Who teaches essential nursing skills?

AJJKRN · Apr 23, 2015

I don't want to turn this into a associates/diploma versus BSN thread but in my area this is the issue that our associates/diploma schools have these skills built into the program during live hands on clinicals after being checked/passed during lab times whereas our BSN programs in the area really lack during labs/clinical time. It has been this way for quite some time and my facility is very aware even with the Magnet push which is why I believe (especially as a designated/trained preceptor) that we continue to be "BSN preferred" here lately with a significant drop in our tuition reimbursement. Just my experience in my area. If it helps, we are not a big city like Chicago but are not rural either and about to be a 400+ bed hospital (level I trauma, teaching, etc) with a wide reaching clinic/sports medicine/walk-in/surgi-center/etc with a community college and a big name university in our town and then several more in the surrounding communities.

llg, PhD, RN · Apr 23, 2015

In my region, it is not a ADN/Diploma vs. BSN issue. It is inconsistent for all types of schools. Some of the programs with the least amount of clinical time and instruction is in our local ADN programs (the for-profit ones especially).

My point is that it is inconsistent across the board. Some schools do a better job than others in teaching those types of nursing skills just as some schools to a better job than others in teaching the more academic content.

LadyFree28, BSN, LPN, RN · Apr 23, 2015

In my region, it is not a ADN/Diploma vs. BSN issue. It is inconsistent for all types of schools. Some of the programs with the least amount of clinical time and instruction is in our local ADN programs (the for-profit ones especially).
My point is that it is inconsistent across the board. Some schools do a better job than others in teaching those types of nursing skills just as some schools to a better job than others in teaching the more academic content.

This.

It depends on the school, the program, and if the resources are available.

I was taught those aspects when I went to an ADN, then PN program, and when I went through my BSN program.

We also have to remember that many new grads are not securing positions as quickly as it used to be, and are also dealing with liability issues from facilities, making it truly possible that they need a "competency review."

caliotter3 · Apr 23, 2015

My BSN program of a few decades ago was deficient in skills teaching to be honest about the matter. I used to turn my brain to half speed during that class. I do not know why, nor does it matter at this point. In contrast, one of the ASN programs in the area was renowned for turning out the kind of "job ready" novice nurses that many from a different era remember. I learned a lot of things, whether for the first time, or "over" again, on the job.

I would strongly suggest that you have a skills review/"checkoff" session of a substantial duration before the new employee is let loose on the job. A good "review" session, then a skills check-off. While it would be tempting to allow the very experienced to skip the review and just "check off", I would make the entire session mandatory. This way, you could preclude any differences of opinion on somebody's skill set and those who are embarrassed to admit they need a little review, can receive the instruction without anyone knowing that they forgot something they don't use on a daily basis. Yes, this sounds as if you are redoing nursing school, but not really. We all need to brush up once in awhile and all of this can be chalked up to the new employee's first required in-service. It goes without saying that this little 'academy' should be a paid endeavor. From my viewpoint, a lot of persons would be thankful that a new employer took that much interest in getting them ready for their new job.

Libby1987 · Apr 23, 2015

An example, I demonstrate wound care on a patient explaining *why* I'm using certain products and techniques and discussing wound healing principles.

Next time is observing new hire performing wound care and I'm stopped in my tracks when I see that they don't even know how to set up a clean field, open up packages properly, apply and change gloves appropriately. I was not expecting to teach basic nursing and haven't had to until this past couple of years with nurses coming with less than a few years experience. No one is brand spanking new but definitely new generation.

calivianya, BSN, RN · Apr 23, 2015

I learned all of that stuff in the original post in my BSN program. I'd done quite a few Foleys/IVs/etc by the time I graduated.

Now, you mention wound care... I learned how to do sterile dressing changes, sure, but I'm pretty sure various materials and why they were used was mentioned only briefly, if at all, in school. Knowing what all the various wound care products were used for is something that came with time. In fact, I'd say it's something I'm still learning because it seems like every facility has different preferred products, so it seems like that's something I'm going to re-learn every time I change jobs. I saw a lot of silver products at my last job, which I haven't used since I left there, and a lot of Dakin's solution now, which I had to ask what it was because I'd never seen it before, as examples.

Libby1987 · Apr 24, 2015

We expect to teach wound care and do provide ongoing support, inservices and mentoring following orientation.

The surprise to me was that I needed to bring it all the way back to infection control and clean technique. Even after demonstration and encouragement to set up a clean field.

Both theory and technique are missing. From varied backgrounds.

proud nurse, BSN, RN · Apr 24, 2015

I learned a lot of my skills in LPN school, and even more hands-on. I learned a few more in the LPN-RN bridge program. Working in LTC made me pretty good at dressing changes, trach care, injections, and feeding tubes. I don't know why but many new BSN's at my hospital have no idea what to do with a kangaroo pump and bottle of Jevity, so I am the go-to person on my floor whenever we have G-tubes.

The CNA's insert foley's at our hospital. I haven't put in a foley in over 3 years, but I believe I could do it again without a problem. There are a handful of skills I learned that I never use or haven't in a very long time.

applewhitern, BSN, RN · Apr 24, 2015

We are experiencing the same thing. Having to give lengthy orientations, for the most basic nursing skills.

Julius Seizure · Apr 24, 2015

I can only speak to my personal experience:

I graduated with my BSN in Indiana in 2007.

At that point, my only IV starting experience was practicing on a mannequin hand in the skills lab at school. We weren't allowed to do them in clinicals.

We also learned how to draw blood in skills lab, during which I managed to stab myself with a vacutainer.

The only meds that I was allowed to handle or pass were PO meds, with my instructor by my side.

I had never placed an NG tube on a real person.

I had never seen a trach in real life.

I had placed a foley or done a straight cath (cant remember which) once in clinical.

I had done some awkward patient teaching on medications that I was just learning about myself.

I did feel pretty comfortable with clean and sterile technique from practicing it in the skills lab, but I had never used it in clinicals for any sort of wound care.

The skills I remember using most in clinicals were making up care plans to hand in for grades, bed baths, and helping patients who needed assistance with their meal trays. Oh, I did help turn patients q2 hours in my ICU clinical. Mostly, clinicals seemed to involved trying to stay out of the way and observe what you could.

I did my best to appear educated and willing to participate when I was orienting to my first job, but I definitely had to learn fast by observing and know who it was 'safe' to ask when I had questions - which was constantly.

caliotter3 · Apr 24, 2015

I can only speak to my personal experience:
I graduated with my BSN in Indiana in 2007.
At that point, my only IV starting experience was practicing on a mannequin hand in the skills lab at school. We weren't allowed to do them in clinicals.
We also learned how to draw blood in skills lab, during which I managed to stab myself with a vacutainer.
The only meds that I was allowed to handle or pass were PO meds, with my instructor by my side.
I had never placed an NG tube on a real person.
I had never seen a trach in real life.
I had placed a foley or done a straight cath (cant remember which) once in clinical.
I had done some awkward patient teaching on medications that I was just learning about myself.
I did feel pretty comfortable with clean and sterile technique from practicing it in the skills lab, but I had never used it in clinicals for any sort of wound care.
The skills I remember using most in clinicals were making up care plans to hand in for grades, bed baths, and helping patients who needed assistance with their meal trays. Oh, I did help turn patients q2 hours in my ICU clinical. Mostly, clinicals seemed to involved trying to stay out of the way and observe what you could.
I did my best to appear educated and willing to participate when I was orienting to my first job, but I definitely had to learn fast by observing and know who it was 'safe' to ask when I had questions - which was constantly.

If you weren't in Indiana, I could swear you went to the same program that I did, just a few years later with nothing having changed in the intervening years! This is sad.