What I wish I had known...

  1. .

    :angel2: :angel2: :angel2: :angel2: :angel2: :angel2:

    Hey all you great nurses out there - !!!

    Please take some time to share some of your hard-earned wisdom.

    I think that most "new grads" start out the same way. Excited, blessed, relieved (out of school! Whew!) and terrified. After we get a little experience we often LOOK BACK and are amazed at just how far we have come on our journey to become the best clinicians we can. Caring for and taking care of others is monumental undertaking - we are responsible for the lives of others. I have accepted that I will never know enough - but, I do work to learn more every day from every experience. It is important to remember where we started and value where we stand.

    I know that I recall being so scared it was a wonder that any patient survived under my care. Grace at it's finest.

    So - what have we learned??


    about NCLEX?






    about IV THERAPY?




    about STRESS RELIEF?

    about SAFETY?



    about DOCTORS?

    about SELF CARE?


    about MANAGEMENT?



    about PATIENTS?

    about FAMILIES?

    about THE B.O.N.?


    about ANYTHING that you would like to have known!!!!

    The sky is the limit! Share what you have learned and pay forward the benefit of experience. I'm betting that there is a LOT of knowledge to share. I don't have to make a mistake to learn the lesson from it - I can learn if you share "your" mistake with me. Likewise, I can celebrate the VICTORY of another - and feel great that I may be able to triumph as well!

    Care to share? There is always someone grateful to learn!

    Practice SAFE!!!

  2. 14 Comments

  3. by   ymjackson1
    Thank you so much for posting this...This is one I'll be sure to watch as I embark into nursing.
  4. by   ChristyRN2009
    Im not a seasoned nurse but I'll impart what I've learned in my 20 months of nursing. Who knows, someone might benefit.
    about NURSING SCHOOL? Nursing school was the hardest thing Ive ever done but well worth it and looking back, really most of it has served me well in my job thus far. Even if I don't remember 90% of the trivial stuff I learned, I learned the basics and learning all those extra facts prepared me for my post school education which has been even more detailed.

    about NCLEX? Just relax and take it. If you fail, study and take it again. Lots of nurses Ive worked with have failed and gone on to become nurses I would trust my loved ones with so it really does mean nothing in the end.

    about GETTING THAT FIRST JOB? Talk to people who work there and make sure its a place other people like to work at. Know the general work load of your area and assess whether or not you can handle that. Not everyone can handle a super busy med surg floor and not everyone can handle the slower pace of some other areas.

    about KNOWING WHEN TO "MOVE ON"? I've honestly not known this particular situation.

    about TIME MANAGEMENT? This is critical. I'm generally disorganized and late in life, so I work very hard at my time management on the job, and if I don't my whole day is awful and my patients suffer.

    about CLINICAL PRACTICE? ?? What does this mean?

    about MEDICATION ADMINISTRATION? Over time it gets less scary and intimidating.

    about IV THERAPY? ?? What does this mean? Giving IV meds? Follow policy I guess would be my best advice.

    about PATIENT ASSESSMENT? Trust your gut. It takes a while to cultivate it but the first time it kicks in, you know it.

    about CRITICAL THINKING? Same as above.

    about WORK-LIFE BALANCE? This one is not that hard for me.

    about STRESS RELIEF? Do whatever you have to, you only have one life and you should not spend it stressed out. We all know the effects on your body.

    about SAFETY? Patient safety has to remain number one in your mind. Never underestimate the ability of a patient to hurt themselves.

    about DOCUMENTATION? Document as you go as much as possible, otherwise you will forget it.

    about KNOWING YOUR LIMITS? I've struggled with this and continue to. You don't want to be the nurse who always needs to be rescued, but at the same time you have to be able to ask for help when you are in the weeds. Use your ancillary help wisely.

    about DOCTORS? They are just regular people who deserve respect if they act respectful. They will generally behave if you have your ducks in a row before you approach them with a problem.

    about SELF CARE? Self care? Healer heal thyself.

    about CONFLICT RESOLUTION? I am not great at this, so I'll be reading up on other people's responses.

    about MANAGEMENT? They have a different goal than you for the most part, just try to fit your goals with theirs.

    about "CUSTOMER" SERVICE? Its not a popular idea, but practicing good customer service with your patient care will go a long way in improving your patients view of you as a nurse and their stay as a whole.

    about ANCILLARY SUPPORT? Use it when you need it.

    about PATIENTS? What about the patients? No two are alike even if they have the same disease, came in for the same procedure and are on the same day s/p.

    about FAMILIES? Families can hinder the healing process of a patient more than any infection or other complication could. Be courteous to them but know when to intervene on behalf of the patient i.e. "I think patient x would benefit from some rest and you look like you need it too. Perhaps you should go home for the evening and let us take care of grandma for the night."

    about THE B.O.N.? Never had a run in so I wouldn't know what to say here.

  5. by   blondnursey
    hmmm lets see
    i wish i had known......

    that any gossip at work will come back to bite me in the ass, even if i was right.

    that i should always have a complete change of clothes and a snack kept in my car.

    that i should always do the extra small thing for my patient & coworker..even if i get home 5 min late

    that i should leave my job at work....taking the stress home just makes it worse

    that if i am burning out to move on before i make everybody unhappy...

    that i should listen to all advice (just listen at least!)

    that i should always keep my mouth closed during incontinence or trach care

    Last edit by blondnursey on Jun 17, '09 : Reason: had more to say
  6. by   NeoNurseTX
    about NURSING SCHOOL? it is NOTHING like real nursing

    about NCLEX? it's not as scary as people make it out to be. at all.

    about GETTING THAT FIRST JOB? network!! call people!

    about KNOWING WHEN TO "MOVE ON"? when you feel you are no longer learning...and you dread work more than anything.

    about TIME MANAGEMENT? always stay a step ahead and be prepared for the worst.

    about CLINICAL PRACTICE? ebp

    about MEDICATION ADMINISTRATION? five rights each time every time. don't trust what the MD ordered to be right and don't trust what pharmacy sends you to be what the MD ordered.

    about IV THERAPY? check your sites every hr. at least.

    about PATIENT ASSESSMENT? watch for subtle changes..

    about WORK-LIFE BALANCE? you need it. work to live, don't live to work. never been an issue for me.

    about STRESS RELIEF? get your zzz's

    about DOCUMENTATION? CYA and have your own malprac insurance

    about DOCTORS? they are human and make mistakes, too

    about MANAGEMENT? those who can't..manage. just kidding!

    about "CUSTOMER" SERVICE? is sometimes a load of crap. this is not a hotel.

    about ANCILLARY SUPPORT? love them and treat them well!

    about PATIENTS? what i'm in it for

    about FAMILIES? some are great, some are crazy...but they all are stressed.

    about THE B.O.N.? exists for the public, not for your benefit.

    about GETTING INVOLVED IN NURSE FORWARD ORGANIZATIONS? i'm in a prof org, but nothing like ANA...seems like a waste of $$
  7. by   Purple_Scrubs
    About Med administration: never ever start taking it lightly. This is when it bites you in the butt. If someone asks you to witness a waste for them, make sure you actually do witness them wasting it. Same for double checking insulin, if they ask you to sign saying you double checked it, make sure you do check it!

    About knowing when to move on: follow your gut.

    About your first nursing job: realize that being a student is a whole different ballgame that when you are THE nurse, even while you are working with a preceptor. Just be ready for it, things that you enjoyed in school may not be the things you enjoy in practice.

    About Doctors: they are human, not gods. Do not place them on a pedestal or allow them to place themselves on one! Same can be said for managers, etc.

    About documentation: if you didn't chart it, you didn't do it. Learn very careful, proactive charting.

    About people in general: they are crazy. You cannot make everyone happy. Accept it and do your best.

    One for my specialty:
    About sick kids: be very worried about the quiet ones. Do not take your eyes off them.
  8. by   chevyv
    I'm a new nurse and love this thread! I'll be listening very closely
  9. by   Cherybaby
    What I have learned is that doctors do not know everything. Sure, they know a lot when it comes to diagnostics but about healing and care? Not much. Like every mother knows her own child better than anyone else, so will you know your patient better than most doctors do. You have to be able to not be intimidated and stay an advocate for your patient at all times. Doctors are human. They make mistakes. It is your job to make sure that they are informed of a patients status. Make sure they know about labwork and that they don't just blow by it in the chart. They have a lot of patients to take care of and mistakes are bound to be made by them once in awhile. You have to be confident enough to speak up (not at them, but TO them) on behalf of your patient. Sometimes you have patients that are very comfortable with telling a nurse a problem, but when the doctor comes around, they keep their mouths shut. This is very prevailant in the geriatric community where people don't want to feel like they are burdening their doctors. This is also where good communication with your docs come into play.

    Good communication with your peers and your superiors is one of the most important things I learned as a nurse...and you don't necessarily learn that in nursing school.

    Good luck on your endeavors!
  10. by   Penguin67
    about NURSING SCHOOL? Do your best to elarn all that you can and get a good foundation for knowledge. IT only strengthens your practice. And, you will continue to leearn things each day in your career. You can't learn everything in nursing school.

    about NCLEX? Studying hard and working hard throughout school is your best preparation. Don't try to cram for it. Do what you cna do to be a good student in school, and you will be prepared. Take a good review course. Get a good night's sleep the night before and know where your testing location is. Figure in traffic as a possibility for your travel time. And don't think that you flunked if you took more than 75 questions.

    about GETTING THAT FIRST JOB? Put forth your best at the interview. You would be surprised at the horrible things applicants do during interviews. If they dont' call you back in 24 hours, relax. they are processing more applications than just yours. I'd give it a week, then call to "check on the status of your application". And apply in more than one place. You might need to relocate to get the job you want.

    about KNOWING WHEN TO "MOVE ON"? You will instinctly know this. Whether it is time to move to another unit in same hospital, to another hospital, to change specialties, or to pursue graduate education. And everyone has different times for moving on. Some stay at the same job for thier whole career. Do what is right for you.

    about TIME MANAGEMENT? One of the hardest skills.Watch what other nurses do and learn from the positives and negatives that you see. A nurse who is organized usually has a better day. (But not always!)

    about CLINICAL PRACTICE? Get in there and learn from everything. Take on the hard patients, they are the best learning situations. Don't be afraid to look up what you don't know and ask alot of questions.

    about MEDICATION ADMINISTRATION? Be safe, not sorry. If something doesn't look right, take the time to investigate, call the MD, call pharmacy, etc... I'd rather give a late med, than make a med error.

    about IV THERAPY? Look at the IV lines, from top (bag) to bottom (insertion dite) EACH time you walk into the room. Untwist lines that are tangled. Look for infiltration. Make sure there are no bubbles in the lines and that the drip chamber shows drops infusing. Make sure the pump is set right and that the right fluid is hanging. Make this a habit each time you enter a patient's room.

    about PATIENT ASSESSMENT? Good assessment skills are a must. Learn from other patient's. Ask to see things on other patients so you can get a visual on it and recognize it the next time you encounter it. If in doubt, ask someone to get a look at your patient.

    about CRITICAL THINKING? Takes time to develop the skill. The more experience you have, the better chance that this skill is more refined. But not always. The mroe experience you have, the more ieces to the puzzle you have for patient conditions.

    about WORK-LIFE BALANCE? Get a life outside of work! Find friends who are not nurses so you can talk about something other than work and truly relax. Don't work OT each time possible, you will burn out and never want to work again.

    about STRESS RELIEF? Spa days are great! Find something that relaxes you and go for it.

    about SAFETY? Take the time to do it right. Pretend that each patients is a member of your family and treat them that way. You will never go wrong.

    about DOCUMENTATION? New grads usually wnat to over or under chart. Finding that happy medium is hard at first. Read charts of other nurses and find your charting comfort zone.

    about KNOWING YOUR LIMITS? If you need help, speak up. Don't try to do something that you dont' know how to do. Only you know your limits.

    about DOCTORS? They are human, too. Be nice to them and good should come around. If it doesn't, kill them with kindness. You will never get written up for that.

    about SELF CARE? Encourage it. Or they will never go down that pathway!

    about CONFLICT RESOLUTION? It doesn't always end up your way, but try to resolve conflicts in an adult way. You can't win every battle.

    about MANAGEMENT? They are human, too, working under constraints put upon them by upper management, that they most likely do not agree with either. But they get to be the bearer of the bad news. Don't kill the message bearer. They need your support.

    about "CUSTOMER" SERVICE? Yuck, can't believe that nursing is headed in this direction, like with scripted services, etc... Do the best you can for all patients, and it will fall into place.

    about ANCILLARY SUPPORT? They are human, too. Be nice. But hold them to their job expectations. There are many threads on allnurses regarding insubordinate PCTs. It's not always pretty, but we are a team and depend upon each other.

    about PATIENTS? They come in all shapes and sizes. It is not up to us to judsge them, but to deliver good quality patient care.

    about FAMILIES? They can be a thorn in your side or your best friend. Find out what makes them tick and work together with them.

    about THE B.O.N.? They take a long time to process NCLEX applications. Deal with it.

    about GETTING INVOLVED IN NURSE FORWARD ORGANIZATIONS? With unity, there is strength. Get involved in ANA, for a check draft of $25 a month, you won't even miss it. Also, get involved in your specialty organization. Professional nurses are working beyond the bedside. Get involved.

    about ANYTHING that you would like to have known!!!!
  11. by   Medic/Nurse

    Thanks to all the amazing nurses that have responded. Great stuff!!

    Maybe there will be others - you don't have to have all - just give us all the best of what you wish you would have known.

    I'm betting that there are some amazing lessons out there - please share 'em. :wshgrt:

  12. by   Medic09
    Okay, just a quickie.

    Always think of those folks working with you as your 'partners', not just 'co-workers'. Everyone - cleaning and maintenance staff, techs, medics, nurses. Docs, too. They are your complete partners. Good patient care and your job satisfaction will benefit from this immensely. If you find a shift where a lot of the staff think this way, stay there! You'll be happier in the long run.
  13. by   Medic/Nurse
    Quote from nremt-p/rn

    i thought i'd add my "best hits" list -

    so - what have we learned??

    about nursing school? i did excelsior medic to asn completion - don't get stuck till you are stuck. sure, it can be hard in distance education - but this will be a good time to add motivation and commitment to your professional tool-box. "if i can make it there - i can make it anywhere"

    i will add that i think school is really the tough stuff. you will cry, feel profoundly stupid at times ---- this is okay. it will pass. now is the time to get organized and if a family is in your corner - time for a sit down. explain your school, childcare needs & even ask chance for financial assistance. ask for their help - what are your goals and timeline. it really does take a village.

    self-care is the key to being a good nurse and without self-care the practicing rn doesn't last long. take care of your self.

    about nclex? okay, all the hard work you have done and now this - arrrugggggghhh! well, you gotta get through it to be eligible to work as an rn, plenty have gone before you and lived to tell the tell.

    my tips.
    i think the nclex review from ncnsb.org that a on-line test bank. do it and do it often
    find your test center drive to it and note construction, locate the test center.
    good breakfast and 15-20 minutes of exercise will engage your brain.
    if you are the anxious, chatty, jittery test taker that had problems - there are exam prep courses (use them)
    i have luck that my md prescribed a b-blockers (to help all that adrenaline stay out of your way!)
    i know how much this means to each and every one and the relief and joy of passing.
    it is okay to fail. you'll dust yourself off and take it again (buck up!!!)

    more answers to come. maybe others could share a few of theirs?

    about getting that first job?

    about knowing when to "move on"?

    about time management?

    about clinical practice?

    about medication administration?

    about iv therapy?

    about patient assessment?

    about critical thinking?

    about work-life balance?

    about stress relief?

    about safety?

    about documentation?

    about knowing your limits?

    about doctors?

    about self care?

    about conflict resolution?

    about management?

    about "customer" service?

    about ancillary support?

    about patients?

    about families?

    about the b.o.n.?

    about getting involved in nurse forward organizations?

    about anything that you would like to have known!!!!

    the sky is the limit! share what you have learned and pay forward the benefit of experience. i'm betting that there is a lot of knowledge to share. i don't have to make a mistake to learn the lesson from it - i can learn if you share "your" mistake with me. likewise, i can celebrate the victory of another - and feel great that i may be able to triumph as well!

    care to share? there is always someone grateful to learn!

    practice safe!!!

  14. by   WYDiceDancer
    about nursing school? the only thing that most of the instuctors want to hear is "yes ma'am, no ma'am, i don't know ma'am and i'd love to learn that from you ma'am". if you find a really good, caring instructor, take them for ever course that you can and let them know how much you appreciate them.

    about nclex? don't cram the night before. if you didn't learn it in the last 1/2/4 years, one more night isn't going to help. a good nights sleep will serve you much better.

    about getting that first job? you won't stay long. and don't beat yourself up if you discover that you don't like your "chosen specialty". you may love kids, but not everyone is cut out to take care of sick kids.

    about knowing when to "move on"? when you plan every waking minute how to tell your boss to go to hell, better start looking for a change.

    about time management? get your "boring" thing done early in the shift, you never know what will come down the pike 15 minutes before shift change.

    about medication administration? everyone makes med errors, just own up to yours and learn from it.

    about iv therapy? can't get in that peripheral line? ask for help, don't keep digging and making your patient miserable.

    about patient assessment? do it the same way every time and you won't forget anything, and start with the feet because they are the least seen item and usually "missed" by others.

    about critical thinking? remember all those care plans? they were not just an exercise in frustration.

    about work-life balance? everyone needs a certain amount of "couch time", you are not the only one that can pick up the extra shifts.

    about stress relief? get a dog, walk that dog, love that dog, stress reduction without medication.

    about safety? you only have one back, and if you lose that, you can't pay your bills.

    about documentation? if it's worth reporting on, it's worth documenting.

    about knowing your limits? we all have them, it's not a character fault.

    about doctors? most are good, few are bad, all have a bigger ego.

    about self care? refer to "stress relief", i haven't had more than a headcold in years because of that one.

    about conflict resolution? good question, let me know when you figure out how to make everyone happy all the time.

    about management? working nights and weekends has it's perks.

    about "customer" service? press-ganey scores are (fill in your own 4 letter word here).

    about ancillary support? they can make or break you shift. make sure the cna's love you or you will be most unhappy.

    about patients? "house" is right, everybody lies. part of your job is to sift through their bs so they can receive appropriate care.

    about families? most need to be sent to their rooms without their supper.

    about the b.o.n.? do what you can to avoid them.

    about getting involved in nurse forward organizations? do it if you want, but i don't see any advantage to it.

    about anything that you would like to have known!!!! just because the coffee is free doesn't mean it's worth drinking. keep a "no refridgeration needed" lunch in your locker, you never know if your food will be left alone in the fridge. keep up on your ceu's, it's no fun having to cram them all in the last week. even if you are "well" take a "sick" day every 3 or 4 months, mental health is at least as important as physical health.