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.....:)
I completely agree with the other poster who attended an Accelerated BSN program (I'm in the northeast too, go figure!) If I could do it over, I would have attended my local community college's ADN program, but I got scared that I would be un-hireable without the BSN. The clinical placements are okay - I'm a CNA who passes meds occasionally. I am shocked at how little work we are doing on clinical skills, then again when there is only one clinical instructor for eight people, it's really hard to get the work done. Especially at student-unfriendly placements. I really think the accelerated programs and direct-entry master's programs need to be cut (and I'm in one!) seeing as how there really isn't a nursing shortage out there (ask any new grad RN!). This of course is just my opinion. If you're debating over the ADN / accelerated BSN question....go with ADN. You can always immediately enroll in your state's online RN-BSN program the day after you graduate ADN
I'm an ADN - our instructors had about 8 students each. And eyes in the back, sides, and top of their heads. Kinda creepy after a while But they were sort of like skill-hunters. No matter who on the floor needed something, they'd stalk the primary nurse (no matter who was assigned to their patients, if any of us), and get us in the door.
The whole 2 years was like that. We started giving meds the 2nd week. Seriously- orals, and eye/ear drops. In a month we were doing all SQ & IMs (and most pain meds were IM back then- they last longer, and don't have the ups and downs of coverage that PCAs do.....I hate PCAs personally- the ortho docs I worked with had a lot of OLD patients- so no basals to avoid codes- they were nice like that.... So the poor geezers (lots of geezers- defined by no teeth, can't hear, vision stinks- and they don't care....the last part is diagnostic of "geezer") would be hurting one minute and gorked the next....IMs were MUCH more 'smooth' in coverage. And one ortho doc who wanted to be sure the IM got to the "M" in bigger patients ordered 3" spinal needles. For real.
IVs came the last semester- by then the idiots had been weeded out (seriously, one guy was a real trip....really sweet- but nothing but rocks between the ears ). Ortho/neuro class (one quarter)....and we all got in to harpoon someone . I was first. I got it on my first try, and felt all good about myself....thus jinxing myself for about 3 weeks. In school, 3 weeks is like a year:o.
You guys are having to put up with NOT doing enough, and suffering after the school is done with you. You're someone else's project. That is so unfair- and it's no wonder the hospitals are looking for experience. The school not giving you the basics is shooting you in the feet.
Wow, I thought preceptorships were standard. I can't imagine working as a new nurse without the experience of my preceptorship--I'd have been totally overwhelmed. Frankly, I wish I hadn't had my last couple of med-surg rotations (one pt=incredibly boring day, unless you're working with a great nurse who will let you do things with her other pts). I would have preferred my preceptorship to extend for the whole last semester. That's where everything finally started to click for me and I understood what all of nursing school had been leading up to.
I really feel like I got a good, solid foundation in nursing school. I went the LPN route then immediately into an ASN completion program. I spent hundreds of hours in clinical. I do wish I'd had more opportunities for skills, but that's sort of luck of the draw--pts don't necessarily need a foley, IV, or NG inserted at the time when I was there. Of course, they don't always need these things when I'm at work either; I've been working for almost 3 months now and just cathed a guy for the first time ever a couple of days ago.
Aurora77 - I feel like I'm going to be a little lost after graduation. I really, really wish we had a preceptorship or capstone our senior year. I work at a hospital in a city up north in my state and the graduates there have a 240 hour capstone, 1:1 with a preceptor, no CI around. I can tell you that I work with these people and I can see a big difference. Not only that, but it allows them to be able to get their foot in the door and the girls (and one guy) I work with have received their choice of jobs upon graduation. And their capstone has them doing ALL nursing duties on the preceptor's full load of patients.
Meanwhile, I am still at clinical on 2 patients doing total care with 16 days of clinical left before graduation. I don't mind and, of course, will pitch in to help patients with whatever I can, but it would be nice to focus on nursing stuff (labs, orders, time management), etc. I also cannot stand the clinical paperwork as it really doesn't teach me anything and I think it's a waste of time, personally. And, we have to still get our meds co-signed by our instructor, which really slows me down (not anyone's fault but the computer system) but this is a BIG time waster and a HUGE pain in the keester. Anyway, enough complaining. Back to paperwork.
maybe the whole thing needs to be changed in terms of clinicals. there are some programs that come to my hospital. many nurses don't like dealing with students/instructers and i don't blame them. then some patients don't want students to do anything. even take vitals/glucose checks. let alone hang an IVPB with you and the instructor in the room. maybe more preceptorship style would work better than 8 students and one instructor in a chaotic med surg floor........also i have worked with nurses of 10 years who never inserted an iv since we have iv therapy teams...........
Thank you for addressing this in a non-judgemental way. The nursing school I attended (highly ranked northeast university, accelerated BSN program) hardly taught us any skills. We had a lab that we attended 5 hrs/wk for six weeks at the beginning of school that taught us assessments, bedmaking, aseptic/sterile technique, transferring of patients and that was pretty much it. We also had to watch a video on catheters and come in to get signed off on them. All other med-surg skills (ng tubes, IVs, ostomy care, etc) were demonstrated to us during a day called "skills boot camp." After we WATCHED our clinical instructors demonstrate these skills to us, we were signed off and allowed to do them in clinical.
Personally, I am a very hands on learner who needs to do something multiple times before it clicks. That is where I would have benefitted 1000% from a skills lab where I could practice to my heart's content.
In clinical I had the opportunity to perform a few of these skills, but I was never confident and always fumbling. The only knowledge I had of them was from what I saw from the instructors and what I read about on powerpoints and in text-books. Even if I did get to perform the skill it was something I couldn't really wrap my head around, because, again, I need to do something several times in order to become comfortable with it.
My senior rotation was a RUDE awakening! My preceptor received her education from a diploma nursing program 30+ years ago and when she graduated she said that she was ready to hit the ground running. Numerous times when I asked questions she would respond to me with "You are the the nurse, figure it out."
It didn't help that for the most part, aside from assessments, all we did at our other rotations were CNA duties. We always started clinical an hour after the nurses on the floor received report and when we got to the floor they would quickly give us a brief report and tell what they wanted us to do for the patients. Usually these things were just bed baths, and ambulation. All I desperately wanted to do was follow the RNs around and actually see what their day was like. I got to do it once, but it was very hard considering they always had 6+ patients, and we had to be constantly overseeing our 1-2 patients. Additionally, our clinical instructors only showed their faces at pre and post conferences and to pass meds with us (one time per rotation).
I passed my NCLEX and graduated with a great GPA, but I am terrified to work as an RN!! I was so excited to go to school and to be able to learn skills, but really I just came out with a headful of poorly written powerpoint notes, and a whole lot of stress!!
I am passionate about changing the way future RNs are educated. Students pay money for a service and at least in my experience, I did not get what I paid for. Then again, maybe I was expecting too much.
Thanks for listening to my rant!
WOW this sounds EXACTLY like my school AND my experience in NS...crazy!!
I wish I had gotten more training in central lines, PICC lines, ports. I graduated in May and I'm ashamed to say I still don't know much about all these. We had a skills lab at my school, but there was no training on this. If we didn't get it in clinical, then we just didn't get it. I also wished I would have had more training in IV's. I know it is a skill that you just have to aquire, but I would have liked to learn more about IV meds, esp IV push. Also learning the different lung sounds and heart sounds. We didn't get any training on this. We did do a lot of clinicals at my school, more than any other school around me. But my school placed a lot of emphasis on oral meds, too much I think. Also we got way too many lectures on therapeutic communication. Such a waste of time. And the paper work was insane. I do understand the point of care plans, but those shouldn't take priority over patient care. We did have a preceptorship, but mine was a joke. I felt more like I was training to be a tech than a nurse. A lot of things really need to change.
I think that nurses need to take a customer service class and also an interpersonal communication class. Just because some nurses dont know how to talk to one another or other staff, they come off rude and with attitude. I had 480 hours of clinicals going thru my program as a lpn. I wish we had more time with IV and PICC, we did go over the calculations.
Wow. I wish so much that I could open up a freestanding new grad center with all of the modern simulators, auscultation teaching aids (someone posted a really good one on breath sounds not too long ago), etc. And keep it open for free.....my dream world :) I'm getting blasted on the general forum for talking about the skills you don't get....and then I read stuff from y'all.
Thank you for starting this thread. I graduated in December of 2010 and it took me along time to find a job in Nursing because of the economy and cut backs in hiring new grads. I finally found a job at a great hospital in another state. Not only am I trying to cope with a new job/career but a new place to live.
All through nursing school, I was aware of how little of the skills we were taught and totally nervous about actually being a nurse and being able to preform. I am finding it difficult to be on the floor, perform skills and manage my time. Does anyone know of anything online or video's that I could purchase that shows the basic skills: drawing up IV push, pumps, PCA's, catheters's, etc.
While in nursing school, I became proficient in PO meds. I only suctioned and changed an inner canula once, never got to do a cath on a real person, etc. I really want to succeed as a nurse but I am feel like I am drowning. I went to a decent nursing school and had a great GPA, I have a good bedside manner (So I am told). I just need to learn the skills.
It hasn't helped, that I am now going to be on my third preceptor. My first preceptor and I just didn't mesh and my second one is going out for personal reasons. I am not even sure who will be my next preceptor. In my home state, I would have received 12 weeks of a preceptorship and here I only receive 6. However, I have asked for additional time. Any advice, would be very much appreciated.
At my first job out of school, the hospital had a seminar each week for about a month that covered a lot of those things complained about here. PICC lines, IVs, pumps, restraints, doctor-nurse communication, handling a death, etc. Yes, some things were a re-hash of school, but it was also nice to get a refresher. It also helped us make friends with nurses on other med-surg floors in the hospital, not just mine. Plus, we got free food & were paid for the time.
I graduated May 2011 and nursing is a second career for me. During my last semester the instructors posted to us that since the hospitals are becoming resistant to having student nurses in their hospitals due to liability so they (the school) will be implementing more lab time to make up with lack of clinical time. I will be honest. I would have high anxiety during my clinicals. However, I think it may be from not having enough clinical time. Once or twice a week of clinical really is enough. My mother-in-law is an RN and back in the day (early 1970's) she attended a diploma program. In that kind of program they are, in a sense, free nursing care for the hospital and in turn the students get daily clinicals. She admits that she had some nurses that didn't want them there but for the most part, the nurses took the time to show them and included them in the care of patients. She says it helped her to learn how to organize and prioritize her day. By the way she is 69 and still works 12 hour shifts in IMC and still loves her job and works in the hospital she did her clinicals in. LOL During my clinicals, MANY of the nurses I was paired with didn't want to have a student. 90% of communication is non verbal and boy do they let you know it. (Hateful 'ole bats) I'm not a spring chicken anymore so I know when I'm getting the brush off. Sorry for my rant. Back to the subject at hand.
Lab can only instruct skills, but it is much different when you are caring for a real person in the real world. More hands on is the solution with nurses (in the hospitals) that want to pass on their knowledge. Just my opinion.
PS I am starting my new job tomorrow in IMC. I am so very thankful for the 6 week IMC course that is comprised of a combination of computer-based modules, lecture/workshops and clinical days. After that I get 6 weeks of preceptorship and more if I feel I need it. Whew!!
Check out the specific topics on YouTube- I hate that it's come to finding some source that may or may not be totally correct since it's not regulated- but it's a start- and you can run some of the stuff by staff nurses when you work.
There is also a really good lung sounds tutorial...just type in the search bar for those. It's amazing what's available online- too bad the schools don't get involved enough to make it unnecessary to find information there. Also, nursing procedure books are available, and a good resource (and worth the money) I'm not sure which one is the most popular these days- but a search for those on the AN bookstore (upper right corner) can help
)
But they were sort of like skill-hunters. No matter who on the floor needed something, they'd stalk the primary nurse (no matter who was assigned to their patients, if any of us), and get us in the door. 
). Ortho/neuro class (one quarter)....and we all got in to harpoon someone . I was first. I got it on my first try, and felt all good about myself....thus jinxing myself for about 3 weeks. In school, 3 weeks is like a year:o. 
MissM.RN, BSN, RN
165 Posts
I completely agree with the other poster who attended an Accelerated BSN program (I'm in the northeast too, go figure!) If I could do it over, I would have attended my local community college's ADN program, but I got scared that I would be un-hireable without the BSN. The clinical placements are okay - I'm a CNA who passes meds occasionally. I am shocked at how little work we are doing on clinical skills, then again when there is only one clinical instructor for eight people, it's really hard to get the work done. Especially at student-unfriendly placements. I really think the accelerated programs and direct-entry master's programs need to be cut (and I'm in one!) seeing as how there really isn't a nursing shortage out there (ask any new grad RN!). This of course is just my opinion. If you're debating over the ADN / accelerated BSN question....go with ADN. You can always immediately enroll in your state's online RN-BSN program the day after you graduate ADN