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 ? 

[londonflo]

On 11/17/2020 at 3:13 PM, angel1312 said:

after covid hit, everything transitioned online, including clinicals.

At most Covid has effected clinicals since March, some through the Summer and this fall. OP, How long was the duration of your program? It seems that your program clinical time was at most one year. Was this an online program with clinical practicums all clustered together or a very short ABSN? 

 

On 11/19/2020 at 8:16 AM, PugMafia said:

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.  

I do believe that a graduate's minimal knowledge competency should be determined at the end of the educational program, if only to make schools responsible for the development and delivery of their curriculums. With this the hospital can count on a limited but certain measure of nursing education in the employee. Hospitals can and do evaluate if the new RN has the critical thinking and follow through ability for the position they're hired for but you are advocating giving the hospitals way too much power over the new nurse's career not to mention passing the buck.

I am old school, but I truly do not understand graduates saying they have to study months for NCLEX upon completion of a comprehensive program and pay for expensive coaching programs. If our educational system cannot achieve the full nursing curriculum of specialty populations: maternal, child, and psychiatric for a start, perhaps we should be looking at a specialized curriculum from the get go like the UK or Australia. It does limit the graduate's employment and future thinking of "I can work anywhere" but it might ensure a more focused and achievable body of knowledge at graduation.

BTW the NCSBN posted this summary of allowable changes in states that have a minimum number of clinical hours (in June):

https://www.NCSBN.org/Education-Requirement-Changes_COVID-19.pdf

I live in an area that is in the top 10 of covid outbreaks in the US  and all our local schools of nursing are still doing clinical. (They did stop in March but started up again in August). 

[violet87, BSN, RN]

I have to say, nothing I did or saw in clinical was really anything like actually being on the job. In clinical, we hardly got time with patients, barely gave meds, and didn't do anything like start IVs or do Foleys. It was all thought process and care plan based. 

When you get hired, tell your leadership and preceptor your concerns. They should understand and be able to get you up to speed. A lot of those nursing skills taught in school are really simple to get the hang of. And the rest are only taught on the job, so you're honestly really not missing much in my opinion. For the touch and seeing a patient, it's the scariest thought yet you'll laugh about the fear quickly after starting. I find that when I do something repeatedly, I learn it and become comfortable. Like the first time I had an a-line with multiple blood draws. Did it 6 times in one shift and I'll never forget how to do it. You interact with patients allll shift long, so the skill comes quickly because its practiced pretty much non stop. Not saying you'll get the hang of it in one shift, but you'll get it way quicker than you think.

One more thing, try to start in a teaching hospital, or large hospital. They take more time to train you and typically don't let you "learn by fire".

Good luck!

*edit: this is my response to the original poster only

[egg122 NP, MSN, APRN]

On 11/19/2020 at 7:59 AM, mmc51264 said:

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. 

Agreed. I had to explain to a supervisor how to reconstitute an IM medication today. They had no idea that IM medications may need that and how the procedure might work. It was quite surprising for me. 

[NurseSpeedy, ADN, LPN, RN]

On 11/17/2020 at 4:13 PM, angel1312 said:

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 ? 

This is scary as hell. Where have the standards gone? We had to have some many hours of logged clinical experience in order to graduate. Your best bet is a job with a great training program or something. Hopefully covid will get under control by some point where a decent training option would be available. Sorry, but your school has done you wrong.

[YG FNP, ADN, BSN, MSN, RN, APRN, NP]

Leaving aside the politics that seems to have become part of the conversation, I am speaking to Angel1312, I would work with the advisors at the school you went to and see if they have any contacts at the hospitals your cohort was supposed to be in. Perhaps they are aware of the situation and willing to take on the new grads they normally interview and work with in their residency programs, keeping in mind that they were the ones who did not allow the clinical hours?  It is the only positive suggestion I can think of.  It is a very difficult situation, and obviously it was not just you who was affected by this pandemic.  

Best of luck to you!

[murseman24, MSN, CRNA]

 

1 hour ago, NurseSpeedy said:

This is scary as hell. Where have the standards gone? We had to have some many hours of logged clinical experience in order to graduate. Your best bet is a job with a great training program or something. Hopefully covid will get under control by some point where a decent training option would be available. Sorry, but your school has done you wrong.

yes

 

[londonflo]

1 hour ago, YG FNP said:

I would work with the advisors at the school you went to and see if they have any contacts at the hospitals your cohort was supposed to be in. Perhaps they are aware of the situation and willing to take on the new grads

Excellent suggestion. Also, may be  the dean or director could explain that letting students in the hospital for clinicals is to the hospital's advantage  -- students may choose a position at a hospital they feel familiar with plus the students will have had some basic experience with their charting with regards to giving meds.  Hopefully some initiative has already taken place to improve the clinicals for 2021.

[murseman24, MSN, CRNA]

This is ridiculous and SHOULD NOT BE A THING.  You should not be able to graduate without a minimum of clinical hours.  When I graduated I worked as a CNA in the ICU full time during the nights while I did nursing ADN program full time.  I did CPR more times than I could count and did every nursing skill one could do multiple times, I was very well prepared, and I was still stressed as can be during my GN program in the ICU.

The CRNA schools around me took their students out of clinical for a few months and have since put them back in.  They now stay longer during the day and their graduation has been postponed.  Many stay past their scheduled hours to make good impressions and gain valuable experience with complex cases.  There is no substitution for clinical experience.  It is expected that you go above and beyond.

This lowers the bar quite dramatically.  I don't know what the legal minimum standard to graduate nursing school is, but this makes it appear like one could do the job after watching some Youtube videos.  Embarrassing.

[murseman24, MSN, CRNA]

On 11/18/2020 at 5:45 PM, 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.  

How can one have the capacity for this when they are focused on how to prime the IV tubing they never got to touch in school?

No, you have to be able to go through the basic motions before you can "ascend" to the level of critical thinking.  

[talya]

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???

Hello, I am a 3rd semester nursing student. Due to COVID many states have allowed for accredited programs to satisfy required clinical hours via online clinical simulation. I satisfied first and second semester clinical hours entirely through online sim. Thankfully in my state we are now able to do in-person clinicals. 

[Words Matter, BSN, RN]

On 11/17/2020 at 1:13 PM, angel1312 said:

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!!

I feel like I know nothing and will be fired from my first job because I am completely clueless. 

When I was acquiring my pre-reqs for my BSN program, I actually had virtual labs for the anatomy, physiology and Microbiology courses. I was so grateful at the time to have found this option as I tried and failed two semesters to enroll in the courses with on campus labs. Real Life Nursing 101 - Adapt and Be Flexible

The recommendation for applying to a New Grad program is solid as these programs will have ample opportunity to benefit from the support of experienced nurses. More than likely, programs have already made accommodations to the orientation phase with the knowledge of the challenges newly graduated nurses faced due to COVID. Your situation is exactly the same as every other nurse soon to be graduating. You will be OK.

Skills can be taught and learned on the job. What can't be taught are integrity, compassion, humility, and respect for self and others which are all a much bigger part of nursing than striking gold with a catheter insertion. 

You may be green and inexperienced, but definitely NOT useless! Keep in mind, even the nurse with 30 years experience started their career green and inexperienced too. You will make mistakes - we all do. Take responsibility immediately, get direction from your supervisor/charge on what to do next, and learn from it. 

Practice good self care so you don't burn out. You cannot care for others if you haven't cared for yourself first. Be well and all the best to you!

 

[Words Matter, BSN, RN]

On 11/18/2020 at 2:35 PM, CommunityRNBSN said:

just like battlefield nurses of yore who learned on the job!

LOVE IT!! Talk about perspective :)