Even after the 2-4 years of intense studying that is required to become a registered nurse, it takes about a year working full-time to feel comfortable in the new leadership position. There is anywhere between 6-12 weeks of orientation with an experienced preceptor, as well as facility-required courses and classes. Nursing school teaches the disease process and basic assessment techniques, but does not prepare the student for the actual nursing role. Below is a brief list of things nursing school does not teach…
- Nurses have autonomy. Nurses see the patients 12 hours/day while doctors view the patient for at most 30 minutes. Nurses are in charge of reporting assessment changes, communicating critical lab values, ordering interventions per nursing protocols, among many other things. Textbooks ensure a doctor’s order for everything, when in reality nurses often drive these orders.
- Nurses do not provide “total care.” In many clinical rotations that I have had, we were assigned one patient and required to complete the assessments, baths, vital signs, and administer all medications. These patient encounters were unrealistic compared with the actual routine of a bedside nurse. Yes, it is in the scope of practice to perform all of these things, however, there is not enough time in the shift to perform all of these interventions for all 5-6 patients. It is extremely important to delegate to nursing assistants and to assist them when able.
- The Davis Drug book is not your best friend. It is much easier and acceptable to use online drug resources such as Micromedex or Medscape. Many MARs actually have reference information for drug administration directly on the administration wizard.
- You will not chart in real time. It is okay to back-time assessments. It is impossible to chart as you complete nursing tasks while ensuring all patients are cared for in a timely manner.
- Over 50% of a shift is behind a computer. This was the biggest challenge for me when transitioning from a CNA to an RN. It is frustrating to have so little hands-on time with the patients, while spending a lot of time reviewing orders, charting, on the phone, etc.
- You do not always have to “call” the doctor. Many facilities have a direct messaging system to relay non-emergent information, rather than calling the doctor for every request.
- Find out what advancement opportunities a facility offers. Anything from tuition reimbursement, mentorship programs, and certification incentives…
- You have to be creative. This applies to many things such as finding new ways to use nursing supplies, working with only two hands, convincing the confused patient to stay in the bed, or communicating effectively with difficult families. One of the funnier moments of creativity was one a nurse used a syringe of normal saline to stop a “seizure” a patient was apparently having. She said this injection of “Normasaline” will stop the seizure, and miraculously it worked!
- The burden of health care is real. Every shift, there will be a patient who is medically cleared for discharge, however is waiting on insurance approval to go to rehab or a skilled nursing facility. A patient is noncompliant with medications because they cannot afford them.
- Use free time wisely. Any extra time should be spent helping out other nurses, researching disease processes, updating report cards, or studying for continuing education. That extra study time will be appreciated during the busy shifts when you are trying to find enough time to pee.
- Having a patient leave AMA (against medical advice) is probably for your benefit. Don’t take it to heart.
- Even the best, most experienced nurse will get yelled at by a patient, family member, or doctor. It is okay.
- Always remain humble and ask questions.. just because you learned how to do something one way, does not mean that it is the best way.
Until next shift,
Shania