What Do You Think You Needed To Learn in School, But Didn't

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by xtxrn xtxrn, ASN, RN (Member)

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Double-Helix, BSN, RN

Specializes in PICU, Sedation/Radiology, PACU. Has 11 years experience. 1 Article; 3,377 Posts

I think what it comes down to is students need more clinical hours. My school really emphasized skills in the lab, but we rarely got a chance to practice in clinical. It's one thing to insert a foley catheter on a manniquin that has a

plastic urethra a centimeter wide. It's quite another to insert one on a frail, confused old lady with an artificial hip.

I think part of the problem is that there are so many nursing schools now. I went to a school in Maine with only two major hospitals within reasonable distance. One was a tertiary care, teaching hospital. The other was a small Catholic hospital with only a few units and no peds/OB. Four nursing schools (two ADN, two BSN) has to compete for clinical time at those two hospitals. The hospitals had a policy that allowed no more than 8 students per instructor. What that boiled down to was one 7 hour clinical per week for each of our major courses. Minus the days we spent in lab and what your left with is roughly 12 days of 7 clinical hours per class. And an hour of that is lunch! Hardly enough time to perform enough skills to make you comfortable.

When I started work as a new grad in a PICU, there were a lot of skills I had never performed on a person, much less on a child- inserting an NG tube, female foley, changing a central line dressing, are the big ones. It wasn't until I started work that I learned how to adapt my technique to accomodate a human.

I was fortunate to have a one hour/week IV therapy elective where we learned venipunctures and IV starts on each other. This was the first year that elective was taught. We were told we would not learn it in school, not because there were IV teams, but beaqcuse each hospital required that you go through their certification, so we would learn then. However, my hospital's IV certification consisted of a written test and three successful sticks. There was no formal instruction.

Great thread!!!

ajt575s

ajt575s

53 Posts

I'm in psych right now, and I'm finding that my psych class was not helpful at all. We spent the whole time going over various types of disorders and therapeutic communication for each disease process. During our clinicals, we barely spent any time with the nurses at all. I don't think many of us even knew what psych nurses do. We just sat around talking to patients in a rehab setting. We didn't deal much with psycotic pts at all.

De-escalation would have been VERY helpful, and should be a must for a nurse in any field, but especially psych. Also, the legalities of psych nursing, specifically, 96 hour/21D/90D holds/restraints/seclusion would have been helpful. Techniques on dealing with problem behaviors would have been good. Usually, acute psych pts have multiple diagnoses or no diagnosis yet and don't fit neatly into these various disorders we discussed in school. So, I haven't found a lot of that "therapeutic communication" geared towards specific diseases or "coping skills" that I'm supposed to teach people with certain diagnoses to be all that helpful.

Also, what to actually DO in certain kinds of emergencies, like chest pain, SOB, etc. would have been great. I feel like we were very rarely told what we should actually do when this stuff happens. Like everyone else, I feel that skills would have been great. Luckily for me, I had an externship during school where I got to learn how to put in IV's, draw blood, etc., and I worked as an aide, which helped me learn how to balance multiple patients. But, I didn't learn those things in clinicals.

newRN_NY

newRN_NY

32 Posts

*** 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.

I'm a CC ADN new grad and it's almost impossible for us to get jobs. Everywhere I see "BSN required/preferred", especially for the new nurse residency programs. I have actually head nurses say that we (ADNs) have more experience with clinical skills. So frustrating -___-

PMFB-RN, RN

Specializes in burn ICU, SICU, ER, Trauma Rapid Response. Has 16 years experience. 5,341 Posts

I'm a CC ADN new grad and it's almost impossible for us to get jobs. Everywhere I see "BSN required/preferred", especially for the new nurse residency programs. I have actually head nurses say that we (ADNs) have more experience with clinical skills. So frustrating -___-

*** Ya that is the trend. there are a few exceptions. For example my hospital no longer hired new grad BSNs into the nurse residency program for the SICU. They hire ADNs only. This is cause so many of the BSNs were not finishing the two year contract required for the residency program before heading off to CRNA school. However there are only 1-4 opening each year.

You are also the victim of two other things. The first is the false and self serving but often repeated propaganda about the imaginary nursing shortage. This propaganda is put out by those who have a vested interest (will make money) from a glut of nurses and is has caused many nursing schools to open or expand their programs. A glut of new grads has been created, exactly as was the intention of the self serving propagandists who put out the false nursing shortage propaganda.

The second is of course the bad economy. This has caused many older nurses to delay retirement and many, many part time nurses to go full time. These two things alone dried up nearly all of the many open positions we had in one of the ICUs where I work.

Of course it is perfectly understandable why hospitals prefer new BSN grads. A BSN grads is highly likely to come to their first job with a large amount of student debt, vs the ADN who come with little to none (usually). Nurses who are seriously in debt are seen as less likely to rock the boat and more likely to tolerate poor working conditions and poor treatment from administration and management. The ADN who very likely owes nothing is seen as more likely to speak out about poor working conditions and refuse to tolerate mistreatment as there is less risk for them to simply vote with their feet.

My only advice is to seek jobs in rural hospitals who do not have a bunch of nursing programs around them.

NotReady4PrimeTime, RN

Specializes in NICU, PICU, PCVICU and peds oncology. Has 25 years experience. 16 Articles; 7,358 Posts

Of course it is perfectly understandable why hospitals prefer new BSN grads. A BSN grads is highly likely to come to their first job with a large amount of student debt, vs the ADN who come with little to none (usually). Nurses who are seriously in debt are seen as less likely to rock the boat and more likely to tolerate poor working conditions and poor treatment from administration and management. The ADN who very likely owes nothing is seen as more likely to speak out about poor working conditions and refuse to tolerate mistreatment as there is less risk for them to simply vote with their feet.

My only advice is to seek jobs in rural hospitals who do not have a bunch of nursing programs around them.

What an interesting perspective. I suspect there's a huge grain of truth in it. Sort of like the rationale my unit uses for hiring new grads versus nurses with significant critical care experience. (The new grad hasn't been "tainted" by experience and can be "groomed" into the perfect drone, no opinions or independent thought coloured by the clinical education or working conditions elsewhere. Problematic? Oh yes!)

newRN_NY

newRN_NY

32 Posts

It is an unfortunate situation. Luckily for me though, I have finally landed a job in a hospital. It's 5 hours north of where I live...but hey I'm willing to relocate if it means starting my career. I read the posts on here about new grads that have been job hunting for 12+ months! Very scary! I wish everyone the best of luck out there, something will come around

Mitts78

Mitts78

13 Posts

I graduated from a 2 year program. Of the new grads that were hired for our hospital (and we rotate throughout the hospital)-only those students that attended the 2 year program had 3+ pt assignment in clinicals. I think this is probably one of the biggest things that schools need to do because when you are out of school-the minimal you will most likely have is 4 pt assignment on days (unless you're in ICU/CCU). Time management is one of the biggest obstacles in nursing...one that probably could be minimized with multiple pt experience in clinical when you have an extra person to turn to (ie not just co-assigned but clinical instructor). I had a 4 pt assignment in clinicals and the 2nd day I had 4 pt assignment on the job, I hit a wall and felt like I was everywhere...so I cannot imagine what students who had a minimal of 2 pt assignment in clinicals must feel like.

I'm the type of person that loves to learn. I'm also the type of person that is very hard on myself. I often have to be reminded by myself, or my preceptors that experience comes with time. I'm not going to get EVERYTHING overnight.

I'm not sure if there is anything else to learn in school because it is simply impossible to have every single experience...

Mitts78

Mitts78

13 Posts

MANY, many hospitals in medium sized cities (100,000 +) do NOT have IV teams of any sort. It is the nurses primary responsibility to insert and maintain all peripheral lines, and maintain all central lines.

The IV Team concept is a myth in more places than it is not :)

I don't think size of the hospital/city has a relevance to IVs. I work in a small community hospital (little more than 200 beds) and we have IV teams. And our neighboring community hospitals also have IVTs-with less beds than we do. The only nurses that do IV starts is the ED, CCU, LDRP and SDS/OR. Our IVT also does chemotherapy for our patients. Though I am in agreement with the majority of the others, I think we should be able to do IVs. I also think if you're on the ONC floor-you should be able to hang Chemo (as long as you are chemo certified).

Mitts78

Mitts78

13 Posts

I managed to graduate from nursing school without drawing blood, starting an IV, inserting a foley (on a person), changing a dressing, using an IV pump, doing anything with drips, assessing wounds, or doing anything with PICCs or CVCs. When I expressed my concerns to the lab instructor, she said "They'll teach you that on the job." I've learned quite a bit since I graduated, but I still can't insert an IV, draw blood, change a PICC dressing, or insert a foley.

Long story short, I agree with xtxrn's opinion that today's nursing students are being screwed clinically. We're not given a chance to learn a lot of skills, then punished for not knowing them. The Nursing Process hasn't helped my practice at all.

WOW!!! Not even changing a dressing? using an IV pump (I can see that if you're at a SNF/LTC). My 3rd semester (of a 2 year, 4 semester program) my instructor had me take an admission from the ED, take the report, do the assessment, and paperwork with my co-assigned nurse co-signing it. We had 3 patients in our 3rd semester and were expected to have 4 pt for at least 3 weeks in our last semester. I guess I am very lucky and blessed to go to a ADN program that allowed us to do this. And to have clinicals at the hospital(s) that allowed us to do this. And I didn't attend school in a big city nor did I have my clinicals at a "teaching" hospital.

We have a residency program for new nurses (used to be 6 months, now it's 4 months) where we float to all the med-surg floors with outrotations to other areas if you're interested (LDRP, ED, OR). Not only are the floor nurses pleased with the outcome of the residency nurses but I have also heard that they are pleased with the 2 yr ADNs that come out of their community college. It is definitely a team effort to make excellent nurses.

I honestly think they should bring back "diploma" nursing. Perhaps not "diploma" but with a degree. Back in the day nurses practically, if not did, live at the hospital where they worked. They lived & breathed nursing!!

xtxrn

xtxrn, ASN, RN

4,266 Posts

There's something to be said for getting the skills down first, and the theory after that...jmho. I definitely am a fan of more education- as long as it enhances the skills you need. The whole BSN vs ADN vs Diploma stuff has been going on for so long. And the sad part is that there is room for everyone. :)

2011nursetobe

2011nursetobe

64 Posts

I feel like although part of the success of nursing school is the curriculum and amount of clinical hours, more importantly, nursing school is what YOU make it. My first semester, I was scared of everything and shyed away from any experience. My second semester I began to realize that this is my chance to learn, and my ONLY chance before I'm on my own. So I took initiative and volunteered for every opportunity I could. I am a very shy person who prefers to be in the background but I began to think about how it would be after I graduated when I had no experience with things.

Yes, my diploma nursing program had TONS of clinical hours and was great at teaching us, but a lot of students ran from opportunities instead of running to them. I had done NGs, at least 7 Foleys (all or most on women), multiple IV starts (most of which were not successful), and was handling 4/5 patients by myself on my preceptorship close to graduation. I had seen 6 codes, done CPR compressions, seen bedside procedures...chest tubes put in, taken out, cardioversions, etc. This was all because I took the initiative to BE there in the room. I asked if anything was going on and jumped on every opportunity I could get to improve my skills. I feel like I made myself available to learn and it has really paid off in my first job. All my co-workers are impressed at how quick I have caught on. I am 8 weeks into a 12 week orientation and I have basically been doing complete care for all my preceptor and I's patients since week 4. Everyone is saying I can be on my own already, but I need my preceptor because I am still learning policy and procedure for our hospital.

I don't ask my preceptor to "help" me with things I know I can do. I need to be able to handle things on my own. I think of myself as being on my own because I know that soon I will be. Now I am the question queen and I ask my preceptor absolutely TONS of questions. How are you supposed to know things if you never ask? You can't! I ask her questions that aren't even relevant to what I'm doing at the moment because I know that one day I I'll need to know these things and I may not have a mentor close by. So, to answer your question...really there's nothing in school they could have taught us more...if I had to absolutely pick one thing, it would have been things like troubleshooting..."What if...." situations..."What if the patient does _____ during a code", or "What if I walk into the room and see _______"

carrie_c

carrie_c

235 Posts

I totally agree, I tended to stay in the background a little when I was in school. Now I wish I would have jumped in a little more. I am the same way now though, I ask my coworkers tons of questions about everything. They probably get tired of hearing me! But I would rather be safe than sorry.