[carebearRN08]

Originally Posted by jjjoy

Unfortunately, it often comes across that if you've been told once, you should *know* it and remember it for all time to come. And that's just not realistic. Each time the experienced nurses ask you those questions, instead of thinking of it like "I should already know this!" think of it more like "Five more times and THEN I'll remember this!"

Thank you, I needed to hear that!

[NightshiftRN69]

The thing that I feel I was less prepared for was
How to choose between the patient who needs me to hold their hand or tell them someone cares and then show that you do or how to find the time to sit with the patient after they tell you "just let me die" or "I'm not faking my pain or illness" or how to clean up a 350 lb patient who was just admitted from an OSH in deplorable condition by yourself and still get all of your patients cared for, give your patients their pain meds when your co-workers come and tell you the need it and all of your paper work completed fully not any mistakes and clock out on time.

[ranaazha]

Originally Posted by carebearRN08

New grad here, 3 weeks off orientation. The hardest thing for me right now is seeing the big picture. I feel like my night is filled with so many tasks; vitals, assessments, check orders, med pass, rinse, repeat. I feel like I don't have a whole lot of time to sit around and think about the patho of my patient's disease processes, especially when most of them have co-morbities and this processes can work together in interesting ways ( pt. with CHF and renal failure; what's causing that edema? did the CHF cause the RF? things like that boggle my mind). I have good enough assessment skills to know when something is WRONG, but when I go get second opinions from the more experienced nurses, they start asking me a ton of questions about the patient that I feel I should have thought of on my own. And the reason why they are asking these particular questions makes sense to me, I know why they are asking me about the electrolytes, CBC, etc etc, I just wish I could think of it on my own. Sometimes I do, I'm getting better, I'm hoping that this is the critical thinking stuff that just comes with time.

I don't even know if that helps answer the original question!

This is a good point because it is a definite reality for new grads. I'm still in this boat, and I precepted for 8 weeks and have been on my own for 8 weeks now.

The big picture is incredibly difficult to see when you're worried about all the tasks, rinse, repeat. (Great analogy, by the way!) The good thing, though, is that, as those "repetitions" become more natural, you are able to look at the big picture. Once charting and passing meds becomes more "routine" (while still maintainingg safety and the 5 rights!), you're more able to look at that big picture and ask "why is this patient on X med and why did I hear X type of lung sounds, hypo bowel sounds, edema in X extremity, etc.

It's good that you're aware of this, though, because it can be SO overwhelming for SO many new grads -- as it was for me!

In any case, be hopeful that, just as you progressed in nursing school, you will progress in the real world. Also, remember: You always get out what you put into it!

[Morettia2]

Ok I am 9 months into my frist year of nursing on a VERY high paced cardiac floor, Interventional Cardiology/CCU step down. I choose cardiac b/c I had 3 semesters of tele in NS, I was the only studet at my school that had 3 semesters tele exp. at 3 different hosp. My NS gave me great experience at a ton of different hosp.'s, and settings. But there are a few things that I wish to god I would have learned in School. Giving report at change of shift,at my hosp. we give verbal nurse to nurse reports, I work 7p-7:30a. I HATE REPORT, I have been doing it for 9 months and it still takes forever to give report, and I am not the only NOC nurse that has this problem, all the NOC nurses are there till at least 8:30am or later giving report. I have had multiple report sheets that I have used and the only one that works is the one that I have made myself that some of the other NOC nurses use. The other thing is my NS, like so many Nursing Schools in PA, don't allow student nurses to start IV's or do blood draws. The hosp. I work at in NJ gave us classes when I started as a new RN. Yea, I can draw your blood and get a vein from any part of your arm, BUT I SUCK at inserting an IV, I mean I am AWFUL AT IT I am certified but AWFUL. But if you need STAT labs I am you girl.The other thing that NS didn;t prepare me for was MD interaction. The MD's I get along with, but it's is the matter of which MD to call, there are conflicting orders written by different MD assigned to the pt. Most cardiac pt's have b/t 2-6 MD's assigned to them. I call both MD's that wrote the orders, they can't agree, so I call the attending and get the final order..it kills me all the time. Since I work nights makes it worse, housse MD, tele resident, cardiac fellow, do I wake this MD up at 3:50AM b/c no one covers them. I have learned ALOT about MD interaction. I think that Nursing Schools should spend a class in the last semester of Nursing school about MD interaction, and Night Shift Nursing. I never once in School learned anything about Night Shift Nursing.I DEF. think Nursing schools should spend a clinical lab on shift report. Each student nurse should have to give an instructor a verbal report on a mock pt (done in the Sim Lab), stating recent procedures, any labs that were done for that day or pending labs, dietary status, IV Drips, PMH, the MD's assigned to the to the Pt. and the speciality of each MD, if the pt. is AC/HS FS, any Daily Wt.'s, I&O's, any upcomming procedures, pending tests, what the PLAN is for that pt.(discharge, rehab, nursing home, home care ect..)...we did care maps in NS, I do them NOW as an RN daily but it still dosen't help, and I am not the only RN on my floor with this problem. I took report from my clinical instructor, or the nurse in the morning while in School. But I RECIEVED report, as a student, never gave report b/c we were only on the floors, as students for 6-8 hours, we never had to give report to the RN's. I Def.think a Sim lab in NS on giving report at change of shift would have helped ALOT.

[ranaazha]

Originally Posted by Morettia2

Ok I am 9 months into my frist year of nursing on a VERY high paced cardiac floor, Interventional Cardiology/CCU step down. I choose cardiac b/c I had 3 semesters of tele in NS, I was the only studet at my school that had 3 semesters tele exp. at 3 different hosp. My NS gave me great experience at a ton of different hosp.'s, and settings. But there are a few things that I wish to god I would have learned in School. Giving report at change of shift,at my hosp. we give verbal nurse to nurse reports, I work 7p-7:30a. I HATE REPORT, I have been doing it for 9 months and it still takes forever to give report, and I am not the only NOC nurse that has this problem, all the NOC nurses are there till at least 8:30am or later giving report. I have had multiple report sheets that I have used and the only one that works is the one that I have made myself that some of the other NOC nurses use. The other thing is my NS, like so many Nursing Schools in PA, don't allow student nurses to start IV's or do blood draws. The hosp. I work at in NJ gave us classes when I started as a new RN. Yea, I can draw your blood and get a vein from any part of your arm, BUT I SUCK at inserting an IV, I mean I am AWFUL AT IT I am certified but AWFUL. But if you need STAT labs I am you girl.The other thing that NS didn;t prepare me for was MD interaction. The MD's I get along with, but it's is the matter of which MD to call, there are conflicting orders written by different MD assigned to the pt. Most cardiac pt's have b/t 2-6 MD's assigned to them. I call both MD's that wrote the orders, they can't agree, so I call the attending and get the final order..it kills me all the time. Since I work nights makes it worse, housse MD, tele resident, cardiac fellow, do I wake this MD up at 3:50AM b/c no one covers them. I have learned ALOT about MD interaction. I think that Nursing Schools should spend a class in the last semester of Nursing school about MD interaction, and Night Shift Nursing. I never once in School learned anything about Night Shift Nursing.I DEF. think Nursing schools should spend a clinical lab on shift report. Each student nurse should have to give an instructor a verbal report on a mock pt (done in the Sim Lab), stating recent procedures, any labs that were done for that day or pending labs, dietary status, IV Drips, PMH, the MD's assigned to the to the Pt. and the speciality of each MD, if the pt. is AC/HS FS, any Daily Wt.'s, I&O's, any upcomming procedures, pending tests, what the PLAN is for that pt.(discharge, rehab, nursing home, home care ect..)...we did care maps in NS, I do them NOW as an RN daily but it still dosen't help, and I am not the only RN on my floor with this problem. I took report from my clinical instructor, or the nurse in the morning while in School. But I RECIEVED report, as a student, never gave report b/c we were only on the floors, as students for 6-8 hours, we never had to give report to the RN's. I Def.think a Sim lab in NS on giving report at change of shift would have helped ALOT.

What causes the night nurses to get out so late? Are the day nurses asking too many questions / expecting too much of your shift? I work days and report lasts anywhere from 20-45 mins depending on how much has gone on that days (a couple orders vs. 20) and the nurse to whom you're giving report (some want the basics and will find the rest out for themselves, whereas others want every bloody detail).

As for report, during my final semester, we had 12 precepting shifts where we did the full 12 hr shift with our preceptor. Once the preceptor was comfortable with us, they would encourage (some more than others) to give report and maybe fill in the details we missed. This was a great learning opportunity because, I agree, report is tough! Even while I was precepting as a NG I found it difficult, mostly because it's frustrating (a) to adapt your personal reporting style to the several other styles that nurses have and (b) my preceptor would do so much for me and NOT tell me about it UNTIL report, so I often felt like a donkey's rear...

Nursing school, by far and away, will NEVER be enough preparation for the real world of nursing. I'm convinced it's just simply not possible. If you're lucky, though, you'll work with some understanding people who are willing to help ease you through the transition process. While I've met a few rotten apples (those nurses that are just plain mean!), most are very helpful. I even have one who HATED reporting off/on with me, who I get along with great now.

There is a light at the end of the tunnel, though!

[november551]

This one time I had a patient coding, and one of the nurses that came to the code said, "We need a stomach tube!!" So I went to the supply room and found something labeled "stomach tube." Brought it back...She said, "NO I MEANT AN NG TUBE!!!" I went back and could NOT find an NG tube. I was frantically searching for the dumb thing for like 5 minutes. Finally that same nurse came in as I was turning over like every stone in the supply room. I said, "I think we're all out of NGs I'll run to central supply!" And she said,"Its RIGHT THERE" grabbed it and ran out. Duh....NGs were labeled as Salem-Somethings ...I just needed to step back, take a deep breath and think for minute.

[deeDawntee]

I am an old time nurse starting in a new environment and even as a nurse with 10 years experience, it sucks being new. Some people are just plain mean to you when you are new. They don't care how much experience you have, they reportedly at this institution put you through a "hazing" period or as another nurse called it, "tough love". Well, I call it bull crap. The biggest thing I would tell a new grad is to develop that thick skin asap and find those few coworkers who will actually treat you well and stick to them as much as you can. As a new grad, you will be especially vulnerable and will want to get some approval for how you are doing. I recall that it was VERY strange that I wasn't hearing anything from anybody for how I was doing and what I have found in nursing is this: no news is good news. You probably will not get the positive feedback that you will want, but just know that you will definitely hear about things you do wrong, so if you hear nothing, that is a good thing!!

[mountainnurse]

I am a new grad working in the ED and while I was nervous about the skills I hadn't had much practice with, I got plenty of time to practice with my preceptor and if something comes up that I have never done before, my co-workers are ALWAYS there to help. I am now after 4 months finding that I wish my nursing clinicals had focused less on the paperwork and more on the patient care. I go home everyday and reflect on my day, what did I do right, what do i feel good about, and what do I feel like I could have done better. I find the times that I feel like I could have done better are when I get overwhelmed with heavy patients or have to watch over my partners patients in addition to mine while they transport a patient to ICU or CT or MRI. ( I always ask for help and never forget about patient safety)

After the first few semesters the paperwork got very repetitive and it felt like we were jumping through hoops with more emphasis on APA formatting than actual content. I actually had a clinical instructor tell me he didn't read my careplans anymore because he knew they would be perfect. I wish my clinical instructors would have pushed us out of our comfort zones to take on more patients as they felt we were safe to do so. I have gotten great feedback from my charge nurses and patients, but had I not done a preceptorship in the ED in my last semester of nursing school I don't think I would have been able to do it.

For example, we would do our pre-planning the day before clinicals, writing 30+ page care plans with pathophysiology of each co-morbidity down to the cellular level, nursing diagnoses with interventions and rationales, serial labs and descriptions of the abnormal values, med tables with action, rationale, side effects, contraindications, interventions and administration guidelines, and different variations depending on the area (med-surg, critical care, peds, etc). We would generally take 2 patients, except in critical care where we took only one patient (and had longer care plans). These care plans took about 16 hours to complete. This all helped immensely to put together the big picture and see how all the comorbidities affected the patient and their treatment, and for me being in the ED, how to assess patients, what questions to ask, etc. NOW FOR MY POINT If we came in on the day of our clinical and were not able to take the patient for some reason (discharged, too many students with one nurse, etc) we would have to choose a new patient and write another care plan instead of caring for the patient. I see the point to the paperwork, but in our limited clinical time I do not see the benefit in doing more paperwork instead of getting the experience you cannot get from books.

I know it takes time and I don't think that nursing school has to get us completely ready, but something my mother told me sticks with me. She was a nurse for 37 years and went to a hospital run school where she worked for the hospital during school. She noticed that as nursing schools moved from the hospitals to the classroom that new grads were less and less prepared for actual nursing. I feel like we needed more clinical time. (I was in a BSN program if you need to know)

[Hopefull2009]

I am almost finished my second year...these are my only skills that I have actually PRACTICED.

bedpans
bath
changing linens
vitals
2 shots

That's it.

[november551]

Originally Posted by Hopefull2009

I am almost finished my second year...these are my only skills that I have actually PRACTICED.

bedpans
bath
changing linens
vitals
2 shots

That's it.

don't worry, you'll have TONS of time to practice everything else from the point that you graduate until you retire. seriously.