We have several new grads in our ER. I'm starting to think that most nurses should have at least a year on a more general ward before learning a specialty.
I'm seeing some clueless mistakes, and lack of basic skill in pt care. That includes things like how to clean a pt and roll and change bedding. Basics about IV med administration, dose calculations, prioritizing, and realities of inpatient care. They have no idea how the rest of the hospital functions.
On top of that, some of them seem to harbor elitist attitudes, as if they are already big hotshots. Yet, they themselves seem to lack the above mentioned skills.
It is interesting that straw man argument that you pose is the lowest level of debating used to put ones opponent on the defensive.
I'm sure there are reasons that you have taken the topic of inexperience and lack of clinical training very personally and out of context. No one has made any sweeping generalizations about about the caliber of all new grads. Maybe you are confusing us with your colleagues. You have your own agenda and that's fine. Please feel free to start your own thread.
First, you don't seem to know what a straw man's argument is.
I have taken nothing personally and your assertion I have is unfounded and illogical. You are the one who has become personally accusatory.
I am not confusing the authors on this thread with anyone. There is nothing so special about your comments in the thread that make them the only ones that I am responding to.
You are the one who is confused because there are many posters who insisted that all new grads need time as a nurse outside of specialty areas in order to gain skills. If you missed their post please take the time to read them instead of accusing me of taking people's comments out of context.
I will feel free to comment on any thread or topic I choose to. You may feel free to comment on any thread, start your own thread or post on another side. I could care less what you do and you would be better served caring less what I do.
I was talking to a fellow new grad who is in the ED. She is getting a minimum of twenty weeks of orientation. Twenty! My jaw dropped. She was shocked to find that I was already off orientation for three weeks with only a six-week orientation. By the time she is off orientation, I will have been on my own for several months.
Something to keep in mind for this discussion. If a new grad is going to start off in some place intense like the ED, a lengthy and extensive orientation is the way to go.
It depends on their background. I'm a new grad but I've been in echocardiography for 16 years with some advanced cardiac skills. I'd be very comfortable in an ICU or ER right now.
However I would think a new grad who's 21 years old with no life or healthcare experience should get some skills basics experience.
In fact I've already completed ACLS, PALS, ATLS, Rapid STEMI certification and Stroke Scale Assessment certification.
I think it says more about how nursing schools are teaching. Med/surg is a specialty of its own; to say that everyone needs to start there kind of seems to disrespect that status. However, schools need to have students prepared at the basic level of functioning; instead, it seems that nursing grads need to be taught how to be a nurse after graduation, regardless of the specialty in which they work.
As a new grad, we were taught the following explicitly:
Nursing school doesn't exist to teach you to be a nurse anymore, it exists to teach you to pass the NCLEX. Your employer will teach you the skills/attitudes they want you to know.
Med/Surg is absolutely the boring basic standard unit that most people start on. Its a good place to learn the basics, but making a career out of it is a poor choice.
I'm not saying I agree with these sentiments, but that is the attitude that faculty had.
Starting the occasional IV as a student just isn't going to make a difference and it's no loss if you don't learn this skill in school. It's one of those psycho-motor skills that takes tincture of time and lots of experience. I didn't learn it in school and I didn't start IV's on the floor (we called an intern because that person didn't have any experience either). It made absolutely no difference in my nursing life that I didn't start my own IV's. I certainly wouldn't have gotten enough experience on that unit to make me a whiz. However, I ended up in chemo administration and although I lacked the tactile skills at the time, I actually had soaked up a lot of knowledge (need to know purpose of the IV, how long will it be in, size of vein needed to do the job and the biggest question then...can you transfuse blood through a 22 gauge IV?) So to all you students: Don't stress about it. There's often a lot more you need to know than now to get that cannula threaded.
It's good to start it in nursing school if you get the opportunity though. In my class, there were a lot of "stay back and watch" people. I was hands on and ended up starting maybe 50-75 lines. Most of them were in the AC, though, which is good enough for some people (I'm fighting my bias to see the ER nurses, because I get patients with lines only in the AC all the time, but I understand at least some of those are because of emergent situations). However, out of school, I spent a good chunk of time in a setting where IVs were rare for me, and it wasn't until my next job that I really got good, out of necessity.
And I also definitely agree that there's a lot more to know. If you can start an IV, it's definitely an important skill to have, but you're so right when you say that it's only one piece of the puzzle. Once the line is in, it's good. You spent two minutes starting it, but you spend the rest of the time doing other things. Knowing line interactions and drugs is especially so much more important. Albumin and versed are not compatible, for example, and that's something that could endanger my patient's life, did I not know that. 95% of cases, missing an IV is not going to do anything (the other 4.99% being emergent situations where you need a line right away, but honestly, if you and others can't start a line, there's always an EJ or an IO, plus there are drugs you can drop via ET tube, and the other .01% being a broken off piece of the cannula, which I've never actually seen happen).
Agree so much with bluedawn, she describes my clinical experience. I still feel like I really haven't seen what a nurse does. I just do my own thing in med-onc. It's been 3 years since graduation. I am a good nurse who seems to still do too much CNA stuff, but that's ok!
This is silly. The minimum number of clinical hours is set by credentialing agencies, not by the schools themselves. ADN's do not do a semester of public health which COUNTS as hours. I heard that Obama was a Shi'ite Muslim a lot of times. Does that make it true?
It's really not that unheard of. My facility has gone through various periods where there was a freeze on hiring BSN grads due to the extended training period that they've required in our experience and there are other facilities in the region that have done the same.
As you correctly point out, BSN programs include public health clinical hours which count towards the total, which ADN programs typically devote those hours to direct patient care in an acute setting instead.
And while the clinical instructor to student ratio and number of hours is standardized, how those hours are spent can vary significantly between oversaturated clinical sites and less constrained clinical rotations. In other words, while students in two different programs may spend the same amount of time within the walls of a hospital, the proportion of time they spend performing hands on care can vary, and at least in my region ADN programs typically have more clinical availability while BSN programs tend to have so many students packed into a single clinical site that they spend a larger portion of their time watching rather than doing.
And while the clinical instructor to student ratio and number of hours is standardized, how those hours are spent can vary significantly between oversaturated clinical sites and less constrained clinical rotations. In other words, while students in two different programs may spend the same amount of time within the walls of a hospital, the proportion of time they spend performing hands on care can vary, and at least in my region ADN programs typically have more clinical availability while BSN programs tend to have so many students packed into a single clinical site that they spend a larger portion of their time watching rather than doing.
See, and that's not actually how it is where I am. Magnet hospitals that aren't hiring ADNs don't allow them in there for clinicals anymore, and so ADN programs have less of an availability. On my unit (not a magnet facility), we get BSN students but not ADN ones. Interesting how places vary.
See, and that's not actually how it is where I am. Magnet hospitals that aren't hiring ADNs don't allow them in there for clinicals anymore, and so ADN programs have less of an availability. On my unit (not a magnet facility), we get BSN students but not ADN ones. Interesting how places vary.
There certainly are some ADN programs that exist in an area with over saturated clinical availability, and there are some BSN programs that enjoy wide-open clinical opportunities, but that would appear to be the exception.
Some magnet facilities are moving towards a higher ratio of BSN's, particularly those that need to pick up points on that measure to make up for other areas. But overall magnet facilities only make up 7% of hospitals. And overall the 6 month job placement rate for ADNs is only 4% lower than that of BSNs. If the facility a nurse wants to work just happens to be one of these facilities then a BSN would be worth the additional cost, but for many other nurses it's essentially nothing more than a massive pay cut.
Was my question about extern programs irrelevant? Are hospitals no longer hiring nursing students?
In my area, the major hospital network no longer hires nursing students as nurse techs (unless they're already certified CNAs) nor does it hire graduate nurses. You MUST pass the nclex before you start orientation. A unit manager can verbally tell you that they will hold a position for you if you have impressed them, but nothing in writing or from HR until that NCLEX is done.
That said, there are a few hospital in Seattle and Portland that still hire nursing students after their first med surg clinical and also hire graduate nurses. These hospitals offer extensive nurse residency programs as well.
I'm in one of the only residency programs in my area, which is for the OR. I have posted before about my BSN program so I won't go into it again here, but I just wanted to say that there are schools out there that are at least making efforts to bridge the gap between nclex preparedness and hands on clinical skills and experience. I personally feel that I had an excellent clinical experience and many, many opportunities to perform advanced skills, hone assessment knowledge, and provide total care for patients of varying acuities.
As the manager of an Orthopedics unit, I totally agree that young nurses need to learn how to prioritize and do the basics for a year, or two before attempting a specialty! I tell prospective hires that if they will give me 18 months to 2 years, and they want to move to more acute care arenas, I will help them get there!
scottaprn
292 Posts
First, you don't seem to know what a straw man's argument is.
I have taken nothing personally and your assertion I have is unfounded and illogical. You are the one who has become personally accusatory.
I am not confusing the authors on this thread with anyone. There is nothing so special about your comments in the thread that make them the only ones that I am responding to.
You are the one who is confused because there are many posters who insisted that all new grads need time as a nurse outside of specialty areas in order to gain skills. If you missed their post please take the time to read them instead of accusing me of taking people's comments out of context.
I will feel free to comment on any thread or topic I choose to. You may feel free to comment on any thread, start your own thread or post on another side. I could care less what you do and you would be better served caring less what I do.