TOP TEN LIST: basic skills you should master..fast!!!!

RainDreamer, BSN, RN · Jun 2, 2005

It sounds to me like you're pretty much on schedule. That's about how it went for me too. The first semester of clinicals (med/surg 1) we just did basic patient care (AM care, help with ambulation and meals, etc), we assessed each patient and continued to learn about the assessment, and started passing meds out at the end of that semester. The only invasive type skills (like the ones you mentioned) that I remember donig is putting in a foley and dressing changes. We didn't do ANYTHING related to IVs during that first semester, we couldn't hang the bags or give any meds IV.

Starting 3rd semester (med/surg II) is when we were able to start giving IV meds, start IV lines, suction, etc. We were never allowed to draw blood or hang blood.

I know it can get a little frustrating there at first, because you want to jump in and do as much as you can. But the basic patient care is important too and even though it seems like you're not learning a lot when you're doing it ..... you are! Talk with your patient. You can definitely comfort an anxious patient at this point ..... some patients love for you to stay and talk with them. I remember having a lot of down time during that first semester, and most of the patients I had each week loved for me to stay in there and talk with them (although, not all of them are like that, you just have to use your own judgement). If they're the type of patient that wants you to spend a lot of time with them, take advantage of that! Talk with them and get a good in depth history and spend a lot of time doing an in depth assessment. It's great practice and it's good to take advantage of that now while you have time .... before you get into your other clinicals where you have more than 1 patient and have more responsibilities and don't always have the time to spend with each one.

wonderbee, BSN, RN · Jun 2, 2005

Sterile gloving. Practice, practice, practice. Sounds simple but can be a pain in the butt if your hands aren't slender.

Altra, BSN, RN · Jun 2, 2005

I understand how you're feeling - I'll be graduating in 10 days and up until about 2 months ago I felt the same way about clinical skills. It does all come together eventually - take advantage of all opportunities to practice, assist, or do something new, and try to be patient. Realize that it's often the attempts that don't go so well that help you to develop hands-on skills -- veins will blow, you will "miss" with catheters, and you'll make a mess when changing dressings. It's OK - things will go more smoothly next time.

Agree with sterile gloving - ridiculously simple after you get used to it, but tricky at first. Even non-sterile gloves - yes, they can be stubborn little buggers to get one (not 50) out of the box when you need to get gloves on NOW. :rolleyes:

Giving report. Seems like this would be a no-brainer, until you have to clearly & concisely condense what's been going on with your patient for the last 8 or 12 hours into about a minute or less. And on the flip side - learn to organize the info that you get in report at the beginning of your shift.

IMO, the skill that is often overlooked is developing rapport with patients & families - it's amazing to me that some of my classmates still have that "deer in the headlights" look when they first walk into a patient's room. Get comfortable with yourself in the role of the nurse - if this doesn't come naturally to you, then concentrate on developing your "persona" or your "spiel" .... whatever you want to call it.

Purposely seek out "difficult" patients -- learn what works for you to establish some common ground with people and work with them to resolve problems or meet goals (this applies to co-workers too, not just patients).

Learn to say, "Let me see what I can find out about that and get back to you." And do it.

OTOH, learn to recognize what is not your problem. Sometimes just saying "I'm sure that's difficult for you" with sincerity is all that you can do.

HTH :)

LeesieBug · Jun 2, 2005

My second semester, I got what I consider very good advice from one of my favorite clinical instructors: Don't get too hung up on "skills".

This instructor said that students are always concerned at getting enough experience with various skills... she assured us that no matter how much we try to cram in, we are going to come out of school NOT having experience with some/ many things. So, take all the experiences you can, of course, but be sure to focus on learning important CONCEPTS....once you have a strong foundation (understand anatomy, biological processes, infection control prinicples, etc) you can always look in a book to learn a new skill and manage doing it. Getting GOOD at things will come with experience. You don't need to launch out of the gate an expert at everything.

Having just finished fourth semester, I understand more and more how everything we learn all comes together.

not now, RN · Jun 2, 2005

I'm gonna go with...

1. Suctioning a trach without making a face :stone. Thank God we learned this in subacute where the patients weren't cognitive enough to notice what face I was making.

2. Putting on sterile gloves. You can practice a million times and then when it's real you still freeze up and get nervous.

3. Wound care/dressing changes. I didn't do one dressing change in nursing school. Now I'm a GVN and I was lost when I helped with my first dressing change.

4. Making an occupied bed. I know it sounds silly but when you're in ICU, giving a bed bath to a patient who's on a vent/multiple lines/chest tube/ect and he get's agitatied when you roll him you want to get things over with as soon as possible.

5. Talking to your patients. I started my CNA job on the break before the last semester of nursing school. Before that job I was horrible with my paitents, after my job I could calm most anyone down. It's a skill that falls to the wayside because you're so consumed with the medical aspect of nursing. I work LTC and I'm the go to girl when CNA's can't settle their residents down.

SCmomof3, RN · Jun 3, 2005

I understand how you're feeling - I'll be graduating in 10 days and up until about 2 months ago I felt the same way about clinical skills. It does all come together eventually - take advantage of all opportunities to practice, assist, or do something new, and try to be patient. Realize that it's often the attempts that don't go so well that help you to develop hands-on skills -- veins will blow, you will "miss" with catheters, and you'll make a mess when changing dressings. It's OK - things will go more smoothly next time.
Agree with sterile gloving - ridiculously simple after you get used to it, but tricky at first. Even non-sterile gloves - yes, they can be stubborn little buggers to get one (not 50) out of the box when you need to get gloves on NOW.
Giving report. Seems like this would be a no-brainer, until you have to clearly & concisely condense what's been going on with your patient for the last 8 or 12 hours into about a minute or less. And on the flip side - learn to organize the info that you get in report at the beginning of your shift.
IMO, the skill that is often overlooked is developing rapport with patients & families - it's amazing to me that some of my classmates still have that "deer in the headlights" look when they first walk into a patient's room. Get comfortable with yourself in the role of the nurse - if this doesn't come naturally to you, then concentrate on developing your "persona" or your "spiel" .... whatever you want to call it.
Purposely seek out "difficult" patients -- learn what works for you to establish some common ground with people and work with them to resolve problems or meet goals (this applies to co-workers too, not just patients).
Learn to say, "Let me see what I can find out about that and get back to you." And do it.
OTOH, learn to recognize what is not your problem. Sometimes just saying "I'm sure that's difficult for you" with sincerity is all that you can do.
HTH :)

Not starting my program til August but I just wanted to chime in that I think this is a wonderful post:) Thanks! And congrats on your impending graduation :balloons:

nicenurse911121 · Jun 3, 2005

Hmmmm well lets see - I have been a RN for 3 years, LPN for 2, before that and a CNA 2 for 14 years in all aspects of the hospital, even ICU, so I have gained alot of knowledge through my years in healthcare, thanks to all the awesome nurses I have worked with. So.... my list would be this:

#1 respiratory- either through V/S or observation, if they can't breathe, they can't live (apply O2, get HOB up, suction, ect. ect. ect.)

Well actually I think I am not answering your question right so... the top ten skills?

#1 assessment

#2 assessment

#3 assessment

#4 assessment

#5 assessment

#6 intervention

#7 intervention

#8 intervention

#9 intervention

#10 intervention

then.......................document, document, document.

I don't know if this helps much but skills come with experience, the more you do them the better and more proficient and competent you will be. But nothing takes #1 over assessment (and yes it is a very valuable skill)- that determines what skills you will utilize to intervene. And never, never, forget Maslow's hierarchy of needs!!! Hope this helps just a tiny bit. :balloons:

Hello everyone,
Don't know if this one has been done before... I am completing my second clinical and have yet to apply many skills in a hospital setting. I took out my first IV line today..sigh... Things are so slow, I wonder how much practice I will have gotten before the infamous MED-SURG II class next fall. From those of you already working or those of you more advanced in your program, what do you believe are the top 10 basic skills that one should master and be ready to contend with in a hospital setting?
For example, putting in an IV line, suctionning a trach, drawing blood, replacing a bandage, comforting an anxious patient, recognizing and knowing how to treat respiratory distress, recognizing and knowing how to treat dehydration..whatever.
Thanks.
N_T_L

Never_too_late · Jun 3, 2005

Thanks to everyone for answering. There is good advice in these posts. Assessment is very important and skills will come with time. I guess to put my question in context: I am in an accelerated program. In my first clinical Cardiology, we were giving out meds from day one. Half way through we were given two patients each every day. We would do research the night before to understand the pathology and the medication of our patients. I would research (what it is, how it works, precautins, bla bla) 15-25 drugs every new patient. Clinicals 2 and 3: Pediatrics and perinatal care, I am doing now and they will end mid-july. Often, I only get my peds patient in the morning which gives me 20 minutes or so to get ready: pathology, meds (granted only a few), work plan. I guess I was asking in the hope of ..saving some time... by having a list of to do's (assessment) and how to's (skills) that would give me a heads up when I come in and have to research my patient before hitting the room for the assessment. And I know about, head to toe assessment but what is essential to know/do to get through the first hour with my patient and then have time to figure out the rest (i.e removing IV, breathing exercises, education about asthma..whatever)? I guess that was the point of the original question.

I may be asking for too much because, granted, there may not be a simple answer to this question .. which is why it was a Top Ten List..if you had to pick...

Thanks.

N_T_L

Nurse Bethie · Jun 3, 2005

What a great thread! I am glad to see students interested in the skills needed for success.

I agree with the other skills like assessment, sterile technique but the number one for me is MEDS!

Having a good grasp of the 5 (or 6) rights and the 3 checks is essential to any nurse. Also you basic aseptic technique related to medication administration. I realize that on clinical you have seen some interesting interpretations of the guiding principles but good med skills (based on evidence and literature, not "the way we have always done it") will be an asset no matter where you work!

Good luck and keep up good practice!

SarasotaRN2b · Jun 3, 2005

Great advice, LeesieBug.

Kris

My second semester, I got what I consider very good advice from one of my favorite clinical instructors: Don't get too hung up on "skills".
This instructor said that students are always concerned at getting enough experience with various skills... she assured us that no matter how much we try to cram in, we are going to come out of school NOT having experience with some/ many things. So, take all the experiences you can, of course, but be sure to focus on learning important CONCEPTS....once you have a strong foundation (understand anatomy, biological processes, infection control prinicples, etc) you can always look in a book to learn a new skill and manage doing it. Getting GOOD at things will come with experience. You don't need to launch out of the gate an expert at everything.
Having just finished fourth semester, I understand more and more how everything we learn all comes together.

zambezi, BSN, RN · Jun 3, 2005

I agree with many of the things that have been posted so far...I too think that learning concepts and how everything fits together is key...technical skills, while nervewracking, can be learned and perfected with practice. Here are some skills that I think are important:

Assessment

Intervention based on assessments

Documentation

Giving a concise but complete report

Teamwork: with co-workers, doctors, etc

Organization of time

Prioritization

"Therapeutic communicaiton" (I always hated that term but it does come in useful)

Medication administration

Education for patients and families

The "Basic" Skills: setting up and turning on suction, foleys, ivs (insertion and maintenence), ngs, dressing changes, maintnence of CTs, sterile procedures, blood administration, etc (All of these will be learned with practice!)

USING COMMON SENSE!

You can always teach someone how to do a skill...learning to to integrate concepts is harder and I feel that this should be focused on during school...if I see X what am I going to do? what needs to be done first?, etc.

Take every opportunity to practice those technical skills while in clinical...But don't forget to watch the RN that you are working with. She/He may not be good a verbalizing what they are thinking so ask (unless things are going downhill fast, then write it down so you can ask later). Ask your preceptor what they look at when they walk into a room. What to they assess first, what catches their attention and what is done to correct or monitor the problem...Stuff like that is harder to catch onto because a lot of it is just practice and experience...the sooner you teach yourself to think about the options and possibilites the easier it will come when you have expereince. Go over scenarios in your head. If my patient has chest pain, what will I do. If I walk into the room and my patient is unresponsive what next? It comes...

good luck to all the new grads and students of the year!