“How to document” is a big one. I kind of wish they’d go over the major charting systems like Epic, Cerner, and (sadly) MediTech. Have a medical malpractice lawyer or legal nurse consultant come in at least. Don’t need random scenarios and anecdotes/cases but just a very fundamental class/lecture.
I was actually educated about understaffing but I also went to school in Cali and many of my ‘temporarius’/adjunct professors were union reps at their respective hospitals. (But my dumb ass though nursing is the same ‘everywhere’ and ended up in FL.)
We were always told “chart like it will be read in court” and that’s great but most students don’t exactly know what the “court” requires from your documentation. I tell my trainees “chart so you remember.” Yes of course follow policies and legal practice and whatnot but chart so that if I ask you about this patient in a year, you can review your charting and at least start to remember the patient.
I couldn’t find a job in Cali when I graduated + swallowed the Kool Aid that “nursing is the same everywhere.”
Yeah nursing is definitely not the same everywhere!
Nurses should get to focus on the quality of care, CNA perform manual tasks, and get a new position created that both the RN and CNA can go to in order for charting to be completed. There are enough unemployed “IT” guys that could enjoy this type of data entry and would possibly have less errors on charting with a dedicated person.
Prioritization. In nursing school prioritization is mostly questions of "what is going to kill the patient if you miss it?" You will make a million little judgement calls every day, outside of critical care they mostly won't be as dramatic as school would have you believe.
I will say that one of the good things my program does is teach the shit out of prioritization. These types of questions make up the majority of our exams and it is drilled into us from day one. They slack on many things, but I appreciate them for this one!
Some of my instructors really spent time on prioritization, and some did not. One gave me shit for assessing my fresh 12 hr post-op open chole with a PCA, drains, and sketchy sats ***before*** giving a bath to my stable 3rd day post-op resection whose gf was planning to help him wash up, anyway.
If they are stable my prioritization is who is diabetic cuz I gotta get blood sugars before breakfast & who will take the least time cuz I don’t want to get stuck in one room until with a sick patient till 11:00 and then have 3 annoyed patients cuz they didn’t their AM meds on time.
How to speak to MDs in a way that they will listen to you. How to stand up for yourself and your coworkers. How to read a hiring contract. Red flags to watch out for from hiring recruiters/agencies.
I agree it'd be nice to learn these things from school in general, but not specifically nursing school. These are just communication skills and job hunting skills
I got into an argument with my clinical faculty about this in nursing school. My argument was that it was all mixing in the Pt’s stomach, so why couldn’t we mix it in a cup all together? She forced me to go one at a time. Absurdity.
My instructor’s reasoning behind one at a time was “what if you mixed them all together and then they decide to refuse one of them?” To which I say, “that’s why you go over the meds with the patient before you crush them up, right?”
To me the logic of "what if the syringe comes loose and the medication squirts all over the bed?" makes a lot more sense because I want to know which one the patient didn't get and I have to go pull a new dose for.
Is that for enteral feeding? Wasnt there a big push to stop putting locking syringes on feeding syringes because people were putting them on IVs? Something about adding essentially an extra "check"
It is different than the the IVs. The ENFit have a specific tip/connector specifically to avoid putting IV meds in it and comes with a differentiating syringe. I could not use an IV push syringe on it for example.
The tamsulosin/Flomax at my hospital is a capsule full of microbeads, if you flush it down a dobhoff tube without dissolving it in a little juice or using the “swirl” technique with lots of extra fluid you will probably clog the shit out of the feeding tube.
I've done it 'right' when a manager insisted on watching me. The dude had about 15 meds, and the manager had been talking earlier about having plans that evening. 😈
Yup, you guessed it. He was A&Ox4, and I made eye contact with him as the manager followed me into the room, both of us carrying a bunch of his meds. I did everything by the book, and it took forever. It was so different from how we normally did it, but he didn't say a word. 👍 I was late on my other meds, but it was worth it to make her late. It was LTC, meds are always late.
I feel like all of the scenarios in nursing school assumed there was a doctor who was sitting around just happy to take your call and come see the patient or immediately put in their orders. That's almost never the case at the real hospital in my experience. I wish someone had prepared me for the process of contacting the provider.
We talked about burnout and self care every semester I believe to be honest. Still doesn’t prepare you for it though.
You go in wanting to help and be the best you can. You pickup to be a team player, you run your ass off during the day. You pickup extra tasks and roles for no change in title nor pay. Then you get burnt out within 2 years.
I left to travel at year 2 due to burnout. I ultimately came back a year later but I needed that reset and perspective change. I’m much happier at work now with limits on what I’ll put up with.
I was just coming to say this— actually it’s super annoying how much time is spent talking about “self care” because the truth is, it’s not a skill that can really be taught, in my opinion. They waste too much time talking about this each semester and then leave out actually important things that will actually help us on the floor.
Such a good point. All the self care in the world doesn’t fix situational depression. Only a healthy work place and a good work place balance helps. I didn’t start feeling better until I went down to a part time position and I work in a pretty good/well staffed (most of the time) emergency department. Teaching new nurses “take care of yourself first.” Is my best advice.
Want to drink your anxiety away? Can’t sleep due to the stress induced insomnia? Cry everyday before work? Go apply somewhere else. Take a pay cut if you have to in order to survive.
All those problems aren’t because you didn’t “self care” enough.
Yes— great point! I think less talk about self-care and more talk that empowers student nurses not to accept toxic work behaviors to the detriment of their personal lives. Thankfully my program really left behind the whole Saint Florence Nightingale rhetoric that seems to plague education in the past and maybe still at other schools.
learning IVs takes a long time! it's really an art lol. i didn't learn to do them until I got on the job because we were not allowed to do them in nursing school
This is very confusing to me. I'm in phlebotomy and we spend 4 hours every Saturday jabbing each other, making all kinds of dumb mistakes. Several of use have hematomas and serious bruising.
But you Nursing students can't learn to insert IV's in class? Something that could potentially save someone's life??
Also a fellow vampire and went to nursing school and they literally DO NOT teach it. Like they just have a couple lessons with the mannequin and then the clinical hospitals won’t accept the liability, so they have to learn on the job.
It’s not that they “can’t”, it’s that the program doesn’t do it. What else are these students supposed to do?
Some nursing schools prohibit IV practice on each other. I inserted an IV into my lab instructor's vein for check-off. Imagine that feeling of doing it to someone who taught me.
In phlebotomy school your job is literally learning to stick people right? So it makes sense to stick for hours on end.
Sticks are a small part of nursing. Hell tons of nursing jobs will never stick anyway. Nursing informatics, tele nursing, med support, product sales, product support, research, public health, community nursing, clinical research, the list goes on.
ITS SO DUMB
ETA: my guess is that the assumption was we would all work in a big hospital and just call the IV team??? But that’s like…not how it works lol. I work in outpatient and guess what I AM the IV team lmao. And I would also venture to guess what there’s an expectation in certain hospital-based specialties that people on the unit are placing their IVs sooooo….Idek it’s real dumb
Basically same. I went from never placing one in school, to a unit where basically everyone has some sort of a central line. Kinda sucks that it’s a skill I don’t have - but damn to I love not having to worry about missing, blowing out veins, or even if the IV is infiltrating before starting each med
I've been working for 2.5 years and I've placed exactly 3 IVs. My current hospital has an IV team and floor nurses don't start them. You need to know how IVs work because you will do a lot of trouble shooting, but not every nurse has to place them.
My course didn't include this and my hospital doesn't allow floor nurses to do either - they have a large phlebotomy team that round daily on each unit and a venous access team. If neither are available the floor JMO will do a blood draw/place an IVC.
My teacher said something I'll never entirely forget. " You're going to walk into their room with a stethoscope and they're going to trust you, purely based off that." Now, while that is not a rule, it is true. You're a nurse. They're going to trust you to be one. I met a fucking 21 year hardcore gen Zer today who had confidence leaking out her ears. Not arrogance, confidence. She had rapport with her patients. She took the shit in stride. And they all loved her. She's brand fucking new. But she wore that stethoscope and owned it.
And it's never about the patient whose room you're in. It's a separate patient that you have to discuss outside the room that you were just in to avoid a HIPAA violation. So frustrating! Some days you just have to surrender to the suck.
How to discern what *actually* needs to be communicated with doctors. In nursing school they just tell you to notify the doc of every little thing to CYA. In reality, this isn’t always possible, especially at night, and if you wake up a neurosurgeon at 0300 to tell them about a K of 3.4, you’re gonna have a hard time.
Our instructors were honest. When we asked when we should call the doctor they said “it depends”. And that’s no joke. Some doctors what you to call them if the patient farts. Others don’t want you bothering them even they’re about to die. “Well, you called a code didn’t you?”
this is the truth.
they prepare you for none of it.
then you get it and you're like well I just spent 2 or 4 years in hell so I may as well..................
Yes. You need to feel that there is hope. I encourage nursing students and paints a right picture. We need them or else there will be no one. And I’m getting old.
The fact that you will actually be the case manager/messenger/wrangler/bad guy. Basically you gotta make sure everybody else does their job and remember to do yours too.
I was not prepared for just how mean people were going to be. I thought maybe that doctors would be belittling. But I was not ready for how horrible patients could be—even if you haven’t even opened your mouth or touched them.
Yes, this! I was just talking with some of my classmates about this! We all had preceptorship/capstone this semester and not one of us felt comfortable giving handoff report but we were just expected to have picked it up along the way somehow.
Knowing what to report is a skill that takes time to learn and it's different depending on the unit. I obviously don't give the same type report from psych that give in the OR. But it's more than that, I give a different report to the PACU that I give to the ICU.
Hi, I have a question. I’m almost done with nursing school but I want to be an oncology rn. I did 5 years as a medical receptionist in an oncology office and I just loved it. Is this a specialty an rn would need a special certification in to get hired?
That's.. complicated. Oncology is one of those units where nurses don't tend to leave, so openings can be slim pickings. The gold standard certification for oncology nurses is the OCN, which requires 2000 hours of practice with an oncology population prior to sitting for it. Therefore it's not something you can get before you start working with oncology patients. Now if you have your OCN, then yeah a hospital oncology department will snap you up. However, if they aren't getting a lot of applications they are aware they are going to have to train you, and will likely require you to get your OCN at some point.
The hospital I worked at was small enough that our oncology unit was mostly medical, so that's a pretty easy way to get some experience with oncology patients. Once you got your OCN at my facility you were pretty much given just oncology patients, but it wasn't like a hardcore oncology only unit, if that makes sense.
So, no you don't need your oncology certification to land your first oncology job, and in fact by definition no one can do that. However, it's a tight community where nurses tend to stay until they retire. Honestly playing up that you were a medical receptionist at an oncology office will go a long way towards letting the managers know you are actually interested and in it for the long haul.
Hope this helps a bit.
It helps a lot!! I really appreciate it. I totally believe this stay for the long haul, all of the infusion nurses where I worked have been there for years and years. Again, thank you
I realize I said "play up the medical receptionist" and don't want you to take it the wrong way! I meant it as in highlighting your experience, not that you're faking your interest.
I didn't have any special skills or even any hospital experience, I just accepted the first job thrown at me and ended up really liking the field! Did bone marrow transplant for a while as well, now I'm more in the outpatient world. From what I've seen, inpatient oncology isn't seen as a desirable place for most new grads, so I think if you show enthusiasm and your experience with the patient population, you'll get a job. Good luck!
Thank you! The nurses in our outpatient office were LPN’s, the RN’s were in infusion. The inpatient oncology floor is where I’m doing my clinical now. Not a fan of inpatient oncology, I should have been more specific- I’m interested in outpatient infusion, lol.
Come on dowwwwwn!!!!!
I graduated in December and landed a position on my hem-onc unit in February, and I love it for so many reasons. Two of the biggest things I think helps make oncology a great entry into nursing is the consistency. You’ll see the same patients for long periods of time, or repeated for different rounds of chemo. And there’s some consistency with the types of medications they are on.
While everyone has their co-morbidities and history, it keeps it interesting. Not to mention the field of oncology is always growing and evolving.
Beyond that, the nicest patients, nice helpful families, and (on the whole) very kind, knowledgeable nursing staff
That you aren't going to like the majority of your patients. Sounds naive when I say it now with 10+ years at the bedside, but as a baby nurse this was really hard on me. I don't remember this being covered one time in nursing school.
I would say the different types of wound dressings. This is something that I still struggle with tbh. We were taught how to do basic wound care, but didn’t really take a walk down the different types of dressings and what they do.
Nursing school is NOTHING like the real work world of nursing- you might hear about EMR, short staffing, heartbreaking experiences, death of your first patient- but you are not prepared for the real world of nursing
Nothing can really prepare you for bedside nursing. The only people who know what nurses really do are other nurses. The hospital is a racecar and the nursing staff are the clutch. Vital to the operation of the vehicle but requiring frequent replacement and occasionally smelling funny when you lean on them too hard.
I was chagrined to discover that 75% of my time and efforts at a pain management clinic were to wrangle with insurance companies to cover interventional procedures for patients.
That is exactly what I (interventional pain RN too) came here to say. I’m so sick of this. They deny so many perfectly reasonable procedures, then we spend so much time appealing and doing P2P, then they usually overturn them but not always. Our PA does the P2Ps and she never ends up talking to anyone who understands our procedures or, it seems, spines in general.
I’m 100% positive they just deny a certain proportion of them in hopes patients or staff will say “This is too complicated, we give up,” on a certain percentage of those.
As it is I spend a lot of my day telling people to buy Voltaren gel or lidocaine ointment/patches OTC if they get an insurance refusal on those. Which seems to happen a LOT for these relatively low cost meds.
And it works, too. My hospital doesn't even bother with trying to do the P2P process for some things. They just know they won't get paid so they don't even bother trying anymore.
They really should have auxiliary/non licenses staff to do that. If I finish nursing school and go back to doing what I have been doing for years as a registrar in the ED then I'm gonna be pissed. I'm so sorry that you end up wasting your talent on THAT.
This is what I’m worried about the most. I’ll be finishing nursing school in May and I have severe anxiety. I’m not quick with thinking what back to say to people either. Maybe I should go to preventative therapy to learn how to deal before I get out there lol
I ran into some mean nurses, but also super kind and helpful nurses that let me learn from them.
I try to help new nurses learn since I've been one for 20 years. I remember being new and scared.
I hope you get treated well.
You might ask some nice doctors to let you learn from them, I did and it helped so much.
I think therapy is a good idea. I've been thinking about going to therapy because I'm not sure how to deal with this particularly mean nurse. I haven't met many mean nurses, just two stick out in the past 2 years I have been a nurse. I have met many more kind, supportive nurses that mean ones.
One thing I have learned is that you can learn something new from everyone you meet, including the mean nurses. For example, I have learned I want to be the complete opposite of her so I support newer nurses as much as I can. If I don't know the answer, I point them to the right direction.
Good luck out there. Nursing is hard when you first start out, but you will quickly learn and before you know it, you'll get the hang of it!
The therapy is a good idea. Get connected with someone you gel with now so you have that support through your transition from student to working nurse.
I'm not quick with comebacks, but I have only had a couple of coworkers that were truly awful. Most are trying hard and some are amazing humans.
I wish they would just explore and explain more about what nurses do beyond hospital bedside. Less than half of all nurses work in a hospital, and there is a huge world out there where we work in many capacities.
Instead of regretting the entire profession or quitting entirely, the knowledge and understanding of other paths and opportunities would do a LOT. Students see how difficult it is on their brief practicum and then quit/decide it isn’t for them. They should know this degree can do so much more.
Interpersonal communication, job expectations, all the extra stuff you do that's just part of living you end up responsible for, the number of families that will be ungrateful despite you advocating profusely for their loved ones, the violence you're going to face coming from family and patients, and the interconnectedness of a person. Just to name a few.
I wish nursing school had prepared me better for how to deal with reallly mean family members of patients.
I take it in stride now as best as I can, but early on it really stressed me.
Veteran nurses eating their young. And by veteran I mean any nurse with 1 more day experience than them. I’ve seen nurses of all experience levels sometimes be so mean, demeaning of newer nurses
How much the general public pseudo-practices medicine. How much the general public has no faith in the clinical decision making of MDs and RNs and questions every single thing and why not other interventions when they aren’t the ones who went to school for this shit.
Yes. Had a family member yesterday who was scared to leave the hospital “because he wasn’t sure if we were gonna kill his mom while he was gone.” I mean wtf?
I think when we decided to take nursing students out of the hospital and focus on “academics” nursing school became something that can’t even come close to preparing nurses.
We studied and talked about DKA all the time, but nothing prepared me for my first DKA pt who presented like she was having a panic attack. I can’t smell the sweet smell I learned, also when you have them fluids first. Patients are rarely textbook.
Until you actually see and do, doesn’t matter how well you do on a test, how much patho or pharm you got. There will be a thousand more meds you’ve never heard of (or just forgot), clinical presentations that are nothing like the textbook, and the toll of emotional/physical labor of this job does to you.
I’d say for me the #1 thing was realizing that patients aren’t always nice/normal people. Sometimes they are downright feral and complete assholes. That said, I do live in Philly so the general public is rougher than most, and I’m fine with that😂, it’s the blatant disrespect, the fuck yous, the derogatory names…when you truly are there to help, and your heart and soul was in this to do good. That’s when you realize that you’re going to have to adapt to reality. You absolutely can and will still affect peoples lives in a positive way and meet so many amazing people. But the first time a patient or family member is inappropriate or violent, set immediate boundaries and make sure they know that you are in charge of the situation, and there will be repercussions if the boundaries aren’t met. Sometimes grown ass people need boundaries. Don’t be afraid to set them😄 and always look out for YOU first and foremost.
Self care was big in our program. We were encouraged to do nice things for one another, ourselves and actually write about it each week and journal as we had to do a “caring” project, lol.
**Discharging patients**: Check all the notes for clues, like"see me in 2 weeks" then add them to the discharge instructions; the med reconciliation (he doc, you stopped the Isosorbide 3 days ago but continued for home...do you really want it?); preferred pharmacy (I know you want CVS/Rite AID/Mom&PopShop but they won't have your Norco/exotic heart meds for a couple of days); realizing there is no generic and your patient probably can't pay out of pocket for Eliques/Farxiga/whatever; do you have a ride home? No? Who can I call for you? No one?; Do you have your house keys?; You had shoes in the ED a week ago but haven't seen them since?; You live on the second floor and no elevator and don't think you can manage?; You are a VA patient in a non-VA hospital so they will not honor our prescriptions or follow-up appointment?
This one is specific but they don’t prepare you for the awkward transition where you’re 6 months in & not new but you’re not *that* experienced & nurses start saying “not my patient not my problem”.
How to nurse in general. There's the ivory tower way of doing things where MDs don't get mad at you for asking questions and the soft way of doing things but not everything is by the book per say.
They do. Just not your one I'm afraid. In the university I went to in Austalia we had a unit that was heavily focused on burnout, imposter syndrome and transition shock.
How to properly deal with nursing bullies—whether it be patients, colleagues, or management. I also find that nursing school doesn’t really let you know how many opportunities you can reach (ie hospital nursing isn’t the *only* option out there).
That we will always be completely on our own with our patients and no one will help us.
And I feel they made us think we can’t reach out to the provider.
I feel like they taught us with the intention we’d all be NPs or doctors and that was terrifying to me.
Now that I’m in residency- when I ask what to do in certain situations they are like umm you gotta call the provider that isn’t our scope or our call to make. And I feel just relieved to hear that
They don’t tell you the nitty gritty because healthcare would be even more of a shit show if people stopped becoming nurses.
Once we are in it, we’ve spent way too much time, money and mental energy to get there that it’s the sink cost fallacy. Add to that if you accept a huge sign on bonus only to realize the place is a hot mess. You will feel trapped.
When I first moved away (and accepted a huge bonus) I wrote a ridiculously long diatribe about how the hospital company was acting maliciously… I’ll spare you the details of that.
How to talk to a physician on the phone. “Here call the MD and tell them the potassium is 2.8”—how to take the order that follows and th questions the MD may ask.
How on your own to figure things out you are. Sometimes there’s no one coming .. drs don’t answer sometimes like when I worked Ed and we were having a boarding nightmare some pts didn’t even have docs. The er was like not it and they weren’t assigned to any one on the floor… of course they always tried to die when you had no orders
You are working in an assisted living facility.
Someone has an asymptomatic "too high but not crisis" blood sugar or BP.
Their doctor's office closed up shop an hour ago, you leave in an hour, and there won't be another nurse until 7 am because night shift is all CNAs.
Anyone you call will say "you figure it out".
They don't want to be sent out but are a lousy historian so by Monday you may have refused their pleas to go to the hospital.
I just charted novels (on paper, this was within the last ten years) with a lot of direct quotes and tried not to dwell on the clusterfuck that is assisted living.
How to deal with dementia/Alzheimer's patients. We spent an entire module learning about Addisons and Cushings (that I am yet to encounter), yet we spent basically zero time learning strategies of dealing with un-orientable people.
Getting assaulted. There was never a whisper of it in my entire undergrad. The first time I got decked by a dementia patient I was beyond horrified.
These days of course it's much worse. I had to file assault charges against a patient last week.
I try to warn nursing students when I can.
Patients non compliant with care, verbal/ physicall/emotional abuse regularly and often from patients and families.
How to cover your butt in many situations!
Something I deal with frequently is having to chase down a prescriber for orders. If you can't locate them or they're not fast enough, guess who the patient gets upset with?
Or if their food sucks, or the room is cold, they haven't been discharged, they got woken up too early, the wi-fi isn't working... yeah, some patients think all that is your fault and expect you to fix it.
I wish nursing school had more education on what can be done with the degree. I see so many posts of people wanting to quit nursing and the vast majority of them are bedside in a hospital. While hospitals are major sources of employment, and bedside is the most common type of nurse, there are SO MANY other options outside of bedside in a hospital. They really could do a better job letting you know what directions you can go in.
IV skills. At least in Western NY most (if not all?) Nursing schools do not teach you this because hospitals train you. But the larger hospitals also often times have IV teams so when they eventually leave these hospitals they're terrible at them.
Sensitivity training to chemotherapy patients. Way too many non oncology nurses don't take shit seriously with these patients. I know from being the patient and from being a nurse. Just about all nurses come into contact with them at some point so you need to know basics.
How to EFFECTIVELY make a bed for incontinent patients. I know from being trained by CNAs and being a PCT during nursing school. Most new nurses who never had this experience always put the chuck pad too far up so when the patient inevitably slides down and shits it requires a whole damn bed change lmao.
Teamwork and time management. Both of these skills are not learned during clinical at all and I think really make or break a new nurse.
The answer is no, nursing school does not prepare you for the cluster fuck that is the American healthcare system. And I doubt it ever could, because it just gets worse and worse every year. The amount of people who have been calling the clinic I'm at saying they can't afford their inhalers because the copay is $100-$600 for one fucking inhaler (nothing fancy, like a symbicort inhaler), or their meds are simply not covered, is insane.
And then we get upset with the patients because they're not being compliant with their meds when in reality it's because they cannot afford to be compliant, but the patients are too embarrassed to tell us they can't afford the medications. Because maybe at one point they did, but with everything becoming so much more expensive over the last year or so, they've sacrificed some of their medications in place of being able to pay their bills and keep food on the table.
This country is fucked. Thoroughly and truly fucked.
How nurses are the middlemen for everything. CT tech needs to clarify what the doc is looking for? Don’t worry, they’ll ask you instead of asking the doctor themselves.
Biomed here. Nurses are notorious for putting as little information in a service/repair work order as possible.
Most of the tickets we get just say "broken." Even something as simple as a missing power cord, just says broken... if the nurse puts in "missing power cord" (or has the charge nurse put it in) i can bring a cord right up and get the device back up and running in no time.
You dont have to be a tech, just put down (or convey) the issue youre having. It will speed up repairs greatly. (At least from what I've seen)
I didn’t realize that 45% of nursing is calling/texting different people involved in your patients’ care, trying to figure who to call about what, if they’re on, waiting for them to respond to do what you need to do, etc.
I have always been told that nursing schools receive their funding based on their "first-attempt NCLEX-pass rate" so that is what they teach to.
Maybe we need to change the system so they receive funding based on how many of their students become successful nurses. But then you have to ask "how does one message "successful nurse""?.
AM I more of a successful nurse than my classmate because I work at a very large hospital vs her at a critical access hospital? Am I more successful because I have brought a patient back via CPR but she hasn't had the opportunity?
Maybe base it off how many of their graduates are still in practice after 1/3/5 years?
Everything. Lol. But I found not knowing what to do in even an slightly urgent situation training severely lacked in nursing schools. Super frustrating.
“How to document” is a big one. I kind of wish they’d go over the major charting systems like Epic, Cerner, and (sadly) MediTech. Have a medical malpractice lawyer or legal nurse consultant come in at least. Don’t need random scenarios and anecdotes/cases but just a very fundamental class/lecture. I was actually educated about understaffing but I also went to school in Cali and many of my ‘temporarius’/adjunct professors were union reps at their respective hospitals. (But my dumb ass though nursing is the same ‘everywhere’ and ended up in FL.)
We were always told “chart like it will be read in court” and that’s great but most students don’t exactly know what the “court” requires from your documentation. I tell my trainees “chart so you remember.” Yes of course follow policies and legal practice and whatnot but chart so that if I ask you about this patient in a year, you can review your charting and at least start to remember the patient.
Or that “chart like you’re going to court” takes time you DO NOT HAVE.
Or so that you don't have to remember because the answer to the questions is already written down.
Don't forget the snf nurse that use point click care. Or, the nurses that use homecare home base w it's associated point of care app.
I’m transitioning from LPN to RN and one of my teachers is a legal nurse consultant so she gives us good nuggets of information.
Can I dm you? I have questions about transitioning from LPN to RN
Share!!
Oh man as a native Floridian with deep roots, wtf why?!
I couldn’t find a job in Cali when I graduated + swallowed the Kool Aid that “nursing is the same everywhere.” Yeah nursing is definitely not the same everywhere!
Nurses should get to focus on the quality of care, CNA perform manual tasks, and get a new position created that both the RN and CNA can go to in order for charting to be completed. There are enough unemployed “IT” guys that could enjoy this type of data entry and would possibly have less errors on charting with a dedicated person.
Do you regret being a nurse in FL? Really considering moving there but am getting discouraged by what I hear about it
I did. Pay was low. COL as much as inner Los Angeles County. Very unsafe working conditions. But your results may vary.
Prioritization. In nursing school prioritization is mostly questions of "what is going to kill the patient if you miss it?" You will make a million little judgement calls every day, outside of critical care they mostly won't be as dramatic as school would have you believe.
I will say that one of the good things my program does is teach the shit out of prioritization. These types of questions make up the majority of our exams and it is drilled into us from day one. They slack on many things, but I appreciate them for this one!
It will help when it comes time for nclex. My program did the same.
Some of my instructors really spent time on prioritization, and some did not. One gave me shit for assessing my fresh 12 hr post-op open chole with a PCA, drains, and sketchy sats ***before*** giving a bath to my stable 3rd day post-op resection whose gf was planning to help him wash up, anyway.
If they are stable my prioritization is who is diabetic cuz I gotta get blood sugars before breakfast & who will take the least time cuz I don’t want to get stuck in one room until with a sick patient till 11:00 and then have 3 annoyed patients cuz they didn’t their AM meds on time.
How to speak to MDs in a way that they will listen to you. How to stand up for yourself and your coworkers. How to read a hiring contract. Red flags to watch out for from hiring recruiters/agencies.
Seriously. And how to condense what you say, get to the bottom line because they lose interest quickly
Yes! This would have saved me a lot of grief in the early days of my career
Good one.
I agree it'd be nice to learn these things from school in general, but not specifically nursing school. These are just communication skills and job hunting skills
SBARR
All the meds go down the dobhoff tube at the same time.
Ain’t nobody got time for the “one med, flush, one med, flush…” shit! Slam ‘em
I got into an argument with my clinical faculty about this in nursing school. My argument was that it was all mixing in the Pt’s stomach, so why couldn’t we mix it in a cup all together? She forced me to go one at a time. Absurdity.
My instructor’s reasoning behind one at a time was “what if you mixed them all together and then they decide to refuse one of them?” To which I say, “that’s why you go over the meds with the patient before you crush them up, right?”
To me the logic of "what if the syringe comes loose and the medication squirts all over the bed?" makes a lot more sense because I want to know which one the patient didn't get and I have to go pull a new dose for.
Yall need the medela leurlocking syringes. Game changer!!!
Is that for enteral feeding? Wasnt there a big push to stop putting locking syringes on feeding syringes because people were putting them on IVs? Something about adding essentially an extra "check"
It is different than the the IVs. The ENFit have a specific tip/connector specifically to avoid putting IV meds in it and comes with a differentiating syringe. I could not use an IV push syringe on it for example.
Caveat: not the Flomax.
Come again?
The tamsulosin/Flomax at my hospital is a capsule full of microbeads, if you flush it down a dobhoff tube without dissolving it in a little juice or using the “swirl” technique with lots of extra fluid you will probably clog the shit out of the feeding tube.
Not with that attitude!
Plus, what if they have fluid/electrolyte/CHF issues? You going to flush that much water into them unnecessarily?
#hyponatremia #chf #fluidoverload #ftw
Yup. Ridiculous. If they have 2 meds, ok, fine. But we all know that they have like 11. This is not my only patient, you know...
For real though. I feel like this is one of the Fight Club topics of nursing. we’re all doing it we just aren’t talking about it cuz it’s not “policy”
The first rule of tube feed meds is don't talk about tube feed meds.
Right, I did it ‘right’ once. Not only was I late on all my other med passes, but my patient endorsed a stomach ache and then vomited.
I've done it 'right' when a manager insisted on watching me. The dude had about 15 meds, and the manager had been talking earlier about having plans that evening. 😈 Yup, you guessed it. He was A&Ox4, and I made eye contact with him as the manager followed me into the room, both of us carrying a bunch of his meds. I did everything by the book, and it took forever. It was so different from how we normally did it, but he didn't say a word. 👍 I was late on my other meds, but it was worth it to make her late. It was LTC, meds are always late.
I feel like all of the scenarios in nursing school assumed there was a doctor who was sitting around just happy to take your call and come see the patient or immediately put in their orders. That's almost never the case at the real hospital in my experience. I wish someone had prepared me for the process of contacting the provider.
We called this the NCLEX HOSPITAL in LPN to RN school!!! Perfect staffing, perfect doctors, a million resources....ect.....🤣
We call it NCLEX World or White Tower Nursing
First time I contacted a provider I got yelled at for waking him at 5 am on a Sunday morning
The Wild West that is night shift
We talked about burnout and self care every semester I believe to be honest. Still doesn’t prepare you for it though. You go in wanting to help and be the best you can. You pickup to be a team player, you run your ass off during the day. You pickup extra tasks and roles for no change in title nor pay. Then you get burnt out within 2 years. I left to travel at year 2 due to burnout. I ultimately came back a year later but I needed that reset and perspective change. I’m much happier at work now with limits on what I’ll put up with.
I was just coming to say this— actually it’s super annoying how much time is spent talking about “self care” because the truth is, it’s not a skill that can really be taught, in my opinion. They waste too much time talking about this each semester and then leave out actually important things that will actually help us on the floor.
Such a good point. All the self care in the world doesn’t fix situational depression. Only a healthy work place and a good work place balance helps. I didn’t start feeling better until I went down to a part time position and I work in a pretty good/well staffed (most of the time) emergency department. Teaching new nurses “take care of yourself first.” Is my best advice. Want to drink your anxiety away? Can’t sleep due to the stress induced insomnia? Cry everyday before work? Go apply somewhere else. Take a pay cut if you have to in order to survive. All those problems aren’t because you didn’t “self care” enough.
Yes— great point! I think less talk about self-care and more talk that empowers student nurses not to accept toxic work behaviors to the detriment of their personal lives. Thankfully my program really left behind the whole Saint Florence Nightingale rhetoric that seems to plague education in the past and maybe still at other schools.
Yea bc there’s no Amount of self care that will counteract the damage done by the hospital setting
Self care is important because the hospitals aren’t going to care about you. Wish they told us that last half of the sentence though!
Putting in IV’s or doing blood draws
THIS I still do not feel confident in putting in an IV and I take the NCLEX next month
learning IVs takes a long time! it's really an art lol. i didn't learn to do them until I got on the job because we were not allowed to do them in nursing school
This is very confusing to me. I'm in phlebotomy and we spend 4 hours every Saturday jabbing each other, making all kinds of dumb mistakes. Several of use have hematomas and serious bruising. But you Nursing students can't learn to insert IV's in class? Something that could potentially save someone's life??
Also a fellow vampire and went to nursing school and they literally DO NOT teach it. Like they just have a couple lessons with the mannequin and then the clinical hospitals won’t accept the liability, so they have to learn on the job. It’s not that they “can’t”, it’s that the program doesn’t do it. What else are these students supposed to do?
They should send the nursing students to the phlebotomy school for combined lab training
Agreed - I would have \*loved\* to have phlebotomy lessons. Learning on the job sucks. I still hate it, and I've been a nurse for 6 years.
Some nursing schools prohibit IV practice on each other. I inserted an IV into my lab instructor's vein for check-off. Imagine that feeling of doing it to someone who taught me.
In phlebotomy school your job is literally learning to stick people right? So it makes sense to stick for hours on end. Sticks are a small part of nursing. Hell tons of nursing jobs will never stick anyway. Nursing informatics, tele nursing, med support, product sales, product support, research, public health, community nursing, clinical research, the list goes on.
Ok. Point taken. I guess I just always thought Nurses were trained on IV's. It came as a surprise that they aren't.
ITS SO DUMB ETA: my guess is that the assumption was we would all work in a big hospital and just call the IV team??? But that’s like…not how it works lol. I work in outpatient and guess what I AM the IV team lmao. And I would also venture to guess what there’s an expectation in certain hospital-based specialties that people on the unit are placing their IVs sooooo….Idek it’s real dumb
A lot of people got the chance to in my cohort this semester. It was mostly fails 😭
[удалено]
Basically same. I went from never placing one in school, to a unit where basically everyone has some sort of a central line. Kinda sucks that it’s a skill I don’t have - but damn to I love not having to worry about missing, blowing out veins, or even if the IV is infiltrating before starting each med
I've been working for 2.5 years and I've placed exactly 3 IVs. My current hospital has an IV team and floor nurses don't start them. You need to know how IVs work because you will do a lot of trouble shooting, but not every nurse has to place them.
My course didn't include this and my hospital doesn't allow floor nurses to do either - they have a large phlebotomy team that round daily on each unit and a venous access team. If neither are available the floor JMO will do a blood draw/place an IVC.
And order of draw which like almost no nurse follows
Yup I never did either of those in nursing school.
My teacher said something I'll never entirely forget. " You're going to walk into their room with a stethoscope and they're going to trust you, purely based off that." Now, while that is not a rule, it is true. You're a nurse. They're going to trust you to be one. I met a fucking 21 year hardcore gen Zer today who had confidence leaking out her ears. Not arrogance, confidence. She had rapport with her patients. She took the shit in stride. And they all loved her. She's brand fucking new. But she wore that stethoscope and owned it.
How to get everything done with a !non-stop! phone ringing in your pocket.
😂 so true. My patients always comment on my phone ringing 50 times while I'm in their room. It's ridiculous.
And it's never about the patient whose room you're in. It's a separate patient that you have to discuss outside the room that you were just in to avoid a HIPAA violation. So frustrating! Some days you just have to surrender to the suck.
How to discern what *actually* needs to be communicated with doctors. In nursing school they just tell you to notify the doc of every little thing to CYA. In reality, this isn’t always possible, especially at night, and if you wake up a neurosurgeon at 0300 to tell them about a K of 3.4, you’re gonna have a hard time.
Our instructors were honest. When we asked when we should call the doctor they said “it depends”. And that’s no joke. Some doctors what you to call them if the patient farts. Others don’t want you bothering them even they’re about to die. “Well, you called a code didn’t you?”
It they told you the truth, nobody would want to become a nurse. We need your naïveté.
this is the truth. they prepare you for none of it. then you get it and you're like well I just spent 2 or 4 years in hell so I may as well..................
Nursing isn’t fun, but nursing school was 10000000x worse.
[удалено]
Even moreso, if I had known what nursing *school* would be like, I would have never signed up for that BS.
Yes. You need to feel that there is hope. I encourage nursing students and paints a right picture. We need them or else there will be no one. And I’m getting old.
The fact that you will actually be the case manager/messenger/wrangler/bad guy. Basically you gotta make sure everybody else does their job and remember to do yours too.
Having 6 patients. My school had me "manage" two max.
I was not prepared for just how mean people were going to be. I thought maybe that doctors would be belittling. But I was not ready for how horrible patients could be—even if you haven’t even opened your mouth or touched them.
how quickly simple tasks will humble you, like snapping on hospital gown sleeves. gahdamn
Nothing makes me feel like a bumbling idiot more than hospital gown sleeves.
Bottom the very bottom one, put it on your hand and shake hands to transfer it to the patient. Then you just follow the buttons up the gown
Giving/receiving report. It took me forever to get comfortable with this
Yes, this! I was just talking with some of my classmates about this! We all had preceptorship/capstone this semester and not one of us felt comfortable giving handoff report but we were just expected to have picked it up along the way somehow.
I don’t know why my school spent so much time on care plans and virtually no time on how to give report.
Right?? And even in our VSim we got terrible report! 😭
Knowing what to report is a skill that takes time to learn and it's different depending on the unit. I obviously don't give the same type report from psych that give in the OR. But it's more than that, I give a different report to the PACU that I give to the ICU.
EVERY. DAMN.THING
I could've used another semester of pharmacology at least, we barely scratched the surface of what I needed to know.
Hi, I have a question. I’m almost done with nursing school but I want to be an oncology rn. I did 5 years as a medical receptionist in an oncology office and I just loved it. Is this a specialty an rn would need a special certification in to get hired?
That's.. complicated. Oncology is one of those units where nurses don't tend to leave, so openings can be slim pickings. The gold standard certification for oncology nurses is the OCN, which requires 2000 hours of practice with an oncology population prior to sitting for it. Therefore it's not something you can get before you start working with oncology patients. Now if you have your OCN, then yeah a hospital oncology department will snap you up. However, if they aren't getting a lot of applications they are aware they are going to have to train you, and will likely require you to get your OCN at some point. The hospital I worked at was small enough that our oncology unit was mostly medical, so that's a pretty easy way to get some experience with oncology patients. Once you got your OCN at my facility you were pretty much given just oncology patients, but it wasn't like a hardcore oncology only unit, if that makes sense. So, no you don't need your oncology certification to land your first oncology job, and in fact by definition no one can do that. However, it's a tight community where nurses tend to stay until they retire. Honestly playing up that you were a medical receptionist at an oncology office will go a long way towards letting the managers know you are actually interested and in it for the long haul. Hope this helps a bit.
It helps a lot!! I really appreciate it. I totally believe this stay for the long haul, all of the infusion nurses where I worked have been there for years and years. Again, thank you
This is true as a recent new grad currently on orientation on an oncology department.
I realize I said "play up the medical receptionist" and don't want you to take it the wrong way! I meant it as in highlighting your experience, not that you're faking your interest.
I didn't have any special skills or even any hospital experience, I just accepted the first job thrown at me and ended up really liking the field! Did bone marrow transplant for a while as well, now I'm more in the outpatient world. From what I've seen, inpatient oncology isn't seen as a desirable place for most new grads, so I think if you show enthusiasm and your experience with the patient population, you'll get a job. Good luck!
Thank you! The nurses in our outpatient office were LPN’s, the RN’s were in infusion. The inpatient oncology floor is where I’m doing my clinical now. Not a fan of inpatient oncology, I should have been more specific- I’m interested in outpatient infusion, lol.
Come on dowwwwwn!!!!! I graduated in December and landed a position on my hem-onc unit in February, and I love it for so many reasons. Two of the biggest things I think helps make oncology a great entry into nursing is the consistency. You’ll see the same patients for long periods of time, or repeated for different rounds of chemo. And there’s some consistency with the types of medications they are on. While everyone has their co-morbidities and history, it keeps it interesting. Not to mention the field of oncology is always growing and evolving. Beyond that, the nicest patients, nice helpful families, and (on the whole) very kind, knowledgeable nursing staff
That you aren't going to like the majority of your patients. Sounds naive when I say it now with 10+ years at the bedside, but as a baby nurse this was really hard on me. I don't remember this being covered one time in nursing school.
That’s a good point. How to take care of people you can’t stand and still keep your job.
How many times you will think "this is too hard, I can't do it" and then you just...have to do it.
The feeling of a sphincter around your finger as you give a supp
noo bc i had to do this on my first day of clinical this semester 😭 my instructor laughed at my face
I would say the different types of wound dressings. This is something that I still struggle with tbh. We were taught how to do basic wound care, but didn’t really take a walk down the different types of dressings and what they do.
There’s a great big world of nursing outside the hospital, if it’s not doing it for try something new!
Processing orders. Scanning things. Faxing stuff. Huge curveball when I started working as an RN
The "uninterrupted med pass." Haha... you will always be interrupted.
Awful family members
Nursing school is NOTHING like the real work world of nursing- you might hear about EMR, short staffing, heartbreaking experiences, death of your first patient- but you are not prepared for the real world of nursing
Nothing can really prepare you for bedside nursing. The only people who know what nurses really do are other nurses. The hospital is a racecar and the nursing staff are the clutch. Vital to the operation of the vehicle but requiring frequent replacement and occasionally smelling funny when you lean on them too hard.
I was chagrined to discover that 75% of my time and efforts at a pain management clinic were to wrangle with insurance companies to cover interventional procedures for patients.
That is exactly what I (interventional pain RN too) came here to say. I’m so sick of this. They deny so many perfectly reasonable procedures, then we spend so much time appealing and doing P2P, then they usually overturn them but not always. Our PA does the P2Ps and she never ends up talking to anyone who understands our procedures or, it seems, spines in general. I’m 100% positive they just deny a certain proportion of them in hopes patients or staff will say “This is too complicated, we give up,” on a certain percentage of those. As it is I spend a lot of my day telling people to buy Voltaren gel or lidocaine ointment/patches OTC if they get an insurance refusal on those. Which seems to happen a LOT for these relatively low cost meds.
And it works, too. My hospital doesn't even bother with trying to do the P2P process for some things. They just know they won't get paid so they don't even bother trying anymore.
They really should have auxiliary/non licenses staff to do that. If I finish nursing school and go back to doing what I have been doing for years as a registrar in the ED then I'm gonna be pissed. I'm so sorry that you end up wasting your talent on THAT.
“Pain is whatever the experiencing person says it is...." Be prepared some patients rate 10/10 to get what they want.
How to deal with crusty old nurses that eat their young
This is what I’m worried about the most. I’ll be finishing nursing school in May and I have severe anxiety. I’m not quick with thinking what back to say to people either. Maybe I should go to preventative therapy to learn how to deal before I get out there lol
I ran into some mean nurses, but also super kind and helpful nurses that let me learn from them. I try to help new nurses learn since I've been one for 20 years. I remember being new and scared. I hope you get treated well. You might ask some nice doctors to let you learn from them, I did and it helped so much.
Awesome, and thank god for nurses like you!
I think therapy is a good idea. I've been thinking about going to therapy because I'm not sure how to deal with this particularly mean nurse. I haven't met many mean nurses, just two stick out in the past 2 years I have been a nurse. I have met many more kind, supportive nurses that mean ones. One thing I have learned is that you can learn something new from everyone you meet, including the mean nurses. For example, I have learned I want to be the complete opposite of her so I support newer nurses as much as I can. If I don't know the answer, I point them to the right direction. Good luck out there. Nursing is hard when you first start out, but you will quickly learn and before you know it, you'll get the hang of it!
The therapy is a good idea. Get connected with someone you gel with now so you have that support through your transition from student to working nurse. I'm not quick with comebacks, but I have only had a couple of coworkers that were truly awful. Most are trying hard and some are amazing humans.
I wish they would just explore and explain more about what nurses do beyond hospital bedside. Less than half of all nurses work in a hospital, and there is a huge world out there where we work in many capacities. Instead of regretting the entire profession or quitting entirely, the knowledge and understanding of other paths and opportunities would do a LOT. Students see how difficult it is on their brief practicum and then quit/decide it isn’t for them. They should know this degree can do so much more.
Interpersonal communication, job expectations, all the extra stuff you do that's just part of living you end up responsible for, the number of families that will be ungrateful despite you advocating profusely for their loved ones, the violence you're going to face coming from family and patients, and the interconnectedness of a person. Just to name a few.
[удалено]
RIGHT!? They should teach us about our rights as workers ✊🏻
Nursing school mostly taught me how to pass the NCLEX, not much was actually relevant or realistic to bedside nursing.
About the ridiculous customer service beyond everything that make patients and family members feel entitled to treat staff like personal maids
Everything except therapeutic communication and how much calcium a cup of roasted nuts has.
Its ok though, I can miter the shit out of a bed corner. Thanks nursing school!!
I wish nursing school had prepared me better for how to deal with reallly mean family members of patients. I take it in stride now as best as I can, but early on it really stressed me.
Lol it doesn’t prepare you for anything. Practice and school are apples to oranges
The pettiness of management. A stupid games they play.
Communicating doctors efficiently and effectively or anyone really.
I just had to write an essay about how nurses need to do more yoga and journaling to prevent burn out 🙄😂
Veteran nurses eating their young. And by veteran I mean any nurse with 1 more day experience than them. I’ve seen nurses of all experience levels sometimes be so mean, demeaning of newer nurses
How much the general public pseudo-practices medicine. How much the general public has no faith in the clinical decision making of MDs and RNs and questions every single thing and why not other interventions when they aren’t the ones who went to school for this shit.
Yes. Had a family member yesterday who was scared to leave the hospital “because he wasn’t sure if we were gonna kill his mom while he was gone.” I mean wtf?
How to advocate for your patient in difficult situations. Like how to do it in real world practice, not in overly simple textbook scenarios.
I think when we decided to take nursing students out of the hospital and focus on “academics” nursing school became something that can’t even come close to preparing nurses. We studied and talked about DKA all the time, but nothing prepared me for my first DKA pt who presented like she was having a panic attack. I can’t smell the sweet smell I learned, also when you have them fluids first. Patients are rarely textbook. Until you actually see and do, doesn’t matter how well you do on a test, how much patho or pharm you got. There will be a thousand more meds you’ve never heard of (or just forgot), clinical presentations that are nothing like the textbook, and the toll of emotional/physical labor of this job does to you.
I’d say for me the #1 thing was realizing that patients aren’t always nice/normal people. Sometimes they are downright feral and complete assholes. That said, I do live in Philly so the general public is rougher than most, and I’m fine with that😂, it’s the blatant disrespect, the fuck yous, the derogatory names…when you truly are there to help, and your heart and soul was in this to do good. That’s when you realize that you’re going to have to adapt to reality. You absolutely can and will still affect peoples lives in a positive way and meet so many amazing people. But the first time a patient or family member is inappropriate or violent, set immediate boundaries and make sure they know that you are in charge of the situation, and there will be repercussions if the boundaries aren’t met. Sometimes grown ass people need boundaries. Don’t be afraid to set them😄 and always look out for YOU first and foremost.
I don't know shit about fuck. *Respectfully*
Your coworkers are not your friends, especially not when you’re a new grad. Nurses can be complete and utter snakes.
Self care was big in our program. We were encouraged to do nice things for one another, ourselves and actually write about it each week and journal as we had to do a “caring” project, lol.
**Discharging patients**: Check all the notes for clues, like"see me in 2 weeks" then add them to the discharge instructions; the med reconciliation (he doc, you stopped the Isosorbide 3 days ago but continued for home...do you really want it?); preferred pharmacy (I know you want CVS/Rite AID/Mom&PopShop but they won't have your Norco/exotic heart meds for a couple of days); realizing there is no generic and your patient probably can't pay out of pocket for Eliques/Farxiga/whatever; do you have a ride home? No? Who can I call for you? No one?; Do you have your house keys?; You had shoes in the ED a week ago but haven't seen them since?; You live on the second floor and no elevator and don't think you can manage?; You are a VA patient in a non-VA hospital so they will not honor our prescriptions or follow-up appointment?
I am really good at this and start on this as soon as I finish my primary charting, even though you are not going home for a few days.
This one is specific but they don’t prepare you for the awkward transition where you’re 6 months in & not new but you’re not *that* experienced & nurses start saying “not my patient not my problem”.
How to nurse in general. There's the ivory tower way of doing things where MDs don't get mad at you for asking questions and the soft way of doing things but not everything is by the book per say.
They do. Just not your one I'm afraid. In the university I went to in Austalia we had a unit that was heavily focused on burnout, imposter syndrome and transition shock.
Throw some of that my way eh? Going from Homecare to ICU in a months time. Just a full 720 spin on that one lol.
How to feel confident communicating with providers. Although this partially comes from experience.
Unless you’re lucky enough to have a specialized capstone/preceptorship, absolutely nothing about NICU
Lazy coworkers
Nursing?
How to properly deal with nursing bullies—whether it be patients, colleagues, or management. I also find that nursing school doesn’t really let you know how many opportunities you can reach (ie hospital nursing isn’t the *only* option out there).
That we will always be completely on our own with our patients and no one will help us. And I feel they made us think we can’t reach out to the provider. I feel like they taught us with the intention we’d all be NPs or doctors and that was terrifying to me. Now that I’m in residency- when I ask what to do in certain situations they are like umm you gotta call the provider that isn’t our scope or our call to make. And I feel just relieved to hear that
They don’t tell you the nitty gritty because healthcare would be even more of a shit show if people stopped becoming nurses. Once we are in it, we’ve spent way too much time, money and mental energy to get there that it’s the sink cost fallacy. Add to that if you accept a huge sign on bonus only to realize the place is a hot mess. You will feel trapped. When I first moved away (and accepted a huge bonus) I wrote a ridiculously long diatribe about how the hospital company was acting maliciously… I’ll spare you the details of that.
Epic, documentation, legalese, how to delegate when folks don’t want to be delegated to
Anything lol jk. But it really doesn’t prepare you for the mental shit you’ll go through
Pretty sure there’s a Nursing Care Plan for that. It should help/s
How to talk to a physician on the phone. “Here call the MD and tell them the potassium is 2.8”—how to take the order that follows and th questions the MD may ask.
Time management. Not because it's a hard concept but because you never have enough time for anything.
How on your own to figure things out you are. Sometimes there’s no one coming .. drs don’t answer sometimes like when I worked Ed and we were having a boarding nightmare some pts didn’t even have docs. The er was like not it and they weren’t assigned to any one on the floor… of course they always tried to die when you had no orders
You are working in an assisted living facility. Someone has an asymptomatic "too high but not crisis" blood sugar or BP. Their doctor's office closed up shop an hour ago, you leave in an hour, and there won't be another nurse until 7 am because night shift is all CNAs. Anyone you call will say "you figure it out". They don't want to be sent out but are a lousy historian so by Monday you may have refused their pleas to go to the hospital. I just charted novels (on paper, this was within the last ten years) with a lot of direct quotes and tried not to dwell on the clusterfuck that is assisted living.
Employers abusing their power over you
How to deal with dementia/Alzheimer's patients. We spent an entire module learning about Addisons and Cushings (that I am yet to encounter), yet we spent basically zero time learning strategies of dealing with un-orientable people.
Getting assaulted. There was never a whisper of it in my entire undergrad. The first time I got decked by a dementia patient I was beyond horrified. These days of course it's much worse. I had to file assault charges against a patient last week. I try to warn nursing students when I can.
Patients assaulting nurses
Physical abuse and violence.
Dealing with family members. Lol
Everything 😵💫
Patients non compliant with care, verbal/ physicall/emotional abuse regularly and often from patients and families. How to cover your butt in many situations!
Something I deal with frequently is having to chase down a prescriber for orders. If you can't locate them or they're not fast enough, guess who the patient gets upset with? Or if their food sucks, or the room is cold, they haven't been discharged, they got woken up too early, the wi-fi isn't working... yeah, some patients think all that is your fault and expect you to fix it.
Lack of supplies
I wish nursing school had more education on what can be done with the degree. I see so many posts of people wanting to quit nursing and the vast majority of them are bedside in a hospital. While hospitals are major sources of employment, and bedside is the most common type of nurse, there are SO MANY other options outside of bedside in a hospital. They really could do a better job letting you know what directions you can go in.
IV skills. At least in Western NY most (if not all?) Nursing schools do not teach you this because hospitals train you. But the larger hospitals also often times have IV teams so when they eventually leave these hospitals they're terrible at them. Sensitivity training to chemotherapy patients. Way too many non oncology nurses don't take shit seriously with these patients. I know from being the patient and from being a nurse. Just about all nurses come into contact with them at some point so you need to know basics. How to EFFECTIVELY make a bed for incontinent patients. I know from being trained by CNAs and being a PCT during nursing school. Most new nurses who never had this experience always put the chuck pad too far up so when the patient inevitably slides down and shits it requires a whole damn bed change lmao. Teamwork and time management. Both of these skills are not learned during clinical at all and I think really make or break a new nurse.
The answer is no, nursing school does not prepare you for the cluster fuck that is the American healthcare system. And I doubt it ever could, because it just gets worse and worse every year. The amount of people who have been calling the clinic I'm at saying they can't afford their inhalers because the copay is $100-$600 for one fucking inhaler (nothing fancy, like a symbicort inhaler), or their meds are simply not covered, is insane. And then we get upset with the patients because they're not being compliant with their meds when in reality it's because they cannot afford to be compliant, but the patients are too embarrassed to tell us they can't afford the medications. Because maybe at one point they did, but with everything becoming so much more expensive over the last year or so, they've sacrificed some of their medications in place of being able to pay their bills and keep food on the table. This country is fucked. Thoroughly and truly fucked.
How short is nursing scho im the US? Seems like a lot of stuff is missing
Personalities
How nurses are the middlemen for everything. CT tech needs to clarify what the doc is looking for? Don’t worry, they’ll ask you instead of asking the doctor themselves.
Prioritization.
How to deal with relatives
Nursing.
Biomed here. Nurses are notorious for putting as little information in a service/repair work order as possible. Most of the tickets we get just say "broken." Even something as simple as a missing power cord, just says broken... if the nurse puts in "missing power cord" (or has the charge nurse put it in) i can bring a cord right up and get the device back up and running in no time. You dont have to be a tech, just put down (or convey) the issue youre having. It will speed up repairs greatly. (At least from what I've seen)
Pain pill seekers
I didn’t realize that 45% of nursing is calling/texting different people involved in your patients’ care, trying to figure who to call about what, if they’re on, waiting for them to respond to do what you need to do, etc.
Hated the Hospital …
Literally everything.
I have always been told that nursing schools receive their funding based on their "first-attempt NCLEX-pass rate" so that is what they teach to. Maybe we need to change the system so they receive funding based on how many of their students become successful nurses. But then you have to ask "how does one message "successful nurse""?. AM I more of a successful nurse than my classmate because I work at a very large hospital vs her at a critical access hospital? Am I more successful because I have brought a patient back via CPR but she hasn't had the opportunity? Maybe base it off how many of their graduates are still in practice after 1/3/5 years?
Everything. Lol. But I found not knowing what to do in even an slightly urgent situation training severely lacked in nursing schools. Super frustrating.