What overwhelms you the most? What did NS NOT prepare you for?

[BeenThereDoneThat74]

Hi new grads!! I am trying to gather some real life information to bring back to my clinical students. I don't want this to be a bashing thread about your instructors (because it's never OUR fault...ha ha ha ), but rather a reflective thing.

The reason I pose this question is this: My students (as many others before them) think that nursing school (and nursing thereafter) is all about skills!! If I had a dollar for every student that has complained that they have not inserted a foley, or are nervous about it, I'd be a millionaire!! Our graduating class did a survey (for a research project) and the most popular answer for "what skill do you feel most unprepared for as a new nurse" was that!! This beat 'taking care of a vent patient' :uhoh21:. Meanwhile my students (while very good this semester... 2nd semster) still at times could not give me a nursing diagnosis, tell me why patients were on a baby aspirin (pain?), where the MD orders are in the chart (or why we need to check MD orders to the MAR, not MAR to their cheat sheets) or other "non-tangible" skills.

I know skills are important. But as time goes on, you get these skills. I tell them a monkey can insert a foley and set up an IV. I also told them that I would never fail someone who did not perform a skill correctly (ie break sterility during a foley). Maybe it's just me, but the other things are more important, like how to assess, problem solve, prioritize, communicate, and most of all apply the theoretical knowledge into clinical practice. I tell them there is a reason they sit there in lecture.

So basically, I wanted to know: has anyone ever been thrown off orientation because they didn't remember how to perform a basic skill, or made a mistake with it? What gets you caught up as a new grad? And what can I tell my students (I have a feeling that nothing I say will help )?

[Seasoned]

:bow:very smart of you to ask!!!

always missed in all nursing programs, but the definitive survival on any unit and any setting, in any specialty, on any shift:

how to navigate through nursing office politics!

after 34+ years of nursing i am remiss in not having written a book! any seasoned nurse will tell you how well you fit in, very unfortunately, will make or break you with any employer. nurses with all the skills down pat will not make it if "they" don't want you there.

you want to reduce the reality shock for your students? you want to keep them from crying in their beds after shifts wondering why they wanted to become a nurse? invite a very office politics savvy seasoned nurse to speak with them. to be effective it should be an 8 hr day: office politics for the nurse - what it is? how it affects your work. or maybe a q & a panel discussion seminar with different perspectives on different perceptions. the effect of different work environments (shift, settings, specialtys...). and then most important how to navigate though it all.

can't find anyone (i am available) include the book-learning-experience of

"ending nurse-to-nurse hostility, why nurses eat their young and each other" by kathleen bartholomew, rn, mn

- about $100 for 200 pages but worth every letter of every word in it.

preparation is key! i don't smoke.

[cardiacRN2006, ADN, RN]

Maybe you could encorporate into your post conference having each student give approx a 2min report on each of your students patients that day.

Also getting over the nerves of calling a Dr. Have your students practice on each other of calling a Dr for a problem, once again "just the facts maam"

Love these 2 ideas. At post conference, you can make them give you a 'shift report'.

And also, you can have them call YOU, the clinical instructor, when they see a situation that they would normally call a Dr.

For instance, make them call you if their pt has an abnormal lab. You are busy as a CI (Drs are busy too) and they may understand what conditions warrent a call and which don't. When they call you, you can ask them pertinent info just as a Dr would!

[cardiacRN2006, ADN, RN]

Ok, now that I've read all the posts...

I have to agree with nurse educate and I see where she is coming from.

She is not saying 'skills don't matter' she is saying, "stop focusing on ONLY the skills"

Students need to take a step back and look at the whole picture.

I had a student last week. She was so focused on charting the Q1 VS. Great. Thank you. But did you notice that the pressure is now 80? Chart later, let's do something now!

Students that I see in clincal rotation are so focused on skills that they miss some really good stuff.

So while learning skills is very important, it's not THE most important thing, and not more important than critical thinking, and critically acting/doing.

[SoundofMusic]

Nursing school did not prepare me for a patient I had yesterday -- vomiting non-stop, wimpering, crying, demanding and seeking drugs through her IV all day long, refusing all tests, refusing to bathe, refusing to get out of bed -- just wanted her drugs on schedule and that was it.

I mean -- they just don't tell you about these things in nursing school. I am also still trying to figure out why/what the doctors are treating her for.

[Calzonan RN]

All of these are great suggestions, I wish I had read this thread when I first graduated!!

What I wish nursing school had taught me....

1. Always watch your back. Just because your preceptor talks to you like you're her friend, you're not. She's there to pass or fail you, and if you don't fit into her idea of the 'perfect nurse' then she'll fail you regardless of skills.

2. Office politics. These people are not always your friends. They won't consider you a friend until you prove your worth. Never assume there isn't a hidden agenda somewhere.

3. Open communication between you and your preceptor with weekly sit downs is a key to making sure you're on track towards getting off of orientation (wish I had known this one, or insisted upon it).

4. How to really manage several patients at once. Time management skills are the key to staying on top of everything.

5. How to perform skills while charting before/during/after them! Nonstop charting on everything from saying hello to your patient, change in positioning of your patient, ANYTHING you do until you give report to the next nurse.

6. How difficult mentally it is to be a new nurse and try to learn the computer system, abbreviations, specialized skills, time management, charting horrors, balancing patients, when meds/vs/iv site checks are due... the list goes on.

7. Being a new nurse is like boot camp in the military. They throw everything at you and try and make you break. If you don't break you get to stay.

8. They expect you to be capable of running an emergency situation, even if you've never been in one before.

9. At the end of orientation they expect you to be a better nurse than the rest of their staff.

10. Don't ever let them know you're scared about anything or appear like you lack confidence in something you've never done, they'll use it against you later.

11. That nurses really DO eat their young...and then complain about staffing.

This may only be in L&D orientation. But this is what I have found. The honeymoon is definitely over....

[bookworm1]

I am not a nurse yet-just one year to go, but some things I would like to see changed while I am still in school:

-more clinical time. We have one 11 hour shift per week to work on the floor. I don't feel like we get to see enough, hear enough, experience enough with one shift per week! The classroom portion is very thorough, but to see the things we are discussing would help immensely!

-Hospital politics. I know this has been mentioned before, but even as a student I can tell that each floor and each area within the hospital has their own 'system'. Much of it is just personality, but we should still be exposed in greater detail!

-there are just too many other things to discuss! I know that I still have two clinical semesters left, but I still feel so unprepared for the 'real world', as if we aren't learning all that we should.

[Dragonnurse1, ASN, RN]

It is an unfortunate occurance but sometimes patients present with a complexity of sx that is very complex. Thats why doctors "practice" medicine. Or perhaps she is exhusted from the "problems", tired of the tests, Tired of trying to live. When you hurt and no one can stop it or explain it you get depressed. Perhaps you need to review the chart. Sometimes just sometimes we , nurses, the PATIENTS advocate, have to go toe to toe with the MD's just too open their eyes to something they might be missing - and chart, chart, chart (not your opinion) chart your observations, the patients actions, what she says - use quotes- anything. Some day that charting might make a big difference in her life because another MD may read your notes:wink2: and figure it all out.

Most of all keep on trucking and know that in some small way you can make a difference and do make a difference in the lives of evey patient you care for. You may not know it now but what you and all nurses nationwide do 24/7 is care for the life of this country, Moms, Dads, sons, daughters, nieces, nephews and on and on.

And without nurses Doctors would not be able to care for anyone. :anbd:

Please to all nurses that read this thread do not give up, never give up the good fight. I had to because it was quit or die and now I am dependent on all of you that can continue carry one:bow::redbeathe

[cherokeesummer]

I'm going to read the thread as much as I can but while I'm thinking about it I figured I'd reply. I think for me skills were a big thing but like you said you can learn as you go. So I can't really put that at the top of my list. I think for me its:

time management for real (2-3 pts in clinicals vs. 8-10 (4-5 couplets in my case) for real life work as a nurse.

Meds, meds and more meds - more understanding of them anyway. Or at least some smarter/time saving ways to remember them.

Lab values/readings - understanding them and how they apply to a diagnoses I suppose.

Toughness/ability to function under pressure and ability to handle a bunch of stuff coming at you at once (guess that would fall under time management LOL).

[cherokeesummer]

Great thread and thanks so much for thinking of your students and thier concerns.

I graduated in Dec 07 so nursing school is FRESH in my mind. Let me tell you the hardest part I had in acclimating into the nursing world. It was not the technical part per say, as that comes with practice and on the job training. I found my hardest part to be report. That may sound silly, but getting a good report is so important. "Just the facts maam" is what a good mentor nurse told me. Maybe you could encorporate into your post conference having each student give approx a 2min report on each of your students patients that day.

Also getting over the nerves of calling a Dr. Have your students practice on each other of calling a Dr for a problem, once again "just the facts maam"

DITTO...lots and lots of handoff communication practice is a good idea b/c I've been practicing for about 6 months now and still feel funky at report time LOL sometimes anyway!

[listener]

Dear Nurse Educate,

Thank you! I've really enjoyed reading this entire thread (as well as the very long BSN vs. ADN thread, which I think complements this one) and although I don't even start NS until Jan '09 I can't resist contributing a bit of my own naive perspective to this issue of skills vs "non-tangible" skills. I like to use analogies, so here's my little scenario:

Imagine that you're playing softball (rookie), you're in center field and the batter pops up and it's your ball. What are you thinking about as it approaches? About the baserunner on 2nd and about how many outs there are already and where you should throw the ball once you catch it?? Hopefully so!! But if you aren't confident in your fielding skills the ONLY thing you're going to be thinking about is "I've got to catch this one!", or maybe "Oh my God, I'm gonna drop it!" And EVEN if you already know exactly what you should be thinking about in this softball scenario, if your mind is blinded by this insecurity in your own skills, it doesn't matter WHAT you actually know if you can't retrieve that information in the heat of the moment.

That's my 2 cents on the importance of teaching the skills vs. "non-tangible" skills. This applies to any profession, it's human nature. Of course critical thinking and the science of nursing are the bottom line here, but if new nurses (obviously some more than others) have doubts about their skills, I can imagine that nursing education is going to get more bang for the buck by doing whatever it takes to get students comfortable with their basic skills.

Once again, great thread. Luv this website!

[muskylounge]

Imagine that you're playing softball (rookie), you're in center field and the batter pops up and it's your ball. What are you thinking about as it approaches? About the baserunner on 2nd and about how many outs there are already and where you should throw the ball once you catch it?? Hopefully so!! But if you aren't confident in your fielding skills the ONLY thing you're going to be thinking about is "I've got to catch this one!", or maybe "Oh my God, I'm gonna drop it!" And EVEN if you already know exactly what you should be thinking about in this softball scenario, if your mind is blinded by this insecurity in your own skills, it doesn't matter WHAT you actually know if you can't retrieve that information in the heat of the moment.

That's my 2 cents on the importance of teaching the skills vs. "non-tangible" skills. This applies to any profession, it's human nature. Of course critical thinking and the science of nursing are the bottom line here, but if new nurses (obviously some more than others) have doubts about their skills, I can imagine that nursing education is going to get more bang for the buck by doing whatever it takes to get students comfortable with their basic skills.

Once again, great thread. Luv this website!

I love analogies. This is a good one. The most important lesson with this analogy is that "practice does not make perfect." If the center fielder throws to second base every time eventual speedy gonzales will burn him/her and take third base via tagging up. The correct play the caught fly ball goes to third base with pitcher backing up a poor throw. Perfect practice makes perfect.

I am also from St Louis. I will start my clinicals Fall 2008. ( I am soooooo excited) I found this topic extremely interesting as to what I may need to extract from the next two years or try to extract as much as possible to help prepare me for post RN. Not focusing on the exam that gives you your RN title will be difficult for any student but I see the reasoning for those speaking in terms of experience learned being more important than book smart.

As far as nursing not being ready for the real world work environment I am not sure how that could even be possible. RN's do or perform different jobs depending on their setting. Would a school nurse need the same structure as a ICU nurse? Would a dialysis RN need the same NS experiences as that or a RN that would work in LTC facility. I know that the core RN program is what it is, and the field that the RN decides to pursue will specialize and expand their experiences. On the job training is sort of expected by me. My ability to sink or swim does affect peoples lives but I hope to God that I or someone would discover gross incompetentcies during a 4-12 (or longer) week orientation depending on your chosen field.

I have heard a couple of quotes comparing surgical MD's to RN's. This is not at all comparing apples and oranges. Would you expect a surgeon to learn on the job? I hope not. Thats why they go to school for 8 years instead of 2years pre-req's plus 2 year associates degree. Not to mention the huge internship required before they are a surgeon doing procedures on their own or the head of a team. They do learn on the job during these years preceding the internship. No Dr. leaves Med school and performs neuro surgery. This takes years of watching then assisting and then finally when residency is completed they get to become what they have specialized in.

I hope do get out of NS skills that I need to progress as a RN. I hope to have an open mind to nursing politics. I wish to always be humble enough to ask anyone for help.

[SoundofMusic]

It is an unfortunate occurance but sometimes patients present with a complexity of sx that is very complex. Thats why doctors "practice" medicine. Or perhaps she is exhusted from the "problems", tired of the tests, Tired of trying to live. When you hurt and no one can stop it or explain it you get depressed. Perhaps you need to review the chart. Sometimes just sometimes we , nurses, the PATIENTS advocate, have to go toe to toe with the MD's just too open their eyes to something they might be missing - and chart, chart, chart (not your opinion) chart your observations, the patients actions, what she says - use quotes- anything. Some day that charting might make a big difference in her life because another MD may read your notes and figure it all out.

Most of all keep on trucking and know that in some small way you can make a difference and do make a difference in the lives of evey patient you care for.

Thanks for these thoughts. It really opened my eyes. I will start really reading those progress notes, and really charting some of my own, more than my one time a day "required" progress note. I wish I could have preceptors that would make me think this way .... But, alas, they do not.