NEW GRADS

Serhilda, ADN, RN · May 6, 2018

No. A lot of these things were covered in nursing school or are addressed during new grad residencies. It'd be a waste of my money honestly.

FurBabyMom, MSN, RN · May 6, 2018

While I agree, there are usually things new grads are less familiar or inexperienced with, I don't think it's fair to blame only the schools. I am not a new grad, but haven't been out of school that long either. Some of the comments of several hours a week just with most of it clinical? I cannot comprehend that. We used to spend 6+ hours a week just in nursing lectures (other classes separate and depending on the meeting schedule and hours - about 4 hours in person there too), plus 8 hours of clinical, an hour of lab/simulation each week, plus then independent time spent on homework, clinical prep or summaries, and lab/skills time. Maybe it has changed in a relatively short time...

I do not think those things can be taught always in a classroom setting. Nor do I think it's fair to expect schools to universally teach students what they need to know when there are so many differences between facilities. I've worked in 4 hospitals, and each ones' criteria for rapid response has been different. Documentation standards and expectations vary sometimes between units let alone hospitals and the EMR of choice heavily influences those standards. I think that with SO many differences between facilities and even between states (not all students work where they were educated) - hospital should expect to have a significant investment in teaching some of these skills. At the time I started in my hospitals' OR - we were on a different EMR than the rest of inpatient nursing, one of our educators taught us what we had to chart. We no longer do that - we now only send staff to the classes provided by ISD and then they learn from individuals as they orient. Which has benefits but has significant drawbacks as there is not necessarily consistency. One of the most useful things that happened as a student for me was an instructor took us to the desk, asked for a copy (or several) of the downtime forms. She suggested we examine these as they gave a good indication of what is easily available to chart and what the expectations might be.

At one of the hospitals I worked at, we had a significant tele and critical meds class. We were not allowed to be the only ones signing tele strips without passing tele class. It was amazing - I learned sooo much. We had to take critical meds before we could independently give those meds. Both were required regardless of experience level. As for deteriorating patients - I was lucky enough to work as an assistant before I worked as a nurse. I was the person to walk in on a patient who I rapid responsed - I did call the desk and the charge nurse came to the room, and once there I called while she tried to manage the patient. I saw enough situations where we rapid responsed or transferred patients to a higher level of care, and I saw deterioration even in ICU. I think my least favorites were codes we ran during transport or when I'd been asked to helpng school. They often let us hear concerning heart sounds, or shared what their assessment concern is/was to teach us. We couldn't document assessments but there was no reason we coudln't listen to a heart murmur or watch pupil reactions, etc. If we were busy - sure, we were busy. But nurses invested the time to teach us as opportunities arose. They also pulled me into emergent/deteriorating situations when I was on orientation as a nurse.

My point is - it is not just schools failing students and new grads. We're kind of failing them when we don't teach them everything we can. We have to ask ourselves - do we take every opportunity to teach them when they're on our units as students, specifically when 1:1 doing a preceptorship or capstone? Are we willing enough to teach the assistants we know are nursing students the "why" behind what we do or when? No, they can't do those things independently or even with assistance in most cases but the why helps so much. Do we debrief and discuss things after the crisis is over?

Apple-Core, ASN, BSN, RN · May 7, 2018

New Grads:
If there was a class offered for new grads would it be of interest to you? Topics covered
-Critical thinking skills
-Time management
-Charting
-Basic meds used in the ICCU, ER and telemetry
-identifying a deteriorating patient
-identifying a septic patient
-Rapid Response
Is there any other topics you'd want to see covered and would this be a class/seminar you'd be willing pay for?

Id say that all these should be covered in nursing school. However, what would *really* help, IMHO, is a class that covers all this stuff BEFORE nursing school starts - a prerequisite almost.

SpankedInPittsburgh, DNP, RN · May 7, 2018

New Grads are New Grads. They know what they have been taught and are pretty generic. I think all this stuff (and more) should be gone over in orientation in a practical hands-on manner.

Amethya · May 7, 2018

Wait... you don't know vitals and charting? How can that be? I thought nursing school taught that too. (Am CMA, and that's things we are taught)

katyq82 · May 7, 2018

I am about to graduate in a couple of weeks, and the items you list were all taught in my nursing school- in lecture, sim lab and clinical. But I think that (as with any profession), there is a big difference between knowing these concepts intellectually and putting them into practice quickly and accurately in a real life situation. That can only come with on the job practice. I hope that more hospitals will invest in orientation or residency programs that allow new grads to practice these concepts safely. A good start would be to train and reward experienced nurses who want to precept. To answer the question, I might consider taking such a course as a new grad- but I think that many people who could use a new grad type class might not be super self-aware and reflective enough about their practice to see the value in it. It would be better coming from the employer. FYI, the NCSBN does offer an online new grad class called "Transition To Practice", but it seems to cover more abstract concepts than what you are describing.

verene, MSN · May 7, 2018

As a new grad:

-Critical thinking skills

-Time management

I think a lot of critical thinking and time management only come with time and experience. Debriefing after incidents helps with the critical thinking and time management is something you learn by doing. Each work setting requires a different flow so it is something you adapt over time.

-Charting

Covered pretty well in school. I also got a run down of facility specific charting during orientation. Everything else I've been able to either figure out on my own or quick question to another nurse.

-Basic meds used in the ICCU, ER and telemetry

Pretty specific to the setting. I got basic telemetry reading in nursing school, and assume if I entered a specialty requiring ICU/ED medications and greater telemetry understanding I'd get the training from my employer.

-identifying a deteriorating patient

-identifying a septic patient

-Rapid Response

All of this was covered in nursing school. We had lots of time devoted to assessing with looking for both positive and negative trends in patient function. We also had a decent amount of time devoted to sepsis.

Rapid response was done in simulation, and discussed thoroughly with the understanding we would need to know facility specific protocols. All of us placed at the hospital I did many of my clinical hours at also got trained on that facility's protocols during our time there with the expectation that we could independently call a rapid response if needed. I never had to call one, but several of my classmates did.

In short I don't think I'd find this course useful. I'd really hope a student coming out of school would have basics in all of these areas (except ICU/ED skills/meds).

Career Columnist / Author · May 10, 2018

There is a knowledge/skills gap between nursing school and clinical practice.

Currently hospitals address this with residency programs designed to bridge the gap.

HalfBoiled, BSN, RN · May 11, 2018

It would be helpful for someone who passed the NCLEX >2-3years and still seeking a job.

Kate2016, BSN, MSN, RN · May 14, 2018

My hospital does this. Mandatory monthly meetings for new grads for a year. I found them helpful. Went over things like safe patient handling, charting, and had a set apart time for us to get up and talk about anything we wanted such as a rough shift or a good catch. I know a lot of new grads thought it was annoying having to come in for the meeting but I truly found it helpful and now, a couple years later, I feel I am a better nurse because of them. Our house supervisors ran them and it made me feel at ease during my shifts because I felt like I could approach them with anything.