What They Fail to Teach You in Nursing School

You graduated from nursing school with honors and you really know your stuff—anatomy, medications, codes, and the medical shoptalk that makes you sound like a pro. But as any experienced nurse will tell you, honey, you got a lot to learn.

Nurse, wife, mom, and childbirth educator, Amy Bozeman’s article in Scrubs gives newbie nurses a clue about what their first few years will be like as a real working nurse:

Your personality will change. After you've witnessed a few deaths, births, screams and pain, your personality will change. Dealing with death in a healthy, professional way is something they can’t teach you in two years of clinicals. Nursing will become who you are, not just what you do. You’ll learn to act quickly in emergencies, putting your personal feelings and reactions aside.

Your reporting will change. You learned SBAR (Situation-Background-Assessment-Recommendation) reporting in school, but only after working in the trenches as an RN will you learn how to give and take a report. Nurses are taught to report all patient details in narrative form; physicians are taught to use brief “bullet points” that provide key information to the listener. Somewhere in between is where you’ll end up.

Your time management will change. You’ll do a lot of charting, and you have to be fast, efficient, and thorough enough to get out at the end of the shift. This is where you’ll really learn time management. You’ll need to multitask and prioritize, especially when you have half a dozen patients who need this or that.

Your stress management will change. In school, you may have downed lots of Red Bull and coffee to stay alert and reduce the stress of exams. You may have eaten junk food and not gotten enough exercise. To stay healthy as a working nurse, you’ll have to eat healthy and visit a gym at least twice a week or you’ll get sick, gain too much weight and simply burn out.

Your dealings with doctors will change. You’ll learn how to effectively communicate with grumpy, mean doctors in life and death situations, doctors who hate their jobs, never sleep, and see you as an irritant, rather than a medical colleague. On the other side of the coin, you’ll form relationships and share camaraderie with doctors, nurses and patients you never thought possible in what sometimes is a life-and-death work setting.

Bozeman notes that it takes most RNs about five years to even get somewhat comfortable in their specialty–and then they have to be really careful not to get cocky.

An acute care nurse since 1980, Janet Foreman’s advice bog notes some interesting skills newbie nurses will need to survive (things they don’t teach in nursing school).

• Self Defense. You need to know how to dodge punches and avoid the death-grip extension reach from dementia patients.
• Modern dance. You need to be able to pirouette with grace when slipping and sliding on a newly mopped floor--while balancing a patient’s food tray or a handful of medications or IV fluids.
• Ambidexterity. Since most hospital rooms are not the celebrity suites you see on TV doctor shows, but 2 beds, 2 bedside tables, 2 IV poles and usually at least 2 garbage cans, you’ll need to perform the same tasks using either hand.
• The art of the deal. Pillows, blankets, recliner chairs and other incidentals are all in short supply thanks to budget cuts. So you’ll have to learn to trade and deal for these items with other nurses.

Think you’re ready to hit the floor running as a new nurse? Take it from the pros, you’ve got a lot to learn once you get out of school.

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