What should we doing by last clinical?

PixieRN14 · Mar 8, 2014

Wow! I am shocked at what little you can do. I have been passing meds since Funds and everything else since Med Surg 1. I am now in my final semester and had the opportunity to place my first foley on the first day of Med Surg 3. I am in a community hospital that is affiliated with a large teaching Hospital. I have to say I have been blessed working with and learning from amazing nurses.

applesxoranges, BSN, RN · Mar 8, 2014

One issue is that people don't put in NGs, IVs, or foleys every single day. I put in one foley and two IVs in nursing school. I have my IV skills from working as a paramedic. We did blood sugar checks all the time. I did suctioning my last semester. We were allowed to but unfortunately, most patients didn't need an IV rotated or a foley put in. It's not a common occurrence.

Honestly, I wish there were still hospital diploma based programs. They sound like they prepared people better to function as a nurse, especially as the nurses were being run through the hospital. A lot of people also claim they had 2 12 hour clinical days whereas we get 1 8 hour or 10 hour clinical day.

lilredrunner · Mar 8, 2014

I'm in an Associate's program, and have done pretty much everything except hang and administer blood products. I also can't draw blood from central lines, but have drawn labs peripherally. I've started, run, and maintained IVs, hung secondary lines and piggybacked antibiotics, and d/c'd lines. Done central line changes and d/c'd a few. Given meds in pretty much every form and route. Put in NG tubes, Foley's, done enemas. Bedbaths, showers, massages, linen changes.. Everything. As a graduate in May, this semester I've taken on 3-4 patients at a time, and the only thing I really can't do independently is coordinate with doctors, calls, and verify orders. Everything else, including assessments, neauro checks, and charting, I've done.

Of course, we also have 12-hour clinical days that are very focused, because we're in a rural area without easy access to hospitals, and the area hospitals are VERY clogged with students. So we get limited time. Maybe it's the focus that makes the difference, because when we're there, we're THERE, and we really commit to it.

As a second year, I'd be appalled and would feel pretty angry at a program or instructor that didn't advocate for me to be put on the same level as an RN and allow me to do more than pass out trays. Not because the tasks are super important (it's really the thought process behind it, since you can train monkeys to start IVs), but because as a student, that's the perfect time to do tasks and make mistakes while under supervision. Much safer and helpful for when you get your license and are out on your own.

pixiestudent2 · Mar 9, 2014

One issue is that people don't put in NGs, IVs, or foleys every single day. I put in one foley and two IVs in nursing school. I have my IV skills from working as a paramedic. We did blood sugar checks all the time. I did suctioning my last semester. We were allowed to but unfortunately, most patients didn't need an IV rotated or a foley put in. It's not a common occurrence.
Honestly, I wish there were still hospital diploma based programs. They sound like they prepared people better to function as a nurse, especially as the nurses were being run through the hospital. A lot of people also claim they had 2 12 hour clinical days whereas we get 1 8 hour or 10 hour clinical day.

I'm in a diploma program, they still exist!!!

CT Pixie, BSN, RN · Mar 9, 2014

"I'm set to graduate in 2 months and am in my final clinical rotation in oncology. I have yet to start an IV or foley, change dressing, do teaching, suction a trach, draw blood, put in an NG or any of the skills we've been tested out in other than giving meds. I have seen nurses do it but have never done it myself.

We started in our first clinical doing bed baths, emptying bedpans and giving foot rubs which I did gladly. However, 2 years later, that's still pretty much all we're doing. Since our first day on the oncology floor, we've been directed to change sheets, get coffee and clean up feces and vomit. We haven't done anything else (except vitals and the occasional meds). I don't even know why are we coming in an hour early to get patient assignments since we barely do anything with them except food trays and bedpans.

To be fair, our instructor almost gave me an opportunity to put in an NG tube yesterday but the patient said she didn't want a nursing student. "

Wow. (for some reason I can't 'quote' the original post. Our school did not have us starting any IVs. The hospital we are affiliated with does not allow students to do it. We could do everything with the IV (meds, flushes, and d/c it but we were never allowed to start one. The hospital has an IV team that starts most IVs. I don't recall seeing any of the floor nurses starting any IVs during my time on the floor. The hospital does train any new grad in starting IVs.

Other than that we were taught all the skills you mentioned and were fully encouraged to do them in clinical. Our instructor would always try to assign patients who were complex so that we could get the experience. However, the opportunity to do all the skills was not always available on the floor we were on at the time. I was lucky enough to have 2 semesters during my LPN schooling in a facility that was a trach/vent specialty facility. As well, during my RN schooling, I did a clinical rotation on the resp floor and was lucky to have a trach/vented pt. My whole clinical group ended up working with the patient over the time we were there.

Teaching is something you can do with any patient you are assigned to and you should be doing it. Educate them on their disease/illness, on their meds, ways to help lesson any pain etc. You can and should educate every patient you have.

Maybe I lucked out because we are a school that is affiliated with the hospital and we had the opportunities that we did to hone our skills etc.

Just because YOUR patient doesn't have the things that you can practice your skills on doesn't mean you can't get the opportunity to do it. I always told the nurses (whether or not they were my patients nurse) if there were any wound treatments to be done, NG tubes, etc...let me know, I'd love to do it. Our whole group learned and practiced that way. The nurses were more than happy to have us start a foley or d/c it or drop an NG etc.

Mandy0728 · Mar 10, 2014

I'm sorry that you feel like you haven't learned much or have been able to do much on your own. I'm in my first semester of NS, and the hospital that our clinicals will be at starting next semester, is at our university hospital which is also a teaching hospital. I've heard a lot of the nurses there are horrible but being that it's a teaching hospital, hopefully I'll get chances to do more.

applesxoranges, BSN, RN · Mar 11, 2014

I'm in a diploma program, they still exist!!!

Well, a diploma program within 20 miles of me. My state only has 3 diploma programs left and I think they are on the opposite end of the state (about 4-6 hours away). I wish they still had more diploma programs because I don't necessarily think that the current education model is necessarily the best for floor entry nursing.

seconddegreebsn · Mar 12, 2014

I'm in the same boat--I've given a couple heparin/insulin shots but haven't done any IMs, given meds thru an NG tube but never placed one, have no idea where to even begin with phlebotomy. The times I've been able to do something worthwhile has sort of been when I go over my instructor's head and ask the nurse directly (the instructor is a very nice woman but hasn't worked as a professional nurse since the ninties and is very slow on her feet, can't figure out how to use computerized med systems, and honestly we spend more time waiting for her to orientate herself than actually doing anything). The instructor kept going on and on about straightening up the bedside and oral care, but, let's be honest--those are NICE things to do (and important in their own way) but they are not challenging nor are they priority - if someone can't breathe or take their meds a perfectly folded sheet is not the first thing I'm worried about.

I've been trying to figure out how to get some experience in but there really isn't any way around it. I volunteer and do PCA work, but it's not the same. I really push hard and advocate for myself during clinicals, but the experience generally depends on the nurse I'm assigned to that day and how much they want me around.

Honestly, I'm graduating in 4 months so quitting isn't an option, and we've very clearly told the staff that they are failing us and they haven't made any changes. What can I do?

Compassion_x · Mar 13, 2014

A lot of the skills things during clinicals are hit or miss, unfortunately. Usually in my situation it's the patient that's the only one to say no, with a few exceptions. There are still things I haven't done. Luckily, dressing changes aren't actually that difficult, I feel like school makes them out to be difficult.

I'm in my last full semester of my ADN program, and I've tried IV starts on two occasions, 4 total attempts. Last semester we did an IV preceptorship in ambulatory surgery, where I did 3 in one day, but had no other opportunities during the semester. I did get experience with IV pushes and IVPB and such, that I haven't had opportunity for this semester. Out of my 4 semesters of nursing clinicals (plus summer) I've done ONE foley (although had an opportunity for SP cath at work once) on a man last semester.

I've never put down an NG, never got to suction (unless turning the nob on the suction for NG pts counts ), or do anything with trachs (never even seen one in person on a real live patient TBH). That said, anything the patient were assigned to has going on that day, we get to do unless they refuse. This includes going and observing surgeries. The nurses are more than willing to let us take some of their load off them.

My last clinical instructor said she worked with a nurse on a med-surg floor who had never put in a foley after working off orientation for months. And realistically, if you get to work and have never done something before, its likely you can get someone to help, even if only observing and instructing. Nursing is, and should be, a team effort. This has been my experience, anyways.

rubato, ASN, RN · Mar 13, 2014

This is really sad. I'm sorry that your program hasn't been conducive to learning hands on skills. I've had some amazing nurses during clinicals, and some that didn't really want students. But, I've managed to do it all during clinicals, including discharges, admits, patient and family education, phone calls to doctors, giving report, assessments, critical thinking and all the hands on skills (except an NG tube). I'm ready. I can't wait to graduate and get out there. The nurses in the unit I'm doing clinicals in this semester have asked me to come work with them. And, that's because of how amazing their teaching is, not because I'm amazing. My instructor is only available for about 30 minutes per day for me in a 12 hour shift, but once we passed meds with her one time, we were free to do everything with our preceptors.

I feel like you've been short changed, and I hope that your first employer can make up for it.

classicdame, MSN, EdD · Mar 13, 2014

elkpark is right. Students slow down staff and they resent it. You will understand once you are responsible for all those patients and their care. However, I do not think that is an excuse to be rude.

What you should know by now is 1) you don't know it all 2) you will never know it ALL 3) who/what are your resources?

leekaye · Mar 13, 2014

"elkpark is right. Students slow down staff and they resent it. You will understand once you are responsible for all those patients and their care. However, I do not think that is an excuse to be rude."

I do get that we're taking up time out of their hectic day so I'm always sure to thank them for whatever they include me in. We've had some very nice nurses. And some who make us nervous just being around them.

One nurse went to my instructor and complained because she saw me crying when a patient died. I realized I was going to cry and put my head down and walked quickly and silently to the bathroom so as not to disturb anyone. I dried my tears and was out within 3 minutes but I got chastised for "unprofessional behavior on the floor" and it was written into my mid-term evaluation. The instructor even said she thought it was ridiculous and we SHOULD feel compassion but she had to include it because the nurse said she was going to report me to her manager. Do nurses really get written up for silently shedding a few tears?