Not Enough Clinical Experience

anonymousstudent · Aug 2, 2011

We have a lot of experience in hospitals and all I feel like I do is assessment, assessment, assessment, and more freaking assessment. Sometimes I give a BATH! Wow. I have passed lots of meds, but the more skill based things I haven't gotten to do. My CI a few quarters ago told me not to worry about it because when you become a nurse hospitals do lots of training. I sure hope she's right. I would love a chance to place an IV or heck, even a Foley, but so far no luck.

b33again · Aug 2, 2011

I am so glad you responded-- it's great to know I am not alone. I am hearing that many hospitals will teach in the new grad programs, so we shouldn't worry.. haha but we do, we are overachievers! Thanks for posting and I will keep you informed... b33again.

ashleyisawesome, BSN, RN · Aug 2, 2011

all of our clincals are in hospitals and it is rare that we get to do a good skill... im finishing my last semester before our specialties, and ive only been able to do one foley (because there just happen to not be any foley insertions when were on the floor :/), ive hung a decent amount of ivs, but its because i seek them out.. some people in my class have not hung one yet, ive changed two picc line dressings, but other than that ive just done meds, assessments, charting and BATHS. haha. i think youll be fine, you will get a lot more experience in preceptorship, and when you graduate they dont expect you to have mastered everything, thats why they have lengthy orientations for new grads...

my best advice is when you are at clinical in the hospital take every chance you can to do things you havent done yet... make a list of skills you want to practice and see if the nurses on the floor will let you do them, even if its not your patient, as long as your clinical instructors okay with it.. and they usually are. good luck!

Certifiable, BSN, RN · Aug 2, 2011

I'm giving this post a *bump*--- I think it's really important! I hear so often on Allnurses about students who say they do so much, it sounds like they are performing open heart surgery single handed :yeah: When in the real world, most of us get as far as a bed bath and thats it.

NSGstudent12 · Aug 3, 2011

I didn't get to do much in my clinicals until our pull outs started. On my surgery pull out i did my first cath and IV while the patient was out. Thank goodness bc it made it sooo much less nerve racking! ha

b33again · Aug 4, 2011

Hi everyone, I had to laugh about all the bath comments. It looks like I could be more assertive in letting nurses know I would like to assist... and Elisheval is right, it's like we are amongst neurosurgeons, the way fellow students brag... My clinical group is rather large and greedy, so I will just have to elbow my way in. Thank you to all who replied! :bowingpur

ParkerBC,MSN,RN, PhD, RN · Aug 4, 2011

I don’t think there is a nursing student that can honestly say he/she performed every task learned in the lab while on the floor. I had a Geriatrics course in my program. So, we did a clinical rotation at a long-term care facility. I found it interesting. You deal with a patient population who is experiencing multiple chronic conditions. In fact, I would venture to say you learned a lot about pharmacology in that rotation given that the residents often times have multiple drugs. If you are on the skilled unit side of LTC, there are opportunities for practice skills, wound dressings and tube feedings for example.

You’re not going to know everything when you get out. Even if you started three IV’s successfully in your clinical doesn’t make you an expert. Take one day at a time and welcome the learning opportunities that come that day. If there is an opportunity during one of your clinical to perform a skill that you have not done yet, let the instructor know. If you can’t perform it, ask if you can watch the other student or nurse perform the skill.

jjjoy, LPN · Aug 4, 2011

It's frustrating enough to get minimal quality intensive clinical experience as a student; it irritates me even more when given the assurance "no one expects you to be able to do all that" and "don't worry, they'll teach you" but at least half the time, colleagues and supervisors of new grads toss out "you've never done what?!" "how did you graduate?!" "you're not picking this up fast enough" (within just a few days or weeks).

I'm sure it's different everywhere but that doesn't seem an unsual experience - unfortunately!

What to do about it? Be persistent, and more persistent, during clinicals to get as much exposure and practice as possible. You may have to be just this side of obnoxious to really maximize your experience. "Round" on each other's patients as students so that you can see as much as possible. Even if you aren't *doing" as much as you'd like, assessment is a big part of nursing and the more you see first hand (eg various symptomatology, wounds, skin conditions, etc) the more you have to draw upon in the future. Presenting on each other's patients is also a good way to help nail down meds, diagnostics, lab values, etc ... stuff that may not be directly tested on in NCLEX-style tests but that will be useful to draw upon in future practice.

I'm sure you see a lot as PCT and asst, but I know when I was working as a PCT, I was so busy with my job responsibilities that I had little time to find out anything beyond what I needed to know as a PCT; so student clinical time for me was best used focusing on issues beyond basic care. I'm very grateful for my nsg asst experience as I never would've learned so many 'tricks-of-the-trade' or gotten as comfortable with basic patient care just on student clinical time.

CBsMommy · Aug 4, 2011

I felt this same way so I decided to go for a Nurse Extern position. Are there any hospitals within driving distance that offer such a position? I've been able to see and do so much more having this position than in my time on the floors during clinicals! I've placed more IVs and Foleys than I can count, I've got to do some dressing changes with wound vacs, got to see/touch chest tubes, G-tubes, etc. I've not done everything and in no way am I an expert but I was able to experience more than most of my classmates. Plus I got great tips from the nurses I was working with and got to work a lot on time management skills.

And, since this is my last semester before graduation, I am going to hand my CI a list of stuff that I would like to work on. I know a lot of other students want IVs and foleys and since I'm already comfortable with that, I wouldn't mind trading those out for things like feeding tubes and other stuff.

Just a thought. Good luck to you and yes, most hospitals do train new grads but the more hands on experience you have now, the easier it will be to transition!

nurseprnRN, BSN, RN · Aug 5, 2011

please, please remember that what we call in the ed biz "psychomotor skills," the things you do with your hands, can be done by anyone with enough practice. hell, we teach lay people how to do peritoneal dialysis at home or suction tracheostomies. but the understanding of why some things are as they are is something you get in better education: more science, more sociology, more psychology, more history, a basic statistics class, exposure to more clinical settings (i doubt if you'll get a full semester in peds, psych, ob, or any public health at all in any as program) give you the insight to ask better questions and make better decisions.

in your first year of practice you'll have plenty of time to do "stuff." what you need to remember is that "stuff" is not nursing, not the core of it, not the part that will carry you through the lifelong learning we call a nursing career.

if you think some people will hassle you for not having done "stuff," then ask your preceptor to put the word out that you want practice. believe me, foleys and dropping ng tubes and iv starts and wound packing will come out of the walls. meanwhile, just expect that you will get some snide remarks, and remember that they are about as important as the fact that you have to park waaay the ehll out in the back forty of the parking lot. which is to say, a pia but not really related to what you're doing here.

CBsMommy · Aug 5, 2011

please, please remember that what we call in the ed biz "psychomotor skills," the things you do with your hands, can be done by anyone with enough practice. hell, we teach lay people how to do peritoneal dialysis at home or suction tracheostomies. but the understanding of why some things are as they are is something you get in better education: more science, more sociology, more psychology, more history, a basic statistics class, exposure to more clinical settings (i doubt if you'll get a full semester in peds, psych, ob, or any public health at all in any as program) give you the insight to ask better questions and make better decisions.
in your first year of practice you'll have plenty of time to do "stuff." what you need to remember is that "stuff" is not nursing, not the core of it, not the part that will carry you through the lifelong learning we call a nursing career.
if you think some people will hassle you for not having done "stuff," then ask your preceptor to put the word out that you want practice. believe me, foleys and dropping ng tubes and iv starts and wound packing will come out of the walls. meanwhile, just expect that you will get some snide remarks, and remember that they are about as important as the fact that you have to park waaay the ehll out in the back forty of the parking lot. which is to say, a pia but not really related to what you're doing here.

i am in an as program and did get a full semester of psych (complete with many hours/days at our state mental institution - in the acute ward) as well as a full semester of peds/ob.

and, while i do agree with you that skills are not everything that a nurse does (far from it), i would rather master as many skills as i can now so that i can concentrate on my "critical thinking" and time management piece and becoming the very best nurse that i can be for my patients.