What they won’t teach you in nursing school.

Once you graduate nursing school, pass NCLEX, and get your first job you will realize just how unprepared you really are. In fact, you will probably wonder ‘what did I just spend the last several years in school doing?’. You’ll feel kind of like you did at your first clinical, but just a lot more in debt. Clinicals aren’t that realist and don’t prepare you for all that much. Even though you get to do stuff in clincials, it’s just not the same in the real world. Thank God for orientation at your job, or those first couple weeks would be pretty terrifying. No doubt, they’ll still be pretty nerve-wracking. Not to mention that first day on your own. Don’t worry though, you’ll be able to look back at all this one day and laugh. Maybe. That or have PTSD like nightmares. Now that I’ve totally freaked you out, I’ll continue with a list of what you won’t know.

  • How to order from pharmacy. Seriously, this is SO easy but I never did it in clincials once. This depends on where you work but in LTC it usually consists of writing the med or sticking the refill stick off the med onto a pharmacy order sheet and faxing it to the pharmacy.
  • How to use the ER box. There will be that time in the middle of your med pass when you realize, ‘shit, nobody ordered his new coumadin dose’. Well luckily there’s a magic treasure box in the med room. It holds the most common medications that cannot be missed (antibiotics, coumadin, antianxiety, etc.).
  • Paper charting. They pretend like they teach you this is nursing school. They don’t. Hospitals are all using EMR these days. You know what needs to be wrote, but you need it to sound professional. So do what any other well-educated person would do: read the previous entries to learn proper charting format.
  • Falls. I didn’t experience one in nursing school. Definitely ask during your orientation so you have an idea or what to do. Otherwise, most places have a protocol/checklist of some sort so you’ll know what to do. PS: You will have a mini-heart attack when your first fall happens. Just sayin’.
  • Deaths. This is always hard to deal with. And nothing makes it any easier. Except knowing they aren’t suffering anymore. Again ask for the procedure while you are still completing orientation so you’re not lost when it happens and you’re on your own.
  • How to call a doctor. Sure you know how to pickup the phone and dial the number. But what do you say? What do you need to know? Think about what you’re going to say before calling so you don’t sound like a blubbering idiot. Also, make sure you have the chart, current med list, recent labs, and a recent set of vitals. Don’t put off calling because you’re nervous.
  • Tape. Holy shit, who knew there was so many different kinds of tape?
  • Removing sutures. I’d never removed stitched or staples in clincials. One day I needed to remove 30-some staples from a mans hip. Hmmm. Well apparently they make these pretty neat little gadgets, they’re basically the same thing as your standard household staple-remover – in scissor form. Presto, staples go buh-bye.
  • Giving report. You need to give the next shift the appropriate information in a quick and to-the-point manner. Condition changes, new meds, any procedures, vitals, heads-up on any issues, etc.
  • Time management. It’s quite a change going from one or two patients to 60 (I am a charge nurse in charge of 60 residents, 2 nurses, and 7 aides). My floor nurses each have 30 residents to medicate, complete treatments, and chart. It’s ALL about time management. Or in the hospital it’s quite a jump from being a student nurse to two patients to being fully in charge of 6.
  • Routine. There’s a basic routine on how to get things done. Sure, everyone has their own version and you will tailor what you learn to fit your needs. But you’re going to have to hit the floor running, nobody’s going to baby you, they’re too busy with their own stuff.
  • Dementia patients. Sometimes it doesn’t matter how much reorientation you try it’s not going to work. Actually, sometimes it’s even worse to try to reorient them. If they think it’s 1954 and they’re late for school, let them think that they’re not hurting anything. Don’t over-medicate to make your job easy, but remember those PRNs. You have to keep your resident safe. If he’s trying to crawl out of bed and hitting at the CNA because he ‘needs to go milk the cows’ and nothing is helping it’s time for a PRN so nobody gets hurt.
  • Multitasking. You will need eight hands. Channel your inner octopus.
  • Breaks/Meals. There’s a good chance you won’t get any breaks when your start your first job because more than likely you’ll be a little behind. And everyone will have those nights where you are so behind and it’s so crazy that you punch out for supper just to go back to work, clock-in 30 minutes later, and go to back to work. Always eat before going into work, you never know what will happen.
  • Shifts. Just because you are scheduled for an 8 or 12 hour shift doesn’t mean you’re going to be able to leave in exactly 8 or 12 hours. And god-forbid the night shift nurse calls in and nobody will cover for her. Hello, long night.
  • Stress. Nursing is a stressful job. This is something clinicals just won’t prepare you for. There will be days you breakdown on the way home. Positive stress-management techniques are needed, that’s for sure.
  • Boxing. No, not to knock out that bitchy nurse, but to dodge that left hook from your agitated dementia patient.
  • Red Tape & Politics. Nursing is one of the highest regulated professions. There are so many rules and regulations. And at times that can be hard to deal with.
  • State Inspections. Clinicals won’t prepare you for this. It’s scary. Having someone watching your every move making sure you don’t make one tiny mistake. Just take a deep breath, relax, and do your thing. Because YOU know what you’re doing!
  • Stocking the cart. You will always be a lancet short, with no alcohol wipes, and just finishing a stock bottle of Tylenol. Get used to it now, the shift before you isn’t going to restock the cart.
  • Drama. Yes, in nursing school you get a touch of the drama but just wait until you are thrown to the wolves on your first day. But I guess when it’s a predominately female profession you’ll have that. But I have noticed (at least in LTC) the drama is more with the CNAs and you’re left refereeing them like a teacher on the playground.

Even though this may sound like the most horrifying job on the planet and you’re in the process of calling your college to change majors, DON’T DO IT! It really is one of the most rewarding jobs on the planet. You get to make a difference in people lives everyday. You save lives.



3 thoughts on “What they won’t teach you in nursing school.

  1. Oh yes, oh yes, oh yes!! I agree with everything! And even though I’ve been a nurse for almost 10 years, I’m not past all that. Some things are still difficult. Especially now when I’ve started a new job in a totally different hospital.

  2. Pingback: Top 10 Posts of 2013. | Lipstick & Tractors

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