New nurses don't know enough?

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I've been talking to a lot of nurses that I know since I have decided to go to school for nursing. I keep hearing over and over again that the new nurses nowadays don't know as much as they should know before starting work.

Is this the case out there? Why is this? It sounds a little scary to think of entering the work force unprepared for such an important job.

Specializes in Community Health, Med-Surg, Home Health.

One of the things I have observed is that the nursing programs of today are not of the same quality as programs in the past. I have spoken to the more senior nurses that I work with, and saw that most of them had more clinical hours. In fact, most of the diploma programs seemed to have two weeks in class, two to three weeks in a clinical setting, where consistency and familiarity allowed for more preparation into the nursing field. Nowadays, it may be one or two days a week, and not even a full day. More time in class hearing theories, but not enough time getting your hands dirty. There are less clinical instructors because the salaries are not competitive, which, creates less seats for RN and LPN programs is another culprit in my opinion.

While it is sure true that no nurse knows everything, I think that the quality of education has shifted to the negative. I don't think I got much out of my experience in my LPN program, but I make do, ask questions and use what I do know to figure out what I don't know and make sure that I go to other nurses to assist me.

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Specializes in ER/ICU, CCL, EP.
One of the things I have observed is that the nursing programs of today are not of the same quality as programs in the past. I have spoken to the more senior nurses that I work with, and saw that most of them had more clinical hours. In fact, most of the diploma programs seemed to have two weeks in class, two to three weeks in a clinical setting, where consistency and familiarity allowed for more preparation into the nursing field. Nowadays, it may be one or two days a week, and not even a full day. More time in class hearing theories, but not enough time getting your hands dirty. There are less clinical instructors because the salaries are not competitive, which, creates less seats for RN and LPN programs is another culprit in my opinion.

While it is sure true that no nurse knows everything, I think that the quality of education has shifted to the negative. I don't think I got much out of my experience in my LPN program, but I make do, ask questions and use what I do know to figure out what I don't know and make sure that I go to other nurses to assist me.

The focus is different. Nursing used to be a real OJT type of thing...all clinical hours and not a whole lot of lecture. We now have a more academic approach to nursing. I am not saying it is superior or inferior, I am saying that it is different.

Medical students used to 'read medicine' for a few years under a preceptor and then go out on housecalls with him until he 'knew enough'. After that, he would set up his own practice. I am rather happy that we don't allow doctors to train like that anymore, and I am personally glad that we concentrate on theory and pathophysiology is nursing school, and then become more proficient after graduation. Most professions do this. Accounting, Geology, Engineering, etc. They all have academic hours and lab hours. Why should our profession be different? Simply put, all jobs have a learning curve, and ours is no different. I feel that the theory I learned is very useful to me, as it comes up every single day in my practice.

For example, we spent a lot of hours on fluid and electrolytes. Maybe some people think that our time would have been better spent in med administration and patient care, but I do not agree. I find the actual 'patient care' part of nursing to be easier than the critical thinking. I needed all of that theory to do my job. Anyone can make a bed, hand a patient a pill, or IV Push a medication. I could teach my 15 year old to do it. The important thing is to know WHY we give albumin, why giving that insulin right now would be a bad idea, or that it is time to call a Doctor when a patient looks like that....

And....in my city, we have some pretty big hospitals. There are also seven nursing schools in about a 20 mile radius. We are constantly short of clinical sites and some programs wind up doing clinicals in places that teach them almost nothing. I am fairly sure that trying to keep a clinical site for a month at a time for 5 days a week would be next to impossible. I had to SHARE my patient with a student from another school on my postpartum rotation.

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Specializes in Community Health, Med-Surg, Home Health.

I believe that both, theory and practice can be given simultaneously. To have a 5 day school week take up 4 days of theory and a few hours of clinical experience does not prepare the nurse for the real world. It takes both, to me. A person can learn why they are hanging albumin, administer insulin after obtaining a glucose reading while in clinical as well as in class. I am not saying that theory is totally unnecessary. But, it is not enough to give just a few hours a week and be limited in what can be done. I have had situations where we would arrive to clinical to have the instructor arrive on hour late because she had another job. Then, was too tired to remain all day and we only stayed 3 hours. What did I REALLY learn? Not much. From what I have seen, those that graduated with having more clinical hours where they got their hands in the mix to apply all that they learned were much more prepared to deal on the battlefield.

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Specializes in Med/Surg, Home Health.
I am a firm believer that with nursing the best learning and training is on the job, you have to put your hands on it, see it, touch it, and sometimes even smell it, lol. You can learn all you can in nursing school, but until you actually see it and know how the apply your skills, its just learned knowledge. For the information to actually stick, you have to be able to apply it to a actual real life situation. If everything happened as it does in text books, life would be much simpler.

Just my :twocents:

I agree. Just like in school, starting an IV on a dummy arm was easy, but starting them on a real arm was a different story. Once I started work, IVs were a challenge, now I can start one on just about anyone. Im called the "IV Queen" now, lol. And it was like that with alot of skills, such as F/C's, NG's, etc. BUT, on the same note, Ive lost ALOT of the knowledge I had when I was in school. Sometimes I will get an admission with a disease process that I have no clue what it is. When I was in school I knew, but now I dont. I think new nurses have alot of knowledge, more than some "seasoned" nurses, but they just dont have the skills down yet and still will learn how to apply their knowledge to real life situations. Thats just part of it though....we all continue to learn as we go. We never stop learning.

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Specializes in ER/ICU, CCL, EP.
From what I have seen, those that graduated with having more clinical hours where they got their hands in the mix to apply all that they learned were much more prepared to deal on the battlefield.

ADN students get more clinical hours than BSN students. That does not make an Associates Degree superior to a BSN for the long haul. (I am an ADN grad, btw) I don't think that how a nurse performs in the first 6 months of their practice is an accurate measuring stick for nursing schools.

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