September 14, 2007, 11:30 am

School Daze (or How to Study When You Are Eight Miles High)

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Alas, my Irish are struggling.

I’ve been into college football long enough to understand that Brady Quinn hunky quarterbacks eventually graduate and young children new freshmen come in to take their place.

I take back everything bad I ever said about Jimmy Clausen. He’s the new starter and he throws the football like rifle shot.

I swear this kid doesn’t even break a sweat under pressure!

Now all Notre Dame needs is some sort of offensive line to (a) keep JC from getting sacked and (b) maybe catch a pass now and then.

I’ll let you know when Charlie Weis calls me for advice.

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Not only was I dealing with gastroenteritis this week, but I also had a non-stop period of back spasms that sent me to my doctor after seven days of trying to do things like, well….walk, for example.

So I have been off work. I have not been idle, but let me tell you that trying to learn statistics when you are on Flexeril and Vicodin is an experience in and of itself.

I’ll leave it at that. Any more details and Emergiblog will become a patient blog instead of a nursing blog! Let’s just say I’ll be paying a visit to the blogs of Jolie Bookspan and Dean Moyer in the next few days!

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I’m noticing a trend in nursing education.

Many colleges/universities are partnering up with hospitals to provide clinical experience to the nursing students.

The next logical question would be: “Isn’t that how it has always been done?”

Yes!

Back in “the day”, our programs partnered with many different facilities. County hospitals, community hospitals, HMO hospitals and free-standing mental health facilities. We experienced different environments, different types of patients/clients and different nursing philosophies. One facility might be known for it’s maternity care. Another for its heart program. One hospital might be in an affluent area. The county hospital would be more culturally diverse.

We saw a wide variety of systems and received a great deal of exposure in a very short period of time. We learned to adapt. Quickly.

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I discovered that the students who use my hospital for their clinical only use my hospital. They use no other facilities for their clinical experiences. Many of them are then hired as new graduates once their program is over.

I have no problems with new graduates – you have to start somewhere and it’s good to start in a place where new nurses are welcomed.

But I ask you, isn’t this concept of using only one facility for clinical experience a throwback to the old days of diploma programs being “attached” to a hospital? Granted, the students are not being used as staff, but I can guarantee you that they are not receiving a well-rounded view of nursing as a whole.

Here are the issues as I see them:

  • A lack of varied experience. Different hospitals have different ways of documentation, different procedures and different types of patients. They also have different nurses who give advice based on what they have experienced. The more you are exposed to, the more you learn. Spend your entire clinical time in Wonder Bread Hospital and not only will you be ill-prepared to adapt to different systems, if you are hired at Smorgasbord University Hospital, you will not be prepared for…
  • Culture shock. Big time. Depending on where you live, you will be dealing with patients from different cultures and patients from different income levels. No, this does not change your nursing care, but you may find the environment in which you are giving the nursing care to be foreign to what you are used to. The hospital where your clinical took place may be well staffed and well stocked with lots of money from wealthy donors. The hospital where you are hired may be the exact opposite.
  • New graduate assimilation. What does a facility hope to achieve by an exclusive partnership with a local nursing college or university? They want staff! But… how many new graduates can be assimilated effectively into one unit? Eight? Ten? There may be a lot of openings for the new grads, but those are there for a reason, reasons you probably won’t see as a student. Show me a unit with a million open positions and I’ll show you a unit that either burns its nurses out or has unit-based issues that nurses aren’t willing to deal with. Guess where you will be hired once you graduate?
  • Retention. The grass is always greener on the other side. If you’ve never experienced the other side, how do you know if this is true? The first year of nursing is the hardest. If a new nurse becomes frustrated, exhausted or just plain tired of dealing with issues encountered on their first job, they will leave to find one that fits. Of course, they won’t know that they may in one of the best hospitals because they have never experienced anything else! Perhaps a new nurse will thrive in a teaching hospital environment or at a county hospital. They won’t know because they never had the chance find out!

In summation, using only one facility for clinical nursing experiences is neither good for the student nor the facility who wants to hire the new nurse after graduation.

The student misses the opportunity to learn to adapt their nursing theory and skills to a wide variety of systems using a wide variety of materials. The facility will lose that new grad to the first sign-on bonus or advertisement that makes another facility look like Hospital Taj Majal.

Nursing education needs to provide as wide a range of clinical experiences as possible.

Anything less shortchanges the student and contributes to facilities losing the very nurses they helped educate.

13 Comments

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  • JohnS

    September 14, 2007 at 12:58 pm

    On the other hand …

    A local hospital (where I hope to work) has partnered with my school. They provided money for extra faculty, extra skills lab space and equipment, and provide supervising instructors for clinical rotations.

    We get about 20 extra nurses per year out of the deal, about a 30% increase (small program).

    The hospital uses lots of travellers, and would prefer not to. And the hospital has probably the highest nurse retention rate in the SF-East Bay area, so they likely don’t see other hospitals, in general, as serious competitors who might poach their staff.

    That’s not all bad.



  • Dean Moyer

    September 14, 2007 at 1:06 pm

    Hey Kim,

    Thanks for the shout out. Sorry to hear you’re having back troubles. I can’t help wondering if the back pain and muscle spasms might be related to the gastroenteritis? I know that kidney infections and similar disorders often cause low back pain. Did your doctor give you any feedback on this possibility?

    The good news is; ordinary back pain from a strained muscle or ligament often resolves entirely on its own within a week to 10 days. No treatment necessary.

    Exercise programs like Jolie and I advocate can sometimes help alleviate the pain, but are more for rehabilitation after an injury heals (and/or to prevent future injury).

    Hope you get to feeling better,
    Dean



  • Crystal

    September 14, 2007 at 6:07 pm

    Kim,

    Sorry to hear you’ve been under the weather. Hope you feel better soon.

    Thanks for good information re: hospitals and new nurses. I’m due to graduate in December and am having a hard time deciding where to go. My school has used several hospitals in our community, which I think is an asset. I live in a big metropolitan area and most them are in need of nurses year round. I have learned through clinical experience (and working as a tech) some of the hospitals I don’t want to work at as a nurse and also some that I think would be good to work at.

    I visit your site as often as I can, which right now isn’t very often. Alas, school work takes precedence. I hope your road to your BSN is smooth! I look forward to hearing about your journey because that is my next step! Thanks again for all your words of wisdom!



  • TofuLou

    September 14, 2007 at 7:23 pm

    Hmm, I haven’t heard of just one clinical site before; Unless you’re going to Loma Linda or something (they gots their OWN hos-pee-tal. I’m in level 3 and I’ve been in two facilities. Both acute care but VERY different experiences. In level 4 we spend some time in L&D at a local hospital, a few weeks at the children’s hospital for pedey and a few weeks at a mental health facility. I’m anxious to stop changing briefs that have as much poo in them as I make myself 😉



  • Jerry

    September 14, 2007 at 10:46 pm

    At my nursing school–a community college in the SF Bay Area–we had ten different rotations at six different facilities: one SNF, one psych unit, one perinatal unit (mostly post-partum with a couple days in the nursery and one in L&D), one pedi unit, and oodles of med-surg. The variety of experience was nice.
    The downside was that we left each unit just as we were getting comfortable and confident. I feel I’d have learned more nursing skills (rather than how *this* facility charts or where *that* unit stores gauze or, jeez, where the *!@$ ice machine is) if I’d gotten just a couple more weeks at each site.



  • Jo

    September 15, 2007 at 5:49 am

    So true!
    I learned in clinicals using 3 hospital systems, 5 different hospitals. You really do NEED that diversity.
    On the other hand, I didn’t have ANY clinic experience in school and it was barely mentioned in class. My school program was designed to train us to be hospital nurses. I’m having to re-train myself in a Doctor’s office.

    I’m also learning to get used to working with patients with insurance and money. None of that at the hospital I worked at.

    When the housewife soccer Mom with the Husband, Lexus,2 perfect kids from the nice side of town calls me to complain that her Thyroid medicine is not “high enough” for her to keep the pounds off. I have a hard time not thinking about my former homeless patients with nowhere to go who were just trying to keep their kidneys working.

    Definitely, culture shock.



  • Autumn

    September 15, 2007 at 7:40 am

    I am a long time Cleveland Browns fan (please don’t laugh) and I can tell you the Brown’s community is eagerly awaiting the day Brady Quinn starts a game. I really hope this is a good thing for both Brady and the Browns!

    My education is at a large state college, not THE largest, but a large one at that. They have contracted with many different hospitals, some of them 30-40 miles away for its students to get experience. I’ll tell you, through 9 clinical courses, I’ve been in 9 different sites from inner city to rural facilities. I feel lucky to have had this experience.



  • marachne

    September 15, 2007 at 10:48 am

    I think of the problems is the competition for clinical sites. In the Portland area there are NINE nursing programs: 5 BS, 4 AD. Yes, there are also a number of hospitals (including 2 level I trauma centers and 2 Level III nicu’s), but the competition is fierce. So one of the (Catholic) unis has teamed up with one of the (Catholic) hospital systems. Their students get first choice of rotations as well as at least some are guaranteed to be hired after graduation. Do I think it’s a good idea? not really, but I can see why they’re doing it.

    One of the partial answers is, I believe, looking very closely at how clinical education is provided. Does providing “total patient care” for one patient really give the best experience? Not always. The use of simulation labs, standardized patients (i.e. actors) as well as a variety of clinical placements WITH WELL PREPARED, TRAINED, AND COMPENSATED clinical instructors and preceptors will a go a long way to helping students develop their clinical judgment. For more on this read “Expertise in Nursing Practice: Caring, Clinical Judgment, and Ethics.” by Patricia Benner, Christine A. Tanner, Catherine A. Chesla



  • Ali

    September 15, 2007 at 7:01 pm

    The university where I took my nursing degree was in a fairly small town with only one hospital, so all clinical experiences were through that hospital. I was very glad that I decided to do my final preceptorship/consolidation placement at the hospital where I ended up working, because I had a chance to get used to the paperwork, policies and general how things are run there. A nice groundwork to start learning from. Starting to work was a nurse after graduation was stressful and overwhelming enough, I can’t imagine what it would have been like if I had to learn EVERYTHING. I think that if schools have the opportunity, it would be good to partner with more than one hospital… even if it did create a bit more work.

    I hope you’re feeling better!



  • Not Nurse Ratched

    September 16, 2007 at 5:51 am

    I chose my school because it, unlike its local competitor, does have a wide variety of clinical settings (the other one is associated with only one hospital). Sometimes I wish I hadn’t, because by the time I figure out where everything is and how the facility hums (how to get my patient some darn lunch?), I’m whisked away to another facility where it starts all over. Still, it’s very valuable to me to see different facilities and philosophies, plus one does get better at sizing up what one needs to know NOW and jumping into the fray!



  • Candy

    September 16, 2007 at 10:23 am

    I agree that diversity is the best way to go, and that finding clinical sites to rotate through is a problem, especially in areas that are saturated with nursing programs (like the Bay Area, with 13 ADN programs and 6 BSN programs currently running, and more in development). The Bay Area Nursing Resource Center is working to help maximize clinical placement, but it doesn’t take precedent over pre-existing relationships between hospitals and colleges, some of which are long-standing. Others, like that between Superior Medical Facility and the college its students attend, operate under a “you scratch my back, I’ll scratch yours” agreement where SMF pays for the privilege.

    Multi-site clinical rotations are the best situation for ALL concerned, but when there’s a shortage, getting a warm (and fairly well trained) body on the floor is the main concern. Mores the pity…

    And, for what it’s worth, I’m sorry that Big Blue was not kind to Our Lady. Not real sorry, since we lost our first 2 also, but a little…


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About Me

My name is Kim, and I'm a nurse in the San Francisco Bay area. I've been a nurse for 33 years; I graduated in 1978 with my ADN. My experience is predominately Emergency and Critical Care, and I have also worked in Psychiatry and Pediatrics. I made the decision to be a nurse back in 1966 at the age of nine...

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