September 5, 2011

Nursing School Versus Real World Nursing

Updated: December 21, 2016


Now that I've worked for a good five solid weeks as a graduate nurse, I feel I can comment on this issue. With being a new nurse straight out of nursing school, I feel nursing school did not adequately prepare me for the "real world" of nursing. Not to say that in a negative way, but "real world" nursing (bedside nursing) requires different things from you. For example, in nursing school, I had one or two objectives (usually the assessment and medication administration portions), and there wasn't a time limit on me completing said tasks. My objectives didn't revolve around time constraints, and there wasn't a penalty for me completing the tasks late. I simply finished my clinical regardless of the task being completed in its entirety. As the focus in nursing school is academic based, priorities are knowledge acquisition and evaluation.

In real world nursing, you must chart at the appropriate times, and you better be giving those medication(s) at the correct times as well. Not to say you will be fired, but you will be spoken to if you can't get your day organized. It's all about tasks, organization, and planning. I wish my nursing program added this to the curriculum because it's of the highest importance. Your nursing skills and license do not matter if you can't get your tasks, assessments, and medications done in a timely fashion. You can't leave (go home) until all your charting and documentation are completed and accurate. I just feel that a course regarding nursing organization and/or preparation would have helped me as a graduate nurse. It wasn't the smoothest transition, but I've caught on quickly and have made sure I'm prepared and organized for my patients. I make that my goal every day.

I'm not one of those nurses that are going to tell you, "You don't know anything until you start working," because I don't believe that. But, I do feel you won't truly understand what's required of you until you hit the floor. Your priority is ALWAYS the patient. That concept has not changed. What has changed is what is needed from you and the time frame in which it is needed in. For example, you have four patients and 20 medications due at 9 AM. It's now 8:30 AM, and you haven't given any medications to any patients. It's up to you to problem solve and organize your plan of action. It might seem like an easy task, but it can be overwhelming. Especially when you're new (so you don't know where everything is), you have one patient who wants to go to the bedside commode ASAP (who is a high fall risk), another patient needs pain medication ASAP (pain 10/10), and another patient has a question regarding his surgery tomorrow. Each person has an issue, and it happens to be at the same time as everyone else. Sounds ridiculous but this happens to me often, and you will be expected to meet each individual's expectations in a timely manner.

Patient care should be your main concern. This will never waver, but you must focus on organizing your tasks and completing them promptly. Sometimes I get to work, blink, and it's 5 hours later. In nursing school, time constraints are a non-issue. When my nursing school instructor would ask me to complete a task, I finished it with no consideration of time. It was about the learning experience, the knowledge, and its impact. The priorities were different. This concept made my transition more difficult.

To help organize my day, I do the following:

  • Arrive 30 minutes early (to get settled in and set up my workstation)
  • Get my shift supplies out and ready (report documentation, writing utensils)
  • Complete a door assessment (walk through) of my patient assignment
  • After report, prioritize my upcoming actions (who to see first, urgent business)
  • Create a plan of action and work in time blocks (using short-term goals)

This routine helps me get my day moving in the right direction and to see if any patients need me right away. Nursing can be crazy, but if you organize yourself and your assignments, you will be successful. Don't let the newness of a profession scare you. Even at my lowest point, I wouldn't trade my job for anything. I love nursing and caring for patients. You just need to find that delicate balance between being proficient at your job and caring about your patients.