I'm an OLD nurse, graduated from a BSN program 25 years ago. I see these posts about "my teacher did this" or "I want to be a nurse but....I don't want to do L&D etc", or "I got a new job but I will be charge nurse can I do it?" or "Why do nurses eat their young?" or "Am I being discriminated against?" on and on and on.....
I went to a 4 year college. My first year I did general classes that would lead me to nursing school, math, biology, chemistry, nutrition, psyc and human development etc...then the spring of my freshman year I applied to nursing school 72 were chosen out of 400.
My sophomore year in college it was game on, anatomy, physiology, microbiology, pharmacology, nursing 101, 102 (or whatever they were called) and some nursing clinical. We started out in a lab learning vital signs, making beds, general stuff I'd call CNA stuff..then quickly moved to a nursing home where we did those skills on real patients.
By the end of that year we were taking care of 1-2 hospital patients on a general medicine or med-surg or ortho floor during clinical hours. This was the days before computers. Our instructor would go on to the floor the day before and assign us 1-2 patients and that evening before clinical we would have to go to the floor and pour through the meds, the chart, the kardex and go home and prepare (pre-planning..we called it)...we had to have care plans ready, med cards ready (no cell phones to look up meds we had to look them up in a book and write them down on index cards) We had to have a plan and know how we were going to care for that patient, and we had to have in depth nursing care plans ready to go by 7am the next morning.
When we gave meds we had to have our instructor present, or sometimes the nurse overseeing the patient could watch, we had to chart, we had to do it. If you came to clinical without a starched white ironed uniform you were sent home. If you came unprepared you were sent home. If you had dirt under your fingernails you were sent home. If your shoes were not white enough you were sent home.. By junior year we were seeing 3-4 patients on a regular floor and less of course in specialty rotations.
We asked to do new things we had never done... If I had never inserted a foley I'd say to the nurses during morning conference, "If anyone has a foley/injection etc today could you let me know, I need the practice". It was a teaching hospital, they were good to help out. I practiced starting my first IVs and IM/SQ injections on each other in class and then got a little more practice in anatomy lab (we had human corpses in anatomy lab)...
We rotated through peds, psch, L&D, Ortho, OR, and ICUs that year. Our senior year was more to get us prepared; first semester I had to work with a nurse in the community for 24 hours a week, keep a journal and meet with her and my instructor weekly. I chose home health. Since she worked 8-5 I had to work 24 hours a week with her 8-5 that semester and work my other classes around that. Of course it was like with any other job in the beginning she did, I observed but by the end of the semester I was expected to be able to see her caseload, do all the necessary documentation and do what she did.
My second semester I had to pick something in the hospital, I chose peds. I worked with a nurse on the floor, again in the beginning I watched, then gradually she piled them on. I remember one day coming across a new med and I stopped to look it up, she asked me what I was doing and I told her...she told me "You have to become more efficient at this business because you can't be wasting all my time like this"...I was scared of her, but I learned so much, she taught me how to chart, how to give meds, carry a patient caseload.. I worked 8 hour nights with her again 24 hours a week was the assignment...I had to keep that journal and have weekly meetings with her and my instructor. OH and by the way in the last month of clinical if she was in charge...I was in charge...Of course she was always there to back me up for everything and she had to watch me get meds ready to give, I had to tell her how I was going to give them, and if it were IV meds or IVP meds she had to be present.
I guess what I'm saying is I don't know how nursing schools operate these days, but I hear so much whining and complaining on these nursing threads...and nurses are afraid of the new grads because they don't know anything...when I graduated after a 2 week orientation at my new hospital (I started out in peds) I was ready to take on my own assignment of 6 patients. After 6-8 months I was confident as a charge nurse. What's happening to our nursing schools and how nurses are educated?
Is it that there are so many more meds and technology has advanced so much after 25 years that it's not possible any more? Don't get me wrong...nursing school was 4 years of HELL..we didn't have computers, I had to type my papers on a old electric typewriter, I had to spend lots of time with my nose in books researching and learning...but it seems we have a different caliber of nurses coming out of nursing schools these days..Or do we?? Am I missing the mark? I'm just curious...
I have to agree with the skewed sample. There are a variety of reasons why people post, but generally, if you're doing well and not in need of extra support in clinical, you aren't the students posting here. Actually, many of the forward-thinking students who realize they require additional clarification go directly to their instructor or they form a study group. They generally aren't the ones posting on the internet.
The student got stuck,( I should say that the needle box was on the patient counter right across her living room and the student tried to recap the needle before putting it into the needle box) she alerted me and the patient loudly, I took her to the sink we washed, scrubbed, washed and applied a paper towel... I settled the patient and had to help the student who was crying loudly to the car. We were pulling out of the driveway and she stopped crying to pick up her cell phone and call her boyfriend on the phone and tell him what happened, meanwhile I was on my cell phone reporting the incident to my supervisor and getting instruction about what to do with the student. Before I got off the phone she had ended her phone call with her boyfriend, and started crying again. I asked her if she would call her instructor and inform her of the incident and she cried louder. I was trying to re-assure her and tell her that I knew she was scared and a mistake had been made and how sorry I was I was trying to be as empathetic as I could... she finally asked me to call her instructor that she was too upset, so I got the number and called her, the student was loudly crying again (I was a bit upset that she could be calm to talk to her boyfriend but now she was hysterical.) I informed the instructor of the plan...I drove with this loudly crying student, trying to reassure her and she kept saying but it hurts so bad...we stopped at a store and I bought her a cup of ice to put her hurting finger into and tried to reassure her that I understood she was hurting, I understand this is a very scary situation, and we go on... she was sobbing. I drove about 50 miles to my office, she still whimpering and sometimes sobbing, but she again stopped crying all together to call her mother, but remind you 15 minutes prior she was hurting too bad to call her instructor.., we got to the employee health nurse that was waiting on us and she kept saying she hurt so bad, and so the employee health nurse again washed her finger, scrubbed her finger, applied some antibiodic cream to her finger and she was absolutely sobbing loudly. Then the employee health nurse informed her that she had to draw blood on her and she got even worse. I held her hand and tried to console her while she got her blood drawn, she jumped and screamed when the needle was inserted. I really tried to be supportive. We filled out papers together the three of us, she whimpered and kept holding her finger....said she couldn't use a pen to sign because her finger hurt too bad....really???? Employee health nurse took me out of her office and behind closed doors told me that this student was too dramatic... My tolerance level was just getting thinner and thinner... Then I was told I had to accompany the student to her school for more paperwork and the student insisted that she stop by her house first because she had to show her mother her finger....she still was sobbing off and on, but a little more silently, sometimes grabbing at her arm where the employee health nurse drew blood.. She started sobbing again loudly when she saw her instructor and her instructor hugged her and told her everything would be alright, she asked for another cup of ice to put her throbbing finger into....this was 4-5 hours post finger stick now... So we filled out necessary paperwork, I left the student after wishing her all the best and offering as much empathy as I could, all day long I wanted to YELL at this girl and tell her to get real, it was impossible she was way over the top and it made me not want students any more, ...went back out to see the patient and draw labs on her and it was after 4pm before I begun to see my last 6 patients for the day ...the student was too dramatic..I think I said that in previous posts, but maybe you can understand now why I say what I say.. That day I called my office after I left the student and asked to be taken off the list of nurses that would precept nursing students. I know there are many of you that would say I should give more a chance but I just don't have it in me....I never lost my cool with the student, and I never told her how dramatic and childish I thought she was being....but it was way over the top.... she had her priorities, she didn't cry or sob when she talked to her boyfriend or her mother, but then she just kept it up and any time someone would talk to her she sobbed worse... I would have thought that she amputated her finger...IT was a simple stick with an insulin syringe...
So if I'm an old batty nurse that doesn't want to work with students after ONE bad day then so be it...but I spent 18-20 years of my nursing experience working with students and ONE bad apple spoiled the bunch.....I couldn't be nice to another student that did something like this...and maybe I should have not tried to be so nice to this one girl, but the sobbing and crying was more than I could take and I didn't want to exacerbate it....
I'll agree with the OP (didn't read through everything). I graduated from a CC LPN program in 1972 (yup dinosaurs really did walk the earth back then;)). My program was patterned on the Diploma schools and we had tons of clinical hours and they were productive hours. Then we had several hours of class after working a full 8 hours. When we graduated we were well prepaired for the jobs we hired to do, we had good time management skills and of course could perform all the necessary skills like foley's, NG insertions etc. Oh and way back then there were NO fitted sheets:eek:.
I'm currently working as a patient sitter in a hospital and I'm down right shocked sometimes when I see some of the newbies lack of basic skills and poor time management. I really think nursing schools today need to re-vamp these programs and get back with more PRODUCTIVE clinical hours.
We recently had an elderly patient who was uncircumcised with a nasty stricture and I offered space closer so the student could observe what the doc was doing...the student glanced at the procedure going on and then WALKED OUT...here was a golden oportunity to learn something real time and they blew it off and I see this time and again with the students.
Our schools were very strict and I think some of that needs to return to nursing schools.
Had a couple of nursing instructors who graduated from the old diploma, live-in-the-hospital type nursing programs. Maybe this was just an exaggeration or I misheard, but they made it sound like hospitals used nursing students as cheap substitutes for "real" nurses. At night, you had entire m/s units staffed with nursing students (RNs) and maybe a couple of relatively more experienced LPNs. Definitely not a scenario that you would see today...
No, you've got it right.
Until late as the 1950's or 1960's there were still plenty of old school hospital diploma programs that ran pretty much the way nursing education was in Flo's days. Student nurses provided a bulk of the care on the wards/floors with *sometimes* the only licensed nurse being their supervisor or the head of the hospital.
Under the apprentice model then used, nurses were *trained* at the tasks of the profession. In simple terms one was shown what to do and perhaps how to do it but not always *why*. As a student nurse you practiced and practiced things over and over again on the wards/floors. This was the reinforcement of whatever one had learned in class.
Changes both in the technology of healthcare and within the profession caused many forward thinking minds to start moving nursing education into the academic/science realm in that nurses of tomorrow would be required to *think*.
The following tells of how this evolved at John Hopkins School of Nursing.
I have to say that as a student, I work as a CNA and volunteer for every dirty job and experience I can get my hands on. We are being taught to pass the NCLEX and write papers in APA format. We do have a 12 hour clinical once a week but are limited in what we are allowed to perform (med related especially) because of the litigious society that we live in. I watch some of my classmates and wonder what the h@%% they will do when reality finds them on a med-surg floor with 10 patients and they have never passed a bedpan or changed a diaper. On another note, I was working a home health case recently and gathering up the breakfast dishes when I felt a prick. The very experienced RN had done a blood glucose check on my patient and left the used lancet insert on the counter and it must have rolled under a plate. We scrubbed it good and filled out the incident form to fax in. I did not realize that I was supposed to cry, call my mom and put ice on it...................
I have taken my pre-reqs and I am hoping to get into nursing school sometime in the near future just for background info. I wish that nursing school was still like this. I want to be scared to mess up. I will be anyway don't get me wrong. I just feel like this approach to teaching/learning forces you to know your stuff. My biggest fear is getting into a high pressure situation and/or a patient's family member asks me to explain something and not knowing what to say or do. I WANT TO KNOW MY STUFF! I want to go into this field being confident in my ability to care for patients. I wish that they still taught like this. I can't complain on how they teach now because HA I don't even know yet myself! I can say that in my Anatomy and Physiology courses that I have taken my teacher was a wonderful teacher in many aspects. She would challenge us and give us critical thinking scenarios but at the same time she was pretty slack. She would always go off on a tangent in the middle of class and left the students to wonder what exactly it was we learned in lecture. I basically taught myself A&P. Which I know you are sometimes expected to do...but not this much! I hope for my own benefit I have instructors that are strict like you had. I want to be put through the ringer because I feel like you will come out the other end knowing what you need to know to be a successful nurse and give every patient your all.
I have taken my pre-reqs and I am hoping to get into nursing school sometime in the near future just for background info. I wish that nursing school was still like this. I want to be scared to mess up. I will be anyway don't get me wrong. I just feel like this approach to teaching/learning forces you to know your stuff. My biggest fear is getting into a high pressure situation and/or a patient's family member asks me to explain something and not knowing what to say or do. I WANT TO KNOW MY STUFF! I want to go into this field being confident in my ability to care for patients. I wish that they still taught like this. I can't complain on how they teach now because HA I don't even know yet myself! I can say that in my Anatomy and Physiology courses that I have taken my teacher was a wonderful teacher in many aspects. She would challenge us and give us critical thinking scenarios but at the same time she was pretty slack. She would always go off on a tangent in the middle of class and left the students to wonder what exactly it was we learned in lecture. I basically taught myself A&P. Which I know you are sometimes expected to do...but not this much! I hope for my own benefit I have instructors that are strict like you had. I want to be put through the ringer because I feel like you will come out the other end knowing what you need to know to be a successful nurse and give every patient your all.
OP, what you are describing IS a change in the culture in the last 20 years or so. Our ability to *cope* is becoming a lost art.
Your description of what happened with the student reminded me so much of a patient I saw recently in the ER. She had tripped over an uneven spot of pavement and sprained her ankle. X-rays of her ankle, foot and tib-fib all negative. But from the moment she arrived (by ambulance) she was dramatic, morose way out of proportion to what had occurred, and outright abusive. All of my attempts to reassure her that the injury was minor and could be managed with a week or so of pain control, use of crutches and rest were met with tears, yelling, and anger. And then the kicker: she said (and yes, this is a direct quote), "YOU ACT LIKE THIS IS JUST SOMETHING THAT HAPPENED AND I SHOULD JUST DEAL WITH IT. YOU HAVE A REALLY BAD ATTITUDE" And she threw the cup of ice I had given her across the room, as an exclamation point. (presumably to demonstrate MY bad attitude )
It took everything I had not to simply laugh out loud at her melodrama. I would have, had she been my own child.
Now -- I will be the first to admit that most people handle an unexpected injury better than she did. And most 19-year olds are not so lacking in self-control as to yell at someone more than 25 years their senior.
But I do see people behaving in all sorts of ways that would have been unthinkable when I was a child, teen, and young adult. It may come as a newsflash for some ... but the ability to "suck it up and deal" does not necessarily mean you're being a doormat, being bullied, or failing to express yourself. It may very well mean that you're not expending unnecessary energy on bucking the system or running away from the system ... and that leaves you time and energy to actually contribute meaningfully.
As I said, I see this as a cultural change not unique to nursing. However, the implication for nursing is that increasing numbers of people now entering nursing will not have the temperament to be effective nurses. If you have a great deal of difficulty with unexpected occurrences in your own life, you have no business being responsible for the life or well-being of another human being. If you are particularly sensitive to others' perceptions of you, you will struggle working in a field with people who are experiencing an unpleasant part of their lives, and may very well perceive you to be just another aspect to that unpleasantness.
Being a nurse has always required an above-average amount of resiliency. Perhaps more so now than ever, when most people are very disconnected from the reality of illness, birth and death as these things are now rarely part of home life -- they play out in hospitals and other settings out of view.
And she threw the cup of ice I had given her across the room, as an exclamation point. (presumably to demonstrate MY bad attitude 
)
joanna73, BSN, RN
4,767 Posts
I have to agree with the skewed sample. There are a variety of reasons why people post, but generally, if you're doing well and not in need of extra support in clinical, you aren't the students posting here. Actually, many of the forward-thinking students who realize they require additional clarification go directly to their instructor or they form a study group. They generally aren't the ones posting on the internet.