Are latest nursing graduates prepared for practice?

The scene repeats over and another time. It’s 2:30 a.m., monitor alarms are ringing at various rates, the ventilator is humming rhythmically, and nurses are performing a synchronized yet frantic dance between patients. I used to be fresh out of nursing school and dealing within the surgical intensive care unit of an urban academic institution. For my final yr of clinical rotation, I selected critical care and immediately decided that this was my calling. I believed I used to be ready, but in my first weeks on the job, the tough reality hit me – I wasn’t prepared in any respect. There was one patient who particularly revealed this fact. I used to be working the night shift and my patient, Mr. C., was recovering on day five of surgery after having had a colon resection to remove a tumor. Mr. C. didn’t come off the ventilator attributable to chronic emphysema. That night, his blood pressure and temperature slowly dropped. His skin was cool and damp. I continued to closely monitor his vital signs. His blood pressure hovered around 90 degrees systolic and his temperature dropped to 36.1 degrees Fahrenheit. I focused on ensuring my medications were administered on time and that I accomplished all required tasks to get through the night. The next morning, during his rounds, the officer on duty was furious. Mr. C was in septic shock and I used to be scolded for not notifying him earlier that evening. My understaffed preceptor had her own patients assigned and was unable to offer me with sufficient supervision. A fluid bolus was ordered, blood cultures and lactate were taken, and antibiotics and a vasopressor were administered. I left work that morning offended and upset that I had failed to acknowledge these subtle signs of sepsis firstly of my shift, when treatment times significantly impact patient outcomes.

This scene is playing out in hospitals across the country and all over the world. New nursing graduates begin their careers armed with a big amount of knowledge but little, if any, clinical judgment. In the most recent report entitled Dr. Anne Dabrow-Woods and Julie Stegman discuss the outcomes of Wolters Kluwer’s New Nurse Readiness Survey. The authors state that newly graduated nurses usually are not fully prepared for practice attributable to “gaps in nursing practice[…]that are attributed to ineffective communication, complexity of the clinical environment, lack of information about patient care, and lack of experience working in teams” (Dąbrów-Woods and Stegman, 2020). They further state that students must apply their knowledge, think critically, and use evidence to make good clinical decisions (Dabrow-Woods and Stegman, 2020).

Many nurses in academic institutions have access to latest technologies and training tools to show students. However, educators working in clinical settings consider that latest graduates are too depending on technology, which prevents them from applying their knowledge to clinical practice. Dabrow-Woods and Stegman (2020) outline several strategies that academic nurse educators and clinical nurse educators can implement to higher prepare nursing students for the workplace. These recommendations are summarized within the table below.

[Reference: Dabrow-Woods & Stegman, 2020]

Later in my profession, I had the chance to work for a medical education company that developed a simulation platform for critical care nurses. We created patient cases and integrated mannequins and monitors that mimic an intensive care unit. Users could assess vital signs, adjust oxygenation, titrate intravenous drips and virtually administer medications. Each activity was recorded in a database that may very well be downloaded to evaluate a person’s performance. Students could improve their critical pondering skills, and experienced nurses could earn yearly competencies, including basic life support (BLS) and advanced life support (ACLS) certifications. This risk-free environment allowed latest graduates and employees to make mistakes, learn from them and construct confidence.

It has been over 25 years since I graduated from nursing school. Technology has had a big impact on our lives over time, and in nursing education, using simulation can increase nursing students’ ability to more quickly perceive the general situation. This involves combining subtle signs and symptoms that, when taken individually, may not seem harmful, but when taken together enable providers to intervene quickly. We have an obligation to adequately prepare the subsequent generation of nurses to have the abilities mandatory to take care of an increasingly complex patient population.

Dabrow-Woods, A. and Stegman, J. (2020). Closing the education-practice gap: constructing trust and competence, latest nurse readiness survey. Wolters Kluwer.