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

Nurses New Nurse

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Hey New Nurses :)

In reading through some other posts, I've been thinking (I'm sorry- I'll try to cut down :D)

What have you found in your first months to year or two that you really needed to have learned in nursing school, but didn't? I'm not interested in bashing any instructor, program, facility....just looking at trends for my own interest in this.

My perspective is that you guys are having to learn a LOT after you graduated that some of us old goats take for granted that you did. But it's obvious that something is different, and it's not just iPods :)

I'm sincerely interested. I'll throw in my own observations later- just interested in what YOU think you needed to know, or do, BEFORE getting hired as an RN.....:)

:up:

BSN grad here. Finished last June in BC, Canada. I felt clinically that my school prepared me well for almost all my skills except for IV insertion (which they don't teach you as many hospitals have dedicated IV teams) and central dressing changes and management. We could always hang a medication if a CVC was connected to a running line, but never un-hook the line, flush the line, or change the dressing. I got a crash course on this when I was hired at my workplace, and now feel comfortable. My school was a good mix of theory and skills practice, and overall I am happy with my education. You can take an IV insertion course if your manager approves if for your area of practice, i.e emergency or critical care. Most med surg floors won't unless you are in a rural area without an IV team. I still wish I could do IV's though, especially when you have to wait a long time for the IV nurse to get to your floor to insert a saline lock.

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BSN grad here. Finished last June in BC, Canada. I felt clinically that my school prepared me well for almost all my skills except for IV insertion (which they don't teach you as many hospitals have dedicated IV teams) and central dressing changes and management. We could always hang a medication if a CVC was connected to a running line, but never un-hook the line, flush the line, or change the dressing. I got a crash course on this when I was hired at my workplace, and now feel comfortable. My school was a good mix of theory and skills practice, and overall I am happy with my education. You can take an IV insertion course if your manager approves if for your area of practice, i.e emergency or critical care. Most med surg floors won't unless you are in a rural area without an IV team. I still wish I could do IV's though, especially when you have to wait a long time for the IV nurse to get to your floor to insert a saline lock.

MANY, many hospitals in medium sized cities (100,000 +) do NOT have IV teams of any sort. It is the nurses primary responsibility to insert and maintain all peripheral lines, and maintain all central lines.

The IV Team concept is a myth in more places than it is not :)

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Specializes in Medsurg/ICU, Mental Health, Home Health.
MANY, many hospitals in medium sized cities (100,000 +) do NOT have IV teams of any sort. It is the nurses primary responsibility to insert and maintain all peripheral lines, and maintain all central lines.

The IV Team concept is a myth in more places than it is not :)

Really? My hospital is in a town of 30,000, and we have an IV team.

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Really? My hospital is in a town of 30,000, and we have an IV team.

Yeah. Really :) All 3 hospitals (one is within a large organization with hospitals in 3 or 4 states). All accept trauma. (2 are Level 1).

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Specializes in Medsurg/ICU, Mental Health, Home Health.
Yeah. Really :) All 3 hospitals (one is within a large organization with hospitals in 3 or 4 states). All accept trauma. (2 are Level 1).

I wasn't saying "Really" to the IV team myth. I know full well several institutions do not have dedicated Vascular Access nurses. I was wondering what the population of the city had to do with it.

Basically? I was teasing you...and being kind of difficult for no reason. :)

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I wasn't saying "Really" to the IV team myth. I know full well several institutions do not have dedicated Vascular Access nurses. I was wondering what the population of the city had to do with it.

Basically? I was teasing you...and being kind of difficult for no reason. :)

Sorry- I'm a bit concrete tonight :)

I thought a larger town with no IV team was relevant :up:

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Specializes in Med Surg.
5. Preceptorship - I think ALL schools need to offer a preceptorship in the last semester of school. My school doesn't do this and if I had known what I know now, I would've gone to a school that offered this.

Wow, I thought preceptorships were standard. I can't imagine working as a new nurse without the experience of my preceptorship--I'd have been totally overwhelmed. Frankly, I wish I hadn't had my last couple of med-surg rotations (one pt=incredibly boring day, unless you're working with a great nurse who will let you do things with her other pts). I would have preferred my preceptorship to extend for the whole last semester. That's where everything finally started to click for me and I understood what all of nursing school had been leading up to.

I really feel like I got a good, solid foundation in nursing school. I went the LPN route then immediately into an ASN completion program. I spent hundreds of hours in clinical. I do wish I'd had more opportunities for skills, but that's sort of luck of the draw--pts don't necessarily need a foley, IV, or NG inserted at the time when I was there. Of course, they don't always need these things when I'm at work either; I've been working for almost 3 months now and just cathed a guy for the first time ever a couple of days ago.

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I never HEARD of a preceptorship until 2003 when I moved from TX to IL. ALL new employees got the same orientation; new grads got a week or so longer. Then the charge nurse (me, where I was) was the resource for the new grad.

Standard new hire orientation when I started in a hospital in 1986 was a week or so. I'd been out for 6 months (spent that in LTC- the only RN-educated nurse in the building - 140 beds- but no license yet).

This is some of why the older nurses don't understand a lot of what is going on with the newer folks. And why I'm nosey :)

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I graduated last year but am currently in my RN year while working. I think we need more clinical time taking care of the patients. I get the book learning and lecture is necessary but at some point in time we have to knuckle down and take care of people. I think one of the difficulties nursing schools face is they try to teach us absolutes on how to do something when in real life it depends on your policy where you work. I don't know how they can compensate for that. Our school has more preceptors days in our 2nd year and those are invaluable to me. Following an RN and helping her with her patients allows me to gather so much real world knowledge.

Ok back to your question, I wish we could spend more time nursing and less time doing paperwork about nursing. I wish we had more clinical hours even though it would make it harder on me.

I totally agree. The paperwork is enough, I would rather be getting hands on experience. I understand needing to know the patho, labs, meds and writing a dx, but when they add in the rest it is overkill. We only go to clinical 2 days a week at my school and this semester we have class one day (so we are off two days of the week), I wish they would add another clinical day!

After reading a lot of these posts I almost feel pretty well off. I'm in my last semester and have done most things that people mention that they haven't. I am fortunate enough to be at a level 1 trauma center doing my clinicals in their TICU the first half of this semester and will be going into the ER next week (our teacher says that we should be doing lots of IV starts next week), so I am learning a lot just in the few weeks that I have been there.

I do wish I got to do more skills like TLC dressing change (I've only done that in the school lab) and other wound care. I've only inserted one foley on a women, but I would like to get to do it on a man before school is out. We did group NG insertion in a lab, but not on a person. I've done multipule PEG tube feedings and med admin. I've drained a ventric, but that isn't hard, and suctioned a few times.

I've only given one IM!

I've only had more then one pt for a few hours though because my other pt got discharged so I'm nervous about having multiple pt! Most of the pts that I have had have all been the same besides the ones in ICU, they have been knee replacement and heart pts and I want a change.

I'm a hands on person and watching youtube and reading doesn't cut it for me, it helps get the idea, but i have to do it a few times to fully get it.

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Specializes in Pediatric Hem/Onc.

I'm a new ADN grad and I started my orientation in mid August. I just completed my 3rd week on my floor - where I worked as a PCA for almost 2 years - with a preceptor. My program included a 120 hours of role transition in the final term and exit HESI.

I definitely agree with the comments about more hands on experience. We had a skills lab, and I practiced so much just the sight of those dummies gave me a headache.....but it's not the same as having an actual patient. My first NG experience was with a nonverbal dementia patient who tried to choke me. My preceptor thought it would be a good learning opportunity. All I kept thinking was "this guy is NOT going to politely take sips of water while I calmly feed this tube up his nose!" but it DID make me think it through. Ultimately I couldn't get the tube down - we tried 5 times between all of us and every time it went the wrong way. He was also my first IV attempt - yeah that didn't work out either lol

CVC care!!! Everything I know about central lines comes from observing while working in hem/onc....NOT from school. I am completely green about it. Thankfully we got a skills day in orientation dedicated to this. I don't understand why I was only taught line care for PIVs. CVCs are common enough that you should have SOME idea of what to expect. Same with lab draws. I accessed my first port last week and could barely keep my hands from shaking.

Report: During clinicals, we spent the first hour looking stuff up and didn't even hear report (other than our last med-surg and role transition - last 2 terms.) Giving report is seriously the worst part of my day :( My first night of role transition, my preceptor expected me to be able to do it. Absolutely terrified me because my head was so full of the details of the night that I couldn't even think where to start. It didn't help that particular unit tape recorded report and my preceptor was stopping the tape every 30 seconds to tell me to reword or add something. Ugh. Now, I've been giving report on 2-3 patients (standard load on my floor.) I have a brain that's really helping me keep things organized so that helps, so my time management is pretty decent....but I miss details. And I know I'm going to miss them, and my preceptor is awesome with helping me, but.....I can't help but think if I'd been exposed to more reports - and that 1 min rundown of "you can do morning care and pass out meds" doesn't count - that I wouldn't feel so intimidated by the whole thing. My last shift I got the evil eye from 2 out of 3 nurses during report. It's starting to wear me down but I'm determined to get better.

I know I'm new and it's expected, but I hate feeling like I suck at my job. I'm just thankful a long orientation is standard for everyone at my hospital, plus there's a year long new grad residency program for support. Some of my friends have been leaving their jobs in tears because they feel so overwhelmed. I don't know what I'd do if I'd only been given a few shifts to follow someone before being thrown out on my own.

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Specializes in Geriatrics, Home Health.

I graduated from an ADN program in May 2008. It was heavy on theory, but light on skills. First semester, skills lab included bed making, transferring, and a lot of procedures on dummies, but very little on people. We couldn't do anything invasive on people, so I never learned IV starts or blood draws.

Skills lab ended with second semester. Once you were passed off on a skill, that was it. If your clinicals didn't reinforce your lab skills, you were out of luck. It wasn't unusual for a student to fail 4th semester clinicals because they didn't know skills that they hadn't used since 2nd semester.

Clinicals were very hit-or-miss. If you weren't very aggressive about doing procedures, at a place that let students do procedures, you spent the shift doing vital signs, ambulation, baths, and glucose checks. My first med-surg clincal was at a rehab hospital. I got report, did vital signs on my 1 patient, and got them up, dressed, and bathed. Then they went to therapy, which left me looking for something to do until the 11:30 glucose checks. Without Pyxis/Omnicell access, I could only pass meds with the instructor present, which meant passing meds once or twice a semester. The instructors were big on care plans and Functional Health Patterns, which I've never encountered in the real world.

The only real exceptions were maternity, at a "safety net" hospital, and peds, at a home for children with brain injuries. I did a lot in peds, and I learned a lot about trachs and vents. I also learned a lot about screwed up families and the dark side of nursing. The nurses HATED us, and weren't shy about expressing that. The first day of maternity, my instructor held up a care plan sheet and said "I don't care about these; I care about what you can do on the floor."

Fourth semester, for my second med-surg rotation, I was expected to know skills I hadn't done since second semester. Most of my clinical experiences involved vital signs, dressing, bathing, glucose checks, and ambulation for 1 patient. I was screwed. I got through it (barely), and I graduated feeling like a CNA who gave meds.

I'm also a hands-on learner, and I applied for a lot of summer externships, but since my school didn't require one, I got no help finding one. I also applied for CNA jobs, but no one (including my advisor) gave me any clues about how to become a CNA without taking my school's $1500 CNA course or a $700 Red Cross course. I finally found out how to skip the written exam 2 weeks before graduation.

I managed to graduate from nursing school without drawing blood, starting an IV, inserting a foley (on a person), changing a dressing, using an IV pump, doing anything with drips, assessing wounds, or doing anything with PICCs or CVCs. When I expressed my concerns to the lab instructor, she said "They'll teach you that on the job." I've learned quite a bit since I graduated, but I still can't insert an IV, draw blood, change a PICC dressing, or insert a foley.

Long story short, I agree with xtxrn's opinion that today's nursing students are being screwed clinically. We're not given a chance to learn a lot of skills, then punished for not knowing them. The Nursing Process hasn't helped my practice at all.

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Wow, after reading some of these I feel really lucky to have gone to the school that I did. I graduated from an ADN program in June and we had lab to work on skills for the first year. In clinical our instructors would find out the skills you hadn't done and would try their hardest to get you a patient where you would be able to practice those skills. We had a lot of experience dealing with CVC's. We only got 1 chance to practice IV starts on each other in lab and most students didn't get many IV starts during clinical (many of the hospitals had IV teams) but I think I got lucky. I did a community rotation at the student health center of our school and got a lot of practice with blood draws and IM's. Then I precepted in a level I trauma center and hit the ground running. I started IV's from day 1, started a minimum of 5 a day along with so many blood draws I can't count. I put in a couple of NG's and many foley's. It was an awesome experience. My school was really big on making sure everyone got as much experience as they could before graduation.

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