you honest opinion

You learn the common disease processes and the required care, then you go from there. You'll always come across stuff that you won't know, and when that happens you look it up. Say to other nurses or doctors, "hey, I've never had a patient with this before- what do I need to watch out for?"

I work in a couple ICUs, so I see a broad variety of things, but things like ARDS, sepsis, heart failure, renal failure, etc. are pretty much the same no matter what.

I get things that I'm still now sure about, so I ask questions. I've known answers to questions more experienced nurses have asked- everybody always has something new to learn.

Before ICU I was a tele floor and I always hated when I'd get a fresh ortho patient from the OR because they had some type of cardiac issue during the surgery and required cardiac monitoring that the ortho unit wasn't equipped to handle. As soon as I finished getting report from the PACU nurse I would call the ortho unit and speak to the charge nurse. I asked what special precautions I needed to be aware of, any special things they did with their patients, what to watch out for, etc. I even had an ortho charge nurse come do a neurovascular assessment with me one time when I was concerned. In return nurses from my unit would happily look at tele strips and help other units evaluate them.

ETA: I have several critical care books, including a textbook, that I keep at home for brushing up on topics. I'm also an AACN member and get journals to keep up to date.

This only applies to "chronic" conditions. Not newly diagnosed.

Once I develop a rapport with a patient, I have never had a problem asking my patient (if they have a chronic condition) questions about their condition.

If I'm not familiar with it, or it's unusual, or there have been changes in treatment I'm not familiar with.

Of course know, assess, get a good relationship with the patient first, then ask. Every time the patient has been happy to "educate" the health care provider.

Also of course then go home and hit the books or Internet.

Pretty much everything I've learned has been on the job. Nursing school was a blur and it focused on the wrong things for the most part in my opinion.

Nursing fundamentals was by far the most useful class to me. I learned the dry basic skills and learned assessment, plus the 5 rights of med administration. That was helpful.

As far as disease process and treatment, I learned on the job. I spent lots of time studying things on my own. I knew the basic difference between say an ischemic and hemorrhagic stroke, but how to assess and treat, we learned nothing. Nothing on what to look for, none of that. And they may have gone over a GCS or NIH scale for 5 minutes but learning all of neuro in one class and testing the next, makes it impossible to learn and retain.

Art lines, central lines, drips, chest tubes, all learned on the job. Nursing school was more concerned that I knew how to calculate micro and macro drip rates.

In pharm, we spent tons of time on PO meds. I deal in lots of drips.

Nursing school was helpful in the very basic skills and how to take NCLEX. Nothing more.

I would like to ask people who have already started working as a nurse, we learn alot in nursing school, but obviously we cant learn everything there or we would be in school forever.

Well, that is one way to look at it... I've chosen to continue to actively build my knowledge base ever since I left school. I have an enormous number of medical references (I prefer them to nursing references) and core science references. I've also taken a number of continuing educations classes outside of my area of expertise.

How much of what you know now is from working at the hospital?

Most of it. It's one thing to read stuff in a book... it's quite another to see it play out in real life (& death) with the accompanying sights, sounds, smells, and tactile sensations (for example, subQ emphysema didn't become real until the first time I felt it for myself... or the smell of an acute GIB who then bled out and died right in front of us...)

Also how do you bring up this conversation to your fellow experience nurses?

Generally something like, "I've never taken care of someone with... what can you tell me about..."

Truthfully, though, I've learned a lot more from talking to the docs than I have by talking to other nurses.