Textbook nursing vs. real world nursing.

[dudette10, MSN, RN]

I've seen that phrase a lot, and I really don't understand it. I'm not being snarky here...I sincerely don't get what that means.

For example, working with difficult people and noncompliant patients is not something taught in nursing schools, so it's NOT a textbook thing...not taught in lecture, but it certainly comes up in clinicals. It's mainly the real world of nursing, but we might have seen it on the floors during our education. Therefore, there is no "vs." about it.

Is it because in "textbook" nursing, the assumption is that every patient is compliant, every role does their job without question, and when you get on the floor, those assumptions no longer apply?

That's really the only thing I can come up with.

I guess my question comes from nursing friends who said to me after I did an FB post that I got a job, "Forget everything you learned in school. You're in the real world now." I use what I learned in school every single day: pharmacology, assessment, pathophys. When I have questions about nursing judgement, my basis for those questions is what I learned in school, although school didn't teach me everything, of course, which is the reason I'm asking the questions in the first place.

How do you define that phrase? What do you really mean when you say it?

[studentgolfer]

I feel like this is a saying that catches on with the students in your class that you know aren't going to be a good fit for a nursing career. The ones with little or no patient care experience but they are dead set on becoming a nurse! ($$$!)

These people think that the floor should be just like textbook where everything is quiet and as you mentioned, compliant.

Of course this is a fantasy world for anyone that has worked healthcare :). I agree with you though, there is no Versus, it is all the same thing -- some people have just prepared themselves for the job better than others.

The ones that jump in and feel lost/hectic because they have never done this before are probably the ones that felt that way going through nursing school courses (so they probably don't have that much to "forget" from the textbook anyway!)

I don't feel there is any reason you shouldn't attempt to apply your education to every case, every time. We went to school for a reason, not so we can just wing it once we get to the floor....Even as a CNA Nursing Student -- RN's were impressed with my knowledge base and there were a few I honestly felt more educated than (only a few, and they would probably be the ones that said "Forget it all, real world starts now"

That's THEIR real world, the world where they didn't actually learn anything to carry over into their profession.

[dudette10, MSN, RN]

This isn't a saying from my classmates; it's an oft-repeated phrase from experienced nurses. I have a lot of nurse friends who've been in the business for a decade or more.

ETA: I'm not criticizing the saying. I just don't understand it because it's never really been defined for me. In my very short experience, it doesn't apply. I can say that my previous career has helped me considerably in mucking through the situations that were never taught in nursing school (noncompliant patients, organizational skills, communicating with peers and other roles, etc.).

[chevyv, BSN, RN]

Ahhh text book nursing vs real life nursing..... Try to look at it like this......everything looks good on paper and then you get into real life and realize it's not the way it usually works. Text books give you a perfect scenario. Real life rarely does. Not everyone presents with the text book rules. Just take a text book view of cathing a female pt and then take it to the real world and tell me how that works. I remember working with a nurse who had no less than 5 caths going in and still not hitting the right spot, lol. We are all so different that it's nearly impossible to text book us!

[dudette10, MSN, RN]

Ahhh text book nursing vs real life nursing..... Try to look at it like this......everything looks good on paper and then you get into real life and realize it's not the way it usually works. Text books give you a perfect scenario. Real life rarely does. Not everyone presents with the text book rules. Just take a text book view of cathing a female pt and then take it to the real world and tell me how that works. I remember working with a nurse who had no less than 5 caths going in and still not hitting the right spot, lol. We are all so different that it's nearly impossible to text book us!

Ok, I see your point. I guess I went into it, though, expecting some of those anatomical differences, so it never occurred to me that it was textbook vs. real world.

[A&OxNone, MSN, RN]

Textbook....

Sterile foley insertion. all the steps, perfectly organized.

Real world..

The pt is so edematous you can't find the right place to put it! Or, the pt is AMS and combative and u have to just be as sterile as possible.

Stuff happens. That's the way I look at it

[dudette10, MSN, RN]

Textbook....

Sterile foley insertion. all the steps, perfectly organized.

Real world..

The pt is so edematous you can't find the right place to put it! Or, the pt is AMS and combative and u have to just be as sterile as possible.

Stuff happens. That's the way I look at it

Ok, I think I get it now. As I mentioned previously, I guess I just expected certain things to be different, and never recognized they were textbook vs. real world.

[Sun_danc3rRN]

My take on it is this: textbook nursing is the perfect world where everything and every decision is black and white. Real world nursing is not a perfect world and there are many shades of gray, as well as black and white.

[ktliz]

My nursing instructors are constantly reminding us that NCLEX questions are to be answered in the context of "Ivory Tower Nursing." That is, if you only had one patient at a time, plenty of assistive personnel, unlimited supplies and equipment, etc. I think that is what people mean when they refer to "textbook nursing." When you're in the real world without the time and resources of the Ivory Tower, you adapt...

[hiddencatRN, BSN, RN]

Textbook....

Sterile foley insertion. all the steps, perfectly organized.

Real world..

The pt is so edematous you can't find the right place to put it! Or, the pt is AMS and combative and u have to just be as sterile as possible.

Stuff happens. That's the way I look at it

This is how I've interpreted it too. The "correct" way versus how it actually gets done.

[dudette10, MSN, RN]

In the context in which this phrase is said and ignoring my own realistic expectations, I really thought it was something totally unexpected and nearly insurmountable by a new grad.

Problems occur. You work around them with guidance, if needed.

I was just waiting for the other shoe to drop in my short experience, and with the explanations here, I now know there is no other shoe. *breathes easier*

[Altra, BSN, RN]

Nursing school (and, by extension, professional training in any field) teaches a blueprint approach to problem-solving, including the scientific/academic underpinnings of professional practice. It has to -- one has to learn the basics, first.

The real world is, of course, far more complex. This complexity involves the idiosyncracies of human beings, the behavior of systems (including organizational behavior, e.g., the health care facility), financial & regulatory realities, etc. You could attempt to "teach" these ... but teaching about the realities of drug shortages, for example, is likely lost on a student who hasn't yet learned about these drugs, their pharmacologic indications, and their clinical use.

The blueprint approach also pretty much excludes priority setting: you learn pathophysiology and what to do about it ... but not how to prioritize/coordinate multiple patients' pathophysiology within the framework of multiple systems.

ETA: Sometimes "the book" is only a starting point. And sometimes, you throw out the entire book.