Things that are learned on the job

How you call a doctor and communicate with them is one on the job skill I can think of. As a new nurse I learned the hard way that when you call a doctor with something abnormal, have the chart, flowsheet and a set of vitals right there when they call back.

On the job, experience taught me how to deal with abnormal findings. Do you call rapid response, do you let the docs know on rounds, do you record it in the chart, do you page someone right away, or can it wait? These are judgement calls that aren't a focus of clinicals.

I think skills in general (IV's, foleys ect..) are not done much in clinicals. The instructor or nurse has to be with you and a lot of nurses don't want to be bothered with it. It is easier to do it yourself. I have seen nurses come out of school having only started 1 or 2 IV's. My suggestion is to do as much as you can. It will definately help when you graduate. Good luck.

Time management with several patients to care for. In school, they will only give you one or two, but after graduation and orientation, there will be more and they will be sicker. They may tell you in school not to be distracted when medicating someone, but the real world is filled with interruptions. You have to learn to listen while doing what you have to do, and also to determine if you have to drop what you are currently doing to prioritize care. And, yes, speaking to doctors is a must. Many of them are impatient, rude and interns can be really stupid (some attendings, too, for that matter). You can't insult their intelligence, but sort of make them think this was their idea.

Also, you have to learn how to do what you need to do for the patient, and while the textbooks, policy and procedure will instruct you one way, the real deal (at least from my personal experience) is doing what is necessary depends on who is on duty. For example, if you have a head nurse that is lazy, or a physician that is not the best, you have to figure out how to get what you need done. Usually, it means skirting around others. This skill takes time, because you have to know the 'lay of the land', so to speak.

Time management with several patients to care for. In school, they will only give you one or two, but after graduation and orientation, there will be more and they will be sicker.

That is why I consider my LPN schooling to be outstanding. Before we graduated, we worked full shifts with a full load of patients. We worked 3-11 and did charge as well (even though in the real world, we weren't allowed to do so).

Time management and how to communicate with doctors are the 2 that I can remember not being well prepared for from school.

And always remember, there are no dumb questions in nursing.

i'm starting nursing clinicals in the fall and i was wondering, what are the biggest things that generally aren't focused on in clinicals but instead have to be learned on the job? i'm thinking more along the lines of actual skills but i'd love to hear your opinion on anything.

thanks.

multi-tasking. you really can assess a patient while you get him back into bed, change his dressing and irrigate his foley. plus you'll have a good idea of his roommate's mental status before you're finished.

prioritizing. you'll have six patients, three of whom need meds, one of whom needs a foley and one of whom just pulled out her one and only iv right as her unit of blood is delivered. plus you haven't been to the bathroom in 10 hours and you're sure your eyeballs are yellow. what do you do first? (answer: go to the bathroom.)

talking to doctors. you'll know enough to have examined all 3 of doctor fox's patients before you call him with the low hct on one of them. (they get really irritated if you page them 3 times in an hour for three different patients.) and you'll have vital signs, lab values and appropriate physical findings in front of you when he calls back. you'll learn who responds better to joking and who you can't get away with it with. and you'll get comfortable with calling either of them.

interacting with co-workers, some of whom are wonderful and knowlegeable and helpful and others of whom are a trifle crispy.

talking to patients and their families.

you get the idea. an rn license is sort of like a learner's permit. it gives you a license to learn, it doesn't mean you know it all!

Can you share what you learned below, but in detail? Would be most helpful!

My goodness I agree with the doctor calling/paging. PLUS let someone else know who you paged if they delay returning the call. It might be the very moment you have to run to the BR or get a sip of water. They really get angry if no one claims to have called.

Don't be too proud to ask someone how they are so good at _whatever____ starting an IV ( I learned from an LPN who had been a field medic-she could start an IV in a noodle, in the rain, in a bumpy jeep.) I learned from a new housekeeper how to get gooky stuff out of my uniforms. A volunteer taught me how to estimate how much ice it takes to fill a cooler. A security guard taught me how to figure out which plug on the back of the bed will stop the call light from constantly going off without the patient pushing the button.

Learn all you can and don't ever think you know it all, cause you never will.