New grad from online RN program with ZERO CLINICAL EXPERIENCE

[angel1312]

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 ? 

[PugMafia, PhD, RN]

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.  

 

 

 

 

[JKL33]

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]

Seems like hospitals are the real nursing schools now.

[mmc51264, BSN, MSN, RN]

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]

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]

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

[Jedrnurse, BSN, RN]

4 minutes ago, Hoosier_RN said:

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

The idea of sim lab counting for clinical hours is...disturbing.

Pre-clinical prep, sure.

[Lunah, MSN, RN]

4 hours ago, Jedrnurse said:

The idea of sim lab counting for clinical hours is...disturbing.

Pre-clinical prep, sure.

Some states do cap the number of hours that can be done via sims; however, with COVID here, I have a feeling many requirements are being waived.

[AdobeRN]

On 11/17/2020 at 5:29 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???

My daughter was basically in the same position.  The school did online simulated labs and when some of Covid restrictions were lifted they allowed a limited number of students at a time to come in to the actual Sim lab for assignments.  All of these "lab" hours were counted as "clinical" hours. 

[bitter_betsy, BSN]

@angel1312 From a recent grad - find a residency program.  I am in a magnet residency program and they have added extra weeks to the "normal" program to account for many of the nurses not touching a patient in their last semester.  By the time we get off of orientation completely - we will have been on orientation for 5 months (our full residency program is 1 year).  One student in our cohort is not doing as well as the rest of the group, but they are working with her and although it may take her an additional 12 weeks to be on her own - they are supporting her through her progress.  

There are things you just cannot learn in nursing school and you have to learn on the job.  I probably did 15 foleys in clinicals and in the last week I have done 2 on the job and I missed on both of them.  Sometimes you have to just throw your hands in the air and question how that's even possible!  Also, there is a difference between learning to delegate and feeling OK to delegate.  The other night I was in way over my head, but it was my first time with a full patient load and more than 1 critical patient at the same time.  It is one thing to ask someone to get vitals on your patient, but its another to ask a nurse to help with your DKA protocol while you deal with another critical patient.  You seriously feel completely inadequate because you can't be in 2 places at the same time.

The situation is what it is = so make the best of it.  Be honest, be willing to work hard and study and apply to every job you are interested in as well as some that you aren't.  My best advice though is - apply to residency programs. Oh - and don't worry about foleys - we don't really do them any more unless they are clinically indicated (which is rare) and I promise you will learn to do IVs when the time comes.  You start by sticking the things you can hit from the next state over, then you slowly get comfortable. 

[Rural_RN]

@angel1312 @bitter_betsy 

Angel, hang in there. You are not alone! I also went through the online clinical scenerio. I just landed a job and start on Monday and I am scared..however, I have not heard of one RN who wasn't scared covid or not and I would bet the RNs who posted negatively on this thread were also scared when they started. During my interview they asked my weakness and I was honest. I said I was weak in skills. That may not always work to your benefit but being open and honest and willing to learn and take direction are huge in the professional world. Ask your potential employers during interview how they train new grads. This question is crucial to your success as a new RN. You will learn on the job and as all nurse graduates know school isn't for the weak of heart.  You get through that and work through the next challenge (new job) as it comes. We must support eachother new and old RNs to keep the profession from suffering even more than it is. You got this! 

Betsy, THANK YOU for your encouragement and great advice! I would agree with you really look for a program that is dedicated to training new grads. My job said they take 6 months and up to 1 year to train and they never leave new nurses alone. That sold me right there.   I am grateful for the support of those, such as you who have gone ahead of us and encourage us as we come behind! 

 

[JKL33]

31 minutes ago, Rural_RN said:

I just landed a job and start on Monday and I am scared..however, I have not heard of one RN who wasn't scared covid or not and I would bet the RNs who posted negatively on this thread were also scared when they started.

Two things:

1) What comments do you consider negative?

2) I'm not sure what everyone being a little bit apprehensive or scared on some level has to do with this.

I will be clear that I am not faulting the OP or any people graduating under these circumstances for the situation in which they find themselves. AT ALL. I agree that probably the only reasonable thing to do is put one foot in front of the other and make the best of it. I do think it's important that we don't treat this as one big "oh well" situation but rather expect better and not let this become the excuse for future nurses to pay the same tuition and receive less training. If you happen to be including my comments under your "negative" umbrella you should know that they are much more in support of new nurses than you appear to have comprehended.