How to maintain knowledge?

I graduated with my BSN 19 months ago. I work on a busy Med-Surg, Tele, and Ortho ward. I have around 120 hours of CEUs since I graduated, from ACLS, PALS, TNCC, EKG classes, inservices, etc....yet I feel that I am loosing much of my nursing knowledge. I remember being told by a nursing instructor that when you take the NCLEX is when you have the greatest amount of nursing knowledge (book knowledge, obviously not skill knowledge). I now feel that is true. When I float to work in the ED, pts there really give my brain a challenge.

Obviously as nurses we can not work *everywhere* to maintain knowledge in all areas, so we must suppliment it somehow. I also can not change the area that I work in (military)- so what CAN I do to keep up with everything? I eventually want to go into ICU (specifically trauma/neuro)- so how do I keep from loosing what I have? Am I just not challenged enough?

I would love to start my MSN, but because of my current job I can not for a while. Any suggestions on what else I can do? Book suggestions? I will soon have LOTS of time to read.

There is no way to be able to keep up each of the skills you have learned if you are not using them. I have been an LPN for one year working in a hospital clinic. I have also taken continuing education classes in order to basically summarize what I need to do to work in certain areas. I know that you are a BSN graduate, but there is a book that has been suggested for nursing refresher courses called Foundations and Adult Nursing by Christensen and Kockrow. It is geared more towards LPN, I admit, but this book includes all phases of nursing from fundementals to med-surg, peds, OB, and psych. It includes a CD ROM on breath and lung sounds, etc.... Many have found this to be a great book to have in their libraries to include basic things. I wasn't trying to give a nurse that has a higher license a simple book, but maybe the summary of things written simply can refresh your memory. In fact, you may be adding words to what you are reading based on what you have learned from your own program. In terms of the other stuff, nursing journals such as Nursing2007, Nursing Spectrum, Incredibly Easy and Advance Magazine for RNs may be of assistance to you. And, with taking the continuing education courses, keep the material neat and tidy, in case you need it again.

Also, be forgiving to yourself. Most nurses master where they work the most. We will forget how to use the fetal monitor, do pediatric dosage calculations or ventilator care (these are examples, only) if we are not in those areas. You may have to find the area that includes most of what you are trying to maintain. Good luck!

Thanks for the great book suggestion and advice...I will certainly look into it! It may be on a "simple" level...but sometimes it is the little basic things that we need to remember the most. Thanks again!

I would strongly encourage you to get your certification in one of your main areas of practice. Or even perhaps in all of them. It really is a very empowering experience and you will certainly be able to use what you learn immediately. Besides the fact that you will be seen as an expert in that area. Many facilities pay bonuses or extra pay per hour for certification.

You have hit on one of the paradoxes of the Nursing Profession. Entry level education for preparation for taking the boards (am I dating myself?) needs to be general and all encompassing. The work places for nurses have become very specialized and force nurses to narrow their scope. Typically this results in a majority of RNs concentrating their continuing education based on what's needed for their current employment. This also true in Medicine but the specialization begins in their residencey programs after graduation from medical school.

This leads to another quandry that hospital administrators and accountants fall prey to. A nurse is a nurse and they are interchangeable in the workplace, therefore, they can be floated anywhere.