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New grad from online RN program with ZERO CLINICAL EXPERIENCE

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Hello everyone so after covid hit, everything transitioned online, including clinicals. I am going to graduate this December but I have a huge problem. I HAVE NO HOSPITAL EXPERIENCE!! The only clinical I went to was at nursing home where we didn't do much besides feeding the residents and taking vital signs. We did not get to pass any medication, look at documentation, etc. I have never done or observed any basic nursing skills such as administering IV, documenting, passing a med, IV push, foley, assessments, etc. I feel like I know nothing and will be fired from my first job because I am completely clueless. What do I do 😞 

CalicoKitty, BSN, RN

Specializes in Med-Surg, Geriatrics, Wound Care. Has 8 years experience.

Maybe you lucked out? Clinicals were incredibly stressful to me, and a lot of people. Just make sure you start in a new-grad program. In my program, I never did real IV things on people, no IV meds, and I don't think I did  a foley on a human. New grad programs will help you develop those "basic" (trained monkey!) skills. 

The scary part for me, though, is talking to and *touching* my first patients. Eventually you get past that stressful part.  Make eye contact with your patients. Touch them. I am a hand holder, and occasional hugger. Learn to really look at your patients and acknowledge they are not all just a bunch of lab values and vital signs.

Other stuff will come with experience. Remember the (random number) rights of medication administration. Make sure you know what and why you are giving medications. You won't remember them all, but your charting system usually gives you info. Talk to your patients about them, I'm giving you this blood pressure med because your BP was 123/45 and we want to improve/maintain it.

You are not useless. You just need to get started. 

Congrats, and good luck!

CalicoKitty, I love hearing that you're a hand holder and hugger too! It's sad that we can't do that so much anymore in the age of COVID, because a human touch is what patients need now. I miss being able to reassure patients in that way.

Jedrnurse, BSN, RN

Specializes in school nurse. Has 28 years experience.

I thought that accredited programs needed to have a certain number of clinical hours and that that was also a requirement of sitting for the NCLEX.

This is not the case???

mmc51264, ADN, BSN, MSN, RN

Specializes in orthopedic; Informatics, diabetes. Has 8 years experience.

19 minutes ago, CalicoKitty said:

Maybe you lucked out? Clinicals were incredibly stressful to me, and a lot of people.

What did you think it would be like actually being the one responsible for caring for a patient with no experience? 

As a student, there are safety nets, instructors, preceptors, and expectations are very different. 

I don't know anyone who would want to go into a job with zero experience. 

This is one of my concerns about Covid. My friend graduated in May with little to no hands-on experience, but thankfully, she had been an EMT before she went to nursing school. 

13 minutes ago, Jedrnurse said:

I thought that accredited programs needed to have a certain number of clinical hours and that that was also a requirement of sitting for the NCLEX.

This is not the case???

I think they are counting virtual hours. It is mind boggling to me. I had over 650 clinical hours in my ADN program. 

I would think that if one of these people approached a prospective employer manager and leveled with them, they might be able to get hired at a place really hurting for employees.  There would be an agreement that the new employer would provide the training and support necessary for that person to succeed and become a productive member of the staff.  This would most likely fly in a nursing home facility notorious for being short of staff.  Better to have someone on board that you are bringing up to speed than to have a consistent hole in the schedule.  Worth a try.  All they can say is that they don't want to take the time or effort.

I experienced having a new grad who had almost no actual clinical training as my nurse. It was not pretty. I am truly concerned for both the new nurses and the patients. A huge disservice is being done to both. 

CalicoKitty, BSN, RN

Specializes in Med-Surg, Geriatrics, Wound Care. Has 8 years experience.

32 minutes ago, mmc51264 said:

What did you think it would be like actually being the one responsible for caring for a patient with no experience? 

As a student, there are safety nets, instructors, preceptors, and expectations are very different. 

I don't know anyone who would want to go into a job with zero experience. 

Honestly, schools get so uptight about how pretty your "nursing care plans" look. They grief nurses about having stripes on their shoes. Have a tattoo, maybe you don't even get into a program. I found a lot of it was petty, to be honest. I hated peds, and really got almost nothing out of maternity (except seeing 3 vaginal births) because I had no interest in working in either population, and those were some of the most stressful clinicals. I got on the job training thru a new grad program.

It is definitely rough but hey— it’s a pandemic, and life is rough right now!  Tons of things that seemed crazy have been normalized. For example, my child has not gone to school since March. In 2019 that statement would have seemed insane. Same as “nursing graduate who has never seen the inside of a hospital.”  I agree with what was said above: Interview, level with all potential employers, be eager to learn, and you’ll find a job. It will be overwhelming at first but you’ll learn quickly. Just like battlefield nurses of yore who learned on the job!  Good luck!

PugMafia, PhD, RN

Specializes in Med/Surg. Has 9 years experience.

I agree, Community.  Here is the thing…in order to go to clinical there must be clinical sites available.   Facilities are turning away students because of COVID.  What should colleges and universities do, cancel the program and add to an already struggling profession? We are short nurses.  Facilities should understand the fact that they are getting students who, some, may not have had any clinical experience.  This would mean the facilities will need to budget more for orientation and training.  I will share with you what I tell my students…I much rather have a nurse who can critically think, assess, and interpret those findings than a nurse who can start an IV.  Skills will come.  The facility will teach you the way they want you to do them.  What they expect that you already have are soft skills and the other skills mentioned above.   

1 hour ago, PugMafia said:

I much rather have a nurse who can critically think, assess, and interpret those findings than a nurse who can start an IV. 

I agree with you but when said nurse hasn’t actually practiced the process enough to figure out that you don’t put the unsheathed needle down on the mayo stand when you’ve decided to reposition yourself and then pick it up again with the intent of using it in all its contaminated glory that is a problem. Fumbling I can deal with, slowness I can deal with, lack of surety I can deal with, heck even missing the vein I can deal with but having absolutely zero grasp of the process and thinking that you do is a big problem for me. Of course there’s always the chance that she wasn’t trained well on the job (although maintaining sterility seems such a basic concept I find it hard to believe she graduated with no inkling that it’s a thing). Regardless, she was sweet and fortunately I had the time to give her a pep talk and a few tips. And bonus...she got me in one stick! 😁

2 hours ago, PugMafia said:

What should colleges and universities do, cancel the program and add to an already struggling profession?

Is it your position that turning out very under-prepared grads is going to help this profession?

 

2 hours ago, PugMafia said:

I will share with you what I tell my students…I much rather have a nurse who can critically think, assess, and interpret those findings than a nurse who can start an IV.  Skills will come.  The facility will teach you the way they want you to do them. 

Also, no. Especially the bolded part. We have not been making strides, in my humble opinion, while we have been allowing business people and non-expert-functioning nurses to dictate more and more and more of our actions and nursing functions. The more unprepared we come out, the more we will need others to tell us which foot to put in front of the other, and the less we have an opportunity to operate as an actual profession.

I don't really want to be adversarial, but come on. How could anyone think it is best for grads who are in debt for a baccalaureate degree to come out into a workplace and require such extensive training that huge corporations are already now sidling them with contracts to the tune of $5-10K? How does that work out for the strength of nurses' professional functioning? How does it help our new nurses to come out under-prepared into a very pressured atmosphere so that over-stressed and pressured nurses who have other priorities can decide their fate?

Secondly, what kind of real-time critical thinking do you suppose people can focus on when they haven't even had to do things like communicate effectively with real patients, assess real patients, prioritize any tasks in real time, troubleshoot, etc.?

Public trust is not going to hold up with these kinds of rationalizations, covid or no covid. We are setting ourselves up for a major reckoning.

PugMafia, PhD, RN

Specializes in Med/Surg. Has 9 years experience.

48 minutes ago, JKL33 said:

Is it your position that turning out very under-prepared grads is going to help this profession?

Don't assume my position.  We have only graduated 1 class affected by COVID.  At least where I live, I have not heard anything negative about them.  As for future cohorts, I do not know.  What do you think we focus on with students in clinical? What do you think we focus on with didactic courses? And yes.  Facilities are required to train and develop their staff.  If they don't, they run the risk of a law suit.  It is the employer's responsibility.  What are your expectations of a new graduate? They can handle stressful situations? They made it through nursing school didn't they?

 

Regarding the profession...I can tell you are passionate about our profession.  It's nice to see.  However, if you feel that business persons and non-expert functioning should not have their hands in making decisions, then get involved with committees at your hospital.  Be the change you want to see.  

 

 

 

 

3 minutes ago, PugMafia said:

Don't assume my position. 

I didn't. I asked you a question.  It was not meant to be rhetorical but rather thought-provoking.

4 minutes ago, PugMafia said:

What do you think we focus on with students in clinical? What do you think we focus on with didactic courses?

What is the meaning of this? I don't know what you focus on in non-clinical site clinicals. But it seems like there probably aren't patients there.

5 minutes ago, PugMafia said:

And yes.  Facilities are required to train and develop their staff.  If they don't, they run the risk of a law suit.  It is the employer's responsibility. 

What? This seems kind of illogical given the topic at hand, as you could take this all the way back to there being no need for nursing school at an educational institution. Just let the hospitals hire people they like and train them to be nurse-workers.

6 minutes ago, PugMafia said:

What are your expectations of a new graduate?

Something more than not having had the opportunity to work with a real patient. AT ALL.

7 minutes ago, PugMafia said:

They can handle stressful situations? They made it through nursing school didn't they?

Part of it, anyway.

 

8 minutes ago, PugMafia said:

However, if you feel that business persons and non-expert functioning should not have their hands in making decisions, then get involved with committees at your hospital. 

What would make you assume that I'm not?

Secondly, part of the change I want to see is an open discussion about the bad decisions for which we are always lining right up and making excuses about.

RNperdiem, RN

Has 14 years experience.

Seems like hospitals are the real nursing schools now.

mmc51264, ADN, BSN, MSN, RN

Specializes in orthopedic; Informatics, diabetes. Has 8 years experience.

2 hours ago, RNperdiem said:

Seems like hospitals are the real nursing schools now.

yep, and many of them are not prepared, or think they know it all and will not accept truly well-meaning advice. 

No pharmacology awareness (lets give SQ lidocaine for pain in a septic knee, Lantus IV). 

Just a small window of, to me, outrageous, inadequacies. 

Because of Covid, so many nurses are leaving nursing and we are so upside down with out new nurse/veteran nurse ratios, that we have nurses that have been on the floor less than a year as being senior, after the charge RN. 

PugMafia, PhD, RN

Specializes in Med/Surg. Has 9 years experience.

1 hour ago, mmc51264 said:

yep, and many of them are not prepared, or think they know it all and will not accept truly well-meaning advice.

This is true.  I was at a site where the most seasoned nurse was one year.  Charge for the day was a nurse only six months.  There was a clogged PICC line.  I told my student to inform her nurse that we will take care of it.  The nurse responded, if it is clogged how are you going to fix it? Ahhh yes....and the student who knows it all.  Generally these are techs/CNA's who currently work in the field.  BUT there is the occasional one who has never stepped foot onto a hospital floor with the exception of clinical who knows it all.  

 

I am not saying I have all of the answers- I don't.  However, professors are doing the best they can given the current situation.  Hospitals are not opening their doors to students during this time.  All we have are simulations and case studies, which according to literature is a good alternative.  

The way schools of nursing are assessed is by the first-time pass rate on NCLEX.  Honestly, it would be better if the student had a three month exam on the floor.  In other words, how the student performs while on orientation determines whether or not she gets her license.  

Hoosier_RN, MSN

Specializes in dialysis. Has 27 years experience.

On 11/17/2020 at 6:29 PM, Jedrnurse said:

I thought that accredited programs needed to have a certain number of clinical hours and that that was also a requirement of sitting for the NCLEX.

This is not the case???

In this day and age, its sim lab. Yeah, scary stuff