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...
-RNTSH -if I may. You would probably find the Saunders Comprehensive Review for the NCLEX RN to be of assistance. Its nicely broken down into systems which (at least for OUR RN program) follow how our class was taught. That is, when we began on one system, the book summarized it nicely, and provided questions that taught you to think much like the NCLEX test does. Sadly for me, I only purchased the book AFTER I'd graduated. I wish I'd had it DURING school -it would have been considderably easier, I think.
Hated doing the 'care plans'. Always found them to be more of a pain than anything else (guess I'm not on the fence about that) -someone in our program found a template that worked with Microjoke Word, and that (at least) aided in composing them, typing 'em up and printing them out -they always came out pretty nice. Of course, they would be a few years out of date, but look around, you could probably find the template (of if you wish, I'll see if I can find it).
Lastly, the thing that helped me a lot (look up every med before giving, etc) was a palm pilot and a copy of Davis' drug guide for palm pilot. I still use this while on the job when I come across a med I'm not familiar with, or unsure of. Its basically the same as the book, but it takes only a few seconds to find the drug on the palm (as opposed to rifling through the book) -and my pilot stays in a pocket so its always on hand. Epocrates (free) also provides a handy program that allows med comparison for incompatibilities. They are just tools, but they can make your life a little easier -and in school, thats worth gold.
I'm just about to graduate myself... I am also feeling that I won't be prepared.. but I guess it just takes alot of patience, and yes, a whole lot more of learning once you get out in the real world. Like they say, the real world is the best teacher.
I was an older nursing student and I have to agree Nursing school never prepared me for the real world...I felt like I taught myself the whole time I was in school, clinicals were a joke. Nursing school was a waste of my hard earned money...I learned alot about nursing my first 6 months in the hospital.
I got a job as a tech based on my EMT-B certification and I will have about 2 1/2 years in as a patient care tech when I graduate with my ASN. Additionally, I am applying for a summer internship and always watching for shadowing opportunities.
What you describe is not unique to nursing. Graduating from boot camp doesn't completely prepare Marines for combat nor does graduating with an IT degree prepare young men and women for their workplace. School imparts basic skills, but I am not surprised to find that there is a transitional period following graduation.
When I went though the LVN program,here in my home town of Kerrville, Tx, I was told by the director of nursing here that school prepares you for your NCLEX. You are not a nurse until you get your License and train on the floor as a nurse. The program I went through was a fast track 1 year LVN school. Let me tell you, it was hard for me and I was in the medical field while in the Navy. To get back to the subject; most programs that I have called upon said that there school was to preprare you for the NCLEX, LVN or RN.:monkeydance:
I am a new nurse LPN 2+ years and I work lots a real job and agency and after working in LTC (lots of tubes, a few trachs and vents) , for almost 1 -1/2 years I started in a hospital and was supposed to get orientation and was thrown to the wolves on the 1st night----BIG TIME on my first night in telemetry. I rec'd no orientation--even thought I was supposed to work with an RN and was given a 6 patients, a few critical. I did not know the histories, the pumps, anything. I wanted to leave and was told they were so short and it would be abandonment. When I was done with the 12 hour shift I was shaking on the way home thanking GOD no one died. I spoke to the DON and she was sorry, but said they were short and it would never happen again. Needless to I never went back ---and now I do work in hospitals now and then and I feel pretty confident...but after that one night---which I will NEVER forget........If I was a kid or not so stupid I would have quit being a nurse right then. -
Yes, nursing school doesn't fully prepare you for the realities of being a registered nurse. It is even more difficult if you went through a fast track or 2 year program because the focus is on recognizing diseases and caring for the patients that have them. The expectations are the ideal and you are correct in needing the "big picture".
I recommend getting a mentor. Someone who is positive, can help you navigate the unspoken decision-making that nurses need to make and set clear and appropriate boundaries with the staff members you interact with. Remember, it is really easy to kick yourself for the 2 things you didn't get done in a shift (that may not be remembered in 2 weeks) but not applaud yourself for the 54 things you did get done and did correctly.
Learning organization is key. Knowing the type of person you are is also helpful. Keeping your expectations realistic is important to avoid burnout.
A mentor picked wisely can be someone you can debrief with. Someone you can ask social-scenario-professional questions of who will "get you" and who can offer valued insite. They should be o.k. with you making your own decisions though, despite their advice.
Learning about the role medical providers (ARNPs, MDs, surgeons, and PAs) have and the decisions they have to make is important too. This will help you know when to interrupt them when they are thinking through their assessments/plans and when to wait to chat.
Nursing education continues well beyond school. There are some really good articles about your role growth from a novice to expert. When you master your area, don't forget that the newbie nurses will need your kindness and support. Best of luck (and hope this helps).-kimmercris arnp
I know this will strike a nerve - BUT, back in my day......, No really, I grew up in nursing in the 60's and ever since I've been in "reality" I appreciate my training more and more. I've been a nurse for 43 years, but I've been calling Drs, taking off orders, passing meds for 46 years.(always with supervision until we were competantr AND confident - I wish I could share my nursing education with everyone - and I have tried to pass it on to new nurses,NAs etc. I may be overweight -but it's NOT from munching on young nurses ! :)
dj "A candle loses nothing by lighting another candle" author undetermined
Why not make nursing a "trade" and have apprenticeship programs set up for us to become RN's. For instance my son who will graduate this spring as a Journeyman Electrician has gone through a 6 year apprenticeship. With most of his learning in paid "on the job training" under more experienced apprenticies and journeymen. He also spent one day a week in a classroom setting learning theory. He did this "full time" for the last 6 years and each year advancing a level in skill and pay. He was paid for a forty hour week therefore did not have to work outside of his field and could consentrate on becoming the best electrician possible. He now earns equal to what I am making as a nurse of 19 years senority. The hospitals would benefit because they would have nursing students or apprentices at all levels to help in pt care, nursing apprentices would benefit by having more on hand in the trenches, type of learning, and "Journeymen" RN's would benefit by having lots of extra hands to carry the load, I think this is an excellent way to train new nurses instead of the puny clinical experiences they get now and then we are expected to teach them the reality of nursing on the floor in a 6-8 week preceptorship. Come on people we are dealing with lives here!!!!
Specializes in ED, critical care, flight nursing, legal.
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.
I have always been amazed at the time and energy The Nursing profession and the Educators have spent espousing this "nursing language" in the hopes of being perceived as a "professional." As you noted, care plans are worthless, and worse, since they are "required" they take the nurse away from what they really need to be doing:taking care of the patient and communicating with the other members of the healthcare team. Unfortunately, all too often, as some of the other posts mention, this interaction with the physician members illicits much distress. Could part of that problem be that when the nurse calls, they speak "nursing" and the physician speaks "medicine?"
Nurses should spend less time learning about "alterations in oxygenation" and more time learning about hypoxia, or CHF, or whatever disease processes they will routinely encounter. I am not saying they need the in-depth knowledge of the physicians (althought I have known nurses who could work up and present a patient better than some residents/attendings), they just need to be able to acurately and concisely communicate the patient's condition to the physician.
It also amazes me that the healthcare industry has tried taking a lead from the aviation industry in the "cock-pit" model of team work in the interests of patient safety, but hasn't identified this basic tenent of communication: everyone must be speaking the same language! Why do you think the "official language" of commercial aviation is english? Why is it that the people in control tower,the Air Traffic Controllers (ATCs), speak the same "technical language" (i.e. the ATCs don't call the approach pattern "an alteration in altitude and direction due to destination arrival.") as the pilots?
The nursing profession would be better served by abandoning this worthless and time consuming effort to have our own language. Let's all learn to speak "medicine" so that new nurses would start out on an equal footing. After all, when was the last time you had to call a doc and tell him the patient had an alteration in his oxygenation? Never!
Gromit
821 Posts
-RNTSH -if I may. You would probably find the Saunders Comprehensive Review for the NCLEX RN to be of assistance. Its nicely broken down into systems which (at least for OUR RN program) follow how our class was taught. That is, when we began on one system, the book summarized it nicely, and provided questions that taught you to think much like the NCLEX test does. Sadly for me, I only purchased the book AFTER I'd graduated. I wish I'd had it DURING school -it would have been considderably easier, I think.
Hated doing the 'care plans'. Always found them to be more of a pain than anything else (guess I'm not on the fence about that) -someone in our program found a template that worked with Microjoke Word, and that (at least) aided in composing them, typing 'em up and printing them out -they always came out pretty nice. Of course, they would be a few years out of date, but look around, you could probably find the template (of if you wish, I'll see if I can find it).
Lastly, the thing that helped me a lot (look up every med before giving, etc) was a palm pilot and a copy of Davis' drug guide for palm pilot. I still use this while on the job when I come across a med I'm not familiar with, or unsure of. Its basically the same as the book, but it takes only a few seconds to find the drug on the palm (as opposed to rifling through the book) -and my pilot stays in a pocket so its always on hand. Epocrates (free) also provides a handy program that allows med comparison for incompatibilities. They are just tools, but they can make your life a little easier -and in school, thats worth gold.