Bedside nurses in acute care have many great responsibilities - monitoring, coordinating, notifying, double-checking, following up... - for several different patients with several different needs with several different staff also working with them...
I don't feel that my nursing program prepared us for the great responsibilities of this kind of nursing. They certainly let us know that "just following orders" wasn't acceptable and that we had to "use your critical thinking" and "use your nursing judgement" and "advocate for your patients" but I didn't feel that nursing school gave me much in the way of practical experience in honing those skills.
Most of the nursing care plans we had to create focused on the 'nursing' component versus the 'medical' component, thus lots of impaired mobility and risk for impaired skin integreity but not so much on the stuff that nurses need to have down - when to call a doc and when not to. How to prioritize and know it's okay that some things won't get done if it's busy. What orders to expect and what orders to question.
So for the first 6 months to a year, new grads are floundering, being asked to provide a higher level care than they are able to, often being scolded (yes, scolded, not informed or educated) for not doing this properly or doing that fast enough or recognizing this condition or noticing that mistake....
People keep warning about the nursing shortage but these conditions do nothing to keep new nurses where they are needed most...
I think one of the most important things a nursing student can do is work as a CNA or a PCT before they graduate.. At least during summers or during vacations.... This really helped me with time management! I am still in orientation... Somedays I feel like I can handle it... somedays i want to cry... today I wanted to cry...
But working as a PCT or a CNA you have your own group of patients and learn about prioritizing... And you learn to respect your assistants as a nurse
The posters on this thread have made great points about this. The best thing I ever did for my career started before I even graduated nursing school - I got a job as a Student Nurse Extern at a large teaching hospital during my junior year of nursing school. I worked under an RN's license, but was able to take 2-3 patients on a Progressive Care floor doing everything (except giving IVP meds and blood). My experience from working made clinicals look like a joke...there we could only take 1 patient, not start IVs, not interact with physicians, and sometimes give meds. Puuuuleeease. Nursing school has its merits, but it is not modeled after reality. I like the idea of having to do a semester long "residency" after graduation, it makes a lot of sense!
This is exactly the reason that all nurses, regardless of the program attended, need to have a mandatory 6- 12 month internship before being let loose by themselves.
Absolutely. If critical/acute care is what you are looking for, then you should shop around for the hospital that is going to give you the best (and longest) training. Heck, this goes for ANY nursing field, even med surg. The last thing you want, as a new grad, is to be told that you will have 7 weeks of orientation and be pulled out after 2 weeks because they are short of nurses.
My nursing school did exactly the opposite. Everyone in my graduating class knew that, in the real world as a grad nurse, we know nothing. Every nurse in every hospital we did clinicals at said the same thing "just graduate". I became comfortable with this realization, because now that i'm a real RN, i know that i have A LOT of work to do. My education, in a sense, is just starting. And i am okay with that.
I totally agree with the idea of a residency or internship-type program for new grads. Looking for a good orientation/preceptorship is the next best thing one can go for these days. Some hospitals, though, require a set contract (eg 2 years) in exchange for their comprehensive preceptorship program. If you quit before your contract is up, you have to pay back the wages you received during the preceptorship. That would be several thousands of dollars. Understandable from the perspective of the hospital sinking so much money into the new grad training as well as paying full wages, but as the new grad, I'd be reluctant to take advantage of this because what if at the end of the preceptorship, I decide that this isn't for me? It would be one thing if it were just a matter of serving out time in a less than favorite job. It's another thing in a nursing job where I might feel that my patients' safety is at sake and I have to keep coming in every day living in fear of not being able to practice nursing care safely. One would hope that any hospital willing to put so much into the training of new grads would be sure to provide a good work environment, but I wouldn't want to gamble 2 years of sanity or several thousands of dollars on that.
Specializes in Med/Surg, Geri, Ortho, Telemetry, Psych.
Well as usual I'm the lone freak who experienced the other side of the story:bugeyes: . I felt completely prepared and was surprised how well my school had prepared me. I went to a community college; but I picked that school because they had a 100% passing rate on state boards.
Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
My CC was similiar. And our board pass rates we 100% every year it was in operation except for one----and one failed out of the whole class. Also, I remember my instructors all varying on their "standards" too----what one said was a great care plan, the other tore up with red ink. Their response when we cried foul? "This is how it is in nursing. You will have to learn how each likes things---just as you will in the hospital, as each dr/practioner is different". I feel we were fairly well-prepared in school. But for "all reality"? No----I think there is no school that can completely do that. Actually nursing is an experience no one can fully understand and feel til he/she is an actual nurse! 100% pass rates for NCLEX are great, but still nothing compares to the "real thing" when it comes to nursing.
Another good option is to do the LPN route first, which focuses heavily on clinical hours (more than double that of the RN programs) with the practical and real-world aspects of nursing being highlighted --- from beginning of shift to end --- and utilizes the last quarter entirely for the student to work in an externship role at a hospital or other facility with a preceptor, taking 3-4 patients on their own while working under the preceptor as opposed to a clinical instructor.
After graduating, the LPN has the option of doing a bridge program to obtain the RN degree, all while working part-time as a nurse in the real-world.
Hitting the floor, LPNs perform skills (with the exception of a few like IV pushes, etc.) similar to that of an RN, so it's a great place to start your career.
I volunteered on a floor and later was a CNA but that didn't really let me see what the nurses were dealing with besides the task work. Also, the school advisory staff kept emphasizing that there was so much more to nursing than bedside nursing.
In regard to the going the LPN route for added clinical experience, some of us are/were in the lucky position where it would take the same or less time to get into and finish a BSN-RN program as an LPN program. This would tend to be the case for college graduates with background in the life sciences.
I made good grades at a well-respected nursing school and went to work on the unit where I had worked in an unlicensed capacity for over three years, in a facility where I had worked for seven. I had two weeks of orientation classes and nine weeks orientation on the floor.
I felt grossly underprepared when I started on my own. With a world of help from more experienced nurses, I'm beginning to feel--well, not uncomfortable, most of the time.
I've seen a number of new nurses, both before and after nursing school. A few really hit the ground running, but most go through a learning process similar to mine. Of those who appeared to adapt most readily, nearly all had done a nursing externship prior to graduation. Clearly, there is a lot of value to that. I think an extended internship for new GNs would also be a great idea. I'm not sure how facilities would fund it. I'd have been unable to work for no pay, but would have gladly worked a few months for half RN pay. I think it's possible reduced attrition might offset some or all of the cost, but I think nursing has a certain amount of unavoidable attrition built in. Most new nurses are young women. Even those most happy in their position are prone to do crazy things like getting married and/or relocating. But, yes, I'm sure many of all ages, genders, and marital status get disillusioned by the difficult transition from nursing school to nursing practice.
How long have you been a RN? I will do my Med-surg this spring. I am only doing theory not clinicals this time. What study techniques do you advise for med-surg. I have delmars-PN n-clex because I am in the Lpn course.
Umm, could somebody explain what an externship/ internship is in the world of nursing? What are the differences? Can I assume that a PCT="patient care tech"? How does a CNA or student nurse positions differ from the other jobs mentioned above? How does one find out about a facilities' orientation/ training period? (What, do you just call and ask: "hi, I'm calling to see who has the best post grad/ new RN training program...")
TigerGalLE, BSN, RN
713 Posts
I think one of the most important things a nursing student can do is work as a CNA or a PCT before they graduate.. At least during summers or during vacations.... This really helped me with time management! I am still in orientation... Somedays I feel like I can handle it... somedays i want to cry... today I wanted to cry...
But working as a PCT or a CNA you have your own group of patients and learn about prioritizing... And you learn to respect your assistants as a nurse