Friday, September 21, 2007

Nursing school 101

I'm going to tell you something about nursing school you may or may not know. Nursing school has three parts to it. The first part is fundamentals which is reading a text, listening to a lecture, taking notes and being tested on the material. The second portion is lab where we practice sticking needles and tubes into orifices on a dummy. That way we can fumble, giggle and drop things in front of our classmates first instead of in front of a real person. The third portion is clinicals where the idea is to combine what we learned in class with what we practiced in lab and do it in the hospital on real people. The idea is to find a patient who has the disease you talked about in class, and needs to have an orifice poked that you practiced in class that week.

I'm explaining this because many of my classmates said they didn't really understand how nursing school works. I had a loose idea, but I confess I didn't know either. We were surprised to find out that it was more than just readin', writin' and taking tests. I had a classmate last year who is a real brain. She had a 4.0 GPA, could get 100 on any test you put in front of her. Once we got to the hospital She lost it. A few weeks later she dropped out of nursing school.

Today was clinicals. I'm always stressed out on clinical day. It's nerve wracking because, as a classmate put it, "it's like starting a new job every day for two years." You have to hit the floor running - picking a patient or three, looking up the medication you'll be giving them, getting report from the nurse who took care of the patient during the night, and planning what kind of care you will be doing that day - even though you don't really know what you're doing.

What makes it so stressful is that we can't just jump in and start working. We have to collaborate with the nurse, figure who is going to do what, and then dealing with the insecurity of not knowing what you're doing. Even harder than that is not letting the patient see that you are nervous and unsure. It takes almost as much effort to pretend you know how to do something you've never done before as it does to actually DO the new thing you've never done before. When a student does something for the first time - say, a dressing change - the instructor has to be there to observe.

Waiting for the instructor to show up on the unit is another layer of stress. Care has to be done in a certain time frame. Once we figure out what we're going to do for the day we have to call the instructor to come watch. Sometimes they're too busy and can't get to you, and the stress ratches up a notch as you wait for the instructor. Then if the instructor doesn't make it, you then have to tell the nurse you can't do the care after all and they have to do it. This is stressful for the nurse, finding time to do something she thought the student was going to do.

Fortunately I have an instructor who is a real sweetheart. It also helps that now, in my second year of school, it is expected that we already have enough experience to work on our own, and the instructor doesn't hover as much.

First year was worse. Since we had never done anything ever, the instructor put us through a little gauntlet I like to call "stand and deliver". The instructor comes to the floor and starts asking questions. What meds is she taking? What's it for? How does it work? What are the side effects? What do you need to know to give the med safely? What are the labs? If the lab is abnormal, why is it abnormal? At the time I hated it, but looking back on it I realize it taught me a lot. Getting ready to stand and deliver means spending a couple of hours looking up everything - the meds, the labs, the disease, any tests that are being done, how they're done and why.

Eventually I got pretty good at knowing what the instructor would ask and being ready for her when she got there. I noticed that once I had that covered the instructor wouldn't hover as much and would leave me alone. I guess she figured that I had a grip on what I was supposed to be doing and didn't need to be watched as carefully. That meant she would go and put pressure on someone else who wasn't getting it. Since then I've noticed that if an instructor is riding someone pretty hard, there's usually a good reason.

It also was a huge help that I spent the summer in the LVN program. I got 12 extra weeks of clinical experience and got the hang of handling several things at once, and that was the most difficult thing I've ever done in nursing school. I also got better at thinking on my feet and prioritizing my day. I learned to be efficient about getting and giving information. I learned to comb through information, pick out the most important facts, and reporting the most critical stuff to my instructor or the nurse I work with.

The stress still lingers though. I had a good day today and almost got to start an IV. But I'm exhausted and my brain hurts. Tomorrow is dialysis day. It's a relief to go to work, doing skills I'm good at, working with people with whom I am familiar, and patients that I've seen over and over for the past 2 years.

I never thought I would hear myself say that.

1 comment:

Anonymous said...

Thanks for your post. I'm about to start an accelerated BSN program and reading about your experience gave me a clearer view of what to expect.