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.
My son just finished getting his BSN at a supposedly excellent program & his biggest complaint is that there was too little clinical & lab time. He is very aware that his skill level is not what it should be to enter the work place. The emphasis seems to be on academics and going on for advanced degrees. As far as attitude, he says too many instructors instill it in their students and unfortunately some students, esp. the younger ones, believe it.
From what I read on AN, it seems that BSN programs much more than ADN programs appear to have an unstated model of nursing education that for the most part bypasses bedside care, i.e., good quality hands on clinical training in acute care in the hospital setting. When I bridged to a BSN program 19 years ago after my ADN program, some of the generic BSN students in the final semesters told me they had received hardly any clinical training and didn't feel prepared to be nurses. From reading here, and thinking about what I have seen, it seems the emphasis in a number of BSN programs amounts to: "Hands on nursing care is an option, but you will probably want to move on to better things than providing direct nursing care, such as our NP or other master's degree programs, so we don't spend a lot of time on it, or really take it too seriously." Clinicals and labs are treated more as flavoring particles than the foundation of one's nursing education.
You would be a nightmare for any preceptor or a headache as a perceptee. I can't even take you seriously with your elitist attitude. Just because you got a BSN from some so called University then you are way better than a college graduate? And why were you taking Organic Chemistry for Nursing? Are you not a Medical School dropout? I don't believe a thing you say about this so called Nursing School but correct me if am wrong.
Being a newly licensed RN who was fortunate enough to be hired into a CCU, I have to say as daunting as the amount of info I absorb on a daily basis is.. It helps when your preceptor is receptive to questions and doesn't brush you off like "you should know this.." Unfortunately, Its not always warm and cuddly. While I'm not one who would be deemed an "elitist", my attitude is that my trust in you to guide me is dented (sometimes beyond repair) when it's a day-in, day-out power struggle. I've had issues with walking up and hearing things said about me behind my back, which is just a matter of respect. I don't want you to hold and stroke my hand.. But it should also be remembered I have a license too and while it might be bright and shiny and new to an older nurse.. I have an obligation to stand up for myself and it.
I also am a visual learner and even the simplest tasks as Ivs and pumps can be daunting until you learn to work with two clumsy hands and haven't gained the additional ones that you seem to sprout later on in your career.
Specializes in Med/Surg crit care, coronary care, PACU,.
In today's economic situation many hospitals are unwilling to invest money in proper orientation programs to assist nurses to do the jobs they were hired for. No, I do not agree that every nurse graduating SHOULD work in the ICU straight out of school. Just because a nurse may have the desire to work in critical care, does not mean there is time, or talent to get you working safely, effectively where you feel supported. After 25 years in critical care I can recall many a situation where I have gone down to the ER to help only to find many new nurses working the same shift, flailing about trying to care for very ill patients. The look of relief on their faces when they see me is understandable, but when they cannot figure out an essential piece of equipment, or a drug, I am rightfully deeply alarmed, and afraid for patient safety. Without adequate orientation, and support on shift thereafter from experienced nurses, you cannot adequately advocate for your patients. Institutions fail nurses and patients daily by not doing due diligence to make sure skill mix of staff is adequate. Fact is, if nurses are not supported to do their jobs, burn out, and rapid job turnover rates are much higher. I want the next generation of nurses to succeed no matter what specialty they ultimately decide to practice in...they will be caring for me when I need it. Lets support each other to achieve safe, caring nurses in all care facilities.
In today's economic situation many hospitals are unwilling to invest money in proper orientation programs to assist nurses to do the jobs they were hired for. No, I do not agree that every nurse graduating SHOULD work in the ICU straight out of school. Just because a nurse may have the desire to work in critical care, does not mean there is time, or talent to get you working safely, effectively where you feel supported. After 25 years in critical care I can recall many a situation where I have gone down to the ER to help only to find many new nurses working the same shift, flailing about trying to care for very ill patients. The look of relief on their faces when they see me is understandable, but when they cannot figure out an essential piece of equipment, or a drug, I am rightfully deeply alarmed, and afraid for patient safety. Without adequate orientation, and support on shift thereafter from experienced nurses, you cannot adequately advocate for your patients. Institutions fail nurses and patients daily by not doing due diligence to make sure skill mix of staff is adequate. Fact is, if nurses are not supported to do their jobs, burn out, and rapid job turnover rates are much higher. I want the next generation of nurses to succeed no matter what specialty they ultimately decide to practice in...they will be caring for me when I need it. Lets support each other to achieve safe, caring nurses in all care facilities.
I like everything about this, except that it does imply that proper orientations are impossible to find. I work in a teaching hospital, and OR residents get a year orientation, which starts off primarily classroom and then shifts until it's eventually all hands on, L&D has a similar program with tests they have to pass, etc. Almost every specialty has a residency of varying length from 3 months to 2 years.
Proper orientation can be next to impossible to find, especially for the many new grads who don't find a job in a hospital. Nursing homes are notorious for putting new grads on the floor with only a few days of orientation.
Specializes in OR 35 years; crosstrained ER/ICU/PACU.
Thank you....my feelings exactly! I attended an ADN program (after attending college to be a teacher). I took the same boards as you did in your wonder-program. And passed with flying colors. Actually, I'm sure you didn't take the same boards I had to take! In the 70's we used pencils to fill in the circles on the answer sheets, & we took 5 separate exams over 2 days. We did the whole test, all 5 of them, not just enough questions to have passed. And yes, I took & Aced all of those science classes. Made the Dean's List every semester, & graduated 2nd in the entire graduating class, too. Eventually went to Paramedic school, did well there, too, with the great skills I learned in Nursing School, & worked both jobs full time. Don't be so quick to put others down. We're all in the same profession, doing the same skills & caring for our patients in the best manner!
My choice of diving into specialty was the experience, considering I'm in my late 30s starting my career and have two children who will both have graduated and entered college soon (my youngest is a Freshman in HS). I hope to travel once I get a few years under my belt and critical care work just made sense. TPTB opened up a door for me and it would have been ridiculous not to jump at such an awesome opportunity. Is it for every new grad? Probably not. But nothing good rarely comes without serious dedication and hard work.
Thankful my ADN program requires we go through and are licensed as CNAs before we can proceed to the LPN and RN class. I was pretty comfortable with patient care. I once saw a nurse from an accelerated program, who was graduating the next week, couldn't even put on a gait belt. It was like the techs will do this when I'm a nurse.
I think it totally depends on the nursing school and the new grad themselves. Most new grads have no idea how the hospital truly works because they've never worked in one before. You can't blame them for that. Plus- a ward and a specialty unit will operate totally different. Nursing schools are simply pumping out nurses who are "safe"- you can only hope for that. But the basic truth is- you don't truly learn nursing until you're in the hospital and thrown into the fire. That's where it "clicks". I went straight into the PICU as a new grad (after an externship there) and it was the best thing I ever did. Not only did I realize that it was my passion and my life's work, but I feel like it gave me a FANTASTIC foundation of pathophysiology, critical thinking, skills, etc. It depends on the person and their willingness to challenge themselves. I don't think it's a bad thing until you get into a situation where ALL your new nurses are new grads and that's who staffs nights. That's where it gets dangerous. But new grads are great because you can shape them into the type of nurse you expect to have on your unit.
Ok so this is my first comment on here but I feel it is beneficial for this conversation. I am a nurse of 2 years and started in the ER so no where near your 22 years; however I feel it's based off the people and hospital environment. I am at a highly critical center that is awarded top 10 in nation for stroke center, a level 1 trauma center, a cardiac and a burn center. We had an extensive orientation process and have opportunities for many different skill trainings. Sure some new people have some errors but that would be with anywhere. I have taken it upon myself to sign up for pretty much all the special skill trainings and became very respected by my coworkers. I have been sent to help out our sister ERs that are not critical acuity based and the experienced ones make many (what I would consider simple) errors. I think our problem is people who transfer in from other ERs or even other areas who think they are all that and don't have critical skill set. We have a high turn around with those people. So even though new grads may make errors, if it is their passion they stick around. It definately is how- as an experienced nurse that you are- help the newbies and reinforce those "basics".
Susie2310
2,121 Posts
From what I read on AN, it seems that BSN programs much more than ADN programs appear to have an unstated model of nursing education that for the most part bypasses bedside care, i.e., good quality hands on clinical training in acute care in the hospital setting. When I bridged to a BSN program 19 years ago after my ADN program, some of the generic BSN students in the final semesters told me they had received hardly any clinical training and didn't feel prepared to be nurses. From reading here, and thinking about what I have seen, it seems the emphasis in a number of BSN programs amounts to: "Hands on nursing care is an option, but you will probably want to move on to better things than providing direct nursing care, such as our NP or other master's degree programs, so we don't spend a lot of time on it, or really take it too seriously." Clinicals and labs are treated more as flavoring particles than the foundation of one's nursing education.