advice for a high school student

Pediatric Critical Care Columnist · Feb 23, 2014

You're right that nursing offers the opportunities for patient care that you described. Under the current government regime though, nurses aren't really in demand. We work short all the time but AHS has a very detailed plan to "reduce the head count" in the nursing workforce. There are currently very few permanent, full- or near-full-time positions available in most areas of the province. The NP track is still struggling for recognition. (I have several friends who are highly-qualified NPs who are almost without exception working rotating shifts at the bedside.) I expect that to change as time passes, but can't provide you with any kind of a timeline. Nursing follows a cyclical boom-and-bust pattern that typically spans about 10 years; right now we're at or near the bottom of the cycle, meaning that by the time you graduate from nursing school, it should be on the upswing again, positioning you well for finding employment and working toward your NP goal.

Nursing school IS HARD. It really doesn't matter which school you attend or how stellar your grades going in, it's still going to be hard. There's a ton of reading, another ton of assignments, clinical practice and difficult exams covering very complex concepts. You'll gain an in-depth knowledge of anatomy, physiology, microbiology, pharmacology, psychology, sociology, mathematics, physics and ethics. On top of that you'll need to learn the fundamentals of hands-on nursing care. If you're also going to have to work part-time to keep body and soul together, it'll be harder yet. Becoming an NP will also be hard. It sounds as though you're thinking of family practice, which will cover a very large amount of knowledge and will include learning new skills. You'll need a certain amount of nursing experience before entering the NP stream so that you actually know what you're doing. And that means working with patients, probably in a hospital setting, on rotating shifts. You have to be aware that most newly-graduated nurses will be required to work nights, weekends and holidays and may not have many choices about where they do it.

I work in critical care. An average shift goes something like this: Arrive early (0645) and get my assignment. Take report from the previous nurse and assume responsibility for the patient(s). Review all medications and treatments to be provided on my shift, making a plan for ensuring it all gets done on time. Perform a head-to-toe assessment of my patient(s) and document it. Prepare and administer medications. Obtain required diagnostic specimens such as blood gases. Analyse and report the findings. Document. Give report to the multidisciplinary team (physicians, pharmacist, dietician, social worker, other interested parties). Perform treatments as ordered (dressing changes, repositioning, IV/NG/NJ/urinary catheter insertions and removals, fluid collections, respiratory care, oral care, skin care, diaper changes and so on). Assist with procedures. Document. Reassess the patient. Document. Lather, rinse, repeat. Report off to the next shift and document. I may transfer my patient to an alternate level of care and then admit another one during the course of the shift. On the patient care wards outside of critical care, the shift looks roughly the same but with more patients involved. Charge nurses who are good at their jobs try to spread the admissions and discharges out so that one nurse isn't overloaded, because there's a lot of work that goes into both, especially paper work. And due to the nature of the job, anything can happen to upset the plan. If a patient deteriorates, the workload increases significantly, as does the documentation. Nurses need excellent organizational, prioritization and time management skills.

You're on the right track, asking good questions about what to expect and this is a great place to get the answers that will help the most. Our members are amazing. Welcome to allnurses.com! I look forward to seeing you around.

JSAN97 · Feb 23, 2014

You're right that nursing offers the opportunities for patient care that you described. Under the current government regime though, nurses aren't really in demand. We work short all the time but AHS has a very detailed plan to "reduce the head count" in the nursing workforce. There are currently very few permanent, full- or near-full-time positions available in most areas of the province. The NP track is still struggling for recognition. (I have several friends who are highly-qualified NPs who are almost without exception working rotating shifts at the bedside.) I expect that to change as time passes, but can't provide you with any kind of a timeline. Nursing follows a cyclical boom-and-bust pattern that typically spans about 10 years; right now we're at or near the bottom of the cycle, meaning that by the time you graduate from nursing school, it should be on the upswing again, positioning you well for finding employment and working toward your NP goal.
Nursing school IS HARD. It really doesn't matter which school you attend or how stellar your grades going in, it's still going to be hard. There's a ton of reading, another ton of assignments, clinical practice and difficult exams covering very complex concepts. You'll gain an in-depth knowledge of anatomy, physiology, microbiology, pharmacology, psychology, sociology, mathematics, physics and ethics. On top of that you'll need to learn the fundamentals of hands-on nursing care. If you're also going to have to work part-time to keep body and soul together, it'll be harder yet. Becoming an NP will also be hard. It sounds as though you're thinking of family practice, which will cover a very large amount of knowledge and will include learning new skills. You'll need a certain amount of nursing experience before entering the NP stream so that you actually know what you're doing. And that means working with patients, probably in a hospital setting, on rotating shifts. You have to be aware that most newly-graduated nurses will be required to work nights, weekends and holidays and may not have many choices about where they do it.
I work in critical care. An average shift goes something like this: Arrive early (0645) and get my assignment. Take report from the previous nurse and assume responsibility for the patient(s). Review all medications and treatments to be provided on my shift, making a plan for ensuring it all gets done on time. Perform a head-to-toe assessment of my patient(s) and document it. Prepare and administer medications. Obtain required diagnostic specimens such as blood gases. Analyse and report the findings. Document. Give report to the multidisciplinary team (physicians, pharmacist, dietician, social worker, other interested parties). Perform treatments as ordered (dressing changes, repositioning, IV/NG/NJ/urinary catheter insertions and removals, fluid collections, respiratory care, oral care, skin care, diaper changes and so on). Assist with procedures. Document. Reassess the patient. Document. Lather, rinse, repeat. Report off to the next shift and document. I may transfer my patient to an alternate level of care and then admit another one during the course of the shift. On the patient care wards outside of critical care, the shift looks roughly the same but with more patients involved. Charge nurses who are good at their jobs try to spread the admissions and discharges out so that one nurse isn't overloaded, because there's a lot of work that goes into both, especially paper work. And due to the nature of the job, anything can happen to upset the plan. If a patient deteriorates, the workload increases significantly, as does the documentation. Nurses need excellent organizational, prioritization and time management skills.
You're on the right track, asking good questions about what to expect and this is a great place to get the answers that will help the most. Our members are amazing. Welcome to allnurses.com! I look forward to seeing you around.

Thanks for this very detailed response, it gave me more of an understanding of what nurses do and what they go through in school.

imizu · Mar 18, 2014

Hi, I figured I once relied on others to reply to threads like these for me, so I may as well return the favour to others.

Q: Are my career goals practical?

Well, competition for graduate school and NP is increasing, so you may want to look at getting into an honors program to show you already had research experience an publishable work in undergrad. Other than that, your GPA needs to be as high as you can get it, and you need to be competent and likeable in order to get good references.

Q: Was nursing school hard?

I'm finishing up my second year of nursing school now at the University of Alberta, so I've had 4 clinical rotations so far and numerous theory courses. Which parts of nursing school is hard depends on your personal strengths.

Anatomy, physiology, pathophysiology, pharmacology, microbiology - I received all A's in these courses where your marks depended on memorization of a lot of information and some application. For reference I graduated high school with a ~92% admission average. I got by with compiling power notes/flash cards 1 week before the exams and memorizing them 2 days before the exam. You may find it harder or easier depending on your strengths.

Nursing theory/seminars - I receive A's or B's depending on the tutor. You can try your best with marked assignments but occasionally the marking can be arbitrary, since the rubrics do not tell a tutor the difference between an 85% essay and an 86% essay, though that can mean 0.4 difference on a 4.0 GPA scale for the student. Context Based Learning (CBL) is often complained about in my program but it's not the worst thing that can happen in your nursing career, just slightly less advantageous if you lack in social skills.

Clinical rotations - It depends how much the tutor can determine their grade based on their impression of you. For first year clinicals, our evaluation of clinical practice was graded, whereas second year it was pass/fail. This meant that in second year, whether the tutor liked me better than the next student would not show up in the grades, and instead your care plan preparation documents and other tangible assignments will determine your grade. If you lack in social skills, you will benefit more from the second kind of grading assuming your sciences are strong.

3. Is becoming an NP hard?

I wouldn't really know, but what I do know has been mentioned in 1.

4. Can NPs in Alberta open and run family clinics like NPs in Ontario?

Haven't looked into this.

5. What to expect in nursing school?

Read the syllabus for each course, the grading percentage per each assignment is clearly listed there. So far I have had online quizzes, in class quizzes, written exams, electronic exams, labs, simulation labs were for experience only and not graded, patient research... it depends on the subject and instructor.

Subjects to expect: all of those mentioned above, nursing research, intro sociology, intro psychology, electives, political science, interdisciplinary health... etc.

A note about sociology/psychology: check with your program advisor to see if you must take the intro course or if you can take any course under that department. For example, many students in my cohort took criminology instead of sociology because that course fell under the requirement and they had more interest in it.

6. Which school?

I can't say much because I haven't really looked into the other programs, but generally you want to consider whether you want a university geared/academic education or more of a hands on kind of education. Deciding this depends on where you intend to apply for graduate school and a host of other factors. Will it matter whether the graduate school you go to recognizes the name of your school? Will I have a hard time scoring good grades compared at a more competitive school and thus have a lower GPA when applying for grad school?

Another thing is to look at your personal strengths: if you lack social skills, go to a program where they will give you first year clinical rotations so you can make your innocent, unintended mistakes stepping on others' toes or not understanding how to interact with patients or feeling like you don't have the right to touch the patients and do all the tasks required of you while it doesn't factor so heavily into your final grades. Look at the clinical hours given after first year, perhaps one school has 300 hours and one has 280 hours (just making the numbers up), it won't make a huge difference on your applications anywhere but perhaps you will achieve a better GPA with less or more clinical hours depending on where your strengths lie.

Ultimately none of that may matter, as long as you work hard for the best GPA you can achieve so you can get into grad school.

7. What's your day like as a nursing student?

During theory course periods: I wake up, go to the university, sit in a traditional large lecture format class (my favourite) or in a small seminar group. If I find a lecture boring I browse other things of interest on my laptop discretely but I always keep an ear on the content and compile what's being said into flash card format right there in class. Nothing's worse than you complaining the lecture is boring and not utilizing that time to get study material done. When I'm done I go home. Not much usually gets done when I'm at home between assignments but if a series of essay due dates are coming up I always schedule to do things ahead of time so anxiety doesn't get to my ability to write clearly and well.

During clinical: you may have alternating morning and evening shifts, usually you have to review medications your patients are taking and pull medication cards from your own drug card deck, you prepare a care plan document whenever you have a new patient, and sometimes you have to provide update documents. On the unit... well, depends on the unit and the shifts. You are gradually given more responsibility over an increasing number of tasks with your assigned patients, usually starting from giving oral medications and providing basic hygiene care and doing basic head to toe assessments -> giving other forms of medications -> giving controlled medications... other responsibilities or task examples include oxygen therapy, IVs, wound care, removing sutures and stitches, feeding tubes... etc.

8. Advice to a nervous kid entering the 'real world'?

Throughout your program, try to improve upon the areas you are weak in whether it's science courses or interacting with people. Try not to take to heart little things that annoy you (ex. students that try to bring you down in hopes of eliminating competition, that silly pointless CBL teaching method, that nurse that always looks at you weird, or even that person who bumps you out of the way on the bus for no reason), save that energy for productive things. If you have a mean clinical tutor in first year, you're lucky! You won't get them again when you enter 3rd and 4th year when your grades really matter, and you start off with higher standards for yourself than those who got nice tutors. Don't spend time complaining about assignments, instead focus on how you can complete the routine assignments like care plans or collect the information for your care plans with higher efficiency so you don't have to stay at the hospital late on data collection day or sleep for 3 hours at night and have to perform at your best at 5am for day shift.