education vs the real world

[transitionRN]

Hi all~

I wanted to know how nurses felt about the disparity between nursing education and real world floor nursing? I am transitioning into the education role but trying to keep a hand in staffing. I'm finding alot of disconnect as I try to "practice what is preached" with the changing climate of in-patient hospital nursing. The two worlds are clashing often.

As everyone finds ways to conform to skin, falls, etc for reimbursement sake, are more significant things getting missed? It's always been a priority for nurses to want to keep patients from falling or getting skin breakdown, but now that the pocketbook is getting hit, it's become #1 with administration. T's are crossed and I's are dotted with huddles, hourly rounding, all the microscopic charting. While not a bad thing, I've noticed that other important things are being overlooked in the crunch to give patient care. For example, safety orders for the approved use of central lines and feeding tubes are missing...frequently. Labs are "lost". Charting times are inaccurate which can sometimes cause chaos. Throw that in with some squeezing staffing and nurses trying to orient new nurses and it ends up feeling like a hodge podge mess.

It reminds of how "stat" stopped being stat because it was so abused. Nurses are trying to prioritize, but with such pressure to focus on completing a mobility assessment, only so much work can be done. Corners get cut and sometimes it's dangerous.

I love nursing which is why I'm veering to education, but I feel like a hypocrite. I"m disappointed in the priorities of management, however I do completely understand why it must be that way from their standpoint. It's a business too. This ethical dilemma really has me torn.

Anyone else feel this dilemma?

[Otessa, BSN, RN]

I think you need to teach to what should be done but also let your students know that there will be many variables depending on where you work, patients you care for, and co-workers, etc, etc.

[skittlebear]

Completely different, that's all I have to say. I learned a lot in nursing school but was not prepared for the "real world" of nursing! This is especially true in a nursing home setting.

[hoope, RN]

It's different.. and i have also seen some nurses not doing things the way we study... Many many other things are different..

But the keep telling me that i will adjust and that i would be just like them ...

I don't think so ... i will things the way i studied .. and i still want to be a nurse with a heart not a Robot nurse.. !!!

[sistasoul]

When I was in school I only got part of the picture. Having 2 patients to assess, chart and give meds on is in no way even comparable to the real world of nursing. Clinicals are woefully inadequate to prepare a new nurse for all of our responsibilities. Throw in 5 patients, get report, meds, assessments, admits, discharges, calling MDs, dealing with family members, pharmacy, PT, radiology, labs, starting IV's, dealing with a new admits medication list that is incorrect, calling for meals because patient does not like what they are having, bed alarms going off, and lastly the charting that takes 25 percent of your time, etc, etc, etc......

I have talked to nurses who received their education through a hospital based diploma program and their clinical education was far superior to mine. These student nurses were functionong as nurses with a full assignment by the time they graduated. In my opinion nursing should still be taught this way.

[Forever Sunshine, ASN, RN]

When I was in school I only got part of the picture. Having 2 patients to assess, chart and give meds on is in no way even comparable to the real world of nursing. Clinicals are woefully inadequate to prepare a new nurse for all of our responsibilities. Throw in 5 patients, get report, meds, assessments, admits, discharges, calling MDs, dealing with family members, pharmacy, PT, radiology, labs, starting IV's, dealing with a new admits medication list that is incorrect, calling for meals because patient does not like what they are having, bed alarms going off, and lastly the charting that takes 25 percent of your time, etc, etc, etc......

I have talked to nurses who received their education through a hospital based diploma program and their clinical education was far superior to mine. These student nurses were functionong as nurses with a full assignment by the time they graduated. In my opinion nursing should still be taught this way.

The nursing program I went to only had 28 scheduled clinical days. The rest classroom. Out of 11 months of the program. Monday-Friday, September-July. Don't get me wrong it was great and my life and outlook on learning is forever changed for the better... but I truly wish there was more clinical experience of what an LPN does in the workplace. We did patient care and assessments.

Adjusting to the real nursing world was a struggle for me. I was not a CNA. Direct patient care was one of the things I learned on the job from either the nurses i work with, or the CNA's. I am still learning too.

[ImThatGuy, BSN, RN]

I know having done a few other things in life that this is true for all professions. They teach you to give you the basic skills you need to enter the work force and work. Sometimes you're closer to the reality of it and other times you're not. You just have to enter a program, such as nursing, and understand head on that what they're teaching isn't necessarily what you'll be doing.

The same was true of police academy and policing.

The same was true of paramedic school although the culture of that line of work exudes laid backness, lol, so we were taught mostly what we'd be doing and what we needed to pass the test. The filler was absent.

The same was true of teaching. Yep, I taught school my first year out of college. I hated managing all the little twerps, but I liked teaching. At any rate, that profession is farthest from reality when it comes to preparation.

In case you're wondering, the paramedic job was a weekend thing I did for a few years for a hobby and pocket money. The teaching was a trial career, and law enforcement is what I've devoted to.

[blueheaven]

When I was in school I only got part of the picture. Having 2 patients to assess, chart and give meds on is in no way even comparable to the real world of nursing. Clinicals are woefully inadequate to prepare a new nurse for all of our responsibilities. Throw in 5 patients, get report, meds, assessments, admits, discharges, calling MDs, dealing with family members, pharmacy, PT, radiology, labs, starting IV's, dealing with a new admits medication list that is incorrect, calling for meals because patient does not like what they are having, bed alarms going off, and lastly the charting that takes 25 percent of your time, etc, etc, etc......

I have talked to nurses who received their education through a hospital based diploma program and their clinical education was far superior to mine. These student nurses were functionong as nurses with a full assignment by the time they graduated. In my opinion nursing should still be taught this way.

In the diploma program I graduated from, not only did we do clinicals in all areas of the hospital (with progressive responsibilities) we DID community health nursing, psych, OB, geriatrics, clinics etc. I feel like I had a very well rounded education with experience in areas outside the hospital as well as with inpatients. You had time to determine over 3 years and the varying experiences which areas would possibly be a good fit (or not) after graduation.

Unfortunately we live in a different time now. Could get into a rant, but it would fall on deaf ears.

[PostOpPrincess, BSN, RN]

I worked in Education and kept my hand in bedside as well.

Major Disconnect? That's an understatement. It's A "Great Wall of China", a huge GULF..

People in Education....to be honest....yes, YOU.....(I've done both)...are

CLUELESS....

[coquifrog50]

I also feel the same way about the "real world" and nursing. I have been an LVN for 16 years and find that I like what I am doing but people are always wondering when I will go back to school. What you brought up here is another reason I won't go back. I would be a horrible student at this time because I have been out of the school scene for so long. I would have to re-adjust my thinking to basics and nursing school rules. My main focus in response to your message is to keep the patient safe and report anything out of range and infection control.

[indigonurse]

Most of it has to do with medicare, medicaid, & insurance reimbursement. A hospital has to prove that the pts. require a certain level of care before these entities will pay. Insurances are all about getting pts. to the lowest level of care as quickly as possible. Then there is the liability issue of proving that the pts. have all been assessed. Most of this stuff has to be done by an RN so this is taking nurses further and further away from the bedside. It is a logistical nightmare for a nurse to get out and do frequent rounds to assess residents when the majority of the time is sitting at a desk with a pen and paper reading and answering countless questions, developing care plans, leaving virtually no time to implement anything.

[dudette10, MSN, RN]

As a student who was a previous "guru" of process improvement at my former company, I am more and more disillusioned with the fragmentation of care and documentation required by the goverment for reimbursement.

I really want to go to Capitol Hill and strangle these idiots. There exists a legitimate problem, and they devise yet another form to "fix it." Why can't anyone look at it holistically? Albeit on a smaller scale, my work involved looking at the process from start to finish and overhauling the whole thing to make it more efficient.

This duct-tape approach to healthcare is killing us, figuratively and literally. The cost of healthcare in the US isn't elevated above other countries due to our technologies or our skill sets. It's due to the paper pushers who think a form to fill out will fix everything.

It's disgusting.