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It's getting better....

Posted

Specializes in Cardiac Telemetry, ED.

I have been an LPN for all of four months, and though I am an LPN, I am given the same patient load as the RNs. I have to advocate for myself frequently in order to avoid practicing outside my scope. I've had some rough nights, and have come "this close" to throwing in the towel.

Recently, I had an epiphany. What I realized is that in NS, we are taught the ideal way, and when we get out into the real world, we are sorely unprepared for the reality. Reality was not matching my expectations, and vice versa.

Another thing I realized was that we, meaning myself, the lone lowly LPN, the RNs on the floor, the charge nurse, the nurse manager, the CNAs, the unit secretaries, the docs, we are all in this boat together.

Once I was able to see beyond my own stress and feelings of inadequacy and fears of failure, and see the support I have available to me and the support I have to offer others, even when all hell is breaking loose and we're swamped with more admits than seems humane, patients circling the drain, computer glitches and random snafus and and and......, things just seem to be better.

I guess the way I see it is, if you have to cross that river of s#*@, you might as well pull on those hip waders and put a big grin on your face and wade right out into it, cause that's the only way you're going to make it across. :lol2:

So I guess I'll hang in there for a while longer. Just wanted to share, in case anyone else out there is having a rough time.

Hellllllo Nurse, BSN, RN

Has 15 years experience.

IRecently, I had an epiphany. What I realized is that in NS, we are taught the ideal way, and when we get out into the real world, we are sorely unprepared for the reality. Reality was not matching my expectations, and vice versa.

.

I don't understand why some nursing programs are not talking to their students about this. What you are describing is a well-known phenomena in nursing: It's called Nursing Reality Shock.

There was a best-seller written on this waaaaay back in 1974- here's a link:

http://www.amazon.com/Reality-Shock-Nurses-Nursing-Paperback/dp/B000MEAQGC/ref=sr_1_1?ie=UTF8&s=books&qid=1195373618&sr=8-1

I really think programs should include open discussion re: Nursing Reality Shock in their curricula.

Anyway, Nancy, glad things are going better for you. Keep goin' at it, and keep those waders pulled up tight!

Virgo_RN, BSN, RN

Specializes in Cardiac Telemetry, ED.

Maybe when I'm finished with school, I'll have time to read something besides my texts! I'm not sure why they don't touch the subject in school either. I've mentioned it to a couple of my instructors, and they haven't appeared too comfortable with the subject. Perhaps it is a Pandora's Box that they are somehow forbidden to open. Don't get me wrong; I love my instructors. The are really wonderful. I have had nothing but their full support, and have no horror stories about nursing school to tell. Perhaps the subject is too politically charged?

Anyway, thanks, and I'm hanging in there!!!!!

MIA-RN

Specializes in Med-Surg, ED.

Reality shock is such an experience! I remember about 4 or 6 months into my career when it hit me. I think its when my rose-colored nursing glasses came off and I saw the realities of how a hospital works, how shifts are set up, how patient loads are handed out etc etc....I emailed one of my former instructors and he said to just ride it out, it gets better. And it did.

I wonder if they don't talk much about it in school because they have to teach us 'by the book' and we have to learn 'textbook nursing'. I mean, the NCLEX situations take place in a perfect world, so we need to know how to function in that imaginary world in order to pass that exam. In real life, we may have 6 patients who all need something right away, screwey orders, and docs not answering pages. If they told us how it really is....would we all have stayed in the program?

All of us who are out there now have learned (or are learning!) that there are more ways to skin a cat, and that there are more ways to do the job than just in the fashion laid out in school. School gave us the bare basics and even though at the time it felt like so much information, the reality shock comes when you realize yeah....I passed the NCLEX....but what the heck am I supposed to do with these patients now??? I have been watching it hit the new grads on my floor to various degrees and reminiscing to myself about when I felt it as well.

OP--thank you for your uplifting post! I am glad that you have been able to see the big picture and that you shared it here to help others going thru similar situations!

If they told us how it really is....would we all have stayed in the program?

good point

Hellllllo Nurse, BSN, RN

Has 15 years experience.

It's funny, many times when seasoned nurses post on this forum saying how it really is, students get mad. I've been told off by a couple of students on allnurses for sharing my views of the realities of nursing.

MIA-RN

Specializes in Med-Surg, ED.

It's funny, many times when seasoned nurses post on this forum saying how it really is, students get mad. I've been told off by a couple of students on allnurses for sharing my views of the realities of nursing.

That might be due in part to the rose colored glasses I mentioned in my post. And I don't mean anything negative about students. But its hard to see it until you are actually in it, and it doesn't mean that nursing is a bad profession. Its just different from what you think until you are in it and doing it. One could argue that other careers are like that as well I suppose.

Hellllllo Nurse, BSN, RN

Has 15 years experience.

I've had other careers- they're definitely not like that, imo.

Ivanna_Nurse, BSN, RN

Specializes in CCU MICU Rapid Response. Has 18 years experience.

Thank you for you post Nancy. I needed your optimistic words today, as a new grad, there are days that I feel like I am drowning. (My poor patients... Im such a bad nurse.) I feel defeated when I leave in the morning....and I feel like that every day. I appreciate your outlook and optimism, and I am going to take some of it with me when I head into work tonight. Ivanna

pagandeva2000, LPN

Specializes in Community Health, Med-Surg, Home Health.

Maybe when I'm finished with school, I'll have time to read something besides my texts! I'm not sure why they don't touch the subject in school either. I've mentioned it to a couple of my instructors, and they haven't appeared too comfortable with the subject. Perhaps it is a Pandora's Box that they are somehow forbidden to open. Don't get me wrong; I love my instructors. The are really wonderful. I have had nothing but their full support, and have no horror stories about nursing school to tell. Perhaps the subject is too politically charged?

Anyway, thanks, and I'm hanging in there!!!!!

Yes, they cannot really tell you, because the instructors are basically training you to answer the questions for NCLEX-PN; and if they deviated from there, there would be trouble to come. And, let me tell you, you will probably still be reading texts, but under different circumstances, and maybe a bit less stress. I read now for a fuller understanding of the illness and nursing implications moreso than learning for the first time just enough to memorize for the exam.

For example, I work in a clinic, do healthfairs and occasionally do homecare, where a great deal of teaching is done. I have information handy in my PDA such as a drug guide, diseases and nursing implications, and the Taber's Medical Encyclopedia installed. In the clinic, I am not sure what will walk in, and if something is unfamiliar, I pull it out and read a bit just before I call the patient inside, and make a note of it to read further when I get home. When I am about to go to a healthfair, I need to know the theme of what services we will be providing and I read a bit before I go there, and the same for the home; the diagnosis of the patient, medications and nursing management while I am there. Nothing is textbook, unfortunately, however, I have a guideline to follow and chart. Good luck!

pagandeva2000, LPN

Specializes in Community Health, Med-Surg, Home Health.

And, I can understand what you mean when you say that you get basically the same load of RNs. The scope of practice for us can be vague, but there are times where you have to draw the line. For example, in my clinic, we are told that all new patients coming to the clinic for the first time ever as well as patients newly diagnosed with a disease such as diabetes must be assessed by an RN. Reality may not allow for that in many cases, but, if I begin to interview the patient and it sounds as though it is beyond my capabilities, I will chart in a heartbeat that I gave basic teaching and endorsed the client over to the RN. I will explain to that RN why I did so, and if she has issues, then, well, it is up to her to deal with it, because, while reading the scope of practice in my area, it distinctly states that our roles are NOT interchangable. I usually do this in the case of newly diagnosed diabetics. There is a lot of teaching that I have not learned (am a new nurse also, one year old...LOL).

But, yes, nursing is nothing like the books, or what is taught. And, I agree with you; we just have to try and stick it out together; RNs LPNs and CNAs. I can work around some things, but there are others I WILL NOT touch, because if something happens, no one will say that I had the right to do a particular procedure.

MzMouse

Specializes in LTC, office. Has 19 years experience.

In my final semester of nursing school I had a fabulous clinical instructor who did try to give us the realities. She taught us the ideals, because it was her job; but she also told us about the difference between what school teaches and the realities of nursing in the real world.

I don't think anyone can be prepared for the harsh truth, but I was grateful for her honesty.

Yes, they cannot really tell you, because the instructors are basically training you to answer the questions for NCLEX-PN; and if they deviated from there, there would be trouble to come. And, let me tell you, you will probably still be reading texts, but under different circumstances, and maybe a bit less stress. I read now for a fuller understanding of the illness and nursing implications moreso than learning for the first time just enough to memorize for the exam.

For example, I work in a clinic, do healthfairs and occasionally do homecare, where a great deal of teaching is done. I have information handy in my PDA such as a drug guide, diseases and nursing implications, and the Taber's Medical Encyclopedia installed. In the clinic, I am not sure what will walk in, and if something is unfamiliar, I pull it out and read a bit just before I call the patient inside, and make a note of it to read further when I get home. When I am about to go to a healthfair, I need to know the theme of what services we will be providing and I read a bit before I go there, and the same for the home; the diagnosis of the patient, medications and nursing management while I am there. Nothing is textbook, unfortunately, however, I have a guideline to follow and chart. Good luck!

"Nursing reality shock", can be avoided/minimized, by providing 6- 12 month mandatory internships, like PT, PT, Pharmacy, and of course, MD. No other health care profession expects its new grads to function like experienced nurses the day after they graduate. It is an unrealistic expectation.

As I stated in a previous thread a couple of days ago, nursing is the only health care profession that expects this of their new pracitioners. It accomplishes nothing but burn out, frustration, and new nurses leaving the bedside in droves. JMHO.

Lindarn, RN, BSN, CCRN

Spokane, Washington

megananne7

Specializes in Assisted Living, Med-Surg/CVA specialty.

I don't understand why some nursing programs are not talking to their students about this. What you are describing is a well-known phenomena in nursing: It's called Nursing Reality Shock.

There was a best-seller written on this waaaaay back in 1974- here's a link:

http://www.amazon.com/Reality-Shock-Nurses-Nursing-Paperback/dp/B000MEAQGC/ref=sr_1_1?ie=UTF8&s=books&qid=1195373618&sr=8-1

I really think programs should include open discussion re: Nursing Reality Shock in their curricula.

Anyway, Nancy, glad things are going better for you. Keep goin' at it, and keep those waders pulled up tight!

I'm still in nursing school and I often hear instructors say "Well this is how it should be..." and then will go on to tell you the way it's usually done.

I am a student and appreciate your honesty. I'm expecting hell for the first year, but hoping to get used to it or get out. But what us students really need to know is:

Is it even worth it? Are you telling us to forget it? OR Are you saying it is hell for a while until you get used to the ropes..............

Virgo_RN, BSN, RN

Specializes in Cardiac Telemetry, ED.

Well, I got my butt kicked tonight, and of course, while bicycling home in the rain, I remembered all of the things I forgot to chart.:uhoh3:

But a couple of things made the difference between getting my butt kicked and wanting out, and getting my butt kicked and thinking this is great experience that will make me a better nurse. One of those things was having the support of the nurses around me, including my charge, who pitched in and helped out when they saw I was going under (one of them said she owed me one, since I had helped her out a couple of nights before when I actually had a little free time). The other thing was that since I had my Big Epiphany, it really wasn't a shock to feel that sinking feeling yet again; instead of feeling like crying or just walking out the door, I just pulled up those hip waders and kept on trudging along. And last, but not least, the oncoming nurse that I gave report to was so stinkin nice. My God. I just can't thank her enough for being so understanding instead of judgmental. I've had those nights where you get your butt kicked and to top it off, the oncoming nurse makes you feel two inches tall for not getting enough done. It's so wonderful to have that not happen.

So, I guess what I would say is it's hell for a while. I don't know if you ever get used to it, and whether it's worth it or not is completely up to you! I am not going to let this job beat me down; I'm going to keep trudging along and become the best nurse I possibly can.

pagandeva2000, LPN

Specializes in Community Health, Med-Surg, Home Health.

"Nursing reality shock", can be avoided/minimized, by providing 6- 12 month mandatory internships, like PT, PT, Pharmacy, and of course, MD. No other health care profession expects its new grads to function like experienced nurses the day after they graduate. It is an unrealistic expectation.

As I stated in a previous thread a couple of days ago, nursing is the only health care profession that expects this of their new pracitioners. It accomplishes nothing but burn out, frustration, and new nurses leaving the bedside in droves. JMHO.

Lindarn, RN, BSN, CCRN

Spokane, Washington

Your humble opinion is very correct, unfortunately. I have been an LPN since 2006, and the orientation I had basically sucked, but I have to remain here for at least three years because this facility sponsored my education by allowing me to be on paid leave without showing my face at work until the nursing program was over. And, they also gave me time off to study for the boards.

My clinicals were poorly managed, compared to nurses that obtained their licenses at least 10 years ago. Had only one day a week, and not the whole day. Other programs from the past had one week clinical, then one week of theory. Those nurses worked wings around us, and were more acclimated to the set up of the hospital. Our staff ed at this hospital is so sorry that I have sought continuing education credits from outside sources. And, as you said, I am burned out, frustrated and downright angry. Each time I get ready to go to work, I feel a heaviness in my body and soul. We are not doing right by these patients at all. It is a rush job, a meat market, basically. I do enjoy nursing, but not under these circumstances. My hospital had the nerve to apply for magnet status, and from my observation, when the surveyors came, I do not think they were impressed. I have to say, I hope they do not receive that accreditation, we do not deserve it. If they really observed, they would see that many of us received CEUs and certifications from elsewhere, that served us better.

pagandeva2000, LPN

Specializes in Community Health, Med-Surg, Home Health.

I am a student and appreciate your honesty. I'm expecting hell for the first year, but hoping to get used to it or get out. But what us students really need to know is:

Is it even worth it? Are you telling us to forget it? OR Are you saying it is hell for a while until you get used to the ropes..............

It is hard to say. You have to have a passion for nursing, on any level. And, in many cases, you will not see the real deal until you are actually in the foxholes with us. I can't say it is not worth it, but I will say that you will have to give yourself accolades, because it is highly likely that administation and management may not show you their appreciation except for when Joint Commission is arriving or some other regulatory agency. Then, they want to shove you up like a platter.

There are good things as well, but I think that many more seasoned nurses think we got the same education and clinical experiences as they did, and it is not so. I think there is a culture gap between what is taught in nursing school versus actual practice.

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