Big difference between last day as student and first day as RN?

[zaggar]

I have 2 years to go before I see the day I'm an RN, so after reading several threads I have a question. What makes that first day as an RN so different from the day before?

I'm assuming most people work as a patient tech or nurse extern while going to school. Some posts make it sound like they never saw it coming; like nursing work was more difficult, stressful or depressing than they ever anticipated, and that they never discovered this until after graduation.

[Can't Wait]

I'm a fairly new nurse, graduated in Dec. 06 and started on Med/Surg in Feb. I had patient experience before going into nursing school. It really doesn't matter. Your first job as an RN is so different because you are entirely responsible for a full patient load. You are interacting with the entire health care team, and your taking orders, clarifying orders, admitting, discharging, preparing for surgery, getting consents signed, and making decisions for the patients that you never made in nursing school. The list goes on. I don't know about everyone else, but in my nursing program, we left half way through the day, we didn't make decisons for our patients, the nurse did! And we always had our instructor near by. Sure, there are resources on the floor to ask questions, but everyone is busy, and often times, decisions need to be made right away. Eventually, you settle in and start becoming comfortable, but the first few months are scary and overwhelming, and even long time nurses have those type of days. This is why its such a big step from nursing school to RN. Its really just a huge adjustment, but like anything else in life, you work through it.

[Mommy TeleRN, RN]

My first night off orientation I had 8 pts two were vents!

[Mommy TeleRN, RN]

In nursing school I swear you spend half the time searching for your teacher to do just about anything to the patient. Then 90% of that time she was too busy to watch you do your skill so you had to have the nurse do it. Then if your patient had some kind of change your job was to tell the nurse (and notify your instructor who just said "did you tell the nurse?") Then the nurse would take action or call the doc, etc. I kept thinking "umm what about when I'M the nurse?"

As a student you do not do admits or discharges (I learned to do those at my extern job)

Also at least for me... as a student I felt like I mostly did CNA work and pass meds. As a grad nurse on the floor I am we are well staffed with CNAs and I get to focus on nursing duties. I also get to do an entire 12 hr shift where things have a better flow. At school we had a max 8 hr day and one hour of that was lunch and nothing really flowed right. I always just feel really disoriented at clinical. So far I'm liking my job way better. I will like it even more when I pass boards and am allowed to do everything I need to (with some guidance of course) Right now my facility pretty much only allows me to assess. I pull meds and make sure everything is given etc but the nurse still has to give them.

I'm working nights so I'm NOT looking forward to starting the call the doctor thing lol... that is something I never did as a student.

Also it's weird because at clinical we had to do ALL this paperwork the night before and we knew all about our pt the day before. The last 2 clinicals we got our pt info on the fly like in the real world and I felt SO lost. At work it's the same way yet it feels ok. Maybe it has to do with the more familiar disease processes (I have mostly CHF pt whereas in clinical it changed with every rotation...OMG the pulmonary rotation ick ick ick) and I also like the charting better at my facility so I can easily find the info I need (most of it is on the computer) At clinical it was all paper charting and I didn't have any access to computer info like lab results, so I felt LOST esp if my pt left the floor and the chart went with them.

So in summary (sorry I have insomnia..my night off lol) I like the real thing way better thus far!