I know the old days but modern day, where are the essential patient care skills being taught and confirmed?
ie
Sterile technique
Clean technique
Foley care and insertion
Patient teaching
IV infusion principles
I'm currently thrown off by needing to teach these skills, which ones or any could I expect to be taught in school or is it generally inconsistent?
ETA Prior to very recent years, it truly never occurred that these weren't known skills, we'd review and check off competency but we weren't needing to teach them.
Now I'm wondering if these are questions we should expect to have to ask, ie do you know how to perform sterile technique? (That would have been insulting to nurses educated in past years and newer nurses are newer to me/us).
All entry-level programs have mandated number of clinical hours regardless of degree level. Also, budget and clinical placement availability precludes a program from offering more hours than the minimum. Therefore the oft-repeated "ADN programs get more clinical than BSN" sound bite is a fallacy.
It's usually the luck of the draw as to what manipulative tasks students get to practice in clinical. Everybody gets caught up by the end of their first year in practice, though, and then those IV starts and Foleys are much less exciting.
Specializes in public health, women's health, reproductive health.
I learned these skills and checked off on them in lab and then had an opportunity to practice a couple of them in clinical settings, but not enough times or with enough regularity to feel proficient. For instance, I inserted a foley catheter in my first semester, both in lab and in the hospital on a patient. But my next opportunity didn't come until two semesters later. Simply not enough practice. I found myself watching videos of some essential skills to keep it fresh in my memory how they are done.
We've been meeting and strategizing how to handle this. It's becoming apparent that this is not going to be a few isolated situations. It seems home health may be becoming a new training ground.
In hind sight it makes sense, nearly everyone historically got their start at bedside, but now fewer newer nurses aren't getting that and those who are may not be getting the basics fine tuned there either. How many get the kind of attention to perfect their techniques when everyone's running? Even if a nurse has done some catheter changes that doesn't mean that they had the type of mentoring we used to get (Remember those instructors from the dark ages that would make you redo making the hospital bed in your first semester until you got it perfect? They were the same with all of our nursing tasks, it seemed over the top at the time but we got those basics down solid). And nurse extern positions seemed to have been more common on top of residency programs. Looking back no wonder we were able to get so much hands on experience, ASN or BSN.
With the common threads about preceptor issues, I wonder if it's this kind of expectation of each other that's behind the problem. Here we're thinking they knew more or should while they're thinking we should be more patient with their starting point. I can see where managers are giving vague feedback about how a new nurse is performing, it took me a couple of weeks to put my finger on it and it could have gone the same way, I could have told my director that something is just missing and that it's not going to work out. And then new nurse posts that the orientation wasn't comprehensive enough, the expectations were too high and they don't understand where they went wrong..
Specializes in Med nurse in med-surg., float, HH, and PDN.
We had a "Basic Nursing Skills 101" class and labs as our very first class, which were followed up by clinical practice with our class instructor acting as our clinical instructor. Of course, my school was hospital connected and all the instructors well known to the hospital staff, so between them they actively scheduled in as much as they could. Once a skill had been covered in class and a lab, it was not unknown to have another instructor pull you from a classroom to go over to the hospital and do a procedure, and then return to class. Seemed like the instructors and the staff all worked together so we could get in the 1-2-3 of the skills: Learn, practice, do. In our class , nobody escaped or was overlooked, and therefore got a lot under their belt by the time med-surg. clinicals rolled around.
These were the first things that were taught in my LPN program, and we were tested on them over and over again throughout the program... It's never left me!
Specializes in Education, research, telemetry, med/surg.
I currently teach the skills/basic interventions class. It is in the first semester my program's BSN program. One major issue I see in the community I live in is that this area is just SATURATED with nursing schools. There is such a demand for clinical space, and students don't get all the experience I think they should get.
The BSN program I graduated from was in a different state. We learned about skills in the beginning as well, but honestly the only skills I was ever able to do in the clinical setting were meds, CNA tasks, and really, that's about it. Luckily (for me), the school required that you attended a internship during the summer, and that is where I was actually able to do more skills. That really helped me be more confident in what I was doing. The program I teach at now does not require it, and doesn't even require that the students take a CNA course prior to entry (which was new to me), and the reason they don't require internships is because it would be impossible for the students to all get the chance to do it.
I agree that it is a problem. Honestly- I believe all nursing students should have taken the CNA course. That way, they can focus on the nursing things, and not have to focus so much on those BASIC nursing skills, like transfers and bed changes. I also know that if we as a program required that, we would have no students, because there are plenty of schools in the area that would take them.
What the answer to this is... I don't know. Thanks for asking!
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....
I had the exact same clinical experience in my RN Assoc. Degree program in the early 2000's. However, I had done most of the procedures as a LPN.
Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
SHOULD be taught in nursing school. It was in mine. But I have noticed instructors dumping students on staff and leaving (presumably for other clinical sites) and expecting that we, the staff, teach them these basics and have them perform them under our supervision. I think that is highly inappropriate and disrespectful toward already overloaded nursing staff to take this on. That is what instructors are paid to do themselves.
I don't know what on earth is going on; nursing school tuitions are higher than ever, but new nurses are being turned out failing the NCLEX multiple times and not knowing basics. Our school graduates all passed the NCLEX on their first attempt. Pass rates always exceeded 95% in that school since its inception.
And as mentioned, orientation is longer than ever, and it takes more time to bring them up to snuff to even learn their specialty.
I do agree with the above poster who says RN students should be CNAs first. I think that should be a prerequisite before even being admitted to nursing school. That way, RN skills could be concentrated on and more time alloted for these skills, not giving bed baths, TPR, etc. Every student should know these things before beginning nursing school.
It just seems wrong somehow and students are paying a LOT of money and not getting their money's worth.
Specializes in Med nurse in med-surg., float, HH, and PDN.
I remember students from my class (forever ago) had never even put a stethoscope in their ears, never mind knowing how or what to listen for when checking a blood pressure. Of course, now I see many with the cuff that does everything by digital magic....
And I can't even begin to imagine how a nursing program doesn't even cover practicing such basics as sterile fields/gloves/opening packages for dsg. changes and catheterizations. GADS!
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.
And some schools value skills AS academic content!
Not to change the subject, but would anyone be willing to speak to how students can gauge whether or not a program will be lacking in these areas before they apply (if at all possible)? Obviously, showing up for an interview with a checklist of skills and frantically yelling "WILL YOU TEACH ME THESE THINGS?!" is probably not going to work out in your favor, but maybe things to look for in class descriptions or tactful questions to ask?
Lulu, I think it is a good idea to get in touch with the program directors and ask about the programs. There is nothing wrong with having a list and asking if the skills are taught and how they are taught. If you are currently working in a healthcare setting that has nursing students come in for clinical, ask them about their program. When you get in touch with the program director of the schools you are interested in, you can also ask them if they can get you in touch with a current student or recent graduate so that you can discuss things with them as well.
I started at a technical and community college and received my ADN. At the beginning of our first semester of nursing courses, we went over these skills and had to be competencied on them before we were even allowed to go to a clinical site. We had some students that failed out of the program due to being unable to pass these competencies. It was that important to our program. I can't imagine not doing these things before being in clinicals.
nurseprnRN, BSN, RN
1 Article; 5,116 Posts
All entry-level programs have mandated number of clinical hours regardless of degree level. Also, budget and clinical placement availability precludes a program from offering more hours than the minimum. Therefore the oft-repeated "ADN programs get more clinical than BSN" sound bite is a fallacy.
It's usually the luck of the draw as to what manipulative tasks students get to practice in clinical. Everybody gets caught up by the end of their first year in practice, though, and then those IV starts and Foleys are much less exciting.