Terrified Mortified Petrified Stupefied

[Terra Fermata]

Hi! I am a student studying nursing at a university in Virginia and am halfway through my second semester of the four semester nursing program (It's a BSN with two years of general education and two years of nursing). The other day I had my first clinical on a medical-surgical floor (previous clinical sites have included: rehabilitation/elderly care, psychiatric care, and women's health) and it completely terrified me. I spent the day working on a plan of care for a specific patient, performing interventions I had done previously in lab, class, and clinical, and shadowing a nurse. The part that throws me for a loop is that the nurse was given six patients and was able to juggle all of them perfectly, page the doctor frequently for updates and to request certain medications, prioritize care, deal with new prescriptions being added after 9:00 medications had been administered, and keep a level head about it all. I have had two patients at most at a time and the program I am in theoretically prepares you in the last semester for four patients at a time but six seems like a large jump. The sort of fast decision making, complicated balance of tasks and duties, and synchronization with other members of the care team all intimidate the heck out of me. Does it still feel this way once I graduate? What sorts of things can help prepare me for these key factors of being a successful nurse? As of now I am leaning more toward specialties that are not necessarily direct care or fast paced so that I would have time to think things through and would have less of a chance of making a mistake that could cause a sentinel event (such as psychiatrics, informatics, allergy, or legal nursing). Any advice on what to do?

Also on another note, how much of what you learn in nursing school do you apply to the field? I constantly feel inundated with information that I perfect for the tests and because it's interesting but wonder if I'll ever use again.

[Lev, MSN, RN, NP]

Hi Terra,

Hopefully you will feel less intimidated by the time you graduate and one day YOU will be able to juggle a full assignment just like that nurse. Nursing is a huge learning curve and it will get better. Competence and confidence comes with time and experience. Nursing school does not prepare you for the real world. It gives you the knowledge that will enable you to practice safely as a novice nurse. Much of nursing is learned on the job and it never ends, but your books have value too.

[RunBabyRN]

You won't graduate feeling like you know everything (if you do, you're wrong!!). You are CONSTANTLY learning as a nurse. Right now, you are building a foundation. Your job right now is to learn about some of that prioritization, time management, and delegation. That's the stuff the NCLEX will be asking you, anyway, and that will matter when you are a nurse. It will become less intimidating, and there will be moments along your student career and your nursing career where things really "click" for you, and you'll feel like a "real" nurse. There will always be stressful situations that make you want to run screaming. That's ANY job. Learning how to calm yourself, focus, and prioritize will serve you well, and these are skills you are slowly developing over time.

One of my jobs is generally not very fast-paced (home IV infusions), but things can still turn really quickly. I sometimes give infusions where you're monitoring vitals Q15 minutes, and the vitals can go absolutely haywire. I've stopped the infusion, called the MD and pulled out the EPI-Pen and been at the ready to head to the ER before with my patients. ANY job (including psych, allergy, etc) can require critical thinking and thinking on your feet RIGHT NOW at any time.

Depending on your specialty, you may not see some of the material again, but in most areas, there is some crossover. I am constantly researching my patients' diagnoses. Some of them, I've never even heard of, or we barely touched on it in school. When I've been in women's health, I've had psych patients, a patient with cerebral palsy, and other complications that are not specific to that specialty. It's good to at least keep some of it in mind, and to have some familiarity with what's going on. In med/surg, I'd see nurses looking up stuff about their patients, too, or how to do some procedure. You are never exempt from having to know this stuff.

[HappyRN14]

I just graduated and felt the same way! I don't have a nursing job yet, but I am completely freaked out by managing a patient load or dealing with acute patients. However, I have friends who were totally anxious about the same thing and yet they're working med-surg and ICU jobs now and feel more and more comfortable every day. One of the things one of my instructors told us that made me feel more comfortable about this was that when you get your first nursing job you WILL have an orientation, and most of the time it's for a certain period of time. But if you feel you need more orientation time you can always ask for it. Also, no employer is going to expect you as a new grad to know squat! Well, they're going to expect that you know basic nursing knowledge from school and that's it. You'll learn on the job and you will not get 6 patients assigned to you until you're comfortable with it and/or your charge nurse feels comfortable with it. You'll always have reference materials at your fingertips as well. There's usually medication books, med-surg, and all sorts of nursing literature at the nurse's station for you to look at when you're stumped or questioning something.

Don't get down on yourself for being a student and not being able to handle more than one patient either. It's completely normal!

Hope this eases your jitters! Good luck with the rest of school :)

[SubSippi]

Nobody is ready to take a full patient load the day they graduate. Nursing is hard, but you don't have to be a genius to do it. There are lots of us, and most of us are regular people.

The most important thing isn't necessarily knowing exactly what to do when there's something wrong with your patient, but being able to recognize a change. It'll be things like a patient has started getting more confused throughout the day, seems to be having a harder time breathing, or has suddenly gotten really pale or sweaty. You may notice that a heart rhythm just looks different than it did earlier...it's not a big deal if you don't know the rhythm, because you know enough to find someone who can help. You see a change, you don't know what to do or what it means, find someone who does.

If everyone is okay, just do your thing. Give the patients their medications, change some dressings, chart chart chart, deep suction a trach, call the doctor for some Ativan for the patient who won't quit screaming, chart chart, give report, go home. Repeat the next day. You won't be good at it at first, but nursing isn't so hard that a person with at least average intelligence won't get the hang of things after a few months.

Just pay attention. And don't freak out.