what did you learn in the real world that you wish you learned in nursing school?

meadow85 · Sep 9, 2008

nursing in the "real world" is nothing like you learn in school, in my opinion. i have learned more in 1 year of work than i have in 4 years of undergrad. seriously.

iwanna · Sep 9, 2008

I would say the number one is time management. And, many times things are so different in the real world of nursing than what we learned in theory. Also, there are many skills that you don't have an opportunity to learn while in nursing school. They just tell you that you will learn it on the job. I firmly believe that there should be a six month period of just clinical before graduating from nursing school.

ChristineN, BSN, RN · Sep 9, 2008

I wish my school would have taught phlebotomy and IV starts in nursing school (even if we were just practicing on dummies or each other).

I wish we could have been able to do our senior internship in the specialty we were planning on working in, instead of having to do med-surg. I went into pediatrics, and it would have been a smoother transition if I could have spent that time studying in peds.

I wish instructors would not put so much emphasis on the proper written format of a care plan, and focus more on if you can verbalize what's most important, if you can collect data from the chart and assessment, etc.

I wish we could have had more mock codes and stimulation type excercises. Even though nothing can truly prepare you for the first time you have a pt code, I thought these excercises helped some. (I will note my school is trying to get more, in my time there we had them for Fundamentals, and then in Critical Care, now they have them for OB and Peds as well).

I'm sure there's more, but, for a new grad's perspective, that's it for now!

jjjoy, LPN · Sep 9, 2008

I firmly believe that there should be a six month period of just clinical before graduating from nursing school.

Or some sort of standard "intern" or "residency" period where the student/new nurse has more independence and responsibilities than a student in a generic clinical rotation but isn't counted in staffing numbers to be equal to a fully-qualified RN. And this period should be something like six months of full-time clinical time (or some set number of clinical hours that equals that). In this scenario, a nursing graduate couldn't professionally practice nursing until completing this requirement, ensuring that facilities don't try to rush new grads off of orientation as soon as possible. Such experiences could also be valuable for nurses wishing to move to a new specialty or re-entering the profession after time off.

RNperdiem, RN · Sep 9, 2008

I would have liked a primer about who all those other medical personnel are around us are, what they do, and how we can use them to help our patients.

It is hard to be part of a team if lacking in knowledge about your teammates.

I graduated knowing nothing about the differences between interns, residents, attendings and fellows. I was uncertain about the role of respiratory therapists,speech therapy, PT, OT, dietitians, wound-and -ostomy nurses in care of my patients.

pagandeva2000, LPN · Sep 9, 2008

Personally I think they should be throwing the idiotic nursing theories and nursing care plans out the window and focus on the medical model of patient care because like it or not, that is what we have. Nursing care plans aren't read or even looked at by anyone!

Totally true. I can understand the use of care plans in a sense, just to have a learning tool for the disorder, however, no one reads them, they take too much time away from patients to create and many times, they have generalized ones floating around the unit, anyhow, making this a total waste of time.

And they never teach the shortcuts or little tips that help in the real world. Not all shortcuts are dangerous, IMO. And I don't think you can survive without them.

I came to the conclusion that they drilled into us us the 'right way' in order for us to remember it for NCLEX. Maybe so, however, you have no choice but to take short cuts, or we would be there forever and no one would be taken care of.

Also, there are many skills that you don't have an opportunity to learn while in nursing school. They just tell you that you will learn it on the job. I firmly believe that there should be a six month period of just clinical before graduating from nursing school.

And, then, the job will say that you should have learned this in school...it is a never ending situation.

One of the things students should learn about is the toll nursing can take on the body. They should teach the students to see the podiatrist, warn of plantar fasciitis and other foot problems that develop, purchasing support hose, stress reduction and self preservation...seriously! I am shocked that as many years as I have worked as an aide, I had not developed symptoms of heel spurs until I obtained my license. How my shoulders hurt from so much stress...how I still feel tense at the end of the day, no matter how much sleep I get. This, to me, is also mandatory, to prepare people fully for what they are getting themselves into. :twocents:

bossynurse101 · Sep 9, 2008

Things I wished I knew then:

1. Speak up in clinicals - ask to do, do, do do. You will feel so much more confident when you get out there.

2. Dont take out so many student loans

3. Listen to the PATIENT - they know more than you think.

4. Dont judge - ever

5. Dont cram - you'll never remember the stuff in the years to come, and you WILL use this knowledge later.

6. Ask lots of questions, get lots of input from nurses who have been there (allnurses.com)!

SuesquatchRN, BSN, RN · Sep 9, 2008

What did I learn after graduation?

Everything.

hellerd2003, RN · Sep 10, 2008

That although nurses are listed as one of the most highly respected professions annually in national polls, you will get no respect if you're a bit slow bringing a glass of water. And that you may have a patient requesting a glass of water during a code, and although the patient KNOWS a code is occurring (and is smart enough to know what that means), they are upset because, God forbid, a dying patient takes precidence over their glass of water.

Mudwoman · Sep 10, 2008

Take a phlebotomy class before you go to work.

The clinicals you are doing in class and on the floors are absolutely NOTHING like what you will experience once you start to work. Those care plans are obsolete and we now chart by exception.

Management thinks you can fly with the speed of light and leap tall buildings with a single bound. You will do more with nothing than you ever thought possible. Just when you think you can't do any more work, they will tell you differently. If you can't do it, there are new grads like you that will try.

You will spend most of your time with your most critical patient and other than a quick assessment and meds, you will never lay eyes on your other patients.

You wonder which will give out first, your feet or your back. You will buy the extra large economy size of Advil and Tylenol.

JAHCO and Press Ganey are the most hated words in your vocabulary.

Start now reading every time management/setting priorities book you can find.

You are kind and love caring for people, but you will learn that you hate some patients. Caring for them totally drains you and makes you hate your job. You hope they get discharged soon.

When a patient dies, it hurts.

You are scared that you will not pick up on something, will not do the right thing. You are always scared that you will do harm. You are always scared that you will loose your license..............no matter how long you have been nursing, or how good you get. You will realize just how unsafe nursing is.

Doctors and patients can be mean.....really mean. Other nurses can be mean......really mean.

Those isolation patients that you get to avoid in nursing school.......well, you don't get to avoid them in the real nursing world and you may have several at one time. All those skills for isolation do not work if you don't have an isolation room with an ante room. In the real world, we are lucky if we have one dedicated isolation room. Trust me, we NEVER have only one isolation patient.

Get to know the following term and what it means to you....Flex scheduling.

Also get to know the term "Genesis Project". All hospitals are going to it. Did you know that all nurses have blue folders to chart in if the hospital is doing Genesis?

No one is going to save you when you are drowning, because they are also drowning.

AnnaSL, BSN, RN · Sep 13, 2008

I totally agree. All of those process recordings were rediculous. While I was working as an aide in school I seen firsthand that the nurses did not have time to do all of the things school had us doing. While I agree we must convey caring in how we talk with our patients but a half an hour conversation is never going to happen.
I think school emphasizes careplans to much and other paperwork such as risk management, quality control, and process recordings way too much. We needed more time clinically without having to worry about all of the school paperwork stuff. I just graduated in May and the memories are still vivid.

Hmmm... honestly, for me, on my own opinion, it actually help... I can still remember when Nursing Care Plan was first introduce to us, it was a 7 column form.. then turned to 5 then 4.. It was actually exposing us on the background on what, ASSESSMENT, PLANNING, INTERVENTION AND EVALUATION, all about.Up to the point that you dont have to put it in writting and it's already there IN YOU. at the same time, it was introduce to us to give us an understanding and to make it easier us we go through it stage by stage...

True, we dont have a lot of time to have a conversation with the patient, but as a NURSE, why do we actually talk to them??? it's not actually the TALKING, it's how you do your talking...

We tend and talk to the px still QUIETLY OBSERVING them with a CLINICAL EYE... looking for signs of PAIN, DIFFICULTY and things that are vital and SHOULD be SEEN by A NURSE... You develop this through YEARS of TRAINING.. and exposure..

If you are the kind of nurse that go inside the px room during ROUNDS, asking them how they are but not REALLY LOOKING AT them but INSTEAD directly focusing yourself in the IV inserted and tubes, then you are actually starting from nothing... Develop a clinical eye..

you see, for me, WE WILL NEVER LEARN TO PRIORITIZE if a PLAN is so hard for us to DO... PRIORITIZATION is learned and earned through experience.. Like I said before, everything does not come from the book...Manifestations and CASES are different on case to case basis, and it is not done as a Package in the BOX...