I just recently graduated from nursing school and am sitting for state boards.
During nursing school, I had the opportunity to start 2 IV's. Both of them were failed attempts. I never had a patient during clinical with a NG tube, trach, chest tube, or really any type of tube. I also never had the opportunity to draw blood. I feel unprepared in the real world due to lack of experience. I have had a lot experience with wound care, medication administration (IV, IM, SQ, PO, etc), catheters, complete physical assessments.
Is this a typical thing for new grad nurses? I don't want to feel stupid asking for help starting my first IV on the job, or suctioning a trach...
This it totally normal! I just graduated in May myself and there is a lot of hands on skills I don't know how to do! But I had a clinical instructor remind me once that knowing how to start an IV or insert a G-tube isn't what makes us nurses, it's the knowledge we receive that helps us determine if a patient is going downhill, or about to crash and needs intervention! We can teach anyone off the street to insert an IV. You get the picture! The skills will come!
I'm trying to remember when I learned these things. I graduated so long ago that it's a blur. Other than catheters I think I learned most skills in my extern and residency programs. Most of the students in the area had no problem finding extern jobs or willing orientation programs.
What I do remember is one year out of school I was starting IV's, hanging blood and inserting NGT's in the home setting. And veerry little paperwork. Crazy.
Specializes in orthopedic/trauma, Informatics, diabetes.
I got a lot of experience as a CNA II (in NC, there is a second level of aide that has a higher scope). I could do trach care (established), insert Foley, Tube feeds, remove PIV, ostomy care (established) and wound care on a wound 48 hours.
I only have only a few IV sticks and don't draw labs. I am spoiled in my job and would like to be more proficient in those other things. I have to opportunity to learn though.
Our school said that anyone could teach a nurse a skill. Being a travel nurse, I have figured out that some hospitals are better at it than others. I left nursing school having never started an IV because we werent allowed to start them as students. Pretty much my first year, I failed at all of them (knowing what I know now, I didnt have my tourniquet tight enough). After that, I got better. I still blow one from time to time even after a few years experience because I dont have the opportunity to start them often enough on my unit. Most patients come to the floor with two lines, so it's pretty rare to need to start one, but I can do it now. The first few times I cared for a trach patient I asked respiratory to watch me and that was very helpful. Then I got a job at a hospital that loves hands on education and wow, what a difference. I felt like I learned more there in my orientation than I did at my two years at the first hospital.
Please do not focus on the ability to start an IV or draw blood. Those tasks will be learned on your first job. In nursing school I never started and IV. I am pretty good now. The true art to nursing is your assessment skills and ability to think like a nurse. For example: When you patient is in heart failure, what is he or she going to look like, what symptoms, what are your interventions as a nurse. Prioritization is another key thing along with communication. You will be fine.
Specializes in public health, women's health, reproductive health.
I don't know if it's typical but is certainly my situation. I wasn't allowed to do many things as a student and didn't have enough opportunity for some of the things we were allowed to do. Now that I am working, that reality really stings. I wish we had MUCH more hands on opportunities in school. Things were heavily weighted toward tests grades. Test grades were just about everything.
The reality is that there's just no possible way to make sure EVERY nursing student in EVERY class and EVERY clinical gets experience with EVERYTHING you're going to come in contact with in the real world.
There were many, many things I came across on the GI surgical floor I started on that I had only seen pictures of in books. Things like chest tubes and drains being some of them. I had only attempted a couple of IV starts as well. It's just the way it really has to be because in clinical the instructors only have so much control over what you will get to see.
Don't be afraid to ask. Find the nurses that seem to enjoy teaching, or don't mind at least, and let them share their knowledge. Also, try to watch as much as you can. If there's a procedure you haven't seen and you have a chance to go see it, then go. If you see IV therapy going to start an IV then ask if you can go watch and get some tips.
Remember, you have to be the one to make learning happen, whether in school or in the real world.
As a new grad it is normal to feel overwhelmed by the "tasky" things like starting IVs, inserting NGTs, foleys, etc. You will get help in orientation. Do not be afraid to tell your preceptor what you need help with. She will find you the experience. The most important skill in nursing is your assessment skills...trust me.
One thing I'm not seeing is newer nurses having done some homework beforehand, it's like they're hearing and seeing it for the first time.
Somethings definitely take feel, others are more step and precaution oriented. If you read about, view and do some make shift dry runs on your own time to develop muscle memory of the steps, you'll likely feel less awkward and will master the skills quicker.
And ask for opportunities to observe, ask your coworkers to grab you to watch whenever they're going to do something (but don't slow them down with questions you could have answered from your own study or they might avoid inviting you).
This is why I wish I had more students on my shifts. As long as their clinical instructor is cool with it, I let them try almost anything. IV starts? Here, try it on healthy veins first, I'm cool with getting stuck. Same with IMs. Seeing their nurse sitting there at the desk with an IV in their arm makes patients and families laugh and feel better about the care that they're getting. Same with me having the students tell me about the meds they're about to give the patient in the room. (Have had a few clinical instructors thank me for the chances I give students, and students for teaching them things that they don't go over in class. I'm doing all this anyways, why not just say what I'm doing?)
I've had people start in my department who, after years of nursing, still aren't comfortable with many of the basic skills. And that's okay, because we make sure that there is somebody somewhere in the hospital that can come to help.
One thing I do expect of new grads and new to the department nurses is a willingness to look things up, instead of just saying "I don't know" and giving up. That just causes the rest of us to not be as willing to help, which leads to tension and a poor working environment.
I feel for the new grads of today. It's hard to find the clinical skills you need for work and everyone wants experience. Get in a job and I guarantee the experience will come. When we graduated, most, if not all jobs available, were in the hospital. Shortages were so regular that many of my class went right to work in ICU after graduation. But when DRGs came along in 1983, nursing opportunities moved to clinics, outpatient surgical centers, home health, insurance companies, etc. as hospital stays were reduced, beds closed, and need for hospital nurses diminished.
Nursing is more than a job-it's a way of life, a way of caring and learning, and sharing and grieving and a profession like no other. I call it nurse-onality because 40 years later most of my friends (who have long since migrated from the bedside) are nurses. Who you are and how you care is so much more than the tasks of care. You will learn IV skills, chest tubes, NG tubes depending on where you work. No one, however, can teach you how to care.
Best wishes and good luck with your profession and don't sweat the small stuff.
TarheelGirlx3
107 Posts
This it totally normal! I just graduated in May myself and there is a lot of hands on skills I don't know how to do! But I had a clinical instructor remind me once that knowing how to start an IV or insert a G-tube isn't what makes us nurses, it's the knowledge we receive that helps us determine if a patient is going downhill, or about to crash and needs intervention! We can teach anyone off the street to insert an IV. You get the picture! The skills will come!