How do I become stronger clinically?

  1. I work on a surgical floor (with occasional medical patients), for a bout 2.5 years now and there are many colleagues on my floor whom I admire very much. They seem to know so much about everything, able to talk to physicians, PA's, NP's on their level about possible causes for a patients symptoms, possible treatments. They know what s/s to look out for so many conditions patients come in with. They know medications seemingly inside and out.

    I don't at all feel inadequate at my job and I feel like I provide safe and competent care to my patients. But some of my colleagues are on a whole other level, it's like they are former ICU nurses that are now working on the surgical floor.

    How do I become like that? Are there any resources you guys recommend I study? I'm sure experience has a lot to do with it since they have seen so much over the years (they have been nurses for a while), but I don't want to be passive about my improvement as a clinician. How should I go about improving and learning?
  2. Visit alexamasan profile page

    About alexamasan, BSN, RN

    Joined: May '13; Posts: 21; Likes: 15
    from VA , US
    Specialty: Med-Surg

    18 Comments

  3. by   nursej22
    This will depend how you prefer to learn. Does your facility have a learning and development department? They may have some resources for you. I would recommend going to any in-services you can. Look for courses to prepare you for Medical/Surgical Nurse certification, or there are books.

    You can sign-up for Medscape for free, and they have basic info on various medical conditions.

    I would narrow in on topics that come up the most frequently to start with. Probably renal and liver issues, sepsis, acid/base balance.
  4. by   KatieMI
    Free Medscape

    Emedicine.

    Uptodate, if your facility has it for free.

    Even good 'ol Wiki, for the beginning.

    Read about every. single. thing you do not understand or want to know more. Key is persistence. The day you learned nothing, you did not live.

    Do your physical assessments the way they supposed to be done (yes, I know, you do not have time. Find it. And do it with no gloves)

    Access. Access. Access!

    Bug your education department - sometimes they offer classes, meets, free access to online lectures of nursing societies. If they have such things, use them.

    If you find someone who loves to teach, do whatever for this person.

    If you really want serious knowledge, get the "major set"(normal physiology, pathophys, pharma, micro - this order) Lange books for med schools. If you buy used, they do not cost that much. And they are not impossible to understand.

    It takes time and patience. But the results worth every moment of them. When you stand there and just ******* know what is going on, and what to do, and what to expect. You. Just. Know.
  5. by   CalicoKitty
    I kinda pick something I'm interested in an sorta run with it. I do med-surg, but I like wounds, so studied that for a bit. Many of my patients were on telemetry (not a telemetry unit), and I became more interested in reading the tele strips 'better'. I took some online training modules through work, and even an in-class course or two for EKG reading, etc. Lots of focused stuff has a pretty huge learning curve. Once you start to delve into it, you get an idea of how much you really don't know.

    I'd pick something you already like or are 'naturally' good at, and go from there. Because awesome at hearing/finding murmurs. Excellent trach care. Be the person people run to when they need a PIV.

    There are the online places like Medscape. You can youtube lots of videos if you want tips on techniques. Your hospital probably has online courses to learn, and likely has others you can choose from (some of mine are even CEU offerings). Maybe there are in-services or other classes at work you can take. Go to a conference in something you're interested in (may cost a little money, maybe work would pay for it, but you can also get a lot of CEUs).

    You may never be great at everything, you may always kinda suck at some things. But, you can pick up knowledge and skills, then add to it. It's continuing education.
  6. by   Davey Do
    Good advice all around.

    I sense a feeling of the inability to integrate your skills and personality into the role of the competent nurse who you are, alexamason.

    Eat, drink, sleep, and play your specialty. Emulate a competent coworker. Practice being the nurse you want to be. Fake it 'til you make it.

    It may feel awkward at first, but take an eclectic approach. Glean the good stuff.

    Case in point: Years ago, I read an H&P by a physician that sounded like he was talking to me- it wasn't all textbook jargon, although there was plenty of it. The physician referred to the patient by name and the report ran like a story.

    I loved that physician's style and set out to document in a like manner. When I worked Med Surge, the DON said, "I can tell from your progress notes you've had a lot of psych experience because your notes are filled with good information but sound so personal".

    Mission accomplished.

    As far as relating with patients and other professions, I tend to integrate my personality into my professional self. I can be extremely knowledgeable and techy-sounding, but can also be personable and inquisitive. Professionals and patients tend to enjoy bantering, discussing options, and sharing their knowledge and/or perspective. This tact seems to be symbiotic and builds good rapport.

    I find your endeavor to seek knowledge and viewpoints to build on your professional self admirable, aleaxamason. Good luck to you!
  7. by   HelloWish
    I am still at the beginning of my nursing career, as I have been a nurse for 2.5 years now. However, I work in a critical care role and find my knowledge base growing. Any patient I take care of with a condition I am not thoroughly familiar with, I go home and read about it or watch youtube videos. It helps to understand the bigger picture, what and why the doctor is doing what they do and to educate future patients. I also read about the medications. Patient's ask me a lot questions now because I can answer them and they appreciate it! Often times patient's will tell me I explain more to them than their physician. I also try to round with the doctors because when they explain what's going on I listen and learn and can rephrase it in a way the patient will understand or explain to family later on.
  8. by   Neats
    Growing into a more competent professional takes dedication and time. I applaud you for being concerned and wanting to better your professional career. One of my fears is becoming stagnant. I often picture that pound in the middle of summer with the haze of growth on top, starting to dry up, smelling like the trash needs to be removed to the curb side....you get my point.

    It is easy to learn about things you are interested in, you could easily become Subject Matter Expert and have others come to you for advice. Find what interests you and develop yourself, learn all abut this and when discussing it communicate in a manner like they do not know anything, that this is the first they have heard of it. If you can explain it in layman's terms in two different ways i.e. two different scenarios then you know the material. I do this with hypertension to my patients. I have a mid level discussion to see where they are knowing about the disease (I ask the patient, educate the patient, use journal studies about hypertension). I also have a lower level discussion that includes a garden hose (I am tactile and visual). Most everyone gets the garden hose scenario and hypertension, although I advocate medication my focus is much more an the patient lifestyle.

    I guess what I am trying to say is this you have to really know the material inside and out. Watching UTube videos, reading journals, practicing on a doll, a piece of fruit (injectable) or manikin is very helpful. In your work environment you should have training materials and some sort of lab or access to a lab. If you are alumni to a local college you can go into their labs too with permission. Red Cross is a good environment to learn. When I wanted to get real good at lab draws I asked my nursing instructor Sister Mary Margaret if I could be paired up with a phlebotomist, she allowed me to do this because this is how I learn-hands on and lots of repetition for some things.
  9. by   JadedCPN
    Never be afraid to ask questions. And never be okay with not knowing. I have found that these 2 simple things are a great start to not only increasing your knowledge base but increasing your confidence as well.

    12 years later and I still have no problems asking a physician to explain something to me if I don't understand the reasoning behind what was ordered or the disease process. 9 out of 10 times they are more than willing to educate anyone.

    In terms of being okay with not knowing, I mean that you should always take it upon yourself to figure out the answer instead of just accepting that you don't know an answer. Whether that means asking someone, looking it up, Googling, etc.
  10. by   Ruby Vee
    Quote from alexamasan
    I work on a surgical floor (with occasional medical patients), for a bout 2.5 years now and there are many colleagues on my floor whom I admire very much. They seem to know so much about everything, able to talk to physicians, PA's, NP's on their level about possible causes for a patients symptoms, possible treatments. They know what s/s to look out for so many conditions patients come in with. They know medications seemingly inside and out.

    I don't at all feel inadequate at my job and I feel like I provide safe and competent care to my patients. But some of my colleagues are on a whole other level, it's like they are former ICU nurses that are now working on the surgical floor.

    How do I become like that? Are there any resources you guys recommend I study? I'm sure experience has a lot to do with it since they have seen so much over the years (they have been nurses for a while), but I don't want to be passive about my improvement as a clinician. How should I go about improving and learning?
    At two and a half years in, you're just becoming competent. (It takes about two years, although I cannot recall, at this precise moment, the name of the genius who wrote that.) So if you are providing safe and competent care to your patients, you're about where you should be.

    Now, I'm all about learning and improving, and there are many ways to go about that. Books, You-Tube videos, journal articles, Medscape . . . all kinds of things. But the simplest, easiest and most basic thing is to make it a point to know your patients inside and out. A surgical floor is busy -- I get that. So every shift, pick out one patient. Know them inside and out -- admitting diagnosis, comorbidities, lab values and test results, meds -- everything. Read the doctor's notes, both the admitting physician and any specialist's notes. They won't make a whole lot of sense at first, but as you keep working on it, you'll gain a window of insight into the doctor's thinking. If your perusal of the patient's chart leads to questions, write them down and look them up. Or ask the physician on rounds. Don't have rounds? Ask a resident to explain it to you -- residents love to teach because it consolidates the knowledge in their own heads AND they get to know something that you don't. Win/win. Write down questions to look up at home after your shift or on your day off. (I know, I know -- homework is "YUK!" But if you really want to get good, it's necessary.) If you still don't understand why something works the way it does, or why it doesn't work the way it's supposed to in THIS patient, pick brains until you do understand it. Gradually, you'll get a reputation for being someone who wants to know more, and physicians will start taking the time to teach you. Ask to watch a surgery -- you will learn tons. As you learn more, you'll find yourself doing all of this automatically with all of your patients. That's when you'll become the whiz and everyone will want to pick YOUR brain!
  11. by   JadedCPN
    Ruby Vee made a good point about watching surgeries - I was on a surgical floor for 7 years that did a lot of complicated pediatric surgeries like spinal fusions and bladder augmentations. When we started taking spinal fusion patients, we all had to watch a video of the OR procedure during our education. Even just watching the video gave a more real, visceral understanding of how intense and extensive that surgery which lead to a better understanding of post op needs and pain control.
  12. by   Workitinurfava
    Is there someone that can mentor you on your floor?
  13. by   murseman24
    There are plenty of good nursing books to expand your knowledge. I had one on EKGs, one comprehensive critical care book, one on general pharmacology, and one on cardiac that I would read parts of which interested me. If you're looking into EKGs, Dale Dubin's "Rapid Interpretation of EKGs" is golden and an easy read.
  14. by   ~♪♫ in my ♥~
    Use the resources that the physicians used when they were learning...

    Harrison's is a great place to start.

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