Nursing school didn't prepare me for reality

emmycRN · Mar 14, 2007

I totally agree with you. Nursing has worked so hard to create it's own language and seperate inself from medicine that many of the things we're taught in school are completely irrelevent. I did learn a lot from doing care plans in school but only because of the interventions. I don't feel my nursing career has profited at all from knowing all NANDA approved nursing dx. In the unit I work on we keep a care plan for each pt in the chart but they are pre-printed, not individualized, and nobody can explain to me thier usefulness. In fact, nobody even reads them, but many dutifully sign their names to the bottom.

llg, PhD, RN · Mar 14, 2007

For nursing schools to truly prepare their students, the programs would have to be lengthened -- and that's not a popular solution for most people. But even within the existing system of nursing education, some programs do a better job than others, regardless of the type of program (ADN, Diploma, BSN, etc.)

So many people on allnurses.com say that it doesn't matter which school you go to as long as you pass the NCLEX and get that RN after your name. I think the concern you raised in this thread is a valid one. Some schools do a much better job of preparing their graduates for the real world than others. It does matter if you go to a "good" school or not.

So ... that puts the burden on the employer to provide sufficient orientation and mentoring for the new grads. That's why it is so important to pick that first job as a new graduate carefully. Some hospitals do a better job of helping their new grads with that difficult role transition than others.

caliotter3 · Mar 14, 2007

I agree totally with what all posters have said. When I got to my first job, I didn't know anything about calling a doctor, monitoring a pt: what to look for and when and what to report and to whom. The only reason I had any idea at all about supervising my CNAs was because I had extensive experience in supervision. I certainly wasn't exposed to it in school. During our last semester in clinical, we were officially prevented from doing certain tasks at all. I basically was taught nothing about the nuts and bolts of going in at the beginning of a shift, taking over a group of pts, and doing what a charge nurse is supposed to do during her/his 8 hrs, then turning over the pts.

llg: I agree with what you said in your last paragraph about carefully choosing your first employer; but there is no (to my knowledge) method of finding out how different places operate or treat their new employees. Most of us don't have networks of nurse friends to consult ahead of time. Many try to get the inside info from this bb, but that is limited.

I wish my nursing school would have addressed the entire day to day role of the nurse and I also wish that instead of 2 weekly "visits" to clinical, that we would have spent as a minimum 4 days a week in clinical. That, I believe, would have prepared me for the real world of nursing.

Lisa CCU RN, RN · Mar 14, 2007

I think this is exactly why I like the school I go to and the area I work in. In out last semester we get a preceptor and work our way up to taking care of the full load that the nurses do at that hospital--some are 3-4, but others take up to 10!

In our second semester, we did get 3 patients, so that helped a bit. All the hospitals in out area hire you on as externs so you can get some extra practical experiences.

I think I will be ready, but I do admit I've never called a doctor before, but I see some of the reasons why you would call and they try to teach us normal expectations from abnormal and reportable ones ( a big part of tests).

I think we may have to do that in the last semester. I'm alomost 3 down and to go!

lindarn · Mar 14, 2007

Bedside nurses in acute care have many great responsibilities - monitoring, coordinating, notifying, double-checking, following up... - for several different patients with several different needs with several different staff also working with them...
I don't feel that my nursing program prepared us for the great responsibilities of this kind of nursing. They certainly let us know that "just following orders" wasn't acceptable and that we had to "use your critical thinking" and "use your nursing judgement" and "advocate for your patients" but I didn't feel that nursing school gave me much in the way of practical experience in honing those skills.
Most of the nursing care plans we had to create focused on the 'nursing' component versus the 'medical' component, thus lots of impaired mobility and risk for impaired skin integreity but not so much on the stuff that nurses need to have down - when to call a doc and when not to. How to prioritize and know it's okay that some things won't get done if it's busy. What orders to expect and what orders to question.
So for the first 6 months to a year, new grads are floundering, being asked to provide a higher level care than they are able to, often being scolded (yes, scolded, not informed or educated) for not doing this properly or doing that fast enough or recognizing this condition or noticing that mistake....
People keep warning about the nursing shortage but these conditions do nothing to keep new nurses where they are needed most...
I guess I just wanted to vent on this!

This is exactly the reason that all nurses, regardlesss of the program attended, need to have a mandatory 6- 12 month internship before being let loose by themselves. Nurses need to get over the attitude, that new grads should be able to "hit the ground running", the day after graduation. Doctors don't go out and do heart transplants, or brain surgery, until they have completed an internship and residency. Family physicians don't either. So why should nursing continue to loose new grads due to "new grad burnout". They are set up to fail.

In addition to doctors who do internships and residencies, PTs, OTs, Pharmacists, etc. This is not a new idea.

Lindarn, RN, BSN, CCRN

Spokane, Washington

Gromit · Mar 14, 2007

No school is going to REALLY prepare you for the real world -well, the only chance one really could would be a return to the days when hospitals taught nursing from the ground up -kind of like having a true built-in internship. But its beyond the scope of the clinical sessions we have in shools that are not 'in' hospitals. It would certainly be easier on the new grad if they were, but that really isn't the way things are done anymore. I agree with the above that a facility should give a suitable internship period before cutting a new nurse loose. I think OURS lasts about two or three months, if memory serves.

CHATSDALE · Mar 14, 2007

not even the best of schools can really prepare you for the day to day work required of working on a floor and being a team leader

if you can possibly work and go to school get a job as a cna and observe all you can as a student...if you have already graduated choose the hospital with the most comprehensive orientation

new grads are often not really prepared for the interview and they just go in praying that they get hired and they don't ask the tough questions that will let them know what they can expect

the only thing that an experienced nurse can do is to mentor new nurses way past their official orientation

SmilingBluEyes · Mar 14, 2007

So ... that puts the burden on the employer to provide sufficient orientation and mentoring for the new grads. That's why it is so important to pick that first job as a new graduate carefully. Some hospitals do a better job of helping their new grads with that difficult role transition than others.

This is the bottom line. The schools cannot possibly prepare everyone for every specific contingency/policy and governmental change that affects our work. Let's put the burden on the employers, not the schools, where it belongs. I have yet to see a new graduate ready to work without a long and thorough orientation. You could get an MSN and not be prepared. Experience is that part of the equation missing in nursing school. And taking responsibility for our own learning is also a critical part of the equation---and many just don't.

nursemike, ASN, RN · Mar 14, 2007

I made good grades at a well-respected nursing school and went to work on the unit where I had worked in an unlicensed capacity for over three years, in a facility where I had worked for seven. I had two weeks of orientation classes and nine weeks orientation on the floor.

I felt grossly underprepared when I started on my own. With a world of help from more experienced nurses, I'm beginning to feel--well, not uncomfortable, most of the time.

I've seen a number of new nurses, both before and after nursing school. A few really hit the ground running, but most go through a learning process similar to mine. Of those who appeared to adapt most readily, nearly all had done a nursing externship prior to graduation. Clearly, there is a lot of value to that. I think an extended internship for new GNs would also be a great idea. I'm not sure how facilities would fund it. I'd have been unable to work for no pay, but would have gladly worked a few months for half RN pay. I think it's possible reduced attrition might offset some or all of the cost, but I think nursing has a certain amount of unavoidable attrition built in. Most new nurses are young women. Even those most happy in their position are prone to do crazy things like getting married and/or relocating. But, yes, I'm sure many of all ages, genders, and marital status get disillusioned by the difficult transition from nursing school to nursing practice.

RNperdiem, RN · Mar 15, 2007

Who would believe now that a couple of generations ago, student nurses were the nurses in hospitals? The supervisors were the only graduate nurses.

ayla2004, ASN, RN · Mar 15, 2007

their is plans by the Nurse and midwifery council NMC which is the UK professional regulator in the UK like BON in the states.

To have new nurses work for a year post academic qualification and then get registered as RN. The issue for students is what pay we we have if we aren't able to fulfill all the roles. Without out PINs (license) any action espically giving medicines need counter signing by a RN.

Its felt that since we are no longer hospital trained though we do 50%-50% theroy to practice hours. we lack the clincial practice to walk into our first jobs, we spend out last placement taking on managment of a gropus of patient but not a ward. Nurses trained in the hospital schools by there third year where used tpo runnning wards. However i've been told my many a staff nurse both hospital trained and university educated that the first 6 months are the hardest, just because your a RN inside u haven't changed, as one said one day a doctor looks past you the next he wants all the answers.