This is probably a subject written about and talked over multiple times, but it always rears its head. Why? Because these holes in a new nurse’s education persist!
Here are some practical, real world applicable things that I think a nursing school should be paying a bit more attention to.
1. Prescriptions, Orders, and Pharmacy: When I started my first nursing job, I was at a loss about how the order process went. Verbal orders, phone orders, written orders, having to relay them to the pharmacy first, acknowledging that you relayed them to the pharmacy, following up…this was all new to me. If you don’t work in a facility, you might also have to deal with insurance! Learning the ropes around medicare and medicaid, preferred drugs, and prior authorizations would have been nice.
2. More about Diagnostic Imaging: Yes, we learned about all the types of diagnostics, but not much focus was placed on how they really affect nurses. It is such a huge part of a patient’s care, especially in a hospital. How to prepare patients for IV contrast (antecubitals, anyone?), knowing how to read diagnostic orders, and even some practice reading the result reports would have helped!
3. Giving and Receiving Reports: I learned SBAR and other acronyms to help structure a report, but never learned what exactly is essential to be telling the next nurse. Even more importantly, I never learned what questions to ask when receiving a patient! As a new nurse, I was a great listener, but I really didn’t ask the right questions, and that hurt me during the shift.
4. Navigating Paper Charts: Those giant binders with a gazillion multicolored papers and tabs and other crap? How the heck do you find anything in there? Well, as it turns out, it isn’t TOO bad once you get used to skimming through papers and scanning for what you’re looking for.
5. How to Advocate for Yourself: We learned all about advocating for patients. But we all know there are times when nurses are put into situations that they shouldn’t be. It’s hard to speak up as a new nurse, especially if you’re not sure that you’re in a bad situation! Nursing schools should teach new nurses how to recognize unsafe environments, not only for patients, but for themselves.
6. Admissions and Discharges: Going through the basics of an admission and a discharge would have been good. Of course, each facility will have a different specific set of criteria, paperwork, and process, but hitting the most important points would have been nice. Teaching nursing students what resources to use during a history-gathering besides patient self-reporting would have been really useful! Who knew you should be making sure to get a verbal report from the previous facility’s nurse on a transfer? Who knew pulling aside a family member to pick their brains would be essential? It’s obvious to me now, but it wasn’t obvious to “new nurse me.”
7. How to Look Things Up: As much as I learned from nursing school, I would be embarrassed to tell you how much more I learned from Google, Epocrates, Medscape, WebMD, and other common sources. The truth is there’s just too much to learn in too little time. The rest needs to be researched on the fly. Every nurse needs some way to do this, whether on a smartphone, a computer, or a tablet. New nurses should also be taught the need for this: too many nurses enter the field expecting they should already know enough to thrive in the workplace. Not true!
Kevin is President of Brilliant Nurse, a new company offering NCLEX Reviews purely online. He also owns Kevin’s Review, an NCLEX review portal.