New nurses don't know enough?

linzz · Apr 30, 2008

As an LPN and likely BSN student, I too am bothered by lack of clinical time and the excess of class time. Even though initial RN licensure in Ontario is now 4 years and the LPN 2.5 years, there is still not enough clinical time and of course this is due to the expense of hospital instructional time, however it can be very tough on the new grad who feels unprepared. I think in the ideal world we could do more floor time and less elective time. I also agree that the changing entry to practice requirments have really created a hornet's nest of political problems which of course are enacted daily in the workplace.

racing-mom4, BSN, RN · Apr 30, 2008

I feel as I had a bit of an advantage at graduation because I was a CNA for the 4 years I was in school. That is not required. I never worked so hard for such little money but it did give me 4 years of hands on in the hospital.

I really looked at my CNA job as part of my schooling. I was one of just a handful of nursing students who were CNAs in my graduating class. Maybe that should be a requirement.

Plus in my humble opinion I think a CNA that is in nursing school is a great CNA to have. I was fortunate the the hospital I worked at as a CNA paid a hefty portion of my tuition in Nursing School. But it was a fair trade off. They got me as an employee for a minimum 20 hours a week, and in return I got a nursing degree and now work for them as an RN.

MzMouse · Apr 30, 2008

I learned as much if not more my first year of practicing nursing than I did through nursing school. I still learn; every day. The nurse that thinks he or she knows everything scares me.

MisMatch, LPN · Apr 30, 2008

As a current nursing student, I would like to add my :twocents: to the excellent points already made.

In school, we rotate through clinical rotations so fast your head is spinning. By the time we figure out the layout of the floor/facility, where everything is located and how records are kept/charting is done, we're off to a new location. In addition, as students, we must go through so many rotations: LTC, med-surg, OB, peds, psyc, ect. that it's impossible to become proficient in any one area. It's not until we get out of school and start working in one area that we can focus on becoming proficient in that area. Nursing is such a vast field that it would be impossible to learn all we should know about the various fields before graduating.

I believe that's why, in nursing, lifelong learning is imperative.

lindarn · May 1, 2008

Nursing need to take a page from PT, OT, Pharmacists, and REQUIRE A ONE YEAR PAID INTERNSHIP BEFORE NEW GRADS ARE LET LOOSE ON THEIR OWN TO CARE FOR PATIENTS!! Increasing the level of education will also bring into play the concept fewer numbers allow the ones that are in the profession to charge more for their services. And yes, we need to start to bill for our professional services just like PTs and OTs do. Until we bill for our services, and are finally considered a "money making cost center", our names will continue to appear on the negative side of the balance sheet, and our professional services will continue to be rolled in with the room rate, housekeeping, and the complimentary roll of Toilet Paper and box of Kleenex.

Nursing needs to get over the attitude that new grads need to "hit the ground running", the day after graduation. No other profession places this stress on new graduates. The new grads in other professions are allowed to continue to learn after graduation. There is nothing to be ashamed of if move to this. There would be alot less "sticker shock" after graduation, and there would be alot fewer new grads running out the door a year after graduation. We are not doing any one a favor allowing this. Forget that the hospitals want new grads coming out of the woodwork. Fewer new grads would make the hospitals and nursing homes have to focus on retention, not recruitment

Nursing claiming their own cost center that we bill for would give nursing the respect and control that we should have. That of course, is the last thing that hospitals and nursing homes want. They are still trying to find ways to not have to need nurses in hospitals and nursing homes, and they continue to bribe our elected officials to allow the de- professionalizing of the nursing profession.

We all need to put our heads together and find ways to accomplish this in order to better the nursing profession. JMHO, and my NY $0.02.

Lindarn, RN, BSN, CCRN

Spokane, Washington

suanna · May 1, 2008

I don't mean to be critical of the new grads out there but I can understand the criticism. When I was in school we got a lot of focus on assessment and proceedures. There was just enough theory and "care plan" stuff thrown in to allow for a perspective of independent practice. The students that are comming out now seem very well versed in research, care plans, and theory but they don't know NSR form V Fib., haven't a clue about time management, wouldn't know rales-rhonchi-wheezes if they tripped over them and have never held a angiocath (IV). Theory is great but when you are taking care of 6-8 patients on a busy med/surg floor you aren't thinking about old D.Orem vs Sister Whats-Her-Name. Your are trying to pass your meds, do your assessments, keep your IVs patent, and hoping you don't miss something in your assessment that kills someone.

The local universities seem to be depending on the "preceptorship" part of the program- when a student works one on one with a RN in practice for a rotation to provide for thier practical skills. Because of lack of preceptors,only about 60% on the students take this rotation-the rest follow a traditional med/surg experience. Everyone needs to develope thier skills when they are a new grad-but honestly I would love new grads to have a better grasp of the basics before they hit the floors.

zimsaint · May 1, 2008

As an LPN and likely BSN student, I too am bothered by lack of clinical time and the excess of class time. Even though initial RN licensure in Ontario is now 4 years and the LPN 2.5 years, there is still not enough clinical time and of course this is due to the expense of hospital instructional time, however it can be very tough on the new grad who feels unprepared. I think in the ideal world we could do more floor time and less elective time. I also agree that the changing entry to practice requirments have really created a hornet's nest of political problems which of course are enacted daily in the workplace.

WOW.....in the US LPN programs range from 9 to 18 months with 12 months being the average. The RN is as little as 2 years with only 1 year bridge programs for LPNs. ( As an LPN I completed a distant learning RN program core in about 6 weeks and waited a few months for clinical...all total less than 6 months). My question is ........Why does the US consider Canadian RN programs inferior (don't accept your boards and make you take the NCLEX and additional learning) if you all have longer, possibly more stringent requirements for your RNs? :confused:

elkpark · May 1, 2008

I don't mean to be critical of the new grads out there but I can understand the criticism. When I was in school we got a lot of focus on assessment and proceedures. There was just enough theory and "care plan" stuff thrown in to allow for a perspective of independent practice. The students that are comming out now seem very well versed in research, care plans, and theory but they don't know NSR form V Fib., haven't a clue about time management, wouldn't know rales-rhonchi-wheezes if they tripped over them and have never held a angiocath (IV). Theory is great but when you are taking care of 6-8 patients on a busy med/surg floor you aren't thinking about old D.Orem vs Sister Whats-Her-Name. Your are trying to pass your meds, do your assessments, keep your IVs patent, and hoping you don't miss something in your assessment that kills someone.
The local universities seem to be depending on the "preceptorship" part of the program- when a student works one on one with a RN in practice for a rotation to provide for thier practical skills. Because of lack of preceptors,only about 60% on the students take this rotation-the rest follow a traditional med/surg experience. Everyone needs to develope thier skills when they are a new grad-but honestly I would love new grads to have a better grasp of the basics before they hit the floors.

Very well said! I agree completely.

linzz · May 1, 2008

Zimaint: I have no idea why Canadian nurses need additional training to work in the USA. . Although our nursing program are longer, I doubt that they are better, just longer and maybe spread out over a longer period of time. Years ago, here in Ontario, nursing jobs were scarce, so I wonder if one of the reasons that the nursing programs were made longer were to decrease the supply of nurses although nobody would ever say that out loud.

husker_rn, RN · May 1, 2008

As veryone has said, you won't know everything you need to know....I've been at it for 16 years and STILL don't know enough. But.....I do know what I don't know and I DO ask for help or a second opinion when I need to. Only someone brash or ignorant feels like they know it all. Find a good mentor and good luck !!

GilaRRT · May 1, 2008

WOW.....in the US LPN programs range from 9 to 18 months with 12 months being the average. The RN is as little as 2 years with only 1 year bridge programs for LPNs. ( As an LPN I completed a distant learning RN program core in about 6 weeks and waited a few months for clinical...all total less than 6 months). My question is ........Why does the US consider Canadian RN programs inferior (don't accept your boards and make you take the NCLEX and additional learning) if you all have longer, possibly more stringent requirements for your RNs?

I do not think it has to do with quality of education. Modalities and nomenclature may differ from the US to Canada. For example, you may see a blood sugar in Canada charted in mmol/l, where in the US you would see mg/dl. I suspect the testing is a way to ensure the Canadian nurse is knowledgable with the modalities used in the USA. I would expect the same of US nurses that want to practice in Canada.

truern · May 1, 2008

As a new grad I wasn't expected to "hit the floor running". I had an extensive preceptorship with great nurses showing me the ropes, holding my hand when needed, and not hesitating to kick my behind if necessary. I guess that's NOT the norm everywhere, but in my opinion it should be.

Also, after I graduated from my nursing program they asked recent grads for suggestions regarding improving the program. Surprise, surprise....they actually listened and made some great changes!

As new grads you can't be expected to know everything, but you should know what you DON'T know and ask for guidance.