Ooohhhhhh if I had a list for all the things I wish I would have done while I was still in nursing school and had the luxury to be there on a medical surgical floor for clinical.
Here it goes
1. Learn to start an IV, granted we were not allowed to start IVs for patients unless a patient was willing to let us and a mentor/preceptor/ was willing to show us. If I had done it in nursing school I would not have had to worry about it now as a New Grad
2. Keep a perfect collection of all my nursing notes with perfect labels all stored away in a binder.
Instead I have binders full of messy notes in various categories. I do however have one folder of my most important notes. Medication calculations, head to toe assessment in detail, common medications, Mental status exam, Glascow Coma Scale, HOBIC measure for patient discharge, Basic Life support notes, and important laboratory values.
** on a happy note I emailed myself a lot of my electronic note resources since my .edu email will expire soon.
3. Maintain a perfect relationship with my clinical instructor, (mine was difficult to get along with). You will need to have "letters of recommendation" and good References from a former instructor to obtain a hospital entry level RN job.
4. Take elaborate notes from clinical for New Grad interviews. They will ask you so many questions that are just random such ....
How do you deal/ or have dealt with difficult patients?
Can you tell me something you regret doing/ a situation you would have changed in your nursing practice and what you learned from it?
Give an example of a time you have gone above and beyond for a patient
Tell me about your Capstone project (Big nursing research project for nursing students Senior Year)
How do you know your patients are satisfied with your care?
5. Practiced my SBAR report giving in clinical and in simulation lab. It seems so simple. Situation- Background- Assessment- Recommendation. Then reality hits you in REAL LIFE and your patient is deteriorating, coding, etc and you have to call that MD And report the changes and seek guidance and use critical thinking skills to prioritize your next nursing moves that are a matter of LIFE or DEATH.
6. Practice my fundamental nursing skills in dry lab. Take initiative in clinical to do as much nursing skills as I feel confident and read to fulfill.
** My particular nursing school had us do the much dreaded "Pre Care" you go to the hospital in your nursing professional uniform (not scrubs) and you go into the patients electronic medical record and you look up all their information to make a care plan. You think of nursing diagnosis, look up all the medications, see the labs, the treatments, and organize and study what you will do for the patient the next day at clinical.
FYI I would only get to the hospital at like 530 pm the night before because I had a different class that same day I had to be at. I would stay up until 230 am trying to type up a care plan and look up medications. You have to be at clinical by like 630 am. You are so tired and scared of messing up it serves as a horrible learning environment. You are afraid if you ask a question you will either A. "look dumb" or B. "get failed for not properly preparing". You seek the nice nurses to help mentor you and feel like a scared little mouse when the so-called strict nurses question you on everything.
The first time you do something as simple as a quick glucose check freaks you out. "Hello Charge Nurse, Hi thank you. Can you please help me go do a glucose check. This is my first time." He smiles at you with a gentle smile and you know his patient care load is the least since his job is to be responsible for all the patients on the floor. He grabs extra supplies in case the lancet does not draw enough blood. Your patient asks "Have you done this before?" You smile and explain that you have been trained for this and are with an excellent nurse to help give assistance. Here goes nothing.. oh please oh please will there be a drop of blood and let me not hurt this patient. I just want it to confirm it is reading.
When you finally get the glucose level.. well it aint over yet. Then you have to check the MAR for the sliding scale insulin dose. Draw up the correct amount in using the right technique. Have it double checked by Two real RNS (you dont count) and then find the right subcutaneous tissue and administer it. and guess what.. .. that would take a regular nurse minutes and to you it seems like you just ran MILES. You have to chart what medication you gave. The amount. The location you injected it.
That is just one example of the many terrifying moments a new nurse in clinical has to endure. You have huge lecture exams to study for. Simulation scenarios in Sim Lab to conquer. Patient care techniques. CNAs laughing at your inexperience at bed baths. Hoping your noncompliant patients do not make you look foolish. Explaining to terrified patients that you are skilled in doing this procedure to help them (perhaps all you ever did was read a book on it or practice it once in dry lab). Use therapeutic communication techniques. Everything you do you need a nurse there to help. Some nurses have less patience than others. You have limited availability to practice these "nursing" skills since the equipment is expensive and you have to have an actual patient to use these skills on.
Lets see in my three years of nursing school I have done all this...
straight catheter once
care of a chest tube once
IV pumps maybe 6 times
IV push 10 times
Picc Lines and Central Catheter
G Tube feeding with assistance at least 10 times
Oral Medications 60 times at least
Wound Care - simple care
Bed Baths - 10
Therapeutic Communication - always
Vitals- always
Head to toe assessments- Always
Incentive Spirometer- 30 times
Ostomy Bag - once
Pressure Ulcer Care- Once
Trach Care and suctioning twice
Never inserted anything.. no foleys, no NG tubes, Never seen hemodialysis, Never seen a patient receive Blood, Never seen trauma, Never did CPR,
Seen one C Section, The OR is super bright nothing like Greys Anatomy. Never saw a woman give birth. Never took care of a patient with fetal demise
During Psych, seen one take down.
7. Spend more time during clinical enjoying myself as a nurse. I was often scared, intimidated, and praying for the shift to end. During my senior year of nursing school, I learned to relax more. I was the only Senior student on my floor and it was nice to be under one mentor and apart of a team. I learned to do end of shift report and better charting and best of all TEAMWORK.
8. Practice NCLEX style questions from Day 1. A lot of medical surgical nursing exams are multiple choice NCLEX style questions. It is important to learn test taking strategies for these types of exams. Save yourself a lot of time and headache later down the road.
Those three years were very interesting. I had to fight extremely hard to stay afloat. I went through many emotions, trials, struggles, etc. I survived and made it through.. I am excited to move forward on the journey of nursing to my first New Grad Job.
