What Do You Think You Needed To Learn in School, But Didn't

sbostonRN · Sep 20, 2011

I would have liked to learn how to insert an IV. Many of my clinical skills that I've learned the first few months on the job were just not available in nursing school. I had maybe 40 patients TOTAL the entire time I was in nursing school, which is the number of people I take care of in a week now. So there's more opportunity to see G-tubes, insert Foleys and care for central lines.

Seems one of the big things I haven't done yet is insert an IV. Many of my coworkers did this in NS but we did not.

NoviceRN10 · Sep 21, 2011

I agree that IV starts are a skill that I would have liked to have learned in school. I was taught during orientation, but then don't have to do them because we have IV techs available. Now I know the steps, but actually doing one and picking a good vein are another thing .

jujubee1 · Sep 21, 2011

Thank you for addressing this in a non-judgemental way. The nursing school I attended (highly ranked northeast university, accelerated BSN program) hardly taught us any skills. We had a lab that we attended 5 hrs/wk for six weeks at the beginning of school that taught us assessments, bedmaking, aseptic/sterile technique, transferring of patients and that was pretty much it. We also had to watch a video on catheters and come in to get signed off on them. All other med-surg skills (ng tubes, IVs, ostomy care, etc) were demonstrated to us during a day called "skills boot camp." After we WATCHED our clinical instructors demonstrate these skills to us, we were signed off and allowed to do them in clinical.

Personally, I am a very hands on learner who needs to do something multiple times before it clicks. That is where I would have benefitted 1000% from a skills lab where I could practice to my heart's content.

In clinical I had the opportunity to perform a few of these skills, but I was never confident and always fumbling. The only knowledge I had of them was from what I saw from the instructors and what I read about on powerpoints and in text-books. Even if I did get to perform the skill it was something I couldn't really wrap my head around, because, again, I need to do something several times in order to become comfortable with it.

My senior rotation was a RUDE awakening! My preceptor received her education from a diploma nursing program 30+ years ago and when she graduated she said that she was ready to hit the ground running. Numerous times when I asked questions she would respond to me with "You are the the nurse, figure it out."

It didn't help that for the most part, aside from assessments, all we did at our other rotations were CNA duties. We always started clinical an hour after the nurses on the floor received report and when we got to the floor they would quickly give us a brief report and tell what they wanted us to do for the patients. Usually these things were just bed baths, and ambulation. All I desperately wanted to do was follow the RNs around and actually see what their day was like. I got to do it once, but it was very hard considering they always had 6+ patients, and we had to be constantly overseeing our 1-2 patients. Additionally, our clinical instructors only showed their faces at pre and post conferences and to pass meds with us (one time per rotation).

I passed my NCLEX and graduated with a great GPA, but I am terrified to work as an RN!! I was so excited to go to school and to be able to learn skills, but really I just came out with a headful of poorly written powerpoint notes, and a whole lot of stress!!

I am passionate about changing the way future RNs are educated. Students pay money for a service and at least in my experience, I did not get what I paid for. Then again, maybe I was expecting too much.

Thanks for listening to my rant!

xtxrn, ASN, RN · Sep 21, 2011

Thanks- I appreciate knowing this. :)

Keep 'em coming :up:

It's sad that IVs were sort of glossed over...a LOT of places don't have IV techs- and instructors must know that on some level....you guys end up getting ripped off- and then hollered at AFTER school for something that you weren't exposed to.

I'm listening :heartbeat

poopprincess · Sep 21, 2011

IVs, NG tubes (still haven't seen one even put in), Foleys (I did one). I think time managment is huge. I graduated never having more than 1 pt. so it was complete chaos trying to adjust to 5. Even 2-3 pts. would have given me something to work with. I was a nervous wreck about actually workign as a RN because I knew there was a lot of basic stuff that I didn't know.

TexRN08 · Sep 21, 2011

More about IV drip management! Titrating/bolusing/weaning (esp. drugs like propofol, versed, fentanyl, levophed, nitroprusside, dopamine, vasopressin etc), ideal ways to set up multiple drips (when you have more drips than ports), how to prepare for common bedside procedures (intubation, a-line insertion, central line insertion, Swan-Ganz insertion, TEE etc), external pacemaker set up/use, reading ECGs, Swan-Ganz catheter readings (what they mean, how waveforms should and shouldnt look), how to properly write nursing notes (what to include, HOW to say things correctly etc)... im sure I can think of more, but these are things I really felt unprepared for as I started my first nursing job..... some of these topics were taught but not emphasized and others I may have seen a couple of times in clinicals but not nearly enough (think I may have titrated a nitroprusside drip and thats about it during school).. Other things were neglected simply because they were not utilized at the hospital where I did clinicals/went to school (ie. Swan-Ganz and narrative-style nursing notes)

xtxrn, ASN, RN · Sep 21, 2011

More about IV drip management! Titrating/bolusing/weaning (esp. drugs like propofol, versed, fentanyl, levophed, nitroprusside, dopamine, vasopressin etc), ideal ways to set up multiple drips (when you have more drips than ports), how to prepare for common bedside procedures (intubation, a-line insertion, central line insertion, Swan-Ganz insertion, TEE etc), external pacemaker set up/use, reading ECGs, Swan-Ganz catheter readings (what they mean, how waveforms should and shouldnt look), how to properly write nursing notes (what to include, HOW to say things correctly etc)... im sure I can think of more, but these are things I really felt unprepared for as I started my first nursing job..... some of these topics were taught but not emphasized and others I may have seen a couple of times in clinicals but not nearly enough (think I may have titrated a nitroprusside drip and thats about it during school).. Other things were neglected simply because they were not utilized at the hospital where I did clinicals/went to school (ie. Swan-Ganz and narrative-style nursing notes)

Those are pretty much needed by critical care or ED.... I can understand why those aren't covered in nursing school, since most nurses don't go into critical care...the ones who do are motivated to learn them :) Kinda like you don't get a lot of NICU or detox info. Not enough of the class needs the info to get jobs....

xtxrn, ASN, RN · Sep 21, 2011

What I'm hearing so far is that basic procedures/skills and some everyday nursing info was glossed over at best, and not enough was expected of you in order to graduate with a solid skill base.

I'm still listening :)

surferbettycrocker · Sep 22, 2011

i would have liked more about charting and legal implications of being a nurse and charting and what have you. also more hands on skills---foley catheter ng tube ostomy care. the bread n butter of basic bedside nursing is NOT being taught and reinforced its being 'shown' in many bsn programs i think:twocents:

xtxrn, ASN, RN · Sep 22, 2011

I really appreciate you guys telling me this stuff. It really helps to know where your frustrations lie, and how it is really different for you than when I was in school. I'm not working anymore (disabled) but still care a lot about nursing students and new grads. I liked teaching the little I could when students were on the floor- and would seek them out for little things (since I didn't necessarily have the patients they were assigned to).

I'm still listening :)

And if someone wants to PM for some reason, I'm in the book

dudette10, MSN, RN · Sep 22, 2011

It's sad that IVs were sort of glossed over...a LOT of places don't have IV techs- and instructors must know that on some level....you guys end up getting ripped off- and then hollered at AFTER school for something that you weren't exposed to.

Some states don't allow venipuncture--Illinois doesn't, although some of my classmates whispered that "their nurses" on various rotations allowed them to do it. I think that's why many of us don't learn it on real people.

I've already PM'd you, xtxrn, so I think you already know that what I wish I was taught in school simply can't be taught there. It's the care management thing...docs, paperwork, etc.

ETA: Ok, one thing...more exposure to troubleshooting Foleys, G/PEG tubes, IV sites, etc. Sometimes, they work as intended, if you know how to troubleshoot them without being terrified by them.