No IV Practice / Little hands-on practice in clinicals

[SlyFoxRN]

Hello all,

I am half way finished with my 1 year accelerated BSN program, and so far I like it for the most part. Our classes have been really interesting and in depth regarding disease processes, etc. and I'm doing quite well. One thing that is starting to worry me however is what I perceive as a big gap between the didactic and our clinical component. Clinicals, quite frankly, kind of suck. Mainly we just shadow nurses, very little hands on. The only hands on stuff I've done (after 4 months of clinicals now) is remove an IV catheter, take vitals, do an assessment, and give out a few medications. We can only give out medications if our clinical instructor is with us, and with 6-9 students per instructor, we are lucky to give out medications once per rotation. I've given one shot - a vaccine. We're not allowed to do anything with IV's at all - we won't have ever inserted an IV or practiced a blood draw when we graduate aside from a 20 minute lab dedicated to it (we stuck a dummy arm once). I just feel like when I graduate I will be totally incompetent and it's scaring me a little. Anyone have a similar situation?

The odd thing is, my program is supposedly very well regarded. We are ranked highly as far as nursing programs go, and hospitals in the area prefer our grads over any other school around. I don't understand what I'm missing here. Is it common for nurses to have little hands on practice before graduation??

[VICEDRN, BSN, RN]

It sounds like this is a common problem, but classroom based information is still given in most programs. Is it IM? IV? If IV, how long is pushed? I have no idea. I feel like I am being prepped to prescribe/diagnose (aka: be an NP) more than I'm learning to be a floor nurse. I appreciate knowing exactly WHY physiologically my patient is exhibiting certain symptoms, but I honestly feel a little upset sometimes when I have no idea how to prime an IV tubing to help relieve them...

I just keep telling myself I can pick up skills easy once I go into new grad orientation at my first job...but then I wonder if I'm going to look like an idiot once in orientation. I wonder if I'm going to be given simple tasks and have no idea how to do them...

GIGANTIC SIGH! This issue has been addressed about a trillion times on this site and what you are about to find out is that there are differing opinions about what constitutes appropriate training for nursing students.

Lots and lots of folks here will tell you it should all be skills. They will be supported by nursing students who's teachers (mostly ADN school in my experience from reading here) told them that's what nursing is.

Lots of other folks will tell you its all about the critical thinking skills.

Here's what I think: You will find that the collection of skills that you think are so important are likely not even reserved to practice as an RN in your state. EMTs, paramedics, CNAs, LPNs all do these precious skills of yours and it really doesn't matter. (In the teaching hospitals, MDs must be checked off on a certain number of peripheral ivs, lab draws and foleys. Skills they consider not so complex and easy to grasp.) You will also find that even if you learned them in nursing school, it will not be until you do them after school on a routine basis and in the context of providing care under your own license to your own patient will it matter much.

Most of these amazing skills everyone raves about can be learned in ten minutes flat and are taught on the regular to other types of personnel that didn't spend time and money in nursing skill.

In terms of patho and critical thinking, you will find that this is the "skill" most often reserved to you. You are the link between patient and doc. (I personally don't find many CNAs calling the MD.) The MD will be listening to your assessment and even maybe asking you what you think the clinical picture is for this patient. This is the stuff you must learn in school but that's just IMHO.

[MissH1967, ASN, RN]

This has been a great thread with so many anxiety-relieving thoughts and opinions. I won't graduate for another 14 months and I am already freaking out about caring for patients on my own and my lack of technical skills. I definitely think I need to work on my therapeutic skills.

I have so much appreciation to those here who impart their wisdom.

[Vespertinas]

Once you're hired, you can ask to spend like 5 hours in the ED doing nothing but sticks. They'll appreciate it and you'll get plenty of exposure

[nursejen07]

I think most nursing students worry they aren't going to be proficient with the "hands-on" skills once they graduate. Luckily, no one is expecting you to be! Yeah, we've all dealt with the crochety old nurse that doesn't want to show you how to do something then yells at you when you don't know how to do it. But grumpy people are a part of life, and most nurses are more than happy to answer questions or help you out if you need it. Never be afraid to ask questions or be worried you're going to look dumb if you don't know how to do something. I'd much prefer to work with a new nurse with lots of "dumb" questions than with one that thought they knew everything.

As far as school goes, it may help to keep a list of skills you want to accomplish and go over it with your preceptor/instructor. My school was touch-and-go when it came to teaching me skills and it was kind of up to the students to throw themselves out there in order to get experiences. It all depends on the nurse you are shadowing. Sometimes you get a surly one that couldn't care less whether you learn anything or not, but keep your eye out for the great ones that actually *want* to teach you things. I'll never forget the nurse I worked with in day surgery that asked me what I wanted to learn that day. When I told her we had been learning IVs in lab but I'd never gotten a chance to do one on an actual person, she brought me to the nurses station and announced "This is my student and she wants to learn IV inserts today! Anyone who needs an IV start, come find me and we'll do it for you!" The floor was grateful for the help and I was grateful for the experience.

Also, it helps to keep an ear out for opportunities that other nurses on the floor can provide. No one says you have to stick to your nurse like glue, especially if you have a, um, less-than-helpful one. If you see the blood bank drop off some blood, grab the nurse that picks it up and ask her if you can watch her hang it. Heard about a patient that's going south? See if you can tag along as they (hopefully!) transfer him to the ICU. Don't get in the way, but wait until things have quieted down a little on the floor and ask all the questions you had along the way.

I know it's easier said than done in these situations. I remember the stress and anxiety of nursing school and feeling like I didn't know bupkus when I graduated. But you will learn it eventually, and as long as keeping your patients safe is your #1 priority, you'll do fine!

[Klimpys]

I have being doing pre-reqs for the nursing program of a local community college. I will start actual nursing classes this fall. One of the pre-reqs was to get your NA 1 license. My adviser said one of the reasons they started requiring it was because they only accept 25 students a year, and they always had some that later dropped out because they didn't realize that part of their job was to wipe butts, make beds, clean vomit, etc...When a student eventually dropped out, the school could not fill that open spot. Our NA 1 clinical was at a nursing home. My school also decided to give a extra points towards being accepted into the nursing program if you earned your NA II, which I did. During that class, my RN teacher told us how she learned to do blood draws (in a break room with fellow classmates sticking each other.) I decided that I would take a phlebotomy course. I am so glad I did, because I have learned of the damage you can do when you don't know what you are doing. These side classes have cost me some extra money, but I feel they will help me in the long run in feeling more confident in what I am doing during my nursing classes. If I can land a part-time job at the hospital as a tech it will help me get my foot in the door.

[umcRN, BSN, RN]

pretty common. I never put an IV in until I started working in a NICU. In the NICU nurses did all their own IV's so we were very encouraged to just start doing them. Now I work in a peds cardiac ICU and I would say almost all the nurses who were new grads within the past 5 years have no idea how to place an IV, they all use the hospitals IV team (or me when they learn I know how to put IV's in!)

[tothepointeLVN, LVN]

if you see the blood bank drop off some blood, grab the nurse that picks it up and ask her if you can watch her hang it

oh yes this was a very successful strategy for a classmate of mine and myself. the nurses would love it they could hang and we would do the vitals checks and sit with the patient in case anything went afoul. volunteer yourself up for scut and you might get some perks too.

[BuckyBadgerRN, ASN, RN]

My school requires that you take the CNA course before you can apply to the nursing program. I heartily agree with what you are saying!!

[subee, MSN, CRNA]

Why do we even have accelerated programs? Jobs are scarce anyway. Do we need people who are rushed through a bare bones program merely to rush them through a NP program to assemble an "advanced practice" nurse with no nursing experience? For what purpose?

[Klimpys]

I just wanted to add to my previous post regarding the NA course and phlebo. These classes are offered in the Continuing Education department and were two nights a week. They lasted anywhere from four months (phlebotomy) to six months (NA II). I took them at the same time I was taking my curriculum classes. They did/will not slow me down from getting my RN.

[threebrats46]

I didnt learn how to put in IV or draw blood until my first job. Most nursing programs don't teach it. You aren't incompetent at all...all the skills will one day be so natural to you and you will think back and laugh. I felt exactly the same way you felt when I graduated nursing school.

[shortnorthstudent]

Assessment is nothing without intervention. A is only one letter in ADPIE. It's just as important to do a thorough head-to-toe as it is to know what to do, then do it well.

I believe the OP's schooling is not conducive to this but, sadly, not the exception among nursing schools nowadays.

I disagree with you. Assessment is absolutely important. However, you are missing the boat on interventions. Those skills that many are so interested in are not independent nursing actions. You cannot drop an NG, start an IV, put in a foley, pass meds, etc. without an order. The interventions that are within the nurse's independent scope of practice are not those skills. As the nurse, you can do SO much to help your patient based on your assessment and those are the interventions that you need to be focusing on in nursing school. Knowing that your patient is going to breathe better if you put them more upright, that you can prevent pneumonia by teaching the patient to use the incentive spirometer and making sure they use it, ambulating your patient and so much more. Those aren't the sexy skills, but it is the bread and butter of critical thinking and is what makes an RN different than someone who has simply been trained to draw blood or put in an IV. Plenty of non-RNs are trained to perform the skills that we get so excited about in early nursing school. But, Assessment IS an RN specific skill that we are educated to do. Note the difference in my language between trained and educated. As a nurse on a floor you may never have to insert an IV (depending upon your type of unit). Does that mean you aren't really a nurse? Absolutely not. It means that your time is taken up with responsibilities that the CNA, medtech, phlebotomist, LPN, etc. cannot do.