[belabelisa]

I really need your help.

I'm about to graduate and feel as if I don't know nearly enough! In school, we are taught SO MUCH and retain SO LITTLE. I feel like my brain has been overloaded with details about disease processes, obscure medications, and such (much of which I don't even remember) and I don't have the essential “down and dirty” nursing knowledge that I will use on a day to day basis. Don't get me wrong, the details that I learned in nursing school will be very useful and will provide me with a strong foundation for nursing decisions but, right now, I just want to make sure I have enough basic knowledge to not kill anyone (and to effectively respond to the common patient problems).

When I get nervous, I make lists. And that's where I'm hoping you can help me. I want to make a list of the absolutely essential knowledge and skills that I need to know to be a somewhat competent graduate nurse. I think it would ease my mind so much to be able to go through and review the things that I absolutely need to know.

So... what are some things that you think fall into the category of essential nursing knowledge? (particularly for a med-surg floor) Which things (technical skills included) will I encounter frequently. Which lab values do I need to make sure I know the meanings of? Which medications do I need to know? Which problems do I absolutely need to know how to respond to? Which diseases processes do I need to understand most?

Thanks so much!

p.s. I posted this on the Graduate Nurse's Forum as well, but I wanted the advice of some seasoned nurses too. (Ha! I just pictured a nurse sprinkled with salt, pepper, and oregano - but, I digress)

[belabelisa]

As with my other post, since it's my question, I'll go ahead and respond with some of the things I think are good to know...

Lab Values:

PT, PTT, and INR.
White Blood Cell Count
Platelets
The Cardiac Enzyme Markers

How to respond to:

Decreased O2 Saturation
Hypertensive Crisis
Crazy High or Low Blood Glucose
Respiratory Distress
Signs of MI
Seizures
Aspiration
Fluid Overload

Technical Skills:

IVs and IV Pumps (Of Course)
Dosage Calculations
Trach Care
Central Lines
Feeding Tubes

Drugs:

Digoxin
Morphine (I work on an oncology unit)
Insulin
Potassium
Coumadin and Heparin


Okay – that's a start.

[ready4crna?]

Here are some essential knowledge tidbits from a "seasoned nurse":

Blood goes round and round, Air goes in and out; Any variation on this is a BAD thing.

All bleeding stops....eventually.

Activated charcoal does not come out of scrubs once it has been through the gi tract.

When in doubt, give oxygen.

Full moons are a by product of psych meds and hospital gowns.

Turn the patient who is about to throw up AWAY from you, preferably toward the annoying family at the bedside.

The above patient will get sick immediately after a linen change and 5 minutes before report.

But seriously, your nursing education starts once you are done with school, all the pertinent info will be drilled in through daily practice and use. You will not remember everything from every class, but it will equip you to be a competent, safe practitioner. I've said it before, if nursing school made you anything more than a novice, hospitals would not need new grad orientations. Now, go study for the boards, and stop making so many lists.

[maryloufu]

Calculate I's and O's (in your head at least) every 2 hours or so on the floor. The end of the shift is a very bad time to realize that your patient is anuric.
If you feel in your gut there is something wrong with your patient then you must address it. God gave us those gut feelings.
When you are new on the floor watch how other nurses organize their shift- do not feel like you have to do things exactly like everyone else- find a way that works for you.
Never give a drug without knowing what it is. Never give a med that someone else drew up.
I think you need to know
Coronary Artery Disease
Congestive Heart Failure
Renal Failure
Diabetes-
but that is because most all of my patients have these disease processes.

[RainDreamer]

You will learn a lot on the job. I felt the same way when I graduated, but then I realized that you learn a lot with on the job training. But I agree that it's important to have some basics, good thread!

When you start on your unit, ask your preceptors/mentors/experienced nurses for what books/journals they would recommend that are essential for that particular type of nursing.

To start with, learn how to do a good assessment ...... actually a great assessment. Great assessment skills are imperative and that's one of the things that can really help you in the long run. Once you can do a great assessment, the other things will fall into place. Being able to assess that the patient is fine, then that's good. Being able to assess if something is wrong, then that's great ...... if something is abnormal, then report it. Once you can assess something that's wrong and report it to the appropriate people, you'll be just fine.

[Aprilhere]

Try studying for boards with someone NOT in the healthcare field. Lol...it won't do much for your studying...but it'll quickly remind you how far you've come since first semester. I felt like I was having anxiety attacks near graduation. I couldn't BELIEVE they were going to let me be a nurse.....I didn't feel ready...dispite my good GPA. When I studied with my husband..and had to explain everything...I realized how much I HAD learned..and knew I learn the rest on the job.

[MA2006]

This is a great thread thanks for the Info!