I need to say this because my mind is going to explode from stress.
I got accepted in ABSN program in Texas with a high NCLEX rate, 97%-100%, each year, and a good reputation. I moved there and started. There are two things driving me crazy and I wonder if you guys are experiencing the same.
1-the first thing is the skills lab. What we are doing is watching videos each week, have a lecture then take a quiz on them and that is it! No on-hands training! What makes things worse is that we supposed to have a check-off on medication administration, wound care, Foley's catheter, and no lab! We are supposed to watch videos about them, go to the lab for one hour to practice those skills alone with no help, then do the check-off in front of the professors!
2-the clinicals are worse. They were telling us that clinicals will be the first semester. Fine! What is happening is we see the pts for an hour looking at their files, then the rest of the time we are discussing random subjects with the clinical professors! No, we don't practice the skills at the clinicals.
Are you guys experiencing the same? How is your skill lab and clinicals look like? I know that COVID makes things more complicated, but I want to know how others do. I'm really afraid of going through nursing without proper skills. I don't think this is a good way to prepare a nurse. And I can't imagine I paid all of this money in such education. I'm thinking seriously to transfer from this school.
Your clinical practicums are following a usual method of the case study method of learning which has been used for medical and nursing education for atleast a hundred years. It always starts with a review of the patient's presenting health problem and any other additional concerns. While researching the pathophysiology and usual symptoms you are aquiring the basic knowledge to understand the disease process and what you should look for. Additionally, you can learn what medications are being used since this seems to be the primary initial treatment in Western medicine. I think you are also taking a pharmacology course concurrently, is this right?
I agree with you about the "case study method" and learning about the diseases and the used meds. one thing here: we don't discuss the cases. we just write and submit them and that is it.
I read the book "health assessment made incredibly visual" I got videos on Youtube for lung and heart sounds and listen to them from time to time, I know this is the least I can do.
yes, I'm taking a pharmacology course, there is no pathophysiology course however, it is embedded in the med-surg, which is not bad.
18 minutes ago, londonflo said:
The lack of validation of your assessment skills concerns me. While an instructor may not observe every student assessment, there should atleast be some time for this. Is it possible to ask for help with something you seem unsure about...like pedal pulses, return of bowel sounds, lung sounds? Are you able to participate when your RN performs theirs?
they were trying, but being in a long-term facility, the nurses were really hostile, and I understand this due to them being very busy, and we were on the floor for an hour. I tried to build connections with the nurses there, but we had to be in that hall for the rest of the clinical hours.
24 minutes ago, londonflo said:
The lack of skills lab is also a concern. How are skills presented to you? (video or actual demonstration)
The skills were demonstrated as videos only. and there was a funny story behind this: dome of the demonstrated skills are outdated, some of the students failed the checkoff because they followed the videos!
26 minutes ago, londonflo said:
Can you practice on your own in the skills lab with PPE? When you are doing 'check-offs' are you using actual supplies and mannequins? What do your classmates think about this? Are there some make-do arrangements such as atleast letting you handle the equipment? Actual application of the principles of skills in clinical is different but at least you can learn how to handle the equipment. I thought I saw that you are taking an actual skills class this first semester, what is taking up that time?
No practicing in the skills lab with PPE, this is a dream for us! when we did the check-offs we did them on mannequins, and that was really cool and when the lab instructors explained the errors we did I felt that now we are learning. currently, they are talking about going to skill labs next semester in person which is great and I hope they won't change their minds! it will be funny to imagine how are we going to learn IV lines based on videos. and with my experience with them, I can see them ask us to practice on ourselves!
My classmates hate it, but as they are saying " nothing we can do, we are stuck, the important thing is getting the NCLEX, and we can learn later!"
As a solution, I'm trying to get a job as an extern nurse, do you think this will help?
34 minutes ago, londonflo said:
Practice questions have not been part of a curriculum but are always requested by students. Some students use resources like Saunders or other NCLEX books. Are there any students in semesters ahead of you to ask for recommendations?
I actually do this myself, using Saunders and success series by Davis, Nursethink has some questions, there are two factors here. The senior students used ATI, so their recommendations are the same about Saunders and the other materials. In addition, they didn't have a problem finding practice questions because ATI had a question bank, I tried to get it and I contacted ATI but they told me it is a school-based thing that individuals can't purchase on their own.
Another concern about nurse think, it is only for med-surg, what are we going to do with our classes?
39 minutes ago, londonflo said:
If you choose to transfer I doubt you will be able to use the credits you are earning this semester. Your program has excellent pass rates for the last 5 years.
Yes and this is a big problem, losing all that time and money and starting all over in another state is a serious thing, besides I'm 40 years old! and only three semesters left! but if I transfer it would be to Loyola University Chicago, I have an admission for Spring, which is ranked 57 out of the best 100 nursing schools in the country. It is a hard decision, but losing a semester with the money or losing the whole career? This is my dream which I pray every day to be excellent in it.
If I'm staying, any advice how can I survive the lack of training? as I mentioned, I'm trying to get an extern nurse position to be around nurses and see what they are doing. anything else I can do?
This is usual, in my experience, for the first clinical. The patients are stable, some communication in a non-stressful situation can occur amd you will learn the physical changes that occur in the fragile elderly. Chart review is sometimes hard, because there is so much interaction among the disease processes it is hard to pinpoint exactly what can be attributed to what pathophysiological process. Also the charts are set up for the type of information gathering that occurs in long-term settings and there is little data in the way of current labs.
Physical assessment is hard in this setting for a number of reasons. First the residents are wearing clothing and it is not easy to remove. Second, the residents are not expecting a shift assessment that is very detailed. Hospital assessments are so much easier. Patients are in bed so can turn, sit up or get in a position that helps. Hospital gowns allow visual, auscultation and palpation access. Thirdly, patients are expecting they will be assessed by multiple people, multiple times a day, and even some pointing out of some changes by one practitioner to another. They expect to be awakened for hospital activities. Fourth, you are looking for changes and expect to see changes for the better or maybe worse. Your assessment skills will get honed in the hospital setting. This will come.
37 minutes ago, olaswaisi said:
they are talking about going to skill labs next semester in person which is great
This is great news. The school does have a vested interest in providing necessary instruction and practice of skills.
39 minutes ago, olaswaisi said:
it will be funny to imagine how are we going to learn IV lines based on videos.
Before specialized mannequins we learned by watching filmstrips! Your ability in this skill will most probably be achieved after you graduate and we have all mastered it with some method of instruction and practice. Some schools do not even teach it, I have heard. (and yes, I have taught in schools where students did practice on eachother!) Somebody I worked with told me they had to insert NGs into eachother-- quite a long time ago.
You are a great self-directed learner and I applaud you for the enthusiasm and energy you bring! Sometimes it seems like you will never get to the 'meat' of nursing but it will come. You are in an ABSN program and moving you along in the role and responsibilities is planned out.
Getting experience as a nurse extern is a good plan but beware of losing out on enough time for your studies. Loyola is an excellent school, well respected. I am biased probably because I went to another Jesuit college almost 50 years ago. I wish you courage in your decision and wish you better learning experiences next semester, wherever you attend.
You are AGGRESSIVELY missing the forest to argue over the trees. The point made to you has nothing to do with comparing nursing assessment to CNA assessment, the point was that if you are truly spending your entire clinical shift doing CNA stuff, then use those opportunities to practice RN assessment.
If you honestly are getting zero input from your clinical instructor, and the floor nurses refuse to help you, then make note of the patient's diagnosis, and once you get done doing whatever CNA skill you are doing for the patient, do your own history and physicial. Write down your findings, take them out to the clinical instructor and share with them, get input on good things and bad things. If your clinical instructor won't participate, Google the disease process and see if your assessment findings hit or missed anything major.
Or, I guess you can continue running around with this giant chip on your shoulder and continue to gain absolutely nothing of value from nursing school.
OH, you're one of those you should pay thousands of dollars to show up to clinical and do what you can do from the comfort of your own home on the computer for free. I get it now. Stupid me, expecting clinical instructors to actually engage with the students and do the job that they're getting paid to do: teach.
OH, you're one of those you should pay thousands of dollars to show up to clinical and do what you can do from the comfort of your own home on the computer for free. I get it now. Stupid me, expecting clinical instructors to actually engage with the students and do the job that they're getting paid to do: teach.
No, I’m one of those who figures out how to make the best of a bad situation. You do whatever you want, good luck in school!
I need to say this because my mind is going to explode from stress.
I got accepted in ABSN program in Texas with a high NCLEX rate, 97%-100%, each year, and a good reputation. I moved there and started. There are two things driving me crazy and I wonder if you guys are experiencing the same.
1-the first thing is the skills lab. What we are doing is watching videos each week, have a lecture then take a quiz on them and that is it! No on-hands training! What makes things worse is that we supposed to have a check-off on medication administration, wound care, Foley's catheter, and no lab! We are supposed to watch videos about them, go to the lab for one hour to practice those skills alone with no help, then do the check-off in front of the professors!
2-the clinicals are worse. They were telling us that clinicals will be the first semester. Fine! What is happening is we see the pts for an hour looking at their files, then the rest of the time we are discussing random subjects with the clinical professors! No, we don't practice the skills at the clinicals.
Are you guys experiencing the same? How is your skill lab and clinicals look like? I know that COVID makes things more complicated, but I want to know how others do. I'm really afraid of going through nursing without proper skills. I don't think this is a good way to prepare a nurse. And I can't imagine I paid all of this money in such education. I'm thinking seriously to transfer from this school.
I'm just grateful that my program allows me to keep going. I'm spending more time with my practice tests, pharmacology, and other classes when other activities aren't available. It seems I have a good time with pathophysiology. I also read (and review the previous chapters) the procedures that the nurses do, such as what to do about a new postoperative patient and etc. When I was in the clinical sites, I had good experiences. I assessed a few patients, passed med, and charted them. The floor nurses were busy. I had chances with nurses who had discharged and admission on the same day plus calls. The nurse was elaborating...when he or she felt that those were important for me to know. Other things, I took care of them that I can do as a student nurse. I helped around.
My colleagues, some of them, are unable to attend school because their nursing school is closed.
No, I’m one of those who figures out how to make the best of a bad situation. You do whatever you want, good luck in school!
I'm done school. But I also believe that the ton of debt I'm in should have been for ACTUALLY BEING TAUGHT.
Seriously, do you go to a restaurant and hand them money and then happily leave without ever getting any food? Or do you pay the mechanic and leave with your car still broken? Would you pay your babysitter to just never show up and leave your kid home alone? So why is it acceptable to be paying colleges thousands of dollars to have instructors that are completely hands-off?
Again, I can teach myself at home for completely free. I can research the pathophysiology of a patient's disease from my bed. So, seriously, give just one rational reason why it's acceptable for students to have to show up to clinical, work as an unpaid CNA, and get almost no instruction from their teacher for the entire day? If this was ANY other field, those instructors would be fired on the spot. But in nursing, we have absolutely no backbone.
I'm just grateful that my program allows me to keep going. I'm spending more time with my practice tests, pharmacology, and other classes when other activities aren't available. It seems I have a good time with pathophysiology. I also read (and review the previous chapters) the procedures that the nurses do, such as what to do about a new postoperative patient and etc. When I was in the clinical sites, I had good experiences. I assessed a few patients, passed med, and charted them. The floor nurses were busy. I had chances with nurses who had discharged and admission on the same day plus calls. The nurse was elaborating...when he or she felt that those were important for me to know. Other things, I took care of them that I can do as a student nurse. I helped around.
My colleagues, some of them, are unable to attend school because their nursing school is closed.
Well, I understand your comment about " stop whining and make some effort to learn, and be grateful that your program still open!"
I agree with you that we should do our best to learn the subject as much as we can and to become the best of ourselves. However, you still need a director, and instructor to tell you the right and the wrong. Don't underestimate the value of professors, other than lets close all schools and hospitals and go learn by yourself! it is easy to project the schools' failure on ourselves and pretend that it is our fault to learn more.
You learned the assessment by yourself, try to do it, put the stethoscope on the pt's chest to listen to his heart. Pam ! nothing at all! you are sure that you did, according to the book correctly, and you still can't hear anything! only the experience of your instructor will lead you at that time. When you do an IV and the instructor can show you an easier way and more effective.
It is not whining, it is a simple ask to get what are you deserve, what are you taking loans for.
from your profile name, it looks like you are a CNA and probably working in a hospital, you have access to nurses and learn from them, good for you, but guess what? not everybody has this chance.
Before specialized mannequins we learned by watching filmstrips! Your ability in this skill will most probably be achieved after you graduate and we have all mastered it with some method of instruction and practice. Some schools do not even teach it, I have heard. (and yes, I have taught in schools where students did practice on eachother!) Somebody I worked with told me they had to insert NGs into eachother-- quite a long time ago.
I can't thank you enough for your supporting comments, I made my mind to stay in my current school and get a job as a nurse extern until something happened that turned everything upside down.
last Wednesday, I got an interview for a nurse extern position and they asked me to sign a "skills checkoff list" from my clinical instructor. and when I did, the clinical education manager at the school said that she can sign off the skills which we had been checked off officially!!
I attached a pic for the list, if you can see it, the ones which are circled in red we took them in the school, and as you know, we didn't practice them in the skills lab, we just watched videos about them. the two circled in yellow are the only ones in that list we had been checked off officially!
This move scared me to death! they make it clear that they didn't train us to do those skills! we are on our own! I wonder what the HR in the hospital will say when I send them this list with only one signed skill or about their reaction when they asked me about the rest and I tell them that we watched videos about them! probably I will lose the interview!
we didn't practice them in the skills lab, we just watched videos about them
I really don't think it is as bad as you think. The handwashing, gowning, gloving can be learned by watching. I think our lab may have had a live demonstration instead of videos and 'our lab' made have students film a return demonstration but frankly, it can be mastered one time on the clinical unit. Just know the order you put them on and take them off. The postop needs all are learned on a post op floor. You cannot do a return demo on incentive spirometry etc. I haven't seen TEDs in years. I don't know how you can return demo on O2 therapy ? maybe how to put a nasal cannula on (prongs go down). When you study respiratory diseases and corresponding therapy you will learn the different delivery systems. Restraints should have a return demonstration for tying correctly. Ask someone on a unit if you have someone in restraints to show you. To be honest, I so rarely apply them that I always have to ask for someone to watch me do them. But I was always in an acute care hospital setting. You will not be alone when called to practice this skill.
Bedmaking used to be a major skill until we had fitted sheets. Now there is nothing to it, perhaps the top sheet. 'Hospital" corners are a thing of the past -- we had to do those when all we had was flat sheets. There was always a discussion on whether the pillow case opening should be seen from the door or not! From a recent 11 day experience as a patient I can say my sheets were changed once - while I was in surgery after a week of laying in bed. For some reason it was neglected, although it should not be. I always liked making beds -- it is kind of mindless and when I would start helping students they would stare at me in wonder as to why I was helping. (PS. I failed my first bedmaking demonstration in 1975 so perhaps I am overcompensating! :LOL) Assisting with aseptic procedures must mean opening packages. I have no idea how Covid has disrupted your planned educational activities. I do know a student acquiring Covid would cancel out any further academic participation that semester for that student probably.
Physician order entry is specific to the institution so there is no teaching that at a university. Frankly this list looks very old and does not represent what a first semester student would have had experience with. Somehow I bet this is used for anyone seeking a CNA/PCT position.
Perhaps because you are in an accelerated program the expectations are different. It is too bad you program did not require you to complete CNA training because all of that is covered in a clinical setting if they are available. Because of Covid last Spring several classes were not able to complete their programs and it did impact on their program admissions this fall.
Well, I understand your comment about " stop whining and make some effort to learn, and be grateful that your program still open!"
I've never said that you were whining. If you can't handle this situation, the effect of this pandemic where the instructors and student nurses cannot do much, especially for you, I suggest you wait for the right time. Perhaps, you can compromise with the director of your program because you'd prefer that you want to be able to hone skills prior to your graduation. That's a legitimate reason to hold your education. The hospitals and other facilities are banning students. I will probably face the same circumstances. I don't know yet. There's no call or email from my clinical instructor.
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subject as much as we can and to become the best of ourselves. However, you still need a director, and instructor to tell you the right and the wrong. Don't underestimate the value of professors, other than lets close all schools and hospitals and go learn by yourself! it is easy to project the schools' failure on ourselves and pretend that it is our fault to learn more.
I value my instructors/superiors, but I cannot bleed them this time because of the COVID-19. That's up to the hospital. I don't want to add up in their headaches. My teachers are the only people I'm relying on right now. I do get clinical practices no problem. I'm concurrently on the floor. Therefore, I'm grateful that I'm in the program despite this pandemic. Other schools are completely virtual. Again, I'm delighted and grateful that I'm not in your situation or other people.
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You learned the assessment by yourself, try to do it, put the stethoscope on the pt's chest to listen to his heart. Pam ! nothing at all! you are sure that you did, according to the book correctly, and you still can't hear anything! only the experience of your instructor will lead you at that time. When you do an IV and the instructor can show you an easier way and more effective.
One reason I became a CNA was to avoid problems like people who lack experience in direct patient care. I don't know most of the things the nurses do, but I learned to be flexible and be ready for the unexpected.
At the beginning of nursing school it's pretty normal not to get much hands-on practice with skills in clinical. My first quarter clinical was also in an LTC, and we spent most of the time researching the patho, the meds, taking vitals, helping patients with ADLs, and doing some H2T assessment. If it's med-surg clinical, you should definitely be getting opportunities to practice your nursing skills - at the very least, assessment, charting, and PO/SQ/IVP med admin.
Regarding skills lab, my school has also had to close down the lab due to COVID and we are watching videos on ATI as well as having the instructors demonstrate from their homes via Zoom. Then we are supposed to record a video of ourselves performing the skill using props or whatever we have available at home - this quarter I got to do a central line blood draw and dressing change on a piece of cardboard and last quarter I got to hang an IV on my chandelier... it's pretty comical. Of course, it's also unfortunate and far from ideal, but I just try to remind myself that I don't necessarily need to be able to perform every skill perfectly on my first day as a new grad nurse. And depending on the skill, once you've done it a few times, you can do it pretty comfortably on your own. Remember in the clinical setting you will always have the policy to look at if you need to review steps before performing on a patient.
My school also does not give many practice questions and the students generally use Quizlet or other online resources. I've found that most of the questions on Quizlet are copied from textbooks or the online supplements that go with the textbooks, so I trust that they are legitimate questions (though of course it's a copyright violation).
It's a tough time to be a (student) nurse... hang in there.
If I could turn the clock back, I should have called my clinical instructors and/or program director if I could accept on the job training as a student nurse. I was offered at my workplace, but I refused without thinking. So, someone else took it.
I had no idea that I could accept it. We'll see this time. I'll definitely take advantage of the opportunity.
olaswaisi
60 Posts
I agree with you about the "case study method" and learning about the diseases and the used meds. one thing here: we don't discuss the cases. we just write and submit them and that is it.
I read the book "health assessment made incredibly visual" I got videos on Youtube for lung and heart sounds and listen to them from time to time, I know this is the least I can do.
yes, I'm taking a pharmacology course, there is no pathophysiology course however, it is embedded in the med-surg, which is not bad.
they were trying, but being in a long-term facility, the nurses were really hostile, and I understand this due to them being very busy, and we were on the floor for an hour. I tried to build connections with the nurses there, but we had to be in that hall for the rest of the clinical hours.
The skills were demonstrated as videos only. and there was a funny story behind this: dome of the demonstrated skills are outdated, some of the students failed the checkoff because they followed the videos!
No practicing in the skills lab with PPE, this is a dream for us! when we did the check-offs we did them on mannequins, and that was really cool and when the lab instructors explained the errors we did I felt that now we are learning. currently, they are talking about going to skill labs next semester in person which is great and I hope they won't change their minds! it will be funny to imagine how are we going to learn IV lines based on videos. and with my experience with them, I can see them ask us to practice on ourselves!
My classmates hate it, but as they are saying " nothing we can do, we are stuck, the important thing is getting the NCLEX, and we can learn later!"
As a solution, I'm trying to get a job as an extern nurse, do you think this will help?
I actually do this myself, using Saunders and success series by Davis, Nursethink has some questions, there are two factors here. The senior students used ATI, so their recommendations are the same about Saunders and the other materials. In addition, they didn't have a problem finding practice questions because ATI had a question bank, I tried to get it and I contacted ATI but they told me it is a school-based thing that individuals can't purchase on their own.
Another concern about nurse think, it is only for med-surg, what are we going to do with our classes?
Yes and this is a big problem, losing all that time and money and starting all over in another state is a serious thing, besides I'm 40 years old! and only three semesters left! but if I transfer it would be to Loyola University Chicago, I have an admission for Spring, which is ranked 57 out of the best 100 nursing schools in the country. It is a hard decision, but losing a semester with the money or losing the whole career? This is my dream which I pray every day to be excellent in it.
If I'm staying, any advice how can I survive the lack of training? as I mentioned, I'm trying to get an extern nurse position to be around nurses and see what they are doing. anything else I can do?