Questions about actual student training experiences

suzanne4, RN · May 8, 2007

We are seeing conflicting information posted, and as I say always go to the source, so I am interested in the skill set that you are actually getting and what you need help with.

I know for a fact that assessments are not done by the nurses there as we do in the US. Do you need help with breath sounds and heart tones? This is something that will need to be documented each shift on your patients that are in the hospital. And it is required in all hospitals.

gemini_star, BSN, RN · May 8, 2007

This is a very good idea. You are so kind helping future nurses. I had already undergone first semester of clinical duty for the past three months and the only nursing skills that I had experienced personally are:

V/S

Wound drainage and dressing

Administering meds (Oral, IM, Skin test)

Nursing notes

IV push (with CI supervision)

Assisting in incision and drainage

Assisting in casting

Assisting in circumcision

Measuring Input and Output of Fluids

Adjusting IV flow rate

Endorsing patients

That's about it. Although some of my classmates had already enema, insertion of foley catheter, and assisted in OR. I'm hoping to learn new skills next semester, more on hands on. It also depends on the hospital you are being rotated. If you are assigned in a ward that has few patients that only needs V/S plus if your CI is lazy, you are unlucky. It's for you to make most of your time learning in just a span of short time.

purplecotton · May 8, 2007

Hi. When i was a nursing student (2005 grad.), we had good and not so good CIs (clinical instructors). Basically, we did assessments (typical v/s, inspect., ausc., palp., percussion...), IV regulation, certain procedures (basic ones such as IM, SC, skin tests, IVP for inj.; foley cath. and straight cath. insertions, CBG...under supervision, of course). Depending on where we were assigned (med/surg. ward, ER, OR, pedia., ICU, etc.) opportunities to do procedures and how often varied on the availability of pts., cases at the time, CIs, and nursing student's initiative to learn.

That's why, in my opinion only, i feel that having some working experience here (choose your hospital wisely) is better than not having any at all simply because nothing beats working and learning when you are on your own. You are literally forced to learn when you are completely accountable for your actions- that is you have your license. Here, we just have to jump in and learn as we go along, on a case to case basis. In order for us to cope, we have to read as much as we can, not ever hesitate to ask questions esp. when in doubt, and watch how procedures are done by experienced (good) nurses. Since we don't have the resources for training as in the US, in most situations, the nurses have to "train" themselves. Since students here have limited skills and opportunities, when they become licensed, they should find work in a hospital that has a good training program (You can always ask what the orientation, clinical immersion consists of and for how long. Also, in that time you can see how good or not good the regular nurses are and that would give you an idea of what you'd eventually be, to an extent, as a result of their training.)

Unfortunately, the RNs here are not "uniformly" trained. It really depends on the hospital and staff you work for. Some are really good in training and some are absolutely terrible.

No way can one compare an RN with at least a years experience (or even half a year of experience) with a student nurse who just graduated, with no experience whatsoever. The learning curve is great once you start working, even here in the Philippines. You learn a lot once you start working and that is no joke. The stuff you do as a student here (in RLE exposure) is tiddliewinks compared to what a regular staff RN does on a daily basis. Yes, we do more "in-depth" assessments as working RNs. Some of the nurses do minor suturing as well. It all boils down to your choice of hospital, choosing to work and gain worthwhile experience after graduation, and initiative to learn (the right way of doing things).

purplecotton · May 8, 2007

I'll just add a bit...about the CIs with no clinical experience..it is true. Sadly, many CIs WITH valuable experience are also leaving the country and so, who is left? Hmm.. unless schools and hospitals here have better, more attractive offers than what the US has to give, this deterioration in nursing ed. and sooner or later, RNs in hospitals will be affected as well. Also, students who are taking up nursing here shouldn't just see this opportunity as an easy ticket to leave the country because they have to come to terms with the reality that it is a whole new ball game when you get there (be it in the US) and you have to start working. And even here, once you start working, if you were a lazy student who just tried to get by with the minimum requirements, the hospital staff, docs., and patients will give you a difficult time and you won't stay in your job for long. It will only get you so far and you won't get away with the things you used to get away with when once a student. I have seen this happen to some people. You can't get away with bad habits here either unless you like go way "rural" or work in the province where nothing can stop you from doing "bad work".

Mithi · May 8, 2007

Agree with purplecotton that nothing beats having to work here as a staff nurse than sending yourself raw from nursing school straight to the US or any other foreign country where there is, I think, complete freedom in nursing practice.

When I was a nursing student, the procedures that we were doing most of the time were the basic stuff such as taking vital signs, giving medications, documentation, and fluid monitoring. Nursing procedures that I could remember include administration of feedings/enemas, blood sugar monitoring, assisting in wound care, and blood transfusion. Almost all of these are done with the supervision of clinical instructors. I inserted my first straight catheter during my first year as a nurse. Embarassing, but true.

Familiarity with nursing procedures, sadly, depends on the training facility, clinical instructors, and initiative of students. Most of the time we lack them here in the Philippines. In my case, most of my CIs are too careful on letting nursing students observe and do procedures by themselves. There is little critical thinking done and the essence of assessment is not practiced.

IMHO.

RNHawaii34 · May 11, 2007

Most of my clinical instructors are new grads who didn't have enough clinical work experience. most of them are textbooks smart, and able to answer general nursing questions, however, me being an 8 year veteran nurse assistant in the United States before coming back to finish my studies in PI, it was very hard to adjust and relate. I am so used to work with independent, well experienced, critical thinking RNs. But I do not want to compare the experiences of the PI RNs staffs, because things are done differently in PI. Nurses there normally don't assess the patients, like almost all USRN does. mostly they depend on the M.D.s for that. As a student nurse back then, I was exposed to all kinds of clinical exposure. such as: in lying in maternity ( birthing centers), orthopedic hospitals, which I don't really remember doing something special. We also been to mental health hospital, ( equivalent of state mental facility here in the US), which I don't remember doing something special either. been to different OR, DR, assisting surgeon for surgery ( yep, we were allowed to to that back there), then I was also exposed to endless surgical wards, which pretty much, we do the same thing over and over again: vital signs, TPR, BP, etc. that was it. most of my skills I learned from being an NA here in the U.S.I am not surprise if not too many nursing students knows how to describe lung sounds, bowel sounds, heart sounds, is the patient tachy or brady? is the patient AOx3? etc..skills wise, I beleive every nursing students back home should have some type of skills competencies. everyone should not graduate without knowing how to assess a patient..I think that is the very basic nursing skill that a new nurse should be comfortable with, then the rest of the complicated stuff should follow. I am RN for only six months, so I consider myself as a newbie. trust me, I learn new things everyday, and honestly? there are so many nursing stuffs that are not written in the textbooks, which if you are a new grad need to learn and work and learn. I am sure most USRN from the Philippines are aware of what I am talking about. I hope I am not off topic here?:roll

mctina_20 · May 11, 2007

with the proliferation of so many nursing schools and the migration of many experienced and competent clinical instructors/nurses- we can just imagine who are left in the Philippines.

I am a 2000 graduate and i am glad and proud to say that i took nursing not because it was the most indemand job back then. Nursing in the 90's, ( i started my first year in 1996) was at its lowest, in fact our batch was the smallest number of enrollees in the history of our state university. We had the cream of the craft for Instructors and our hospital exposure was hands on and we did everything a registered nurse do with supervision of course. Nursing assessment was a must since NCP was always done the following day for the patients assigned.

No offense meant - but based on my experience, for nursing students or newly grad nurse, nothing beats the graduates of State Universities. I worked with 2 private hospitals with nursing colleges and i cant believe the training that they are getting. It is a reality that physicians will not let nursing students touch their paying patients.

This fly-by-night nursing schools must be closed. They are hiring incompetent clinical instructors and they are having the hardest time getting a good hospital for their students to expose on.

And with a strong conviction - the previous ruling on who should enroll to nursing - must belong to the upper 40% of the high school graduating class be implemented back. It was how it is before.

It is so disappointing that there are lots of incompetent Filipino nurses out there - harsh it may sound but thats the truth. We took pride on how good we are but we must also take responsibility for the bad. Lest not forget the DOMINO EFFECT it will bring.

Nevertheless, there are still a number of great nurses and clinical instructors who choose to stay.

nrswnabee · May 12, 2007

Hi. When i was a nursing student (2005 grad.), we had good and not so good CIs (clinical instructors). Basically, we did assessments (typical v/s, inspect., ausc., palp., percussion...), IV regulation, certain procedures (basic ones such as IM, SC, skin tests, IVP for inj.; foley cath. and straight cath. insertions, CBG...under supervision, of course). Depending on where we were assigned (med/surg. ward, ER, OR, pedia., ICU, etc.) opportunities to do procedures and how often varied on the availability of pts., cases at the time, CIs, and nursing student's initiative to learn.
That's why, in my opinion only, i feel that having some working experience here (choose your hospital wisely) is better than not having any at all simply because nothing beats working and learning when you are on your own. You are literally forced to learn when you are completely accountable for your actions- that is you have your license. Here, we just have to jump in and learn as we go along, on a case to case basis. In order for us to cope, we have to read as much as we can, not ever hesitate to ask questions esp. when in doubt, and watch how procedures are done by experienced (good) nurses. Since we don't have the resources for training as in the US, in most situations, the nurses have to "train" themselves. Since students here have limited skills and opportunities, when they become licensed, they should find work in a hospital that has a good training program (You can always ask what the orientation, clinical immersion consists of and for how long. Also, in that time you can see how good or not good the regular nurses are and that would give you an idea of what you'd eventually be, to an extent, as a result of their training.)
Unfortunately, the RNs here are not "uniformly" trained. It really depends on the hospital and staff you work for. Some are really good in training and some are absolutely terrible.
No way can one compare an RN with at least a years experience (or even half a year of experience) with a student nurse who just graduated, with no experience whatsoever. The learning curve is great once you start working, even here in the Philippines. You learn a lot once you start working and that is no joke. The stuff you do as a student here (in RLE exposure) is tiddliewinks compared to what a regular staff RN does on a daily basis. Yes, we do more "in-depth" assessments as working RNs. Some of the nurses do minor suturing as well. It all boils down to your choice of hospital, choosing to work and gain worthwhile experience after graduation, and initiative to learn (the right way of doing things).

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your opinion is absolutely well-grounded and i most definitely share it. i've always believed pinoy nurses have been a goldmine for u.s. employers because of the skills they possess even before joining u.s. facilities. i'm thinking there couldn't be any other way for them to have evolved into such skillfull nurses except through ardous hands-on experience. i believe they've used the same books as here in the u.s. so basically theory and principles remain constant. (i'm guessing paperback copies of brunner, kozier, pagana, olds) but i can't expect they've all had the opportunity to use laboratories with mannikins simulating a host of situations. i know also that many state universities then kept a crop of well-qualified even u.s. educated nursing faculty who were also quite strict on the floor. whatever hi-technology lacking in labs didn't really look like a problem because it was compensated with long hours in hospitals and community settings. student nurses get to deal with willing patients who were only too happy to get free medical attention while instructors watch their every move like hawks. i've heard how you wouldn't only be trained in basic skills, critical thinking but your mind will be stretched into giving the best care given the shortage of supplies. the entire "set-up" must've worked for the best because if you really think about it, no mannikin can ever substitute the reaction, idiosyncracies of real humans. learning your skills with real people should be the best training there is and will ever be. with this kind of exposure, how can you not be an excellent nurse? and for our nurses who opted to serve in gov't hospitals even for a time despite the miserable pay, it means to me that they've enough dedication to be worth their license. those who stayed on and thought of remaining in the country may have been less adventurous or practical but indeed, heroes, too. those who chose to live their lives elsewhere and learned their skills in the process, i can't call them less dedicated but most likely, talented.

it's sad to hear that many run-of-the-mill schools now aren't as vigilant to this part of their program. and to make it worse, not many graduates aren't too crazy about it either. what matters now is getting out of the country, take a job in the u.s.a. and earn the fast buck. never mind if they don't "own" their skills as registered nurses yet. it appears that u.s. facilities are more than happy to offer training anyway so some people actually reason-- why bother? it's a scary thought for someone like me.

suzanne4, RN · May 12, 2007

Thanks to all of you for posting here. But again, you need to be aware that US hospitals have loved the nurses from PI in the past, but with many schools popping up that have no busniess in the world of preparing nurses, as they know nothing about the profession themselved, then you start to run into big trouble.

And with the higher salaries now being paid in the US, many hospitals are not afraid to cancel a contract because of bad skills, or lack of. And then this comes down to also having to pay back a cancellation fee to the facility, same as if you quit. And it does not look good on your resume for the next facility as to why you left the first. I am seeing too many getting fired now, for not having the proper skills that they should have when the graduated from their program. And yes, you can blame it on the program, but the nurse still has to take some responsibility for attending that program knowing well in advance that there were issues.

No matter where you are, you have to check out the credentials of a program before enrolling:

How long have they been open?

How many of their graduates passed the NLE the first time?

How many of the graduates were able to pass the NCLEX the first time?

Is it an accelerated program wheren the proper clinical experiences are severely lacking or not even done? Completing a program there in 9 months is not going to fly in the US, and we have all seen the results of those that have tried those.

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If you are not getting the training that you should be getting, you should be very vocal about it, and do not take no for an answer, or we are unable to do that here. All registered nurses should have equal training to those of other countries. Not lacking in many skills because there were too many student or not enough patients, or whatever the excuse is. You are all paying good money to attend class. Get your monies worth.

suzanne4, RN · May 12, 2007

So, if it is brand new program there, best advice:

Stay away until they prove themselves. Simple as that. And then perhaps they will have better regualtions put into place.

Pediatric Critical Care Columnist · May 13, 2007

I find it very frightening that North America is pinning the quality of its health care on graduates from some of the programs I've seen described here. Graduate nurses from many North American nursing schools are graduating with limited skills but not to that extent. They at least are familiar with nursing assessment and planning, even if they don't quite have their priorities in line yet.

How do people who obtain their credentials from diploma mills live with themselves? Do they not realize that their lack of knowledge and skill will kill people? I'm sorry, but I want better than that for my family and friends.