What didn't they teach you?

[suanna]

I was talking with friends the other night and we came up with a pretty extensive list of skills/facts we wish they had taught us as part of out nursing education. For new and old alike: What do you wish they had taught you in nursing school that would have helped most when you started in practice? Or, that do the new grads comming out lack that you wish they had been taught? I don't want a put down session about new grads- I'm hoping to hear new ideas for improving the way we educate the next generation of nurses.

[SecondGenRN]

The list was somewhat long and verbal but a few I remember:

How orders work doctor-pharmacy-cardex-mar. Most students have never taken off an order or spokento a doctor.

How to interact with the medical staff- Nursing is taught in a bubble. Once they get out they are suddenly supposed to know how to figure out who is on call, what info to have available, what the chain of command is -intern-resident-senior resident-attending. What to do if you disagree with the orders.

IV therapy- not just starting IVs- which is pretty weak for most students, but common incompatabilities, fluid choice, colloid vs crystalloid, insertion site assessment. I can't tell you how many times I have been called to a floor with a high percentage of new grads and found 3 out of 4 ivs infiltrated. I have actualy has a nurse tell me she had a bit of trouble infusing the PRBCs but once she put it under pressure it got in over a couple of hours- needless to say the patient nearly lost thier are to compartment syndrome.

Report giving- learn to organize the important info into a concise format and pass it on to the next shift.

Geriatric patient specific skills. Students get a full semester with kids, babys, L&D but 80% of your patients are going to be 65y/o or greater. Most students have never heard of a "sundowner", have never helped manage a confused scared patient,and understand the meds and dose ranges as they apply to the aversge 25y/o. Schools need to wake up to the fact that most of our patients are OLD.

There are lots more but it's getting a little long!

we aren't even allowed to start an IV until we have graduated! Also, I think there should be more education regarding addictions

[jjjoy, LPN]

My school didn't allow starting IVs.

I definitely would've liked more realistic clinical training. Employers of all types still expect students to graduate having had a great deal of clinical experience even while many schools don't provide the kind of experience that fosters confidence and competence.

One major educational issue seems to me is what exactly "nursing" is and, thus, what "nursing education" should cover. By using a broad definition of nursing (eg any kind of health education, preventative care, primary care, advanced practice, etc), then there's no clear mandate that nursing education NEEDS to fully prepare students for acute care clinical work. Many nursing school recruiters emphasize that nurses needn't work at the bedside. So no wonder schools approach to education is confused.

One way around that would be to restructure nursing education and licensing/certification and formally create an acute care nursing specialty with it's own unique requirements, perhaps in addition to a basic nursing license (which would cover med administration, patient assessment, etc). To work in a hospital as a nurse, then would require one to specifically apply to and finish an acute care program which would specifically train students for acute care. Hospital specific issues such as working with ancillary staff and physicians and juggling several different patients at the same time, could be addressed in that part of the training.

[pagandeva2000, LPN]

Pharmacology is my pet peeve. We had a so called pharmacology and nutrition course, but the professor decided to allow group tests and was not really proactive in creating good lectures. In fact, after that first semester, pharmacology was not really emphasized ever again, until we got to OB and pediatrics-then I learned about oxytocin. The Med-surg 2 instructor was shocked at how little we knew about medications and I had to take a one day crase course in meds before I sat for NCLEX.

I also believe that we should have had more clinical time, with more patients, because after what is all said and done, SKILLS is what is needed to correlate. Too often, the programs now seem to focus on passing NCLEX, but not for practice in the real world.

[nancynjnurse]

as a diploma grad we had an advantage over the college grads...thats why it was called B***S***in Nursing

[suzy253, RN]

when i graduated from school a billion years ago, we were fully prepared to walk in a hospital the next day and take a full assignment. it was a diploma school where clinical started the first week. by the end of school, we had already experienced charge nurse duties, full nsg. assignments, med nurse for a floor and everything else they could think of to prepare us. today i see a complete lack of clinical skills and more of an emphasis on "delegating". there are 2 schools that use our hospital for their clinical experiences. i find it very sad that they don't spend a full shift there....ever. instructors pick and choose what the student is responsible for (they will give some po meds, but not sq or iv) they will take vs, but not do assessments. they will do assessments but not vs. they will do certain things on 1 patient, but not the other. 2 students will give meds today, but not the other 3. it does a great disservice to the students. it makes it a horrendous situation for the staff trying to figure out what today's game will be. in my opinion, if you want good nurses graduating, you need to let them practice while they are students. take an assignment a whole assignment and deal with whatever comes along the way. it is the only way they will be prepared and confident to take care of someone who is depending on them to keep them alive. you reap what you sow. somehow my instructors were able to keep an eye on us all, you don't see that now.

I graduated a diploma program in 2006 (3 year program) and sounds exactly like how we did it. They're still cranking out diploma-grads!

[smk1, LPN]

Basic understanding of how to talk to providers. We never took orders in NS so we were out of the loop in that arena. The first time I called a doc when I started my job a few months ago, I was SOOO nervous, and he just wanted me to tell him what I wanted. So always have a recommendation in mind, and then learn that with some providers you will have to be a bit assertive because they do not look over their labs or imaging results (shocking I know), and infiltrates, low potassium, etc... will be missed if you aren't very thorough. Try to look through your chart and organize your issues on a piece of paper with vitals before you call so that you aren't calling every 10 minutes. Bundle your calls to the extent possible. A blood pressure of 88/58 is not always a cause to panic! Assess your patient first, look at the trends.

[Melinurse]

Dealing with doctors and trying to manage 6 or more patients at the same time. Why do schools only give you 1 or 2 patients? It would seem that they could at least for your last 2 weeks of clinical get you up to 3 patients. Right now I am training as a GN and day 2 of orientation was baptised by fire, had 5 patients myself and my preceptor had 2 of her own as well as trying to help me. Murphy's Law: What can go wrong will go wrong! Just checking off on skills does not give you the confidence to do them on real patients who depend on you.

[Sterren, BSN, RN]

Time management. Prioritization. I wish I had been required to take a full patient load in clinicals, it would have been more helpful than writing detailed and organized care maps one one patient. I would have learned so much more from just having a second patient, or a third, or six at a time. Having one patient (or even two, once in a while) for 6 hours was not enough to prepare me for working as a real nurse. There are skills I wish I had more experience with (IVs, to echo others here) but time management is the big, huge, flashing red issue I have trouble with right now, that wasn't even touched on in nursing school.