educational format one chooses matters not. That doesn’t mean if you suck at IVs you aren’t a good nurse or if you are technically skilled you’re lacking in a more broad knowledge base. It means we each bring certain strengths and weaknesses to the table and hopefully we are able to find a place that both celebrates and stretches us as the nurses we are.

My apologies for the misunderstanding. I was paying ADN programs a compliment! They are often better at teaching skills. I was in no way trying to say or imply that they are less able to teach the rest of nursing.

Personally, I think community colleges are a great resource and unfortunately, often underrated. The professors are generally better teachers than because they are there to teach, not do research.

I just didn't want to stir up debate about ADN vs BSN. For better or worse, more and more hospitals are requiring a BSN. So my advice to a future nurse is to get the BSN, but starting with an ADN then doing a bridge to BSN makes a lot of financial sense for many people.

[boxofrain]

Many, many thanks for all of your thoughtful suggestions and insights.

In answer to the question about clinical rotations, again, my education was woefully inadequate. Technically, the number of required hours was attained, it's what passed as "clinical" hours that is lacking. I think I stated earlier that I only actually went to the hospital three times during my OB rotation. One of those times we were sent home earlier because there was nothing going on. That rotation was supplemented with sim lab hours. In peds, the entire rotation was more like observation since we weren't allowed to pass meds. This was at one of the top hospitals in my area (also in the entire nation.) I was determined to make the most of it, so I attached myself to the preceptors hip and spent much time chasing her down when she disappeared. I was actually very proactive in all of my placements in this regard. At one point, I asked another preceptor if I could observe a procedure. The instructor happened to be there and she yelled at me, saying, "you don't ask her; you ask me." I just apologized and said it wouldn't happen again, when I knew full well it would happen again. There's no way I would have gotten even the small experience I did without being assertive on the floor. One more thing I will say about clinicals. I know that the school needs some kind of metric on which to grade students, but I feel that way too much time is spent on care plans. The time I spent copying information, since I couldn't print anything out, was precious floor time I could have spent honing my skills.

I did voice my concerns when I was still in school, saying that I didn't feel like I knew what I was doing. My instructors told me "oh, those are things you'll learn on the floor." Not sure if I believed them even then.

Regardless of what got me here, I have to press forward with what skills and knowledge (and hopefully, at least a little wisdom) I do have. I'm trying to pursue some ambulatory care positions and considering school nursing. Also wondering if the universe is telling me it's time to pursue my NP. Again, many, many thanks for all of your thoughts. Keep them coming if so inclined.

[Wuzzie]

13 hours ago, FullGlass said:

My apologies for the misunderstanding. I was paying ADN programs a compliment! They are often better at teaching skills. I was in no way trying to say or imply that they are less able to teach the rest of nursing.

Accepted and thank you for clarifying. As you know it is a touchy subject. Nobody, regardless of their educational pathway, wants to see a new grad crash and burn (unless they are just a nasty human to begin with) just to prove that one way is better than the other but for those of us who have been around awhile it's hard to watch our new grads have increasing struggles and not see them as a result of the changes in nursing education. I, for one, think students are being short-changed and frankly if affects everyone.

[NurseJamillah, MSN, NP]

4 hours ago, boxofrain said:

Many, many thanks for all of your thoughtful suggestions and insights.

In answer to the question about clinical rotations, again, my education was woefully inadequate. Technically, the number of required hours was attained, it's what passed as "clinical" hours that is lacking. I think I stated earlier that I only actually went to the hospital three times during my OB rotation. One of those times we were sent home earlier because there was nothing going on. That rotation was supplemented with sim lab hours. In peds, the entire rotation was more like observation since we weren't allowed to pass meds. This was at one of the top hospitals in my area (also in the entire nation.) I was determined to make the most of it, so I attached myself to the preceptors hip and spent much time chasing her down when she disappeared. I was actually very proactive in all of my placements in this regard. At one point, I asked another preceptor if I could observe a procedure. The instructor happened to be there and she yelled at me, saying, "you don't ask her; you ask me." I just apologized and said it wouldn't happen again, when I knew full well it would happen again. There's no way I would have gotten even the small experience I did without being assertive on the floor. One more thing I will say about clinicals. I know that the school needs some kind of metric on which to grade students, but I feel that way too much time is spent on care plans. The time I spent copying information, since I couldn't print anything out, was precious floor time I could have spent honing my skills.

I did voice my concerns when I was still in school, saying that I didn't feel like I knew what I was doing. My instructors told me "oh, those are things you'll learn on the floor." Not sure if I believed them even then.

Regardless of what got me here, I have to press forward with what skills and knowledge (and hopefully, at least a little wisdom) I do have. I'm trying to pursue some ambulatory care positions and considering school nursing. Also wondering if the universe is telling me it's time to pursue my NP. Again, many, many thanks for all of your thoughts. Keep them coming if so inclined.

Were you working day shift? I just completed my 1st year of nursing on a busy med-surg (mostly surgical) unit, and we were required to rotate off-shift, as needed. Although it would have been difficult for me for a few reasons, I think I would have had a much less stressful 1st year if I'd just stayed on overnights the whole time. Not to say that it's "easy", but on my floor, there were less "moving parts", so to say, than on day shift. For instance, there were less meetings, less phone calls, less family visits, fewer medications to pass (on my unit), we didn't have to make sure our mobility-limited patients ambulated every 1-2 hrs, or were up in the chair for meals (which can take a lot of time if you get that patient cleaned up, and into a chair, and then they immediately have a bowel movement, so you have to move them back into bed to clean, then back into the chair).

Also, were you full-time? I started off 5 days, then went to 3, and I found that I not only had (obviously) less learning opportunities, but I had more time in-between re-performing newer skills. There were certain skills that I only performed once every few weeks (which may have been performed weekly, had I been working 5x/week).

I know there are a lot of people saying that skills alone doesn't make a "good nurse", but as novice nurse, stress surrounding skill performance might hinder all else. And without experience, we have to rely only our critical thinking (which can be a timely process if you have anxiety, and/or are not confident). Personally, before I was good at my basic nursing skills, each task took more time, added more anxiety, and can made me less confident. Once the skills were just muscle memory, I could multitask -- using my hands, while thinking critically.

[Oldmahubbard]

I had no intention of working OB, so my very limited experience there was not an issue. Same with peds.

I studied very hard to understand the usual adult diseases that result in hospitalization.

But I had no actual experience inserting a catheter or an IV.

Most of the important skills were soft skills. Working with other people, calling doctors.

Ironically, one of the many reasons I left- people with acute pain after surgery 3 decades ago only got tylenol.

I disagreed with it, but only a few years later anybody with a little back pain was getting oxycontin.

Now we see the results.

[peaceluvandnursing]

Chin up Buttercup! You sound like a very good nurse to me....you just have to keep swimming.

I think we can all relate to how difficult bedside nursing is...whether as a new grad or learning a new specialty. Your biggest asset is you are AWARE of your weak areas and want to improve.

I think the 16 month accelerated program didn't adequately prepare you for real life at the bedside. NOT your fault. My own NP program, even though a private, expensive school, had "a weekend" of skills practice before sending us out into doctors offices and clinics. OK, student NP, perform this pelvic exam. Uh...say what?

So back up and regroup. Look high and low for a place that has a true New Grad internship or residency program. Not just an orientation or on-boarding period. They are paid positions and can last from 1-2 years and are centered around teaching you the skills to succeed, not weeding out "bad nurses" . They are often listed on career boards as HR assigns them a position number just like any other job. I don't know your story is as far as portability, but any medical center associated with a College of Nursing or Medical School is a good place to start. Don't waste your time with a company who helps you locate a program and charges a fee for this service...watch out for these bad boys!

Two more words: Critical Thinking. If at the end of the day you can't identify where you used critical thinking that day, it could be hard to be a bedside nurse. Trust me, Nursing 101 I was clueless! But I quickly learned that I use critical thinking every time I come in contact with a patient and with experience this only grows. I guess that is why I stay.

Good Luck, You can do this.

[Homecarenurse61]

Do NOT give up on nursing. There are many many great jobs that are NOT bedside. Trust me, in you future years you will realize this. Yes, definitely get another bedside position to get the experience, but after a year try to seek different areas of nursing. This is why nursing is so great. If one shoe doesn't fit, there are 50 more that you can try on. Check out home care nursing after a year of clinical. You will probably fall in love with it. After many years of nursing I have found a niche and work 3 jobs and make $185K a year and work less than my friends that have 40 hr/week day jobs. And I only have an Associates degree. So with a BSN you could probably do even better than that. The possibilities are out there. Good luck

[Kooky Korky, BSN, RN]

On 10/15/2019 at 5:23 AM, 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...

There is something in between all or none.

What, specifically, were you not helping enough with? The boss should give you some specifics. You could pose the question of balance when it comes to how to delegate and how to do RN-only tasks. And as a nurse who is still fairly new, are you expected to be totally up to speed by now?

Make the boss give you some specific suggestions/answers/examples. Not in an angry, accusatory approach from you, but tell her you need some concrete examples and suggestions/pointers.

[Nurse Beth, MSN]

There are nurses who are not a good fit for the acute care and rehab settings. It just causes them pain and disappointment to keep struggling.

You are wise to consider alternative roles and you sound well-suited to academia or research ?

Best wishes

[smc5127, BSN, CNA, RN]

HELL NO, thats bare minimum here in the NY tristate region. If you're an ASN you have to be in a program to bridge to BSN within the next year. ASN nurses don't get hired here anymore.

[NurseCocoBSN, BSN]

It sounds like the last position let you go because they didn’t like you. I’m not saying that to be mean, i literally just lost my dream job because they didn’t like me. I got injured, didn’t qualify for FMLA and even though the hospital offered non fmla leave they told me they weren’t going to offer it to me.

The worst part about that was i KNOW i was doing damn well in that speciality. I was picking it up, and it was everything i had hoped for. I had given up a per diem on another unit in that hospital that i enjoyed, but made the move because i had always wanted that speciality.

I don’t think I would discount your skills at this time.

Let me ask you, did you LIKE working on the floor?

I’m a little confused about this last job, though. Was it a rehab? Transitional care? Regular med surg? A ratio of 6:1 without knowing shift could mean any of those.

I know plenty of people are trying to push you out of acute care in this thread, and maybe I’m reading it wrong, but you don’t sound like you want to leave acute care yet. I truly think a regular, med-surg/tele or tele unit might work for you. Tele in a lot of places usually has better ratios because the patients are monitored.

As someone who did travel nursing and has worked everywhere from med surg to the ICU, while occasionally some nurses do ok with an immediate specialty, most do not. Or they only ever do that one speciality until one day they can’t and they have no actual basis to go from. Also, generally, they’re not up to par with their peers. Straight to specialty nurses also fall the heck apart when they’re pulled to any other unit, without fail.

And? There is such a thing as being OVER prepared. You cannot plan your day out. You can think, ok “go in, meet patients, grab meds, assess and pass med, NEXT !” But aside from that? You can’t plan your day until you see an assignment. You need to prioritize based on that assignment. If youre not in a 100% nursing care facility, if you're on orientation you shouldn’t be spending 30 minutes in rooms with falls risks. That is what you PCTs are there for. When you’re not on orientation, different story.

I don’t think you should give up on acute care yet. I think you’ve got it in you.