worried about being prepared...

[sweetieann]

(please bear with me, gotta get this off my chest. Comments and thoughts are much appreciated!):)

I currently just started my junior year in a BSN program. Last spring semester, I had my first clinical and we did bed baths, head to toe physical assessments, and got patients dressed. We did one nursing care plan with help from our instructor. While we had a lab last semester in which people came in and demonstrated how to insert NG tubes, catheters, hang IV bags, etc, but we never really got practice doing these things ourselves. We didn't have "skills check-offs" that I hear people mention so much on these boards. If there was time, one of the instructors would watch us insert a catheter on the mannequins in lab, but they never checked us off on whether we were doing it 100% properly, just basically so we got the jist of it.

Basically, I'm worried that I'm not going to know what I'm doing when clinicals start up again in a few days, or when I start a real job for that matter. Like, I don't feel confident, for example, on how to insert an NG tube. I mean, I know how to do it in theory, but because I wasn't "checked off" as doing it 100% accurately, I' feel like I'm not as confident as a student from another school, say whose instrcutors were militant in seeing they did it with no mistakes.

One last thing. I posted a question on here yesterday about NG tubes. Sveral people posted saying that if the NG tube was used to decompress the stomach and meds were ordered via the tube, the tube would need to be clamped for 30 minutes so that teh suction would basically not just pull out the medicine before it could be absorbed and deliever its therapeutic effect. That makes total sense now that it was mentioned, but I might not have thought to do it if it hadn't been brought up. However, it was never mentioned in my technology class when we went over NG tubes. All that was mentioned in class was if you instill a med, flush with 30 ccs of water to clear the tube (I guess the prof wasn't assuming this was an NG tube used for stomach decompression). It's just little things like this that scare me, because I don't know when in the course of my education I'm going to pick them up. If the details about NG tubes (just one example) wasn't mentioned in the technology class, when will it be brought up again? IN the clinical setting once I actually start doing more? I feel I should know more for starting my junior year, even though the first year (and much of the second) was prereqs. I feel like stuff like that should have been mentioned in detail, even if it is common sense.

Anyone have any thoughts? Where should a student just entering their junior year last week be in terms of competancy? I know all programs are set up different.

[WSU_Ally_RN, BSN, RN]

I don't think you are alone with the feelings you are having. I go to a school where we have skill check offs, and I still feel that I don't know how to do anything I was supposedly doing right for those check offs. Until you actually get out in the hospital setting and practice, you probably will feel like you know nothing. When you do go to clinicals, you are not supposed to do anything without your instructor present, and they should be there to support you and walk you through all things that you have to do. And also, when you graduate, you'll be in orientation for 10 weeks or so, working with another RN, so it's not like they just throw you into the water and hope you can swim. Most nurses you work with are more than happy to teach you things and help out with things. They would rather you ask and have them teach you, than you think you can do it, and wind up harming your pts. instead.

[Brotherbob, BSN, RN]

I agree with WSU. That is what clinicals and orientation are for. To practice what you know in theory. Don´t worry.

[Indy, LPN, LVN]

There are checkoffs and there are checkoffs. The checkoffs I had for oh, say, sterile technique stuck with me because I had to practice for several hours to get it down right, and I don't have any problem remembering that now. Most of the other stuff, if I know I was checked off on it and haven't done it since, I'll read up on it - if I know it's coming.

[stidget99]

Whenever you get into the clinical situation, whether it's for school or working out in the real world.........it's ALWAYS ok to say "I don't have any experience doing that and am not comfortable". I would bet my $1000 to your single dime that there is not a single nurse who would say, "tough, do it anyways". Better to admit that you don't know than pretend that you do and mess up.

When I started hospital nursing (9 yrs after graduation), I couldn't remember hardly any of the technical skills taught in school. I of course knew the most basic of nursing skills (i.e. clean vs. dirty, safety, etc). I told the nurse manager that I was "less than a new grad" in that the new grads at least have recent clinical experience. I admitted what I didn't know. So I watched and learned. Eventually, I learned to do things on my own and have grown quite proficient in skills like IV sticks, dropping NGTs, administering blood products, or even giving IM injections.

It's good to be nervous. But don't let your nervousness stop you from excelling. Good luck!

[rn/writer, RN]

i don't know how your clinicals are set up but we had to go to the hospital the afternoon before and look up our patient(s). we had to make a list of their diagnoses, meds, treatments, diet, etc. then we would go home and look up everything we could about each piece of the puzzle. the next morning, our instructor would fire questions at us and god help the student who didn't know the signs and symptoms of pleural effusion or the side effects of compazine. that sounds intimidating, but it actually gave us a chance to prepare and read up on any procedures we weren't familiar with. and it helped us put theory into immediate application. this is what no skill lab in the world can do.

you will have a clinical instructor during your schooling. you will probably also be following a staff nurse around. you will have your fellow students. and, when you finally start working, you will have an orientation program with a preceptor. also during clinicals, you'll be at a teaching hospital and many of them have their own skills labs with videos and hands-on stations.

i would recommend watching a staff nurse or your instructor do a procedure, then having them talk you through it before you attempt anything on your own. and always be honest about your limitations. a busy nurse might show a little irritation at having to take the extra time, but anybody with half a brain would rather help you up front than have to deal with mistakes after the fact.

relax, if you can. keep your ears open for nurse intern (or extern or tech) positions that might give you hospital exposure with limited responsibility.

most of us started out very shaky and scared. as a patient, i'd rather my newbie nurse be asking for help from her preceptor than overconfidently bluff her way through a procedure and get stuck.

take care,

[Bijou-Spice]

sweetie715- This is so ironic I was just having this conversation to myself, except unfortunately it was after my day at work!! I just graduated in May from a "good" BSN program and started working about three weeks ago. I am working in CCU and have two preceptors. One is very helpful and patient, but the other (who I worked with today) is just very difficult. Each day I work with the "difficult" one she finds time to comment "what school did you go to? And what DID they teach you?" and rolls her eyes.

I am an older student who has two previous degrees, and normally I am very confident with work and school but with nursing and a couple of verbal jabs and I am doubting myself. I feel inadequate and frustrated on the floor. (But try not to show it.)

During clinical we were told don't worry you will get that experience when you get to the floor.......they forgot to mention that the experience might be under duress! My point is these people are supposed to be preceptors and I can understand the frustration of teaching someone but give us a chance! Show me once, and watch me the first time, and be nearby for my second attempt! Don't give me attitude! I am going to ask question, so please don't look at me like some flake! I do want to learn, but you make it hard to focus when you make snide comments about my education! Is it my fault we didn't have the right type of patient to get every experience!

Okay done with my vent! Now what I suggest to you is TELL your clinical instructor that you need this list of experiences (foley, NG, IV, tube feeding....you know what you want). Tell her or him that they NEED to find where this is happening in the hospital even if it isn't on your clinical floor. Some places like ambulatory surgery are great for IV practice. The more opportunity you get the more relaxed you will feel as you start your job! (I am living proof that lack of hands on skills with real patients is a problem.) You won't leave clinical an expert, but at least you can say with confidence "yes, I did it ONCE in clinical, so will you watch me as I do it again!"

Finally, before I freak you out too much. The experience you have in your new job will really depend on your preceptor and the others in your department. I hope you are assigned someone who "loves the teaching moment".

My final, final thought, I have heard (don't know if it is fact )but supposedly that ASN degree nurses are more competent on the floor when they start because the BSN have all been busy with "leadership , management" classes but within six months we are operating at their level! This is going to be a long SIX months! Good luck! and remember if you really don't click with your preceptor you can ask for another.