How exactly do you learn on the job?

[Bumashes, MSN, APRN, NP]

Hey, I'm about to graduate and take the NCLEX, and I find I have a question that I haven't quite got an exact answer for. I'm hoping y'all can help. Please?

My question is how exactly do you learn on the job about the different pt conditions and which nursing interventions to perform? Before you jump in, let me clarify. I don't mean how do you learn the skills, like starting IVs; obviously, someone has to personally teach/show you those for the most part. But as for knowing that, say for a sickle cell pt, you need to keep them hydrated, control pain, no extreme temps, check for jaundice, etc. How do you learn those nursing interventions? Did you just get a pt load and have to go look up on the internet and research? Do you have a handbook you use? A hospital computer program with diseases and their interventions? Did someone personally instruct you?

I understand that a little of all of these learning techniques will be used, but when you were a new grad with no experience, what was the most common way you were educated on these? I know school gave me a baseline of the most common conditions and their accompanying interventions, but I'm scared of all those diseases that I have yet to learn about. Anyway, thanks a lot for any input. I'm just getting antsy before graduation! :stone

[michellehb]

Well, hopefully when you begin your nursing career you will be assigned a preceptor. He or She will guide you. After that, when you're on your own, you should use the support of your peers and managers. All their experience put together should be a great resource. Then, you'll be on your way.

I'm not sure that happens to everyone. It's ideal. I have observed on the unit I am precepting at, that if you don't know a skill or have a question the nurses will help each other out.

Good luck!

[Daytonite, BSN, RN]

well, you are correct in that you will have learned the basic information about medical diseases and their treatment and nursing interventions in school. in general, the nursing interventions will be about the same. depending on where the individual doctors went to medical school, the medical orders may vary a bit. i know that since i have worked on both coasts of the country i saw a lot of differences in the treatments ordered for the same diseases by doctors. nursing care, however, really didn't change from place to place. you will learn how each place wants to do things their way--there will be the school way and xyz hospital's way. as long as a standard of care isn't being violated, the hospital's way wins out.

one of the reasons i suggest that new grads hire onto a unit that has a more regular population of patient types is because you get to see the same kinds of patients with the same diseases again and again and you get to really learn about those handful of diseases, their treatment and nursing care. you learn the routines because you are doing them over and over. practice makes perfect. and, it's easier to focus on, let's say, neuro, gyn or gi patients than just a general mix of all kinds of patients. this is only gonna happen in larger facilities where they can break down the units into specialties. i started out working on a neuro unit. we had stroke, head injury and postop brain surgery patients and that was it. we knew our neuro assessment better than any other unit in the place. saw every kind of seizure there is. i purchased a textbook of neurological nursing to help me out and read up on things all the time until i felt i knew them better. it was a great experience for a new nurse. i worked in one facility that had a 60-bed general medical unit. new grads came and went because it was hard for them to get acclimated to the constant parade of patients with all kinds of different diseases. they also had charge nurses that weren't helping and giving the grads the same patients on a continual basis. result: confused and stressed out newbies. what i'm saying is pick you first job carefully.

[sneakymom2011]

Daytonite, thank you for the response!

I'm only in my 1st semester of nursing school. I'm not really happy at how we're being taught. It's in 8 week chunks, and I feel as if there's a lot of stuff that's just not being taught due to lack of time.Or the information's being thrown at us fast and furious, and half the time I'm just studying the stuff I need to pass the next test. And that worries me about getting a job and being able to be the best nurse I can be.

But I like the idea of going onto a unit where you see the same types of pts every day.

I will remember this information when I graduate next December.

[KaroSnowQueen, RN]

As the previous poster said, practice makes perfect.

When you get on the floor, ask questions. When you have time, look at the care plans, look up patient conditions in a book or on the net. And if you work on a unit that has x number of a certain condition, then you will see it over and over and learn it that way.:typing

If a patient has a test ordered in that lovely acronym language (ERCP, or HIDA scan), ask another nurse, or call the lab or radiology and say what is this, do I need to do anything special, etc.

The best part for me, of working in a hospital is that I learned something new all the time. A new disease or condition, new tests, new procedures, something always popping up and having to find out about it. And I have been a nurse for many years and love finding out about new stuff!!!:heartbeat

[Chaya, ASN, RN]

I never really learned until I was working on the floor and got to see my pts day after day. I got to see them long enough to follow up the effects of meds and treatments and really learn how effective our interventions were (or were not).

I got to see the difference IV Lasix could make in 12-24 hours; less edema, less SOB and better lung sounds, less anxiety.

I got to see what is normal wound drainage and how it decreases over time at the site of hip surgery; also what it should look like and smell like and how to know when the pt is having an abnormal amount of pain.

I learned what to do first (then next, then next after that) when my pt has chest pain. And how to interpret my findings to further direct my assessment, and which info the MD is going to require immediately when I call him/her. And not to wait too late to delegate any short-term pt care to other RN's. And which ones I need to move the Code Cart to outside the door right away, just in case. And not to panic!