November 24, 2008, 12:53 am

Nursing Clinicals: All-for-One?

A high school class tours a local hospital in the 60′s.

Future Nurses of America, you might say.

The girl in the middle has an expression that just cracks me up!

It’s like she thinks the patient is about ready to explode!

I had that same expression the entire time I was in nursing school.

Seriously.

But that does give me an idea…

We need to start a Future Nurses of America organization starting at the jr. high school level.

I wonder how you start something like that.

Well, well – a quick Google search shows that something akin to this already exists!

So much for my original idea!

(Photo credit: Life Magazine, 1966, Photographer: Leonard Mccombe)

******************

I’m wondering if I am out of touch of nursing education.

Back in the day, when we did our clinicals, we did them at different facilities. I had experiences in the county hospital, a free standing psychiatric facility, a medical center, a couple of community hospitals and a local hospital run by an HMO.

I learned a lot from experiencing different facilities. For one, I knew I sure as heck was not going to work in a county facility. No siree! I discovered I had an affinity for psych nursing and that there was no way in hades that I’d ever work for an HMO.

The point? I had been exposed to different systems, different ways of nursing, different types of patients and different attitudes along the way. Props to Ohlone College – I am the product of a great program that is still going strong.

*****

There is a local hospital that works with nursing students in a BSN program. The students get all their clinical experiences at this one hospital.

Now granted, it’s a decent hospital. It has a psych unit, an ICU, a medical floor, a telemetry floor and a maternity unit. The staff nurses act as adjunct faculty for the clinical students.

Many of the students are hired by this hospital after graduation.

But are they really getting a well-rounded nursing education?

Isn’t it important to experience different types of nursing, different types of facilities, different philosophies, different attitudes, different corporate cultures, different equipment, different ways of performing nursing functions?

Isn’t the ability to adapt something that should be ingrained in a nursing education?

*****

I do think it great that hospitals are willing to partner with universities in educating nurses.

I also think it is a great idea to have staff acting as adjunct faculty for the nursing students; who better to teach than someone who is actually walking the walk.

But I can’t help but think that nursing students are missing out of many learning opportunities by not experiencing nursing at a county hospital, a major medical center (and lord, do we have a TON of those here), a psychiatric facility that has both locked and open units, and a number of community hospitals.

I wonder if the nurses who are hired at other facilities have more “reality shock” than those who stay at the hospital where they did their clinical rotations.

*****

I know this was done under the diploma programs; one hospital for all clinical education. But I submit that nursing is more complex now than it was just 25-30 years ago and one clinical facility does not fit all.

The bottom line? It is expedient for a hospital to partner with a university in this fashion because, essentially, they are educating their future staff.

I wonder if they are really doing the nursing students any favors by limiting their exposure to different clinical situations.

Am I totally off the wall here? If so, please tell me.

Like I said, I may be out of touch with nursing education as it is practiced today and would like to know, especially from the newer RNs, what you thought about your clinical education.

What would you have changed?

Share this:
Share this page via Email Share this page via Stumble Upon Share this page via Digg this Share this page via Facebook Share this page via Twitter

20 Comments

  • little d, S.N.
    little d, S.N.

    November 24, 2008 at 3:59 am

    I go to Villanova, and we do our clinicals ALL OVER THE PLACE, for which I am grateful. I, for example, know already that nursing homes are not the place for me!


  • Katie B.
    Katie B.

    November 24, 2008 at 6:32 am

    The problem is not that nursing program’s don’t want to offer a variety of clinical experiences, it’s that the clinical facilities are not available. This seems to happen for a host of excuses – the facility is not willing to partner with the university, there are no floors willing to accept students or have willing preceptors, and frankly I think students want to be in the big-time bells and whistles facilities with more technology and flashier stuff (at least I did!).

    What would I have changed? I would have liked to see a bigger variety of nursing areas – like administration, policy, research, community outreach, environmental health, informatics – things like that. One of the advantages of a BSN program is that it does prepare nurses for a variety of careers and roles, and it would have been nice to be exposed to those things. But, as I said, when I was in school I was more interested in critical care than anything else, so I would probably have grumbled all along anyway…


  • Candy
    Candy

    November 24, 2008 at 9:16 am

    Very interesting idea, Katie B., to expose studens to the entire nursing spectrum rather than just the clinical side. Astute, too, to notice some medical facilities are limiting or eliminating clinical rotations entirely. (While it might seem like these students are “helping,” they’re actually taking nurses away from the bedside; there’s a cost here).

    I think, as Kim pointed out, with the explosion of technology (not to mention pharmacology) over the past 25 years, it’s all clinical instructors can do to get their students at least acquainted with procedures, not even proficient. In California, as much as 25 percent of clinical time can come in a simulated setting, but even then, the students aren’t getting real hand’s on patient experience. My mom is a frequent flyer on a local med/surg floor (COPD) and often has students. It’s scary to see them (even seniors) come in unsure, unable to do what I think as a simple task.

    This is why we need innovative thinkers (Kim, I’m talking to you!) to overhaul the nursing education system. The way we used to do things has to blend with the systems available now to create a well-rounded, professional training ground for new nurses.


  • wardbunny
    wardbunny

    November 24, 2008 at 11:38 am

    Hmm choices here go NHS hospital, NHS hospital, NHS hospital, private hospital (if you are really unlucky).
    Everything is standardised throughout the 3 main NHS sites (supposedly). So there should be very little difference.

    However students should move around. they need to see all they can see before they are thrown out into the big wide world. It’s too closeted, having all your experiences in one place.


  • Wanderer
    Wanderer

    November 24, 2008 at 2:42 pm

    We all of the inpatient rotations at 1 hospital. Of course that was because it was the only place for a hundred miles or so! I give huge props to my program though for placing us into any health care facility that would have us: school nursing? Check. Free-standing ambulatory surgery? Check. In/Out patient psych? Check. GI Clinic? Check. County Health Department? Check. County jail? Check. And more.

    Lucky for us in spite of living in a small community we were provided with a wealth of different experiences for which I’m hugely grateful. They made the best of what they had. I think it does a disservice to students to be confined to only one institution, especially if there are many available. But that is the rub: there isn’t always enough clinical availability for the amount of students. The laws of supply an demand do apply here, unfortunately. But hey, at least they’re getting the education they need.


  • K.Sapphire
    K.Sapphire

    November 24, 2008 at 3:38 pm

    I think it’s great to do clinicals all over. It’s important to see how different hospitals work and their dynamics. I also think outreach to young aspiring nurses is important to the profession.


  • Julia
    Julia

    November 24, 2008 at 4:18 pm

    I think it is important that nursing students get exposure to as many different areas of nursing as possible. It will allow them to find their nitch quicker and without as much wasted time.
    The nursing school that I attend makes a huge effort to get students involved in all areas of nursing. For each rotation (med/surg, psych, L&D etc.) we have what is called “an outside experience” where we are required to go out into the community to clinics, wound centers, emergency psychiatric facilities and observe what the nurses do in these areas. I have found these experiences extremely beneficial.


  • Maureen
    Maureen

    November 24, 2008 at 7:14 pm

    Kim, again I am a non-nursing voice, and if you prefer I don’t comment, please don’t feel funny letting me know. My experience as a patient has been that the nurses who have only had training at the facility they are working at, are usually much less knowledgeable than when they have been exposed to different hospitals, situations, ideas. And age hasn’t been the factor, or even years of experience, it has been an openness, a willingness to learn different, and possibly better ways of doing things.

    The care I received at Duke University Hospital was better from nurses who weren’t trained through Duke’s system. They realized that they could possibly do things a different way, and maybe that would help me, as the patient. The nurses who were trained at Duke had one way of doing each thing, and it was the right way. Sometimes it is a little thing and it doesn’t matter, but sometimes it makes all the difference in my care and the overall success of my stay.

    Don’t know if this help added to the conversation. I respect nurses much, they truly make or break the care you get as you have much more interaction with them than the doctors or other staff. You all work crazy hours with less pay than you deserve, and to see how dedicated so many of you are to being the best you can be, and helping those coming up behind you to learn the best way possible, it lifts my heart!

    Thanks to all of you!
    Maureen


  • J RN
    J RN

    November 25, 2008 at 2:07 am

    Kim I think you also need to take into consideration the geographical constraints of nursing education, I got my BSN in a rural state. Clinical education was limited to two facilities, the two that were within an hours drive…We were given the choice to drive two hours each direction to a larger “major medical center” but most students did not have the financial means to do so. To make up for this limitation we had an extra “years” worth of clinical rotations (vs the remainder of schools in the state). I do believe that I received an worldly view of the profession, and even work in a nontraditional nursing roll, as do many of my fellow alumnus.


  • Bo
    Bo

    November 25, 2008 at 10:21 am

    My nursing school farmed us out to various hospitals for our clinicals—it was a great experience for us. But then, it was a diploma school and they no longer exist.

    (I feel so old…..)


  • Flo
    Flo

    November 25, 2008 at 7:34 pm

    My program is a BSN program and they have some of the students in one hospital for all of their clinical rotations and then others move all over the place. The reasoning behind have one hospital for all the rotations is that they did a study that showed that percieved and actual stress and difficulty were less with those students who did not have to reorientate at the beginning of each new clinical rotation. That being said, I like the idea of going to many different facilities so that you get to see what is out there and how different places are run.
    ~Flo


  • Nurse K
    Nurse K

    November 26, 2008 at 5:09 am

    I’d have changed the following (I’m a BSNeur):

    13 weeks of OB/GYN? No thanks. That was about the most boring clinical ever.

    More days in the ER. I had one whooping day in the ER. Floor nurses blocking admissions is a theme everywhere, maybe with 6 clinical days in the ER (and 6 in OB instead of 13), that would change at least a little bit. Plus it’s good as a capstone, so many diagnoses in so many body systems.

    We had random half days in some specialty areas, but it would be good to have a seminar class for clinicals in areas like IR, cath lab, administration/research, clinic (we never had a day in a straight-up clinic), etc. Instead of forcing us to learn about alternative medicine for weeks, maybe letting see some more specialties would be good?!

    I live and went to school in a metro area with many hospitals and a few different nursing programs, so we had to spread us out among many hospitals because there were just too many of us.


  • Strong One
    Strong One

    November 26, 2008 at 8:28 am

    Kim, I came from a Diploma program as well and did clinical at differing sites. The experience was good.
    I also worked with students who did their clinicals on my Trauma ICU unit.

    I think this question has a two fold answer:
    We should not only filter out WHERE they do their clinical rotations.. but we should also analyze the QUALITY of that experience. Just b/c you did a rotation somewhere doesn’t mean you learned something of quality. Time in grade does not equal experience.
    It is sometimes a bad idea to put them in the high acuity specialty areas.. they simply get exposure and don’t acquire any additional skill.
    Just my 2 cents.
    :)


  • stephanie
    stephanie

    November 26, 2008 at 11:18 am

    I am currently a student at a local hospital, happens to be the one is was born at, the ed my mother worked in while she was pregnant with me… anyway i digress… we do all of our clinicals in house except for our pediatrics rotation. It is both good and bad I think. good because we get to know the hospital very well, the staff, managers, and how things work. Bad because when we finally do get to go to another hospital we are completely lost. We are so used to doing things one way that its a whole different world.


  • RehabRN
    RehabRN

    November 26, 2008 at 3:46 pm

    Kim:

    I went through a major metropolitan area accelerated BSN program and we went to hospitals all over the place. It all depended on where the bigwigs could get us in. There is apparently a lot of demand for nursing students to get into hospitals in our neck of the woods.

    I did clinicals at our university affiliated hospital (so I knew I didn’t want to work there), a top 10 US children’s hospital, a couple of non-profit hospitals (one a community hospital, one a major network hospital) and at a for-profit hospital. It was very valuable.

    Some of my classmates picked as many close to their homes as possible. You didn’t always get a good experience that way. I was willing to travel where I wanted to be so that was handy.

    I, too, ended up working at the hospital where I was born. I figured it probably wasn’t a bad place to start. ;->

    I really wanted to go to a VA hospital on my clinicals, but none was available when I was in school. I ended up there after I saw what it was like at a private hospital. My patient load has actually been better, because the VA actually (for the most part) uses evidence-based practice.


  • disappearingjohn
    disappearingjohn

    November 27, 2008 at 5:05 am

    Yeah, I did clinicals all over the place, but now the local colleges have all partnered with different hospitals (including ours) and only do clinicals at one or two facilities. I thik that does lessen the experience, but I see the need when there is so few clinical spaces available…

    BTW, Happy Thanksgiving, Kim!


  • NPs Save Lives
    NPs Save Lives

    November 29, 2008 at 8:02 pm

    I agree with you that nurses need to experience all areas of nursing. Where else will they be able to really see how it all works and it tied together. Med/Surg and the ER are also glorified psych units of a sorts. I did a rotation at our local State mental health facility and learned a lot. I needed more exposure to the ER setting and the ICU settings as a student too.


  • d
    d

    December 2, 2008 at 2:12 pm

    Kim, I am not a nurse, but I’m a nuclear medicine technologist. The school I went to had each student go to a “big” hospital and a “small” hospital for their clinicals, or they did until it was my turn for clinicals, when they switched to “just go to whatever size hospital you’ll think you want to work in.” Not very helpful :P They also had us do ALL of our didactic work for the first two years, and then there were seven months of clinical rotations at the end. Basically you spent the first three months of your clinical going, “Oh THAT’S what a bone scan is! Oh THAT’S what you meant by milking the generator! Oh you mean I’M supposed to change that bedpan? Nobody showed me how to do that!” and the next four months of your clinical going, “Oh shit, how am I supposed to get all my case studies done?!” Needless to say, I figured it all out, but now I’m at a hospital that is affiliated with a nuclear medicine program about an hour and a half away and we have no students this year because “no one wants to drive that far.” Not to toot my own horn, but we do studies that no one else in the state does. Most of the hospitals around here are tiny and when these students find themselves on their own (because most of the nuc med departments are one- or two-man crews), they’re not going to know how to do half the studies available to them. We constantly get calls from other hospitals asking what our protocols are. I just want to strangle them and say, “Dude, if you can’t do the test, send them to us!” Wouldn’t hurt our falling stats ;)


  • Malinda
    Malinda

    December 9, 2008 at 2:14 pm

    At our teaching hospital in Syracuse, NY, where I am a student nurse, the majority of our clinical rotations take place in-house. We have several med-surg units, several telemetry units, an onclogy floor, an orthopedic floor, a psych unit and a psych ED where some of us have a one-day experience. We also have experiences out of the hospital for peds (done at a university hospital as our hosp no longer has a peds unit) and one-day experiences for child and adult daycare. I feel that we are prepared well in our floor experiences, but we all know that if we go to the university hospital, for example, to work, they have paper MARS instead of computer meds, they start their own IVs and do blood draws (our hosp has a spearate IV/phlebotomy staff that does everything), etc etc. if we were exposed to a bigger variety of nursing experiences, we would all have a better idea of what we want to do after school, instead of all shrugging and saying, “I dunno, I guess the telemtry floor here.”


  • Joey
    Joey

    August 18, 2012 at 2:37 pm

    Kim,

    Another non-nursing voice here, but one thing I’ve noticed that’s missing in the discussions above is nursing experience with integrative and/or chronically-ill care. I’m not only saying this for reasons to do with the population of patients that hits closest to home for me, but rather because the breadth of diagnostic & clinical exposure that a nurse would receive in these settings appears to me to be substantially different. I know of many chronically-ill patients that still end up going to hospitals as their first line of healthcare, but that’s often because of insurance restrictions. Many w/more complex issues that are on PPOs see doctors outside of these networks.

    So I wonder if perhaps nurses would benefit in the sense. Again, I know I’m not in authority to speak about what nurses need to learn, but I would guess that a diverse education in acute & chronic settings would enable them to identify which cases that come into your hospital would be well-served by being diverted (stealing your verbage!) outside of the hospital or to other specialties, leading to more efficient referrals.


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...

Continue reading »

Find Me On...
Twitter     Technorati

Subscribe to Emergiblog
Office of the National Nurse

Zippy Was Here


Healthcare Blogger Code of Ethics

  • Perspective
  • Confidentiality
  • Disclosure
  • Reliability
  • Courtesy

medbloggercode.com

I Support the Public Library of Science

Dr. Val
Johnson & Johnson
Johnson & Johnson Health Channel
Webicina
Nursing and Web 2.0



Health blogs

Medicine Blogs - Blog Catalog Blog Directory

Alltop. Seriously?! I got in?

Health Blogs - Blog Rankings