From a student - how much of what we learn is really done?

Nurses General Nursing

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I'm a brand new nursing student, just starting week 6, and I'm in a bit of shock with the information we're learning . . . WAY different than what I expected. I had never heard of nursing diagnosis, for example. I have also never had or seen a nurse do a thorough assessment like they're teaching us to do, in my life that's what the doctors do.

My feeling (and please confirm or deny!) is that this is what I need to learn to pass the exams, and the real world nursing is not like this! Maybe I'm wrong, my only real experience with nursing is the nurses at the doctors offices, who basically take vital signs, weight, height etc. and maybe give injections, and a few times when my kids were in the hospital. But I don't get the whole nursing diagnosis thing . . . I mean, why diagnose someone as "impaired respiratory status" or something when you KNOW they have pnuemonia and just need antibiotics and maybe a nebulizer? I don't get it.

So am I right or am I wrong? Is my school teaching us the way things really are or not?

Thanks for any info!

Kelly

Specializes in PeriOp, ICU, PICU, NICU.

Daytonite, WOW!! Awesome explanation-what a brilliant mind!

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Specializes in Med-Surg/Peds/O.R./Legal/cardiology.

Daytonite, I think you pretty much got that subject covered! HaHa! GOOD JOB!!! ( I don't remember when I weighed pts. or just did vitals last!)

ebear ;)

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Specializes in Post Anesthesia.
I.... I had never heard of nursing diagnosis, for example. I have also never had or seen a nurse do a thorough assessment like they're teaching us to do, in my life that's what the doctors do.

My feeling (and please confirm or deny!) is that this is what I need to learn to pass the exams, and the real world nursing is not like this! Maybe I'm wrong, my only real experience with nursing is the nurses at the doctors offices, who basically take vital signs, weight, height etc. and maybe give injections, and a few times when my kids were in the hospital. But I don't get the whole nursing diagnosis thing . . . I mean, why diagnose someone as "impaired respiratory status" or something when you KNOW they have pnuemonia and just need antibiotics and maybe a nebulizer? I don't get it.

So am I right or am I wrong? Is my school teaching us the way things really are or not?

Thanks for any info!

Kelly

You are right and wrong. You will have to learn a lot of impractical ways of doing things to pass both your exams and State Board. For most of us "nursing diagnosis" is an anachronism of out student days {I loved 'spiritual distress-distress of the human spirit'}-? as opposed to distress of some other spirit inhabiting your patient!? Nursing dx are a way of seeing the nurses role independent of other providers of health care. In practice all our roles are interdependent but you have to learn what "nursing" means in order to define your role in the scope of patient care. Assessment is the cornerstone of much of my care as a nurse. You may not do a full H&P on every patient but my system focused assessment is as good as any docs' I know- better than most. The better your assessment skills the better nurse you will be. You are the other practioners (doctors, respiratory, pt/ot, nutrition..)eyes and ears on the patient 24/7. What you miss they may miss until it becomes a crisis.

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I'm trying to keep an open mind as I'm going through. Our instructors have been very open about learning the "NCLEX" hospital ways of doing things, and some of our LPN students are having a hard time b/c alot of what they have witnessed is not proper procedure and they are applying that knowledge on exams instead of reading.

One of our instructors is very, very huge on staying sterile/clean. She tells us that incidents of patients aquiring infections NOT related to their original admission criteria has been increasing in recent years instead of decreasing...and that is because she said that nurses are not practicing basic sanitation...they are forgetting.

She also said if you ran into any "old school" nurses, they are rarely sick...while there are other nurses that stay sick...again, she blames it on sanitation practices.

Last week I went to the doctor's office for a blood draw and the RN walked in, wearing clean gloves, and I stood there and watched her touch the door knob, carrying the computer (for charting), pick up a pen that was laying in the room to write something down, and other things in the room...ALL while wearing gloves...and then proceeded to take blood out of my arm...I actually had to ask her if she wouldn't mind changing gloves before she touched me.

Sorry, that's just nasty.

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Specializes in Med/surg,Tele,PACU,ER,ICU,LTAC,HH,Neuro.

I had to write tons of care plans back in 1981 to graduate. For the first 8 years of practice, actual nursing units didn't write out the care plan. It was a thought process that develops over time with nursing judgments. When they made us start writing them out so they could have a documented proof for quality assurance purposes, it wasn't hard, it was time consuming though.(Thank goodness for computer generated care plans).

I spend up to an hour assessing a new admit, but about five minutes on a resident I have taken report on for the shift. The admitting assessment is crucial to building a therapeutic and healing relationship and there really are no short cuts that might not come back to haunt you.

I had to go to litigation because in one admitting assessment, the client said " I can't wait to get this hernia surgery done, the pain is so bad." I wrote it down just like that.

Come to find out in one hour we are coding her for a ruptured abdominal aortic aneurysm the ER doctor didn't know was part of her history.

The patient had told her family doctor she didn't want to have surgical repair of the aneurysm so he monitored and documented it's it's growth for eight years.

They are cramming you with a lot of information that may not seem significant.

Like emptying a box with 5000 pieces of jigsaw puzzle onto your desk and you don't see the whole picture yet.

In a few years of practice it will all make sense and you will wish you had gotten to learn more.

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Specializes in Med-Surg, Trauma, Ortho, Neuro, Cardiac.
Daytonite, WOW!! Awesome explanation-what a brilliant mind!

Agree, I'm humbled and should have read her response before posting my tidbit of an answer. :lol2:

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Specializes in Emergency & Trauma/Adult ICU.
Last week I went to the doctor's office for a blood draw and the RN walked in, wearing clean gloves, and I stood there and watched her touch the door knob, carrying the computer (for charting), pick up a pen that was laying in the room to write something down, and other things in the room...ALL while wearing gloves...and then proceeded to take blood out of my arm...I actually had to ask her if she wouldn't mind changing gloves before she touched me.

Sorry, that's just nasty.

Keep in mind, a blood draw is not a sterile procedure - the gloves are worn not for sterility but as part of universal precautions because there is the potential for exposure to bodily fluids during the procedure. Your skin touched other things in the room before, during & after the blood draw.

The majority of things you'll wear gloves for are not sterile procedures - just the universal precautions barrier between you & the patient when there is the potential for exposure.

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Specializes in Peds Critical Care, Dialysis, General.

Daytonite:

Your answer/analogy was the BEST explanation every of the nursing process. Copyright that! Nothing to add to that!!!:pumpiron:

Hope you are doing well - always look forward to your posts/wisdom!

Cindy, RN

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Great post and great answers! Thank you! :D I'm not in nursing school yet, but hopefully will be soon, and I'm sure this will help everything make more sense. :)

Tiffany

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When I was a CNA, I thought nursing would just be taking on a different set of tasks. Care plans help you learn an entirely different way of thinking. As a nurse, I do assess, plan, implement care. This was a new way of thinking.

As an aide, I approached my work as a series of tasks to get done. I had a checklist- vital signs, meal trays, baths etc. A good day meant all my tasks got done well. There was no thought of moving a patient's progress forward.

The big change was the switch from the checklist to a problem solving(and preventing problems) approach.

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