Over the past 5years or so I have noticed an increase in anxiety in new grads and I am wondering if the shortened training is causing more problems for them.
When I trained admittedly I trained many many moons ago I trained a full 3 years in a hospital, I know we did not have such hightened anxiety that the new Grads seem to have at the moment.
We got no preceptorship or mentoring and after 5 weeks I was in charge.
Nurse training changed because we complained we weren't support at all and the powers that be wanted to give new grads more support and education, taking them away from the floor for long periods of time.
We were more annoyed that we had so much work to do and the expectations were you hit the floor running.
It seems no different today the new grads hit the floor running with less knowledge and experience.
I know here in America we pay for our education so we want to complete the education in the quickest way possible so it costs us less money in the long run.
It is now more expensive to train the new grads on how to nurse which is great if they actually get the support, mentoring and training for at least 3-6 months but longer if they need it.
It appears that in the nursing profession we can not get it right!
We cannot put all of the blame on nursing education, though. Rates of anxiety and depression among the general population, including nurses, has increased in the last few decades. People are more anxious and less secure.
I had extreme anxiety as a nursing student. It impeded my learning in nursing school. It had nothing to do with my nursing school or my education; it was me. Now, as a practicing nurse almost one-year into RN practice, I run codes on my own and I feel less anxiety each time it happens.
My point? Levels of anxiety and psychological disorders have increased in the last few decades and new grad nurses are effected by this, too.
I suppose I should feel lucky that (I don't think) there are any online-only RN programs. Because academia thinks technology can do EVERYTHING. This is an age that values quantity and expedience over quality time spent. There is no substitute for spending time doing something with your hands. You can't simulate that.
Good topic for a thread. I agree with most of what has been said here.
As schools have cut back their clinical hours, the students get less and less "practice time" ... and are therefore less prepared for the realities of practice. That's part of the concern that some of us have about "accelerated programs," totally online programs, etc.
And yet, when we express those concerns and advocate for longer, more indepth programs, we are called "elitist" or worse because students WANT short programs that don't require a lot of inconvenient clinical hours. We are told that we should welcome the graduates of programs that did not include clinical hours ... or that had most of their "clinical" time spent in a learning lab ... etc.
When we try to require that students "put in their time" at clinical, we are criticized for not suporting people who need to work while in school and/or who don't have the money to pay for longer, more in-depth educational programs.
For nursing education to do a better job at preparing new grads ... students will have to realize that the programs will get longer and that it might become more difficult to work while going to school, etc.
I think the problem is that schools are focusing not on clinical training, but rather on NCLEX pass rates. And you can be a dreadful practicing nurse and still do well on the NCLEX...such is the case with standardized exams.
In general, schools are turning more to a business model. For example, at my school (an ADN program) our entire curriculum is determined by a publishing company (Elsevier). This means that our exams, lectures, etc. are mostly determined by Elsevier. I imagine they did this so that they could have a numbers-based way of supporting their program and reporting their pass rates to the board of nursing -- and they could boast high NCLEX pass rates to get more students. In doing so, they have eliminated things like any sort of grade for clinical performance (which in a way causes students to just "get through" clinicals and labs and skills evaluations, because they aren't rewarded for doing those things well like they are rewarded for doing well on a multiple choice Elsevier test).
So I think it isn't just that the training is shorter. It is also that clinical performance is completely swept under the rug in favor of NCLEX pass rates and HESI preparation. I think back to my "Fundamentals" of nursing class...it was all about legal theory, communications techniques, and test taking strategies. As someone whose background was a BA in a non-medical field, I was baffled...3rd semester I asked my friend who had been an LPN "Um...are they going to teach us how to wrap a wound? Or when to start CPR on someone?" Surely, I could answer multiple choice questions where the right answer was "start CPR" and I think Elsevier/HESI considers that an "application" type question (ha!) but could most students actually feel comfortable *really* applying that? Probably not.
The emphasis is on theory and answering test questions right -- I fear that long-practicing nurses would be APPALLED if they saw what they didn't teach us in nursing school in terms of basics. I remember writing in my first semester evaluation that all I learned in fundamentals of nursing was how to answer NCLEX-style questions, and I really wish my teacher would have been able to teach us "actual" nursing. I gave up on arguing that point now that I'm about to graduate...our school has bought into this whole canned curriculum thing, and it's really unfortunate and scary to me that a person can be licensed based on what one publishing company finds pertinent.
I think the boards of nursing should stop accrediting schools that downplay real-time clinicals and skills in favor of NCLEX predictors and test-taking strategies.
:yeah:You hit the nail on the head. As a SN I dread clinical rotations. Not because I don't enjoy patient care (Pt interaction is a bonus for me), but because I feel like we don't have enough time to get our skills 'set'. This past semester (3rd, med-surg) it was discovered that there were students who had never given a bed bath. I have dealt w/ 2 PEG tubes (still not comfortable with that particular skill set), I have done 1 Foley, and lots of med passes w/ the accompanying drill of information from my instructors. I'm attempting to work in the local clinic as a SN just to get some of my skills.
Hm, one of my favorite clinical instructors would continually tell us that critical thinking was the important thing to learn- specific skills like starting IVs or inserting foleys can be practiced in lab and will be learned eventually. We had 1300+ hours of actual clinical (and, gasp, I did a master's entry program), and I felt like they actually did do a decent job of preparing us. My biggest challenge was that I moved shortly after graduation (husband is AD military), so the hospital I currently work at was completely foreign to me. Going from West Coast to East Coast was a huge change. If I had moved right into a place where I had done an externship or internship/ capstone (or possibly both), the learning curve would have not been as steep. So far, the only skill I've encountered that I really was not at all familiar with was colostomy care, and a helpful charge nurse assisted me and taught me along the way. I still have lots of questions, but quite frankly, everyone experiences different things, and I have even helped out more experienced nurses, so I don't expect to stop asking questions any time soon. =)
I think nursing programs should include a practicum for at the very least 6 months, at most a year, so that students get a feel for indepedent practice. And I disagree that skills are not important. Heck yes they are. I wish I could say that to instructors who say that.
We cannot put all of the blame on nursing education, though. Rates of anxiety and depression among the general population, including nurses, has increased in the last few decades. People are more anxious and less secure.
I had extreme anxiety as a nursing student. It impeded my learning in nursing school. It had nothing to do with my nursing school or my education; it was me. Now, as a practicing nurse almost one-year into RN practice, I run codes on my own and I feel less anxiety each time it happens.
My point? Levels of anxiety and psychological disorders have increased in the last few decades and new grad nurses are effected by this, too.
Oh I don't know about that.
Yes, levels of stress and anxiety are increasing in today's society, but nursing especially for new grads is on another level.
Think about it: Here you are a freshly minted RN being thrown onto a floor/unit basically told to sink or swim, and heaven help you if there is an error or adverse outcome. Your hinne will be out on the street and that brand new license can either have a black mark on it's record or taken away. If that wasn't enough there is the fact you may have harmed or even caused the demise of a human being haunting you day and night.
Don't forget in this Internet connected world we live in, if your *mistake* is serious enough to make the papers and or cause legal action, it and you will forever be linked together by one or two mouse clicks.
If you even tried to recreate across the board a three year nursing program with only a few days off for Christmas, no long summer/spring breaks and so forth you'd have open revolt.
As things stand you have new RNs who don't wish to (or simply won't) work nights, weekends, and or major holidays. So now you want them to miss their family's annual summer get together/fish fry on the coast, or January family ski holiday? Good luck with that.
Back to clinical experience:
Methinks part of the problem is how the nature of hospital/heath care has change, even since the 1980's. Quite honestly so much takes place as out patient service it can be hard to get a decent census for students to *practice* with. What patients there are often are in and out within a few days. With the growing trend of shipping some acute/sub acute patients off to LTC if they are stable enough to be handled there, you've again shrunk the available numbers for students.
Finally as I've been saying for some time now on these boards, hospitals are rethinking their commitment to educating nurses. It started slowly as hospital programs were phased out in favour of college/university graduates, and comes full circle with the attitude many hospitals have; we want nurses to arrive at our doors fully trained and competent with perhaps requiring a little seasoning, but make no mistake we are *NOT* in the business of educating nurses.
I suppose I should feel lucky that (I don't think) there are any online-only RN programs. Because academia thinks technology can do EVERYTHING. This is an age that values quantity and expedience over quality time spent. There is no substitute for spending time doing something with your hands. You can't simulate that.
There is an online nursing program in the us. http://Www.eline.delmar.edu I went to it... I had no problem with nclex or anxiety as a new RN. I think its an individual issue that seems to be more of an issue in todays world than in the world 20-30 years ago.... too much gloom and doom around making everyone worried about every thing.
Good luck with the anxiety. I wish you the best.... all of you.
I'm anxious and today is graduation day. Thank God I worked as a nurse tech though between breaks. God bless my mentor and the other nurses who were there to actually teach me how to be a halfway decent nurse. Clinically I ALWAYS took initiative! If I had just listen to some of my instructors, I would have missed out on a lot. So I went on my own, followed the nurses and I got tons of practice with skills. But they should have encouraged more. Our school was sooooooooooo stuck on writing papers. Some people in our class have still not done IVs, catheters, etc. (Some avoided them) Many of our classmates will graduate as professional APA paper writers...not adequate clinicians though! I can write you a mean paper on Jean Watson...but can't properly document in a medical record to save my life (never got a focused lesson on documentation in the entire program)....that is my main fear.
I went to school in the 70s. I attended a 3 year diploma program (hospital based) which required me to take the prereqs at our local university and attend nursing classes too. Our extensive experience however, was not just in the hospital setting.
If nursing schools today could give students a more realistic picture of what it is that nurses do, students would find out quickly whether or not they would like to continue. The sad part about all this is that so many people spend out so much money for education and get "out in the real world" only to find out they don't like it.
I feel exactly the same way. I have a BA in an unrelated field and went to a community college with a high NCLEX pass rate (that was the only standard I knew to inquire about). We had short "virtual" skills labs, and crowded clinicals only two days a week. I passed the NCLEX in half an hour, but had never started an IV or done other clinical skills except pass meds. I was unemployed for a year between nursing school and being hired for a telemetry floor in a big city hospital, and was supposed to be independent after 15 shifts with a preceptor. I have never had issues with anxiety before, but I am literally nauseous and shaking before each shift and dread going in, feeling that I am not experienced enough to have 4 acutely ill people in my care. The feeling is that if we express concerns, we are "problem nurses". I am considering quitting because I feel so unsafe, and I know from talking to the other new grads at my hospital that my feelings are not unusual.
You will truly benefit taking a refresher course in clinical. I had no idea it had come to this and often wondered why, clinical courses are offered for those already out of a nursing program. At first I thought they were for the nurse who left the field a number of years and had to catch up on the new technology. But the courses in my area, are 4 month basic nursing skills. This is scary, very very scary. I guess it is just another hidden cost..... We won't teach you during your school year, but once you have graduated, we have additional classes that teach you what you really need to know...pitiful, pathetic and downright disgraceful. Peace!
Ps-Allie, I am really very sorry. Things have changed so much and not for the better. Peace!
Multicollinearity, BSN, RN
3,119 Posts
We cannot put all of the blame on nursing education, though. Rates of anxiety and depression among the general population, including nurses, has increased in the last few decades. People are more anxious and less secure.
I had extreme anxiety as a nursing student. It impeded my learning in nursing school. It had nothing to do with my nursing school or my education; it was me. Now, as a practicing nurse almost one-year into RN practice, I run codes on my own and I feel less anxiety each time it happens.
My point? Levels of anxiety and psychological disorders have increased in the last few decades and new grad nurses are effected by this, too.