New grad reality shock?

memphispanda, RN · Jan 18, 2004

I totally think there needs to be more focus on the real world. Ideal is great, but when you get to the floor at 3 am and there is a problem, how are you really going to deal with it? I'm always asking what I am supposed to do about things that we never even talked about in nursing school. When do you *really* call the doc? What do you do about the patient who has no urine output 11-7, claims she doesn't need to go, and shows no signs of distress? What about the soap suds enema ordered at 11pm for the patient who then has a huge amount of explosive diarrhea twice...before the enema is ever administered?

I find that although we were taught a ton of information, we weren't taught what to DO.

StephMSeattle · Jan 18, 2004

I feel the exact same way! I start my new job tomorrow...it's my first nursing job! I'm just kinda' weirded out by everything because I'm not sure of if I'll know what to do. Passing out pills is one thing but knowing what to do if someone stops breathing is entirely different.

sarpa · Jan 19, 2004

The reason to give enema is to cleanse the colon, i think when a resident had episode of diarrhea i think you should notify the DR. and then the Dr. will give you the ans.. Sarpa

zacarias, ASN, RN · Jan 19, 2004

Hey,

I'm a new RN and getting more and more comfortable at my job every day.

"Culture shock" is a reality that every new nurse will face after school but it doesn't have to be a horrible thing. I work at a Magnet teaching hospital and my culture shock was more exciting than terrifying. Being an RN at this job instead of just a student, I was quickly integrated into the staff and felt part of group. I consistenly worked obviously with the same IV pumps, protocols, procedures, that I gradually got comfortable with them every day. This is unlike in clinicals when you're only there for a few weeks and move on to another place.

Also, being a new nurse has it's major advantages over school. While you still plan the patient's care, you don't spend late hours after work working on a care plan to turn in the next day hoping to get a pass grade. While you might be scared that now YOU are the RN and not the student and you have to be totally responsible, I think this is liberating. Now YOU as the RN can fine tune your personal nuring methods on your own terms and really make the care you give "your own."

Tweety, BSN, RN · Jan 19, 2004

I think it's important to know the ideals and develop good habits from the start. Critical thinking is going to develop with time. It's important to find a "mentor" or someone you can trust to help you with decide which things needs immediate attention, which things can be let go, and which things can wait. Never ever be afraid to ask questions.

It's impossible to learn every scenerio in nursing school. It's quite normal to feel overwhelmed, frustrated, doubtful and nervous.

Token Male · Jan 19, 2004

Welcome to our nightmare all you graduates. You will start out like this and soon will be like this:chair: or worse like this not knowing which way to turn; and what you wanted to be was this:nurse:.

All I can say to new members of the profession is PLEASE ask those stupid questions; We old people would much rather you ask us about day to day 'boring' stuff and learn from us than blunder about thinking you know everything or act like you do. (Any body who thinks they know everything can leave now) Let us teach you and we will learn in the process

By the by : the correct time to ring a doctor after they have ordered an enema at 21.00 is 03.30, but only if you are sure they are asleep.

memphispanda, RN · Jan 19, 2004

Originally posted by sarpa
The reason to give enema is to cleanse the colon, i think when a resident had episode of diarrhea i think you should notify the DR. and then the Dr. will give you the ans.. Sarpa

I did learn the purpose of an enema in nursing school. It wasn't *that* bad. The patient with the enema wasn't mine, it was just an example of a situation that came up. The nurse chose not to call the doc and just gave the enema anyway. That's not the choice I would have made.

My point is that when you run into other problems with situations, we weren't really told how to handle that. I know one can't be prepared for every situation, but still--at least discussing options in some cases would have been helpful.

Erin RN · Jan 19, 2004

memphispanda

I wouldn't have given the enema either. I would have held it and called the MD in the AM then if he still wanted it you could go ahead and give it..I would have given it if it was for a bowel prep for some procedure but if it was for the constipation which obviously has now resolved I would not have.

If the pt had two large diarrhea stools and then the enema was given on top of it the nurse could theoretically mess up the pts electrolyte balance and then more problems could arise...

Erin

purplemania, BSN, RN · Jan 19, 2004

I have studied this quite a bit and can tell you that "reality" cannot be taught, although it must be learned. Ideals are taught in order to ground you in theory and standards and to create good nursing practice habits. There is no way to predict all the variables in "real life", so we have clinicals to transition the student a little bit. However, once you are working independently the exceptions become the rule. If you do not have a strong base at that point, you will not know how to function. The nurse who can remain flexible and is able to adjust to changes quickly will reach a comfort level sooner than the inflexible personality. This phenomena is not restricted to nursing. If you read Brenner's book on Reality Shock:Why Nurses leave Nursing you will learn more. The book is old (70's) but the theory is still applicable. One thing the book points out is the nurse who "blames" the school for not teaching everything needed to do the job is a nurse who will have problems. We are accountable and responsible for our own learning and personal growth.

llg, PhD, RN · Jan 19, 2004

Purplemania:

I LOVED your post. The ideals, values, etc. are important. They ground us and keep us headed in the right direction. The nurse who discards them loses his or her way.

llg

Underbedmonster · Jan 19, 2004

As a student, I have similar worries about whether or not "reality" will gobble me up and spit me out. Though it's certainly true that school can't teach about every scenario, something that helps me feel more in control and less worried is asking in lecture and clinicals about scenarios I happen to think of (Obviously this won't help those who have already graduated). Additionally, I'll ask how things are "really" done, and what's the best practice when in the actual situation. I still worry, though. I just hope I can find a mentor--there have been plenty of horror stories on this board to keep me up at night. Good luck, hmccartn! Find that mentor!