Ivory Tower Nursing vs. Real World

[melanie1126]

This month marks my 1 year anniv. as an RN and when I graduated, I came to my tele/med/surg floor along with several other new grads. Most of us went through the same program and were taught the same way. I've seen several people change their practice from the way they were taught, and one situation pertains to chart checks. We were all taught that when we come on shift we were to check the Med Sheet against all the Dr.'s orders on the chart. I am still checking ALL of the orders but I have also noticed that I am always the last to finish my assessments & give meds (which sometimes doesn't make my pt's very happy). I've talked with several of the nurses about this. One or two say they still check them all, some say they go back a few days, some say they go back a week. (Our stays range from 3 days to a month) The nurses who don't check them all say that at some point you have to rely on the other nurses to have caught errors during previous chart checks to catch mistakes b/c there simply isn't enough time to check 6-8 charts, then give meds and do assessments b/c the patients want to go to sleep (I work 7p-7a). We were told in school that we were being taught Ivory tower nursing in an ideal world but there would be things we'd have to give up in the real world. Just wondering how some of you check your charts.

[Antikigirl, ASN, RN]

I am very lucky...most times at my hospital floor the charge nurse or the unit secretary (usually an RN) oversees and double checks all MD orders with the MAR's/Tx to make sure they are current, ongoing, or d/c'd. So much of the time we can go on our way in the AM and get things done with the assessments and meds/tx.

Night shift does another check...again the charge nurse.

So typically they are checked times two. When you have a moment you always try hard to go back and make sure no other things slipped through the cracks. Normally not, but on rare occasions I have run into conflicting orders.

Also, all orders must MUST be read back, so typically the unit secretary or charge nurse must read off to an RN or greater. That is for any changes, new orders, D/C orders and what not....so it is a check/balance system .

Oh and yes...I learned one thing really well about school vs real world..and I must say...all those lovely books I spent a fortune on make great makeshift tables or bookshelf foundations...or great dust bunny collectors! LOL! I still reference quite a few...but wow...so many of them are not even broken on the spine!

I feel that nursing school is awesome for the newbie nurse that needs more structure as they learn how 'they' do nursing. I know I needed more cut and dry rules than I do now! But as you experience different things..you will find no book or lesson can prepair you for some things...and knowing critical nursing skill and time management on your own will be seriously benificial!

And as my best preceptor/instructor told me...you are a baby nurse till your 5 year...then you are a toddler!

I just hit year 6!!!!!!!!!

Congrats on your first year under your belt!

[meownsmile, BSN, RN]

It really has to depend on the patient and how long they have been there. You have a patient that has volumes of orders over several weeks and it is next to impossible to go through all that. If others are doing their jobs, and they should be just as you should be. I would think reviewing a couple days back should be sufficient. You have to remember there are other nurses, ward clerks, nursing supervisors and pharmacy that are also reviewing those orders. Even though you have to always trust yourself, there has to be a point that you trust your co-workers also.