What didnt you do in school?

[aachavez]

I'm getting close to graduation, and theres SO many things I've never done on a live patient! Stuff like, foley, IV's, injections, (all I really have done is some minor wound care and hygiene stuff) It makes me nervous, but hopefully I'll be blessed with a great orientation....SO.... What types of things had you never done on a live person til after you were licensed and working?

Have you precepted a new grad and been surprised at the skills they hadn't had much practice with?

[HouTx, BSN, MSN, EdD]

U of Tx BSN 1980 here (yeah, I'm old). We had an extensive list of technical skills as a criteria for successful completion of our clinical experiences. Many had to be done multiple times, such as IV Access with different types of devices. We practiced phlebotomy on one another. We dropped NGT on each other . . . seriously. Our clinical instructors helped us line up opportunities, but we were also expected to seek out additional ones if we were going to come up short. Many of us came in 'extra' to do clinicals with designated preceptors because we needed to perform additional skills.

I know that 'good' clinical sites are not available to all - partly due to the fact that the number of nursing programs has outstripped available training facilities. Most tertiary hospitals in my part of the country are giving priority access to BSN programs, but have opened up for night and weekend clinical rotations also. Our facilities are tired of nursing schools trying to shift the educational burden to our staff nurses. Clinical instructors need to be on site & physically present and accountable for student skills development - not our staff nurses. That's what students are paying for.

At any rate, we (in the workplace) are being faced with assuming the role of teaching clinical skills to new grads - at the same time we are trying to cope with escalating workloads. Our staff nurses just do not have the time to teach new grads as well as care for their own patients. It's a bad situation and not getting better any time soon.

[BeenThereDoneThat74, MSN, RN]

With evidence and best practices always changing, equipment being updated and new things being invented, skills are constantly being re-addressed throughout your nursing career. It's great to have skills opportunities in school, but in some places, the opportunities don't present themselves.

You will have to learn how to use the latest and greatest XYZ equipment (foley, IV cath, etc) at the next hospital in-service. Learning disease process, the basics of pharmacology, good assessment skills, and most importantly, critical thinking are much more difficult to learn outside of school.

A good nurse doesn't just practice a check-list of skills. A good nurse sees the whole patient and helps guide them through the healing process to help them regain the best level of function they can. Sometimes this means starting an IV, but often it means helping the patient and family understand how to incorporate new medications and new limitations into their daily lives.

Amen!!

[Esme12, ASN, BSN, RN]

I did too, and my experience was different than what many are sharing here. I think there are a lot of factors that are contributing to this:

-clinical sites aren't as willing to let the students do all of these skills. Fortunately, mine is.

-clinical instructors not willing to take on the skills that come their way.

-Either they don't fell comfortable doing it with their students (because maybe their skill level is lacking)

- they don't feel like doing it with them

- timing: Heparin is given at my clinical site at 2pm (TID). Clinical ends at 2pm. I will post conference before, then have 2 or 3 students give the heparin, then we leave.

Or we give it at 1, then wrap up for the day. Not everyone does this.

- or just not enough time. Do you have any idea how long it takes to perform a skill with a student? Much longer than it does for a practicing nurse. You need to go over the skill with them (to make sure they don't mess up in the room), gather the supplies. Then, it will easily take twice as long for the student to perform the skill. YES, it is the instructors job, but when you have to divide your time among multiple students and have committed to passing meds on a certain number already, it may not be in the cards to "drop everything" if an opportunity do insert a foley comes around (at 10am). If you ask the nurse if the patient can wait, they may not be willing to hold it for you (because maybe it CAN'T wait). The instructor needs to balance the workload for the good of the group.

-clinical groups (at least in my areas) have gotten bigger over the years. More students = less individual time for each student.

- no opportunity for some skills. Where we go, RNs don't drop NG tubes. I only did this skill many years after NS, when I started working in Peds. There is rarely a foley opportunity that comes our way. And Ever an IM injection.

As others stated, anyone can learn a skill. The main focus tends to be on thinking and managing. I know that students need to hone their skills, but they also need to figure out how to think, problem solve and prioritize.

I often ask my students to think about what makes a good nurse. Do you think patients say "that nurse hung the best IV ever" or are they more likely to say "that nurse recognized that my mother was in distress, and knew exactly what to do"?

I think clinical exposure is more than just inserting a foley and dropping and NGT. The recognition of distress on a real patient is vastly different that it is in the book....or in a sim lab. I learned valuable lesson at the bedside.

I went to Purdue University...a big 10 school....trust me.....I had academics but we had clinical up the wazoo. We even had to go on weekends. I spent an inordinate amount of my "free time" at school because they mandated we had to do it....and if you wanted to graduate for a top program...you did what they said....and I was a better nurse for it.

I taught clinical.....I ahve been an educator and it is a relentless job that requires far more than what is "required" or what we were paid for...but that was not why I taught. However, I do agree the hospitals are reluctant to allow students for liability reasons.....and the loss of free labor when the school left the hospitals.

But I also think that school could utilize this aging work force....like me who doesn't have a masters (and have NO desire for one) and allow them to teach clinical.

I think nursing programs need to return to some of it's roots and learn how to care for patients or we are going to educate ourselves away from the bedside.

But that is just me.

[NicuGal, MSN, RN]

You need a BSN to teach clinicals at most places and a MSN for class room.

[Dembitz, APRN]

Graduate of a DEN program. In the RN portion, I didn't start IVs, insert foleys, or drop an NG. I did deep suction a trach, hang IV fluids, and give various IM and SC injections. In the NP component, I inserted IUDs, inserted and removed Implanons, and did Paps/STI testing (the Pap/STI testing at times without a preceptor in the room). I found it odd that I learned so few RN level skills while getting some pretty phenomenal NP level skills.

[aachavez]

Twinmom, I'm curious where you go to school, your program sounds like one close to here.

We do have a check off list, from the basics like hand washing and vital checks, all the way up to foley, iv, NG, etc. Once you have been checked off in lab, you are able to do those skills in clinical.

The biggest problem at our program is the clinical sites. Most of our time has been at nursing homes. And not very good ones. We'd spend the vast majority of our time doing 'CNA' work (I am NOT knocking CNA's, a good one is a wonderful thing, however by this time in my education, I should be advancing to RN skills). Even if there was more interesting stuff going on, the staff at these facilities were pretty terrible to us. I'm so happy we're now actually at a hospital for our OB rotation, next quarter is my final one, and I'll be in a hospital for that too.

I just landed myself a hospital job, transporter.... it's not fancy, but hey, gets my foot in the door at a great facility for when I do have my license.

Classroom wise, I feel like mentally I'm prepared, I just hope I get blessed with a patient and understanding preceptor/mentor who will help me gain confidence skill wise. Thanks for the input, it's interesting comparing everyone's very different experiences.

[CrazierThanYou]

For me, nursing school clinicals were about a half step away from totally useless. I learned VERY little as far as skills go. My nursing instructor was always too busy playing grab *** with some of my classmates and the unit nurses.

All my skills have been learned on the job.

Yep, all of clinical was spent doing CNA stuff. Mostly bed baths and bed changes. As I said, useless. I was a CNA for years, I have bed baths and bed changes down pat for ages.

We also had a check off sheet. Doing something in the lab on a dummy is NOTHING at all like the real thing. Nothing.

[CrazierThanYou]

CNA IIs can do caths at my hospital.

[CrazierThanYou]

I wonder if under the old hospital based diploma programs there were fewer new grads complaining after graduation that nursing isn't what they thought it was?

Ha! I guarantee it!

[FranEMTnurse, CNA, LPN, EMT-I]

The only thing I didn't do was starting IVs on real people.

[caughtbuckinoff]

I'd have to say that's interesting. I'm still in my first semester of clinical rotations and our clinical group has gotten the chance to do a foley, NG tube, a ton of injectable meds, PEG feedings, push and piggyback IVs, and full assessments. Not everyone has gotten to do each one of these things but there will be plenty of opportunity over the next few semesters for us to keep at it.

I will say that it depends on the floor you're assigned to, at least in our program. On med-surg we didn't do much more than administering meds and answering call lights. The last few weeks we have been on the neuro floor with a speciality stroke unit and there is always something interesting going on that we can get involved in.

[Mandy0728]

I'm not going to lie, I'm not in the program yet & I've watched YouTube videos on starting IVs and inserting Foley catheters....lol it's helpful!