Student not feeling prepared to graduate. Advice?

[CanuckNurse1]

I'm a nursing student in my 3rd year, will graduate with my RN degree in 2012 if everything goes as planned. The problem is, I don't know if everything should go as planned. In high school, I easily got good grades, so I got used to not really studying for anything. Unfortunately, that habit has continued into university. I cram for my exams instead of doing the assigned readings throughout the semester. I know I'm not learning what I need to be learning to be a good nurse. I'm not going to be competent when I graduate in 2 more years. I decided to buckle down and really do my readings and learn what I'm supposed to be learning this semester, but it's such a busy semester, that I'm just trying to keep my head above water, like every semester before this one.

I know I need to do something about this. And I know I don't have enough time to go back and learn what I was supposed to learn in the past 2 years at the same time as trying to learn the new stuff during the semesters. I'm considering taking a year off after I finish this school year in April (i.e. delay starting my 4th and final year for a year) to work as a care aide or something in a nursing home to get more basic experience and be able to pay rent while diving into the textbooks and trying to learn what I'm supposed to know. (In Canada nursing students can get jobs as care aides and such.) But I don't know if I'm brave and determined enough to do that. Here's something horrible: if my clinical instructor failed me (meaning I would have to re-do this course, which would mean I wouldn't be in school next semester, giving me time to study as I want to), I would thank her. I would be relieved. Because I know I'm not going to be competent when I graduate, unless I take time off to study.

You may reassure me and tell me that everyone is nervous and feels incompetent when they first graduate. There are lots of posts on allnurses.com about this topic. But there are also posts that are rants about incompetent nurses you've had to work with, who are a danger to the patients. That's who I would be. I think one of the biggest things I need to learn is pharmacology. I don't have any of the drug families memorized. (In our pharmacology class, we were taught to memorize the drug families, since there are so many individual drugs out there, it's impossible to memorize all of them, but if you know the families, you'll be okay). I don't know them at all - I can't tell you what a Beta-blocker or ACE inhibitor are, for instance. And I know this is bad.

So... any advice? I guess I'm looking more for validation than advice, actually. I've talked to a few nursing profs and other nurses I know, and they all tell me I'm just nervous and everyone is and I'll be fine. But I hope I've explained clearly enough in my post that I'm really not going to be fine. I guess I'm looking for someone to agree with me and give me the kick in the pants that I need to take the year off or whatever to study and catch up to where I'm supposed to be at.

[tnbutterfly - Mary, BSN]

Thread moved to General Nursing Student Discussion forum.

[Lunah, MSN, RN]

Does your school provide tutors? Kudos to you for being concerned about your education, but I'd hesitate in taking time off -- for a lot of people, it becomes difficult to go back once you've left. Sounds like you know the areas where you need reinforcement. Do you get a summer or seasonal break? (Sorry, not sure what the Canadian schedule is like.) That would be a great time to hit things like pharmacology. I think you probably know more than you realize.

[llg, PhD, RN]

One thing that can help you learn more effectively is for you to get in the habit of thinking about your learning.

As you start a learning experience (a particular reading, classroom session, clinical experience, etc.) ... ask yourself, "What am I expecting to learn from this?" "What am I supposed to learn from this experience?" "Why is this assignment part of the school's curriculum?" Most learning can be categorized as either psychomotor (technical skills), cognitive (facts, knowledge, mental abilities), or affective (attitudes and behaviors). As you identify your learning goals, try to identify ones in all three categories.

As you go through the learning experience ... monitor whether or not you are meeting those expectations. Ask yourself questions such as, "Am I learning what I thought I would be learning?" "What am I going to remember from this experience?" etc.

As you finish the learning experience ... ask yourself questions such as "What did I learn from this experience?" "What am I goig to remember?" "Did I learn a new skill?" "Do I have a greater understanding of anything because of this experience?" etc. "How has this experience contributed to my beliefs and/or attitudes?" etc.

Keep track of your answers to these questions. Keep a journal of your answers to these questions. Make at least 1 journal entry summarizing your learning each week. In the beginning, it would be best to make a journal entry at least 3 or 4 times per week. (If you really can't keep a journal for some reason, at least review the answers these questions with a friend regularly -- though a journal would be much more effective because it would force you to write things down and you could review the journal regularly.)

The process I have just described is a form of "reflective practice." It's a key part of the learning process and it sounds like this is your weakness. You need to learn to "think about your thinking ... think about your learning" so that the activities you do in school become lessons that you take with you forever. Monitoring your learning on an ongoing basis and reviewing what you have learned regularly can help you solidify your learning and give you the self confidence you seek. This process will make your learning visible to you and help you build your knowledge and skills over time.

[Heinz beans]

I was in a simialr situation the year I was planning to finish. I had realised there will be a lot of anxiety as a graduate nurse, (I think you sort of have enough knowledge to know you don't know enough :)) but wasn't comfortable with my level of knowledge and experience.

I asked my faculty to resit the final clinical course again explaining clearly why I thought I wasn't ready to recieve a pass. They gave me a "deferred" grade until I completed the course. This made me feel a bit more at ease and allowed me to complete the course to a level I felt suitable for me. It was just knowing myself and what I needed to do to.

Saying that, don't take time off or resit if you can really help it...most people are nervous when they are grads and do great...it means you really care about your nursing.