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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 guess I just wanted to vent on this!
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.
I'll be an RN for two years in July--graduated two years ago, May. I didn't really have a study "technique." In fact, my study methods were kind of deplorable. Between my job, my home, and the horrendous work load of school, I attended class faithfully, read when I was able, and beat my poor brain to a bloody pulp doing those &*^% careplans. I hated careplans with a white-hot, burning passion. I was very nearly bounced out of my program with a straight-A record for lousy careplanning. So, taking a triage approach, I slacked-off on classes I was doing well in to focus more on careplans. Wound up settling for a B in Pharm, but was able to advance in the program. Got a couple more B's later on, but the world didn't end. The irony is, I probably learned more from careplanning than anyone else in my class--not that my careplans were ever stellar!
I did review for NCLEX. Mainly Kaplan's, but I got some other books, too, and a set of review questions for my PDA, which I could do at the laundromat or when waiting between classes, etc.
Some of my classmates were highly amused by my tendency to doze off during lecture. Instructors were less impressed. I'm happy just to have lived through it.
There are some fairly pointed differences between nursing school and nursing practice. One of my more embarrassing moments in school was passing meds. You had to learn just about everything about every med you gave, and even know something about the meds given throughout the day. So you tell your pt what you're giving, what it does, what to watch for, etc.,etc.,etc., and then you can't figure out how to get the bleeping package open! Nowadays, my old fingers still struggle with the packages, but a med pass might go: "This is dilantin, to prevent seizures, and this is dexamethasone, a steroid, which helps prevent inflammation in your brain. This is metoprolol, which controls your BP and keeps your heart rate down a bit, and, uh, here's your Risperidone..." (I have given Thorazine twice, and so far have resisted the urge to tell my perfectly sane, hiccoughing pts it's a powerful anti-psychotic, but it's so-o-o-o tempting.)
My best advice is to study hard and shoot for A's, because the gap between A and failing isn't very big, but be ready to do a happy dance over a B, because that's still good. It's my nature to focus more on concepts than details, but I think that's good prep for NCLEX, and for practice. In the real world, there usually isn't time to look up every med you give, but I do look up the one's I haven't given previously. Every unit seems to have about 25 you give every day. I might have to look up amiodarone, but I don't think twice about why we do fingersticks on non-diabetic pts getting dexamethasone or solu-medrol. I also as pts if they're on a particular med at home. I've had some taking metoprolol BID with perfectly normal BP and HR--but it's normal because they've been taking metoprolol for the last 5 years.
Sorry I don't have more concrete advice--but nobody ever believes me when I tell them to wear a lucky hat.
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.
Yes, true. Unfortunately, most of the science classes required have an "expiration" date --- 5 years in GA. Many have to retake classes.
The LPN program takes 1 year.
It's a shame to waste time and money on a BSN before one really understands what nursing is all about. For some people, it's a good idea to get your feet wet before making the BSN commitment.
LPN - RN bridge programs are generally one year in length, assuming you have all of your pre-reqs.
An internship is usually after you graduate, externships are usually done for experience between your junior and senior year of school (at least at my hospital that is how they see it).
All internships differ. The one i am about to start is a pediatric cardiac ICU internship. Its one year long, with 2 three-month rotations (your picks are ER, PACU, regular peds floor, and hemo-onc). The last six months are in your actual area of practice (mine would be pcicu). Its part floor, part classroom nursing. I get a preceptor to show me the ropes. In this particular program, there are no assigned patients while i'm doing the internship. Its full pay & benefits.
The way i see it, its like i am being given a 1 year orientation.
The way i see it, these hospitals provide these types of extensive programs because they have eager new grads who typically know where they want to go, so they take that enthusiasm and teach them as much as they can. This molds a new nurse to the needs/desires of the actual hospital. And the new grad nurse gets lots of education.
If you want to know what hospital offers what, dont hesitate to call their HR department and find out if they offer any new grad internships. If you know what area you want to go into, ask if they have that type of internship for your area of interest (this hospital does OR, ER, and ICU programs). I started doing my research about 1 year before graduation, some of these programs have lots of qualifications you must meet.
Do some research, go on the web, go to open houses. If they have a program, they will probably try to push it on new grads...
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.
Several of my classmates were LPNs working toward RN. They were so sharp. Even the ones who struggled a bit with the academic side were miles ahead in clinicals.
"Covering" an LPN at work is another departure from what you learn in school. For a first-year RN, delegating to an 18 yr LPN is pretty much asking her what she wants you to do, saying "Yes, Ma'am." and doing it.
Except, you know, you are legally responsible for what both of you do, so there's a balancing act. I'm lucky to work with LPNs I trust, and I rely on their expertise. I would never want to insult them. But I don't stop critically thinking...
This may seem like a stupid thing to say, but my first BS degree didn't prepare me for the real world either (anyone who thinks college at any level accomplishes that should speak with a new grad of ANYTHING), so I surely don't expect nursing to - although since people's lives hang in the balance you'd think it would do SOMETHING....
Ask new interns if med school prepared them for the real world, though, and I'd be willing to bet you'd get the same sort of answer from them that you're seeing here. And yes, it's a BIT scary if you think about it - so I honestly try not to!
As others have noted, new docs have at least one year of residency. In many fields, the new employee isn't given the same workload as experienced folks for up to six months and aren't expected to know much about their role coming on to the job fresh out of school. In nursing, new grads are being pushed to take a full load ASAP and when they struggle during orientation, they are often told "if you can't handle THIS, how you will handle it when you're on your own in just X weeks?" and derided for not already knowing how to prioritize, how to do things and do them quickly, etc.
If there were more potential nurses than nursing jobs, then, fine, let the training be a bit of a hazing process that weeds out those who haven't already developed quick responses and a thick skin. However, given that we need so many nurses, it would seem more effective to make the transition to nursing smoother. Of course, it's impossible to make it seamless and easy, just not quite the 0-60 in 10 seconds - with hairpin turns - that nursing currently often demands of new grads.
LTC is notorious for not giving adequate orientation for new grads. I've seen some with 2 to 3 days. Then of course when they struggle they get eaten alive. I usually will teach them whatever they are willing to learn, but usually I advise them to first start in a hospital setting, which provides more than that.
In my opinion, I do not care what school you go to and how long the program is, you will never feel prepare after you graduate from nursing school, until you actually work for at least a year. There are so many unique cases patients have. They cannot teach you everything that you going to see. Your skills will come with experience. I think the patients will be your best instructors. I have learned so much from the patients by listening to their needs.
I am in a LPN program at a community college. I have to say that I feel totally unprepared for nursing in the real world. We have two nights of clinicals that last 5 hrs. each. I am in my last semester and have only inserted one catheter and have never done an IV. I have been a CNA since 2000, but have only used that training in caring for my mother. Our clinicals are divided up at different sites, and we only have five people in each clinical. All of the work that we have been doing is CNA work except for getting to do the night-time med pass. I spent my nights at clinicals this week doing vital signs for the entire floor. I am very apprehensive about entering the real world of nursing. I have made excellent grades in my nursing classes, but I know that I am terribly lacking in experience. I truly hope that I get a very good orientation period when I get a job. I know that wherever I go to work at that my eductation will have only just begun.
As others have noted, new docs have at least one year of residency. In many fields, the new employee isn't given the same workload as experienced folks for up to six months and aren't expected to know much about their role coming on to the job fresh out of school. In nursing, new grads are being pushed to take a full load ASAP and when they struggle during orientation, they are often told "if you can't handle THIS, how you will handle it when you're on your own in just X weeks?" and derided for not already knowing how to prioritize, how to do things and do them quickly, etc.If there were more potential nurses than nursing jobs, then, fine, let the training be a bit of a hazing process that weeds out those who haven't already developed quick responses and a thick skin. However, given that we need so many nurses, it would seem more effective to make the transition to nursing smoother. Of course, it's impossible to make it seamless and easy, just not quite the 0-60 in 10 seconds - with hairpin turns - that nursing currently often demands of new grads.
In my own experience, I felt that charge nurses gave me "easier" assignments well past my official orientation, and my mentors during orientation didn't stop being mentors after I was "on my own." I've been lucky, compared to a lot of stories I see, but it seems to me that we have the power to make the transition as smooth as it can be for those who come after us. Some of the ideas kicked around on this forum are well worth considering, but in the meantime, it's certainly possible to nurture new nurses, and each of has opportunities to implement that.
Efforts to promote nursing unity are undoubtedly important, but I think the steps we take individually to promote a kinder, gentler environment are at least as important. Now, with all my months of experience, I try to pass on the good treatment I got. It's simple human decency, but it's also enlightened self interest. As new nurses become strong nurses, it lightens all our loads.
I agree nursing school does not prepare you for reality. No school does. That is why one should work before graduating! I worked and interned while receiving past degrees and I do not understand how anyone can look at a nursing degree as any different.
Besides, it is my understanding that many New Grad programs will not even look at a new RN that is not a former intern/extern. How do they know you can handle the job if you have no experience working their floor or any floor????
Thus, I plan to bust my butt over the next year to land a job at the hospital that will allow me to work on my desired floor upon graduation. I have an MBA so I already know the drill! I busted out the chap-stick (to kiss butt), fixed my reference list to include bigger names and titles, continue to do well in school, and strengthened my hand shake! Am I missing anything?
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I totally agree about the whole nursing DX thing. My instructors never wanted me to use a medical DX to create my nursing care plan, even though you can go to the back of what ever nursing care plan book you were required to buy, look up a medical DX and find nursing DX's listed for said condition. I was reminded that I was not a doctor and that only a doctor could diagnose. I wasn't doing the doctor's job, just reading what had already been done. If the pt's chart said they had DM, then why couldn't I look that up and write my care plan based on that instead of, say "impaired mobility R/T peripheral neuropathy A/E by parethesia". The floor nurses would see us working on this stuff and just laugh. Apparently each unit/floor has their own set of "protocols" that the hospital comes up with for the nurses to follow.
I bet that in order for the nursing schools to offer a certified program, the various "powers-that-be" require nursing courses to be structured around nursing DX's and derivative care plans. Probably feel that eventually it will help to empower nurses. Guess that I'll find out in about 1and 1/2 years!