Feel like I'm not learning how to be a nurse

[NurseNurseNurseNurse]

Hi everyone! I am entering my 8th week of an accelerated nursing program, and I don't feel like I'm really learning how to be a nurse. I don't believe it's an issue with understanding the material, because I feel like I understand what I read and the topics that we're covering this term (patho, pharm, chronic care). But, I don't feel like I understand how this all incorporates into what it is to be a nurse, what you will be doing on the job, and how to compile all the information into actions.

For example, we have a simulation coming up in lab where we will be doing a focused assessment on a patient with diabetes. They haven't explained to us what to expect but it seems we will be taking a health history and doing assessments that are relevant to the patient. I tried my best to make list of all the assessments I think are necessary, and what findings would be indicative of diabetes, but I don't feel like I was really prepared to do that. It seems very ambiguous and like I'm just blindly trying to piece together what a proper assessment would be.

Is this normal? Did you ever feel like this? How do you decide what is important for a focused assessment? Is there a clear-cut way to approach this, or is it more up to your own decisions as nurse?

[Neo Soldier, BSN, RN]

I wondered that many times. Here's the truth: nursing school prepares you to pass the NCLEX. That's it! To be a real nurse you have to actually practice and overtime you develop your own style, you discover if you really were meant to be a nurse or if you made a huge mistake. Nursing school doesn't teach you how to deal with people, or how to have empathy. It doesn't teach you how to be passionate. You learn that on your own.

[NurseNurseNurseNurse]

Thanks for your reply! So in regard to focused assessments (and knowing what assessments need to be done in general) do you think this is something that you learned in school or after school while on the job?

[Neo Soldier, BSN, RN]

Thanks for your reply! So in regard to focused assessments (and knowing what assessments need to be done in general) do you think this is something that you learned in school or after school while on the job?

You learn how to do assessments in school. You need the basics before the job.

[Triddin]

It comes with time, but assessments is your most important tool as a nurse. When I first started, I did every assessment piece given to me on every patient and on my partner until I became more comfortable with being more selective. Being able to do the assessment is just the first piece of the puzzle. Knowing what to do with that information is the next part. I remember when I was in nursing school, a classmates patient had a sat of 78% on room air. Instead of doing any interventions or telling her nurse, she charged her findings. Needless to say, the instructor and the supervising Rn were not impressed

If you want, we can talk about what assssments you think would be important to do/ health history information to gather for this patient and why.

[NICU Guy, BSN, RN]

Nursing school builds upon itself. At week eight of sixty (15 mo. ABSN), you are just beginning to learn the basics. Have faith in the program tha by the end you will have enough base knowledge and skills to start as a fresh new grad in the hospital where the real training begins in your chosen specialty.

[Armygirl7]

Absolutely normal to feel that way! I remember my first semester of nursing school I was like, "What? This is nursing? I don't get it!"

I agree with Neo Soldier - you really learn how to "be a nurse" after you pass the NCLEX and get a job and practice nursing for about a year. It all clicks. School is teaching you how to not kill anyone so pay attention and follow directions!

Simulation is a wonderful tool - often it is not run very well but if your school has trained the facilitator or your professor well enough it should be just stressful enough to challenge you, and then the debrief after the sim is a real learning experience. Study up and be prepared for sim, but remember there's no such thing as getting it all correct in sim - that would be a bad sim! Sim is the time to make mistakes, to miss things, to miss clues etc. In the debrief you are reminded what is the standard of care, and you think about and learn how you might approach this scenario differently, or better, in real life. Getting upset over your "performance" in sim is a real waste of an amazing learning tool.

I got to do a 3 day SIM Debriefer Training at NYSIM center - highly recommend it to anyone who lives in NYC. It was a multi-disciplinary training, so we were nurses, pediatric oncologists, unit receptionists, emergency physicians, respiratory therapists, people from all over the healthcare system. The program was so well run by the facilitators (an MD and an RN) and we all learned so much. And it was reassuring to see that MDs missed things in the scenarios, no one is supposed to perform perfectly because that means there is nothing to learn! But the sim is not a trick, it is not trying to trick you, and a well designed scenario unfolds in ways that can really help prepare you for real world nursing. So keep an open mind about sim, and jump in ready to make mistakes and learn. Keep your sense of humor, don't attempt to be perfect.

I am an ER nurse so we do real world focused assessments all day.

For a diabetic I would want to know:

Any symptom/complaints today?

What's the current finger stick?

Which Type, Type 1 or Type 2 diabetes?

Who is your doctor?

What medications do you take?

How often do you check your bs?

How have your bs's been these last 6 months?

How do you feel you are managing your diabetes?

Are you struggling?

What's the hardest thing (for some it's the diet, for others it's the finger sticks, for others the medication regimen, expense, insurance hassles etc.)?

How's your skin? Any wounds? Any wounds not healing well? Especially your feet? Do you always wear good shoes, even slippers in the house?

Any other health problems?

Have you had a vision check up lately?

Any changes in vision?

Any urinary symptoms of concern?

Tell me about your diet?

Etc., etc., etc.

Also remember, always, trying not to kill anyone: even in sim wash your hands (or announce "I am washing my hands" if no real sink exists), and ask/confirm the pt name and DOB!, and take vital signs.

Utilize every minute of nursing school to practice. Becoming a nurse is like learning to play short stop: you have to practice, and then in real life when the ball is coming at you and runners are on 1st and 3rd you'll know exactly how you want to pivot and where to throw that ball!

Good luck!

[inthecosmos, BSN, MSN, RN, APRN]

You'll get there! Towards the end you'll know a bit more and feel better. You'll learn the foundation in school, the rest comes with experience and time.

[Oldmahubbard]

I would be much more worried if you felt like you understood everything perfectly!

[NurseNurseNurseNurse]

Thank you all so much for your responses, I'm really thankful that this community exists! It really makes me feel a lot more at ease knowing that I should approach sim more as a learning experience, and not a test that I need to pass. I also have almost all of the items that in thecosmos mentioned listed on my assessment list, so that is reassuring!

[NurseNurseNurseNurse]

Thank you all so much for your responses, I'm really thankful that this community exists! It really makes me feel a lot more at ease knowing that I should approach sim more as a learning experience, and not a test that I need to pass. I also have almost all of the items that in thecosmos mentioned listed on my assessment list, so that is reassuring!

[BAY AREA RN, BSN]

thats a normal way to feel, you want feel like a nurse til the end and then you might not feel completely like one. After you make it through a couple of semesters the info will start becoming a second language. You will start answering questions you didn't know you knew. Im in my third semester and don't feel like a nurse but during my clinicals this week i was placed with a nurse and she grilled me on meds, side effects, what to look for and why. Surprising i was able to answer all the questions and the nurse response was that i was really knowledgeable. surprised my self. One day it will all just be there. Don't worry theres a method to the madness. We were threw into our hospitals rotations after 4 weeks and that freaked me out because i felt i knew nothing. But the clinicals and simulations are hands on so it make info stick.