7 Things You Weren't Taught in Nursing School

ElizabethScala1, BSN, MSN

All the things you were not taught in nursing school could probably fill a few volumes, but here are a few that I have collected from emails and conversations with colleagues over the years.

Importance of a Mentor

New nurses orient with one or maybe a couple different nurses, but new nurses could also benefit greatly from having a nurse mentor for their career. Having someone to offer advice on the best career moves and discuss how the new nurse is experiencing nursing as a whole, can keep nurses satisfied in their nursing career by having a sounding board and a guide to help them grow in their careers. The rate of new graduate nurses who leave the profession in their first year of nursing is astronomically high and having a confidante within the profession can help the new nurse navigate the ups and downs of the first year or two and mitigate some of the stress.

This is a service-based profession

That means in service to other people, and that's not always a cake walk. Being a nurse carries prestige, but it's not just about that and the fairly decent paycheck. Sometimes it's about the grunt work too. After a nurse friend of mine told a new nursing student about cleaning up a patient after a "brown" accident, the student said, "but nurses don't do that, that's an aide's job." After schooling the student on just what constitutes nursing care, the student changed her major the next week. She said no one told her she'd have to do those types of things, and she wasn't about to do them for any amount of money.

Patients will insult, kick, hit, bite and sometimes throw things at you

Nurses see patients at a point of vulnerability. Some act out due to frustration. Some medications have side effects that include irritability and anxiety. Other patients are simply unhappy people or are mad at the world. As a nurse, you are the person in front of them and can bear the brunt of their reaction to their circumstances. A thorough report from the previous nurse can eliminate surprises when it comes to patient behavior. Never hesitate to ask for someone, an aide or another nurse, to accompany you into a patient's room.

Losing a patient is never easy... and there's lots of paperwork to do when it happens

Nurses work hard to keep patients alive, and whether a patient codes or passes away from a terminal illness, nurses give all of themselves to counsel loved ones through the beginning stages of grief. I have watched nurses with tears welling up in their eyes making phone calls to physicians, completing paperwork, and just managing the loss while still also caring for other patients. A patient's death may not be a personal loss for the nurse, but sometimes the grief feels the same.

All the nursing roles/jobs that are available to nurses

Although nursing school does provide clinical rotations in several areas of nursing, there are far more than new grads can ever imagine. Nurses are found in every spectrum of the working world from corporations to engineering, industry, and government. The world is a nurse's oyster when it comes to finding a path that interests them. Nurses can also carve out their own niche for a job that suits them to a "T."

Nurse to nurse bullying is real

The old adage that "nurses eat their young" can feel very real, and it has the potential of turning off new grads and good nurses that the profession needs. Dealing with a nurse bully is tough, and if new nurses do not feel confident in standing up to a nurse bully, it is best to talk it over with a supervisor. No nurse should have to tolerate bullying from a co-worker, no matter if you're a new grad or a seasoned professional. Everyone met the same requirements to become licensed. Everyone has a right to be there.

Advocating for your patient when you disagree with the doctor is part of your job

No. Matter. What. New nurses are not taught, at least not effectively enough, that there will be times when they have to challenge a doctor's order. Questioning a doctor may not be comfortable, but remember, you are the last line of defense a patient has. If you don't feel comfortable in carrying out a doctor's order, talk it over with colleagues or a supervisor. You may get some insight on how to approach the doctor and feel more supported, if you're concerned about the order.

One Extreme Example: One nurse I know that was still in training, questioned an order of insulin that had to be specially prepared by the pharmacy. She looked at the syringe and determined that it was simply far too big a dosage. She took her concerns to her preceptor. He advised her to call the pharmacy. The pharmacy confirmed that the dosage was correct. She still did not agree. Her gut told her the order was wrong. Her preceptor said that she could call the doctor, but warned that she would be waking him up. She pressed on and called the doctor. The doctor was fine with being questioned, but stated that the dosage was correct. She again felt that it was absolutely wrong. She called the pharmacist again and asked him to please redo his math. She went back to her preceptor and told him the doctor had confirmed the order and that the pharmacy also recalculated the dosage with her on the phone and that it was correct. The preceptor said she needed to give the insulin. She said she would if he would check to make certain there was enough D50 on the unit in case they needed to push it twice. He assured her there was. She gave the insulin. Within 15 minutes, patient's blood sugar bottomed out and she and her preceptor ended up pushing D50 three times before getting the patient's blood sugar stabilized. The next day when she had the same patient again, the dosage in the syringe was much smaller, and the patient thanked her for trying to look out for him in the face of all the opposition she encountered. This new grad nurse was not taught that she may face such a rough time in questioning an order, and she felt completely guilty about causing the patient distress. She thought she had done the best she could given the situation and three people telling her the order was correct, but she never again distrusted her gut when questioning an order.

The bottom line to remember

You really are the patient's last line of defense.

As stated previously, the list for things you weren't taught in nursing school could be endless. So, expect a part two, and possibly three, as future posts!