In reading through some other posts, I've been thinking (I'm sorry- I'll try to cut down )
What have you found in your first months to year or two that you really needed to have learned in nursing school, but didn't? I'm not interested in bashing any instructor, program, facility....just looking at trends for my own interest in this.
My perspective is that you guys are having to learn a LOT after you graduated that some of us old goats take for granted that you did. But it's obvious that something is different, and it's not just iPods :)
I'm sincerely interested. I'll throw in my own observations later- just interested in what YOU think you needed to know, or do, BEFORE getting hired as an RN.....:)
ditto all the comments on skills. more than one instructor assured me that the hospitals are looking for people who can THINK, and will gladly teach the skills. but my lack of experience with certain skills has been the source of criticism from the other nurses.
also, I'm frequently bewildered by the supply room and all those little do-dads and types of dressing and tape and what all little pieces I need to start an IV or whatever... seems kind of cruel to send me into the job without a LITTLE more preparation in that area
Some states don't allow venipuncture--Illinois doesn't, although some of my classmates whispered that "their nurses" on various rotations allowed them to do it. I think that's why many of us don't learn it on real people.
I've already PM'd you, xtxrn, so I think you already know that what I wish I was taught in school simply can't be taught there. It's the care management thing...docs, paperwork, etc.
ETA: Ok, one thing...more exposure to troubleshooting Foleys, G/PEG tubes, IV sites, etc. Sometimes, they work as intended, if you know how to troubleshoot them without being terrified by them.
I went to school in IL and was expected to do IVs in school. ADN program. 1985. I don't know when it all changed- I couldn't wait to get away from here. :)
Since I've been back here (from TX) I haven't seen students do anything more technical than pass a meal tray (when I was a patient) On pedi I was working, and off-going from nights, so didn't see what the students did- though during my day orientation, a few were wandering around, and when I called them into a room with a 5 pounder if they wanted to see a preemie up close and personal, the instructor came with while they stood there...doing nothing. We had total care of the patients- beginning with passing meds- the second WEEK of nursing school.
I'm thinking you can thank a lot of the attorneys with class action, cheesy malpractice cases (I'm not talking about the criminally negligent situations, angels of death, etc), and pharmaceutical lawsuit advertising on TV- that costs a lot. Once again, the "law" is meddling in medically-related areas that are none of their business....
You guys are getting ripped off. A lot more makes sense since hearing this. Along with the minimum of 75 to pass NCLEX...."back in the day" we had a minimum to pass of 600. Our 'failing' students were getting 8 times MORE questions right than the minimum to pass now...it's nuts.
What is the most sad to me is that so many people are going into nursing because the DO want to take care of people (not 'just' the job/money end- which I know is important, but imo, to deal with the literal cr@p in nursing, ya gotta want it). And they get thrown to the wolves, to learn on the job....the schools need to pay the employers a finders fee....
I'm still listening :) AND THANK YOU for letting me know what's going on- it helps me a lot to know why I keep hearing what is being posted so often on the threads on the general discussion forum. I didn't want to post this there, for fear you'd be shredded for saying anything other than the school was great and you're not worthy to eat worms
more about disease management of diseases we actually see. more about post op care of common surgeries. instead of time wasters like nursing theorists..................................
more about disease management of diseases we actually see. more about post op care of common surgeries. instead of time wasters like nursing theorists..................................
Yeah...I got my ADN, so had one class on general nursing info that didn't fit anywhere else. I don't care much about the theory cr*p. It's "theory"....somebody's ideas....I wanted stuff that I could make practical use of :)
BSN programs have a lot more of that than I could put up with, so never went back (and never regretted it; I was generally in charge, supervising, or my own department with MDSs).
It's sad that the stuff someone could read on their own after getting the meat and potatoes down is forced. Nobody can teach someone how to lead/manage who isn't already prone to that (and I've worked with and for many who were examples of people who were not management material).
How much time did you spend on post-op care? We had most of the fundamentals class (one semester) on a surgical floor...so got the basics with post-op care.
Specializes in burn ICU, SICU, ER, Trauma Rapid Response.
I am an instructor and preceptor in my hospital's nurse residency program. Recently (2010) we had to add 20 hours of basic skills instruction to the residency program. We never used to teach basic nursing skills like blood draw from central lines, IV insertion, central line dressing change and basic assessment skills. It was expected that new grads came to us with those skills, and they did, for the most part. However the grads we have hired more recently had, in many cases, never even SEEN these basic nursing skills preformed. The exception are the grads from the local community college who do all their clinicals at our hospital.
This has added considerably to the cost of training new grads at our hospital.
Specializes in burn ICU, SICU, ER, Trauma Rapid Response.
I'm thinking you can thank a lot of the attorneys with class action, cheesy malpractice cases (I'm not talking about the criminally negligent situations, angels of death, etc), and pharmaceutical lawsuit advertising on TV- that costs a lot. Once again, the "law" is meddling in medically-related areas that are none of their business....
You guys are getting ripped off.
*** I don't think so. Seems to me that all the nursing school in a particular state would operate under the same set of laws. Yet we (instructors in our hospital's nurse residency program) see a huge difference in how prepared the new grads come to us from the different schools.
My observation is that we can predict the level of basic nursing skills a new grad will come to us with based on the program they graduated from. Listed from best to worst.
*** I don't think so. Seems to me that all the nursing school in a particular state would operate under the same set of laws. Yet we (instructors in our hospital's nurse residency program) see a huge difference in how prepared the new grads come to us from the different schools.
My observation is that we can predict the level of basic nursing skills a new grad will come to us with based on the program they graduated from. Listed from best to worst.
1. Local CC ADN program
2. Local traditional BSN program
3. Accelerated BSN program
4. Direct entry masters grads.
After experience with 7 or 8 direct entery masters grads we don't even hire them anymore.
Agree with you on those students getting ripped off.
Thanks for adding this :)
Experience is huge....I had a CNA who was a BSN student working as a CNA on the 28 bed neuro floor I worked on. She looked at my ADN syllabus and was dumbfounded (this was 1986). They didn't even cover the liver or cancer in any detail at all. The ADN program I was in (and this may be standard) divided things up, and clinicals were focused on systems/depts along with the meds that went with each (no separate pharmacology class- it was all interwoven in that semester's "system").
We didn't do IVs until ortho/neuro (which was at a trauma center). And our instructors told the charge nurse that if ANY nurse had a patient with an IV that needed starting, she would like to volunteer us to try...I don't think anybody DIDN'T get to start at least one.
I've heard about direct MSN grads, who never set foot on a floor outside of clinicals...that's a lot of school to keep skills on ice for. Same idea as instructors who never worked the floor....I wanted someone who had done what they were teaching. I was lucky :)
Keep posting, "yearlings" (or whoever :)).....it's good to know what you have been through and are going through because of school...
Specializes in Medsurg/ICU, Mental Health, Home Health.
I've been out of school for five years, but, I wish I had learned...
- what to do in an emergency (this occurs in EVERY area of nursing)
- how to delegate properly (what the state's nurse practice act does and does not designate as strictly to licensed personnel)
- how to gauge patient acuity (ie when to say to the charge or MD "this patient really isn't appropriate for this setting")
As for skills...well, I never started a foley or inserted an NG in school, on a real person. Learned those things pretty quickly as a new grad on a surgical floor! I wish I'd had more time with skills but I learned them fairly quickly.
Oh, and even though I've been doing this for five years...I've never started an IV. Seriously.
I am an instructor and preceptor in my hospital's nurse residency program. Recently (2010) we had to add 20 hours of basic skills instruction to the residency program. We never used to teach basic nursing skills like blood draw from central lines, IV insertion, central line dressing change and basic assessment skills. It was expected that new grads came to us with those skills, and they did, for the most part. However the grads we have hired more recently had, in many cases, never even SEEN these basic nursing skills preformed. The exception are the grads from the local community college who do all their clinicals at our hospital.
This has added considerably to the cost of training new grads at our hospital.
This is what I was suspecting. How could the hospitals not do this- though it's pretty sorry that they have to. You guys are really the last "semester" of school for new grads.
Back when I graduated, there were NO residency programs. Orientation was maybe a week. This was on an acute neuro floor. Heavy gomers. I learned a lot - like any new grad....but I'd done the basic stuff a bunch (I did work in LTC for 6 months before moving to TX- I went from being the agency CNA to the GN (only RN-educated nurse in the building but not licensed yet). I had 60 residents at night including the Medicare folks, all respiratory treatments, a LOT of Foley irrigations (Renicidin was popular back then), G-tubes (we used Foleys, so they were easy to reinsert if they clogged), made the specialized TF formulas, etc...I was 21 years old. I look back on that and am very thankful for 1) a solid nursing program, and 2) a good LTC facility...It was busy, but doable. :)
I graduated last year but am currently in my RN year while working. I think we need more clinical time taking care of the patients. I get the book learning and lecture is necessary but at some point in time we have to knuckle down and take care of people. I think one of the difficulties nursing schools face is they try to teach us absolutes on how to do something when in real life it depends on your policy where you work. I don't know how they can compensate for that. Our school has more preceptors days in our 2nd year and those are invaluable to me. Following an RN and helping her with her patients allows me to gather so much real world knowledge.
Ok back to your question, I wish we could spend more time nursing and less time doing paperwork about nursing. I wish we had more clinical hours even though it would make it harder on me.
This is an interesting question and one that I think about all the time. Here's what I think schools need to work a little more on:
1. Integrating all of the different systems. We go through each system/disease at a time and go through the steps to "correct" it. They never integrate the systems though and we all know people come with their own lists of co-morbid conditions.
2. Paperwork - We are not allowed to complete med-reqs, histories, etc on the patients. I do plenty of charting on my assessment but the other paperwork is rarely seen (MD's orders, etc) by the students.
3. Labwork. Evaluating and learning critical values and what to do. Until my final semester in nursing school, we never looked at the lab values of anything. We knew that sodium level had to be 135-145 but we didn't actually look at them in clinical.
4. Skills - I earned my way into a position as a Nurse Extern and learned more about skills in the summer that I completed my externship as I did throughout all of nursing school even though we learned all of the skills the first semester, including how to start IVs. Just not enough opportunities in clinicals to do them.
5. Preceptorship - I think ALL schools need to offer a preceptorship in the last semester of school. My school doesn't do this and if I had known what I know now, I would've gone to a school that offered this. I work with other externs from schools in my hospital's area and they complete a 240 hour preceptorship, one on one with the same RN, in the area of the hospital that the student chooses (based on grades).
I do think my program is a pretty good program and will move on to get my BSN (I actually like nursing theory) but I do think some areas need improvement (as do all things in life). :)
I just graduated from university here in Newfoundland, Canada this May with my BN. From reading your responses, I can see that there are some things my school has been doing well, but of course, I still feel there are ways it could be doing better.
I'm surprised to see that so many of you did not learn IV insertion and agree that this is something that should be taught in the program. We were taught IV insertion, drawing bloodwork, etc and I had enough practice with this during my clinicals to feel comfortable doing it as an RN. We have a lot of clinical hours in our program, including a preceptorship in 3rd year and a consolidated practicum in 4th year. We are allowed to take on a full patient load (5-6 patients) as we progress through our preceptorship and again in consolidated practicum.
Having said that, there are still certain skills or tasks that we as student nurses were not allowed to complete, which means that caring for 5 patients as a 4th year nursing student was much easier than caring for 5 patients as an RN. I do find that I need to work on my time management. We were not allowed to take off orders until our last year and even then I was not permitted to take verbal or telephone orders from a physician. I feel like because of that, we didn't get any experience with calling the physician to ask for something when it is needed. As the student nurse, I may have realized that there is something needed but there was really no point in me paging the physician as I would have to say "Oh, hang on a minute while I put you on the phone with my preceptor. I'm not allowed to take telephone orders." So, basically, I'd always have to let my preceptor know and she would call and get the order for me. I think this should be changed. There's no reason we can't be calling and getting the orders in our last year. It would help us prepare.
)
Ado Annie, ASN, RN
1,385 Posts
ditto all the comments on skills. more than one instructor assured me that the hospitals are looking for people who can THINK, and will gladly teach the skills. but my lack of experience with certain skills has been the source of criticism from the other nurses.
also, I'm frequently bewildered by the supply room and all those little do-dads and types of dressing and tape and what all little pieces I need to start an IV or whatever... seems kind of cruel to send me into the job without a LITTLE more preparation in that area