What didn't they teach you?

marie-francoise · Jul 13, 2008

I think ADN programs should have 1 fully didactic year (class, book-reading, lab), followed by 1 diploma-style, clinical year during which we are purely learning in the hospital/psych/LTC/clinic setting. Don't know if there would be enough clinical spaces or instructors for that, though.

ChristineN, BSN, RN · Jul 13, 2008

I was lucky to attend a diploma program that had alot of clinical time compared to some of the BSN programs in the area. The only thing I might have changed was making OB and Peds 8 week semesters each. It was a combined 8 week semester, 4 weeks doing clinical for each.

leslie :-D · Jul 13, 2008

As a recent grad,

sue, you're an rn now??????????????????????

leslie

SuesquatchRN, BSN, RN · Jul 13, 2008

sue, you're an rn now??????????????????????
leslie

No, finished the course work, waiting to take the CPNE then NCLEX. I was referring to being an LPN for a big 2 years now.

The RN's from my class had the same complaint. When I asked if they learned anything in clinicals the RN year the answer was a resounding NO.

:)

whodatnurse · Jul 13, 2008

I was talking with friends the other night and we came up with a pretty extensive list of skills/facts we wish they had taught us as part of out nursing education. For new and old alike: What do you wish they had taught you in nursing school that would have helped most when you started in practice? Or, that do the new grads comming out lack that you wish they had been taught? I don't want a put down session about new grads- I'm hoping to hear new ideas for improving the way we educate the next generation of nurses.

Where's this 'extensive list' you all came up with? I want to know this stuff too, as do dozens of others, I'm sure!!! Please do share.

Cindy-san · Jul 13, 2008

More clinical time would have been the best thing. That's really where you start building on the most important skills. It's easy enough to talk about, hard to actually do, I find.

Plus, actual IV starts and blood drawing would have been gold, since it is something I'm expected to do as an RN.

I've also been thinking for a long time that I would have liked a lip reading class.... I find those who can't talk usually can't spell or write legiblely either. It's awfully frustrating for the both of us.

mpccrn, BSN, RN · Jul 13, 2008

when i graduated from school a billion years ago, we were fully prepared to walk in a hospital the next day and take a full assignment. it was a diploma school where clinical started the first week. by the end of school, we had already experienced charge nurse duties, full nsg. assignments, med nurse for a floor and everything else they could think of to prepare us. today i see a complete lack of clinical skills and more of an emphasis on "delegating". there are 2 schools that use our hospital for their clinical experiences. i find it very sad that they don't spend a full shift there....ever. instructors pick and choose what the student is responsible for (they will give some po meds, but not sq or iv) they will take vs, but not do assessments. they will do assessments but not vs. they will do certain things on 1 patient, but not the other. 2 students will give meds today, but not the other 3. it does a great disservice to the students. it makes it a horrendous situation for the staff trying to figure out what today's game will be. in my opinion, if you want good nurses graduating, you need to let them practice while they are students. take an assignment a whole assignment and deal with whatever comes along the way. it is the only way they will be prepared and confident to take care of someone who is depending on them to keep them alive. you reap what you sow. somehow my instructors were able to keep an eye on us all, you don't see that now. :cry:

RNperdiem, RN · Jul 13, 2008

I wish there had at least been a discussion about what to do with abnormal results.

I know that experience really teaches you a lot about this, but I would have liked some thinking exercises about what you would do with abnormal labs, respiratory distress, patient falls and other situations.

Do you call a rapid response, bring the subject up with the docs on rounds, STAT page the doctors, recheck the vital signs, just figure the labs have been abnormal all along and do nothing, what?

bethem · Jul 13, 2008

That

H2CO3 -> HCO3 + H -> H2O + CO2

It could have made so much difference to my understanding of how metabolic acidosis can be compensated for by the lungs! Instead they glossed over the topic and just said "Well, metabolic acidosis can be compensated by the lungs and vice versa. That's how it is, that's all you need to know". I also wanted more anat and phys, as we did hardly any, and more pharmacology. That's why I started a MNurs five months out of uni.

Also time management, how to deal with nurses who just want to see you sink instead of swim, what to do when the baby doc asks YOU what to do, how to cope when you suddenly find yourself to be the most senior person on the floor when you've been out for a whole month, the politics of it all...

Things I wish they HADN'T bothered with for so long: What we would do if we found ourselves in a boat in the middle of the ocean carrying twelve people when the safe limit was 10; how to conduct a double-blind RCT (in tedious detail, for an entire semester); how to create a CV (again, for an entire semester!); Sociology (for two semesters - I got into an argument with the tutor about whether toddlers who point out that Billy has brown skin but Tommy has pink skin are inherently racist, or just observing the difference between them - I beleive racism is taught, not inherent), how to fold a sterile towel back around an Oasis chest drain - why would you ever do that?... there was a LOT of wasted time at my uni. Thankfully in Australia we don't have the insane fees you have in the US, and the government will spot us the course fees until we earn enough to pay them back.

Hmm, it appears I have much stronger feelings about this than I realised!

SecondGenRN · Jul 14, 2008

As a recent grad, I will say that I believe - and I'm going to get flamed for this - that the old ADN way of being ON THE FLOOR and by the end of your training taking and managing a full load of patients was better.
We get a lot of theory and test-taking skills and not nearly enough hands-on. Not NEARLY enough.

I couldn't agree more! BScN is the required education to take the registration exam here and I always feel that I do not have enough hands on experience. Learning a skill once in a 2nd year lab does NOT prepare me to practice on a floor. Also, I am currently doing my consolidation in the emergency department and I would've loved to learn more about cardiac care... I never even SAW a strip till I went there, how sad is that? I also would have liked to spend more time on body systems and illnesses and less on feelings courses.

HM2VikingRN, RN · Jul 14, 2008

As a recent grad, I will say that I believe - and I'm going to get flamed for this - that the old ADN way of being ON THE FLOOR and by the end of your training taking and managing a full load of patients was better.
We get a lot of theory and test-taking skills and not nearly enough hands-on. Not NEARLY enough.

I think this also illustrates the strength of the diploma programs.

suanna · Jul 15, 2008

Where's this 'extensive list' you all came up with? I want to know this stuff too, as do dozens of others, I'm sure!!! Please do share.

The list was somewhat long and verbal but a few I remember:

How orders work doctor-pharmacy-cardex-mar. Most students have never taken off an order or spokento a doctor.

How to interact with the medical staff- Nursing is taught in a bubble. Once they get out they are suddenly supposed to know how to figure out who is on call, what info to have available, what the chain of command is -intern-resident-senior resident-attending. What to do if you disagree with the orders.

IV therapy- not just starting IVs- which is pretty weak for most students, but common incompatabilities, fluid choice, colloid vs crystalloid, insertion site assessment. I can't tell you how many times I have been called to a floor with a high percentage of new grads and found 3 out of 4 ivs infiltrated. I have actualy has a nurse tell me she had a bit of trouble infusing the PRBCs but once she put it under pressure it got in over a couple of hours- needless to say the patient nearly lost thier are to compartment syndrome.

Report giving- learn to organize the important info into a concise format and pass it on to the next shift.

Geriatric patient specific skills. Students get a full semester with kids, babys, L&D but 80% of your patients are going to be 65y/o or greater. Most students have never heard of a "sundowner", have never helped manage a confused scared patient,and understand the meds and dose ranges as they apply to the aversge 25y/o. Schools need to wake up to the fact that most of our patients are OLD.

There are lots more but it's getting a little long!