How did she/he get through nursing school?

RNperdiem, RN · Jun 9, 2018

What leads to failure in the workplace is not really just ignorance by itself. Nursing school cannot teach everything. I float to a different department and wonder how I ever passed nursing school too.

Being unteachable and unlikeable will get a nurse into bigger trouble. The nurses I consider the superstars, combine a deep and thorough clinical knowledge with a willingness to share what they know, and have top-notch social skills. They are confident and humble.

broughden · Jun 9, 2018

Something tells me that potential capacities of many people around us, including our nursing colleagues, are much higher than we can predict. They just not get used. If a person is able to discuss for hours the minorest things about college football or golf or guns, then there are no problems about intellect or memory.

I know there are those who claim IQ tests as being biased on along racial or socio-economic lines, but even if the tests are biased that doesnt rule out over all differences in the capability of intelligence across the entire human population.

Just like other genotypic differences, intelligence falls on a curve. Not everyone can grow up to be 7' tall no matter how well they are nutritionally supported in childhood, similarly not everyone can develop a 140+ IQ. Not everyone's maximum achievable "best" will be at the same level.

Guest219794 · Jun 10, 2018

The difference is you did not become a dancer. The nurse in OPs case did become a nurse and HAS to have the aptitude to be one. So if patients are at risk, it MUST be brought to the attention of management.
Let's say the nurse is in ED. Comes off dumb as rocks. Maybe the ED isn't a good fit for her at this time. Maybe that nurse would Excel on another unit. Management needs to know.

Let's say the nurse is in ED. She is.

Comes off dumb as rocks. She does.

Maybe the ED isn't a good fit for her at this time. It isn't.

Maybe that nurse would Excel on another unit. She won't.

Management needs to know. They do.

Wuzzie · Jun 10, 2018

I got a panic call yesterday from a nurse. Patient was started on dialysis recently and was prescribed colchicine (highly nephtotoxic drug). Nurse was wondering if it should be held.
"Now, just think" - I said - "why should we care about the kidneys now, when the patient already is on HD?"
It took for the nurse full 30 sec and then some cues to realize what it was about.

But at least she asked!!! She had a patient on dialysis prescribed a nephro-toxic drug. She called to clarify if this was okay. It is not within our scope to make that determination. Now panicking was over the top of course but she at least had the sense to know about the med she was giving and its risks. And she asked. It's the ones who don't ask who are the problem. The ones who forge ahead and do things without thinking or reason or rationale. And these are the ones who are usually the least teachable because they believe they are The Best Nurse Ever!

Orion81RN · Jun 10, 2018

People don't know how to accept negative feedback gracefully. It would be wonderful if there was a class in nursing school about how to give and receive feedback!

That is a very good idea. Especially considering that we enter into a career that is a lifelong learning process. I think we should be taught how to both receive constructive criticism and give it (bc much of the time the recipient takes it as bullying and NETY.) I Wish all of us would be more open to others ideas regardless of how long one has been a nurse. Drop the ego and just learn where you can, ya know? Even if it's from a new grad.

Orion81RN · Jun 10, 2018

Let's say the nurse is in ED. She is.
Comes off dumb as rocks. She does.
Maybe the ED isn't a good fit for her at this time. It isn't.
Maybe that nurse would Excel on another unit. She won't.
Management needs to know. They do.

Ok, sure. In your hypothetical situation, the nurse should get another career. In my hypothetical situation, the nurse has the basic knowledge to still be a nurse, but needs to find a specialty suitable for her at this point in her career. Sheesh.

KatieMI, BSN, MSN, RN · Jun 10, 2018

But at least she asked!!! She had a patient on dialysis prescribed a nephro-toxic drug. She called to clarify if this was okay. It is not within our scope to make that determination. Now panicking was over the top of course but she at least had the sense to know about the med she was giving and its risks. And she asked. It's the ones who don't ask who are the problem. The ones forge ahead and do things without thinking or reason or rationale. And these are the ones who are usually the least teachable because they believe they are The Best Nurse Ever!

IMHO, it was well within the RN/BSN scope of practice to make a conclusion that nephrotoxicity stops being a factor once renal function per se is signed off the board. Even if the nurse is not working in HD, it is just plain logical, at least for me. That's why nurses have to study pharma. That's what that pharm book gathering dust near Pixes is for. It just would take a little time to think. But why do that if there is a convenient way to get someone on the phone and declare that "iamonlydoingmyjob, iamjustconcernedaboutSAFETY!!!!"

If determining that, for the same HD patient, dosing of vanco q12h would quite possibly be wrong and calling for clarification would be entirely appropriate for an RN, why the exact the same action with opposite outcome (determining that the drug was safe because the patient is now on HD and therefore NOT calling) would be somehow inappropriate? Only because vanco is used all the time and colchicine is not?

The only one explanation I see is that, despite of doing years of college, hard science and etc., nurses are still not expected to use their knowledge outside of pretty narrow box they are put into by their employers. The box can be more or less narrow, but it is still there, and if a nurse even thinks about looking out of it, he/she is immediately perceived as being "unsafe", "not wishing to learn", "that know it all" and all other mortal sins. The one expected result of it, though, is that nurses who tend to think outside of the box (and therefore can be invaluable asset for their peers) avoid the said peers and bedside nursing altogether. They run - to profile units, to grad schools, to where ever - leaving behind those who are predictable, reliable, rule-obedient and "safe" - till an emergency strucks some very fragile, very sick, very liability-prone patient.

Unfortunately, here is the fact about modern US nursing: the system is more forgiving to bottom 10% of nurses than it is to top 10%. It presses its own cream out.

TruvyNurse · Jun 10, 2018

Yes I've encountered a few nurses that I've questioned how the heck they got LPN or RN behind their name. Nursing itself has a way of eventually weeding these people out. They either cant keep a job from being incompetent or they lose their licenses. There is a 3rd option which is the best case scenario..they LEARN. They get some experience and essentially learn what they should have learned on the job and become great nurses.

Wuzzie · Jun 10, 2018

The only one explanation I see is that, despite of doing years of college, hard science and etc., nurses are still not expected to use their knowledge outside of pretty narrow box they are put into by their employers. The box can be more or less narrow, but it is still there, and if a nurse even thinks about looking out of it, he/she is immediately perceived as being "unsafe", "not wishing to learn", "that know it all" and all other mortal sins. The one expected result of it, though, is that nurses who tend to think outside of the box (and therefore can be invaluable asset for their peers) avoid the said peers and bedside nursing altogether. They run - to profile units, to grad schools, to where ever - leaving behind those who are predictable, reliable, rule-obedient and "safe" - till an emergency strucks some very fragile, very sick, very liability-prone patient.

But how is this the nurse's fault? Or any nurses fault. And how does that automatically make them stupid, overactive and lazy as implied in your first paragraph (that I opted not to copy here). We HAVE been pressed into a narrow box and we are FORCED to stay there. We have no other choice if we want to stay employed. We have our place and the PTB make sure we know it. Step one foot out of it and they will come down on us...hard. Most of us can't take that risk so we dutifully call somebody a few pay grades above us and ask questions that we already know the answers to just to cover our butts. I'm in the middle of a situation like this right now. A couple of rapid response nurses are all butt-hurt about me because by the time they arrived to assist me with a patient in my clinic we had everything done and all they needed to do was transport the patient to the ED. Did I need them really? No. But it's the process I must follow and now I'm in trouble because egos got offended...because I provided excellent, intelligent and timely patient care instead of standing around wringing my hands about what I should do.

KatieMI, BSN, MSN, RN · Jun 10, 2018

But how is this the nurse's fault? Or any nurses fault. And how does that automatically make them stupid, overactive and lazy as implied in your first paragraph (that I opted not to copy here). We HAVE been pressed into a narrow box and we are FORCED to stay there. We have no other choice if we want to stay employed. We have our place and the PTB make sure we know it. Step one foot out of it and they will come down on us...hard. Most of us can't take that risk so we dutifully call somebody a few pay grades above us and ask questions that we already know the answers to just to cover our butts. I'm in the middle of a situation like this right now. A couple of rapid response nurses are all butt-hurt about me because by the time they arrived to assist me with a patient in my clinic we had everything done and all they needed to do was transport the patient to the ED. Did I need them really? No. But it's the process I must follow and now I'm in trouble because egos got offended...because I provided excellent, intelligent and timely patient care instead of standing around wringing my hands about what I should do.

First, I would kindly ask you to please abstain from putting your own words into my mouth. "Not thinking" is not equivalent of "stupid".

Second, nobody held me and thousands of others into that box. Nobody is holding you, or anybody else. It is entirely up to YOU and your peers. You alone is pretty powerless, that's true, but if the majority of nurses refuse to follow another stupid policy AND find way to cooperate with the Powers, it will go down one day or another. Try it - it works marvels!

Third, I am sorry for that RR business, but now you know how I was feeling for my entire first year. If the place where you are doesn't value you for what you are, you have a choice to find a better one.

Orion81RN · Jun 10, 2018

The problem is that sense of rhythm, grace and turnout can be developed only to the point. One has to be born with slight dysplasia of hip joints in order to have good degree of turnout later in life. Some people even seem to crawl gracefully, some are not and there is not much to be done about it.
Unlike the above, logic, analytical thinking and knowledge base can be totally and fully developed, and in pretty much any age. But people just refuse to do it. They refuse to use their own brains.
I got a panic call yesterday from a nurse. Patient was started on dialysis recently and was prescribed colchicine (highly nephtotoxic drug). Nurse was wondering if it should be held.
"Now, just think" - I said - "why should we care about the kidneys now, when the patient already is on HD?"
It took for the nurse full 30 sec and then some cues to realize what it was about.
It was, for me, a common logic. Kidneys are already out of the game as far as we are concerned. Even if the drug kills half of the remaining 5% of function, it doesn't matter from now on - HD is on board. And patient had acute gout, which is VERY painful. I did not need renal dose table, HD filtration dosing table or even advanced knowledge of HD to make this decision, which took me a split second. But for the nurse it seemed to be a significant effort to understand this basic connection. Everything the nurse knew was 1) patient is in renal failure, and 2) drug is bad for kidneys. The nurse just couldn't insert one more dot between the two and connect them all with straight line.
This nurse passed school, NCLEX and everything else and was very successful in a place where I was abused into stress-related cardiomyopathy.

I can see myself making that phone call. I would certainly feel dumb afterward bc it is so obvious. It's a duh moment I would just laugh about. It doesn't mean I don't fully understand the pathophysiology, pharmacology and HD process. Now, if concepts are often missed by the nurse and not just a single "duh moment" then there is a problem.

Wuzzie · Jun 10, 2018

First, I would kindly ask you to please abstain from putting your own words into my mouth. "Not thinking" is not equivalent of "stupid".
Second, nobody held me and thousands of others into that box. Nobody is holding you, or anybody else. It is entirely up to YOU and your peers. You alone is pretty powerless, that's true, but if the majority of nurses refuse to follow another stupid policy AND find way to cooperate with the Powers, it will go down one day or another. Try it - it works marvels!
Third, I am sorry for that RR business, but now you know how I was feeling for my entire first year. If the place where you are doesn't value you for what you are, you have a choice to find a better one.

It was not my intent to put words in your mouth but the overall picture you were painting was not particularly respectful of this nurse especially when you pointed out that it took her longer than 30 seconds to make the connection.

And I am absolutely being held in that box as are all the rest of us who need our jobs and just want to do them. And please don't assume that we haven't tried but we get nowhere. It's very easy for you to say find another place to work but I have retirement to consider and bills to pay so it's just isn't that easy. I may be wrong but I believe I've been doing this a fair bit longer than a lot of people here, perhaps you, so this isn't my first or even third job. It's the same everywhere. Nurses may be the most respected career in the public's view but among our medical colleagues...not so much and I say that as a nurse who actually is respected for my knowledge and expertise who still has to follow the rules. Even the stupid ones.