Six Ways IRL Nursing Differs from Clinicals

I read this post and thought it skimmed a little too much on actual examples and was pretty general. Believe it or not, the field is going to be a little bit different than when you were in clinicals at school. What differences, you ask? Let us count the ways.

1. Doctors want you to ask for what you want.

When you call at 2am to get an order for a blood pressure meds, you’re expected to know what was last given for this patient, what worked best, and suggest it. Only in unexpected circumstances would the doctor say, “Okay, let’s give X medication every six hours as needed for the next three days." As the nurse, you're usually expected to know the standard given dose and frequency. Really.

As a nurse who's worked in psychiatric care for almost ten years now, I call the doctor and say, "Hi Dr. So-and-so, it's Lisa Chou, how are you? Yup, a busy weekend over here. So I have Mr. Ed Norton here. Yep, again. He's having some anxiety. Vistaril okay? Great, thanks." I know that the standard dose is 50mg and that it can be given every 6 hours safely. How do I know? Experience. If Mr. Ed Norton were upward of 300lbs or a longterm psych patient who was used to big doses of the common medications, I might have asked for a bigger-than-standard dose with those rationales.

2. You will either get an awesome set of coworkers or they’ll be terrible.

The team you work with is who you will live and die by. There just is no working on an island in nursing (or most fields).

And they might be really terrible. Or really awesome. The work you do attracts all kinds of people. Some of them will become your best friends for life and you will NEVER forget them. Even when you leave your job, you stay in touch on Facebook and attend reunions and go out to dinner together. You’ll reference patients who have probably passed on at that point and reminisce about the good old days when you would go out “scrubbin’ it” to dance at midnight still in your scrubs at a bar with a dance floor (here's looking at you, Jen). Or, you might end up stuck with a set of coworkers who snitch on you over nothing or refuse to help you with a lift. Your coworkers will make or break you. Get some good ones!

3. Some of your UAPs and other staff may do things beyond their official scope.

Remember how UAPs (unlicensed assistive personnel like nurses aides or patient care techs) are allowed to walk people and that’s it? Ha.

Some of them will be in nursing school and know how to take out a capped IV on discharge. Some LPNs have been working in ICU for 35 years and could run around you in circles with their med knowledge and YOU JUST TRY to take a prescribed IV push out of their hand. Roll with it. Follow your unit and hospital guidelines and culture. No doubt it will differ from nursing school- try not to be such a rule stickler and accept what reality is on your floor.

4. Staffing will always be in short supply.

Unless you’re a school nurse or work in home care, your workplace will be short staffed some days or most days. That’s the reality of healthcare in the United States. Until mandated ratios are in place anywhere besides Colorado or California, you’ll have to deal with it. Sometimes, that means sucking it up and having a rough shift. Other times it means speaking up to your direct supervisor and letting them know that you are unable to manage your patients safely and you fear for your license.

I have left jobs due to under-staffing. When things become unsafe for you to practice nursing, you need to leave.

5. You will forget the meds you memorized and remember the ones you use.

Do I remember any meds from renal or endocrine? Barely. Do I remember all my cardiac, GI, and levothyroxine daily meds? Heck yes. Similarly, nurses who work in ICU know their code meds backwards and forwards. Labor and delivery nurses know their pain control, uterine contracting, and stool softener meds. We all have our specialties! And, over time, some of those meds will stick with you permanently. Enjoy it! It's nice to have a micro-niche of knowledge.

6. You will no longer be shielded from mistakes under someone else’s license - it’s on you now.

This is exhilarating and terrifying. Double check your medications, orders, and all five patient rights. Pull one person’s meds at a time. Make sure you’re following parameters. Never give a med someone else signed out unless you’d trust them with your life. Work overtime while you can. Don’t fall asleep on your overnight break unless you’ve told someone where you are. Chart truthfully and fully. Alert everyone you’re supposed to of changes or abnormal vitals or results. Document the notification.

Lastly: if it’s not documented, it’s not done!

What differences did you note in nursing school clinicals compared to your first workplace? Let us know!

#nursing #nursingschool #reality

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