how well did your clinicals prepare you?

[nedlloyd]

I am interested to know how well people feel their clinicals prepared them for working as an RN. Obviously there is a huge learning curve going from student to practicing nurse. Back when I started you were expected to hit the floor running, manage a team of about 10 patients (RN + LPN team). We were promised in our interviews at least one month of orientation time but were lucky to get that. sick calls would go unreplaced and instead of orientation you were suddenly on your own.

the area i live in has several BSN and ADN programs and my hospital has hired quite a few new grads. I know times are tough out there for new grads and perhaps some have been out of the loop for awhile. however, i see many of them struggling, having difficulty managing care for 3 patients after having worked for a few months.

now i am NOT trying to be judgmental. we are/were all new grads once, the learning curve is HUGE in your first year. I am simply looking for some perspective if you wouldn't mind sharing... what type of program did you grad from, how many clinical hours, how many patients were you caring for in your final practicum, etc.

:)

[SCnurse2010]

Honestly? I don't think clinicals prepared me much at all for real life nursing. I graduated from an ADN program in May and I'm about 10 weeks into my orientation at the same hospital in which I did my clinicals. As much as I loved my program, classmates and instructors, part of me wishes I'd done a nearby diploma program that gives you three clinical days a week (so about 24 hrs a week) instead of my measly 8 to 9 hrs one day a week. Most of the hospitals in our area do a pretty extensive new grad orientation so I think we get a decent transition. I actually started with only 2 patients and am now at 5. Orientation can make a real difference in the transition from student to nurse.

[Daltontna]

I guess it depends on where you went to school and how well they prepared you for the real world of nursing. I precepted 9 wks in ICU and after a few wks I was solo taking care of 2 pts. It's all about time management and priorities! Some are better at than others.

[kgh31386, BSN, MSN, RN]

My school prepared us very well. We had great teachers that us involved in everything going on with the patient. Every skill we learned in skills lab, they made sure we did them on a real patient even if it wasn't required in the clinical part. They taught us all the things about checking orders, calling pharmacy, etc. Then we also had 200 hours of leadership hours where they assigned us to different hospitals in the city. We were there alone on the floor with the preceptor assigned to us(a preceptor from the hospital, not the school). It was basically like nursing orientation. We took the full patient load and did all the admissions, discharges, everything.

[TheCommuter, BSN, RN]

I completed an LPN/LVN program in 2005 and an RN-associates degree program earlier this year. I would say that my clinical experiences during both programs were substandard.

I never once inserted a foley, started an IV, hung blood, removed sutures, performed a head-to-toe assessment, or did any of the basics that nursing students should be doing. I have had to slowly learn skills on the job. My RN program had clinical shifts that consisted of gathering information for the care plan during the first part of the shift, and then actually preparing the care plan during the second half of the shift.

[kgh31386, BSN, MSN, RN]

You never did a head to toe? We had to get checked off on that not only in med/surg, but in our advanced med/surg(ICU). We also did foley's in the hospital, everyone did IV's, and if there were none to be started...our instructors would float us down to the ER for a bit and let us start some there. We did plenty of foleys and IV's in OB. Hung blood in the ICU, all kinds of woundcare, etc.

[Bobbkat]

I didn't feel well prepared for my particular unit, but that's due to being in a NICU, which we didn't really have much to do with while in school outside of one day of observation during OB.

If I had been hired onto an adult unit, I think the situation would have been different. In school I inserted IV's and foleys, did head-to-toes, and managed 5 patients on my own by the end of my senior year preceptorship. I'm still I would still need a lot of support and training, but at least everything wouldn't be brand spankin new. The NICU though....well, it' a completely different beast than my adult focused education prepped me for. I'm eager to learn though, and very grateful for all of the experienced nurses that have helped to train me so far.

[Selene006, BSN, LPN]

I feel like I was better prepared for my LPN program than for the BSN program. The emphasis was always on building + fine-tuning our clinical skills (as an LPN) and it was drilled into our heads that doing big med passes (up to 40 patients) would be our reality post graduation.

My BSN instructors have been helpful, but I find that they don't challenge us as much (clinically) for the BSN program.The most patients I've had in clinical is 2 and the med passes haven't been exceptional learning experiences, either. I've never been to the ER, never hung blood, inserted a Foley, or taken care of a vented patient while at clinical. Sure, there are entrance and exit HESI's, and tons of research papers, teaching tools, and projects to prepare in the BSN program. I certainly feel thrilled that I can read EKG strips and don't feel scared of interpreting ABG's. But the emphasis has always been on PASSING the course (theory moreso than clinical). I feel like a more well-rounded nurse now that I am completing my BSN, but I have heard other students say that they did next to nothing in their clinical rotations. I guess the students' level of clinical preparedness is partially based on the motivations and energy level of the clinical instructor.

[whodatnurse]

I completed an LPN/LVN program in 2005 and an RN-associates degree program earlier this year. I would say that my clinical experiences during both programs were substandard.

I never once inserted a foley, started an IV, hung blood, removed sutures, performed a head-to-toe assessment, or did any of the basics that nursing students should be doing. I have had to slowly learn skills on the job. My RN program had clinical shifts that consisted of gathering information for the care plan during the first part of the shift, and then actually preparing the care plan during the second half of the shift.

With the strong exception of head-to-toe assessment (the ONLY 'skill' strongly emphasized in my clinicals) I have NEVER done any of the things you've mentioned. My so-called med-surg clinical was more like a fundamentals of nursing clinical, if that. We started it very shortly after school started, and because we weren't allowed to perform any skills we had not covered in lab, that pretty much meant we did vital signs and honed our assessment skills...and nothing else.

The lecture portion of med-surg, which didn't come until the following semester, was even worse. The instructor was so bad she had to be removed mid-way through, and her replacement had to make the best of a now rather pathetic situation.

By this point everyone was SO turned off of med-surg that NOBODY and I mean NOBODY did their preceptorship in that area when that time came.

Otherwise, my program was great academically. But it is rather sad that this was the experience we were to have with what constitutes the 'bread and butter' of nursing.

[linguine]

Some instructors made it a goal for us to leave clinical doing caths, trachs and med admin at least one or twice during the quarter. My ob instructor made absolute sure that we got to see at least one delivery, which was very memorable. Other instructors didn't seem to care as much about gaining these experiences.

I learned best when I shadowed the nurse to learn the flow of patient care and prioritizing. I got my skill experience because many of the nurses helped walk me through the skills when my instructor was busy helping the other students! (instructors these days have way too many students to be responsible for during clinical--)

Did we all have the same clinical experience?

No. We had a big class (100+ students) so everyone was separated into different hospitals and different floors for rotations. We all graduated with different experiences. Some learned to start IVs while others did not! Some saw a delivery while others did not. As for our community clinical, some passed out food every week to the homeless population while others taught the elderly how to exercise. The skills we learned varied... and what I found lacking in the nursing clinical education was consistency.

Did clinical overall prepare me for my first job?

Sort of. The hospital clinical helped me get over the sensory overload (smells, sights, noise) of working in a hospital. If I had to suction someones trach or cath someone, I could probably do it because I have done it a few times during clinical... but I'd still be scared to do it because a "a few times" is definitely not enough experience for me!

[mb1949]

Yes and no, sorry to be so ambigous but that is the truth, I had great professors and ci's who made sure you got to do something new all the time and others that were so hung up on care plans that you spent half the clinical searching for latest lab values, hx/ etc. I never did an IV or hung blood, because according to our instructors only license personell can perform these skills in our state. However, we did a ton of suctioning and trach care, and cvl dressings and care including flushing, we did tube feedings and TPN, and dressings but I never did a foley , we went to OR and ER and I got to follow wound care nurse at a major city hospital, that was great, would have liked to give meds more, but all in all we were pretty well rounded, nothing like the real world though.

[Trubie, LPN]

Some things I wish I had done in nursing school (and would have, if the opportunity was presented!):

Taking care of a vent or a trach patient

Starting more IVs (I got do about 5 in school, and I think I missed every single one)

More hands on care of central/PICC lines

Doing a full admission & discharge

Receiving orders by phone and interpreting MD handwriting

Hanging blood

In school we did total patient care on 2 patients and spent A LOT of time doing care plans/mind mapping/pathophysiology flowcharts. I wish I had more hands on and less paperwork!