I graduate in April;
First semester - The curriculum is challenging. You will do a lot of things that you have probably never done before, and you are expected to do them perfectly before you are let near a patient. You will start your walk down the long hallway of learning from those that came before you. Enjoy it, since this is the only place in the world that will teach you these things. Yes, you can crack a book, but there is so much more. Once you get to clinical, your instructor will be too busy most of the time to spend much time with you. You'll pass a lot of oral meds with your instructor watching you like a hawk. Clinicals in fundamentals will be a piece of cake if you have CNA experience or something similar. And don't forget careplans. Those long nights writing 7 million different nursing diagnoses out, copying pages upon pages from the drug reference book word for word, and trying to figure out labs. Staying up until 2am and then having to be at clinicals at 6:30am with your careplan 90% done or risk a clinical failure. The thing I liked most about the labs in first semester is that you will find most things point to anemia, and it is actually an acceptable answer! (just joking about the anemia part, some of you might know what I mean though).
Second semester - The curriculum seems manageable, but after the first exam your head spins. You learn to do IV meds - and if you are lucky your instructor might find time to actually help you do one. Your hands shake with nervousness as you wipe the port with an alcohol wipe the first time with your instructor staring you down. But you get the chance to practice lots of stuff that you didn't get in the first semester. Care plans
are the only real constant in this equation. You start learning real pathophysiology, not just stuff like, "changes that happen during aging" that you studied in fundamentals.
Third semester - Whoa nelly I cannot even put third semester into words. It is equal parts stress, equal parts memorizing every body system and things that go wrong with them, and trying to remember where you left your keys last night as you frantically run around the house trying to find them. Clinicals get longer, the classes in all probability are much smaller, and your instructors aren't very helpful anymore. If you ask a question they will often just thumb their nose and tell you to go home and look it up. You get complicated patients that are on more things than just oral meds these days, and you'll more than likely be on a med-surg floor of some type. Depending on what school you go to, this is also probably the last semester you do care plans. The care plans that you do write, they will only want 2 or 3 of the major nursing diagnoses, and you can stop bothering with all that psycho-social stuff for the most part (unless it is a priority diagnosis of course).
Fourth semester - Well, I'm still here. So I can't say for 100% certain, but here is my impression of it. I'm stuck on a floor, and I have to do everything. I feel like a complete retard most of the time and the only thing that keeps me organized is my little "magic notebook" They expect me to do pretty much everything, I only see my instructor once a day (and she grills me very deeply on my patients), and I also work an entire team (me, RN, LPN and or CNA). It is nice to finally be trusted to do a lot of thing (even if they still won't let me in the suremed). Yes, I've made a few really dumb mistakes. Like last week, I hung this IV bag as a piggyback, and forgot to unclamp it. So the IV happily ran away until my preceptor called me in to point out what I had done (not really a big deal, because it had only run for a few minutes at the higher rate), but still...feeling rushed, and making dumb mistakes. Time flies in clinicals, and it is next to impossible to stay on top of things. Seriously, prioritizing becomes the major thing, and you can forget about all the niceties that you have been used to heaping upon your patients in previous semesters. Pillow fluffed? Bedside table placed just so? A little bit of conversation? Forget about it...I have meds to pass/insulin to administer/charting to do/etc. Priorities...patient safety is NUMBER ONE. Don't do anything that would hurt a patient / don't neglect anything to where a patient gets hurt. I am learning that it is okay to make mistakes, just don't hurt anybody!! I was feeling rushed to pass some lovenox and looking closely at the MAR when I was getting it out, I realized that there was too much lovenox in the syringe that the pharmacy sent up, I almost turned white because if I hadn't double checked I would have overlooked it (double checking is a habit I have gotten into - I know that they pound that in all through clinicals but don't just assume the pharmacy sent the right dose). I mean, if it had been a multivitamin I seriously doubt the patient would have been harmed...but lovenox? sheesh. Your instructor isn't holding your hand to pass meds anymore. Safety safety safety is the number one rule!! Nursing is not about second guessing doctors (although you may do so once in a while), or even knowing every med by heart (that's what drug books are for).
I'll finish with a story about my friend who is a respiratory therapist. He was telling about one time right after he got out of clinicals, and he had to manually ventilate some kid with an ambu-bag type thing. They come in several different sizes, but in the heat of the moment (the kid was blue or something, so it was an emergency), my friend grabbed an adult sized ambu-bag. Anyways, he hooked everything up, and then double checked the bag size. He realized his mistake before he seriously injured that child's lungs. That's training right there!! Remember that the instructors in all levels make you do all these seemingly menial things because that's how they get you in the habit of doing them - And I guarantee that these habits will save your butt someday (and your patient's butts too).