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Advice for future nursing students:

Posted Jan 27 2009 7:13pm

Today's my birthday, by the way. I turned twenty-seven.

This post is dedicated to the three people who've abandoned me, saying I'd never become an RN.

Now that I'm done with nursing school, I've been inspired by little heck's post dispensing advice to future student nurses to supply my own.

This isn't a trivial task, since nursing programs can vary wildly even intra-state, so take this with a grain of salt, the product of my own singular experience in one local nursing school.


1. Assess yourself. Nursing school will likely require a number of changes to your daily routine, study habits, intrapersonal relationships and thinking style. In order for these changes to be successful, it's important to "know where you're at" first, and determine what kinds of adjustments will be necessary to succeed. The nursing program I went through was very different from the co-requisite courses that preceded it in that rote learning and memorization were not effective strategies. I never personally applied that strategy myself, I'm just basing this on my observation of my fellows. Starting with a firm foundation in anatomy and physiology will save you a lot of grief later, you can save yourself a lot of tedious re-learning of previous concepts if you come into this with a good understanding of how the body works and what happens when things "go wrong". Nursing school will test your critical thinking abilities and assume that you've already accumulated the required book-knowledge.

2. Get Involved. Nursing school may seem like a mammoth amount of work, and faculty will no doubt try to con you into thinking that you don't have any free time to do anything but eat, breathe and sleep nursing, but don't give in to the hype. Academically, this is most likely to be easier than the classes you took to get in to the program itself. If you're spending 12 hours a week in class and 40 hours a week studying, you're doing it wrong. Getting involved in nursing-related extra-curricular activities is extremely valuable for a number of reasons, whether you're acing your tests or barely scraping by. Getting involved with your local Student Nurse's Association (or, to a lesser extent, your class government) will provide you with a larger context for the journey you're embarking on. It will provide you with leadership experience that will serve you well after graduation. It will help you network with your classmates and with your local and national professional organizations, lending you physical and emotional support on your journey. It will look good on your resume. It will help you gain the respect of the faculty and administrators. It's likely to be a relatively small time commitment with a large payoff. Look past your nose, and lead your fellows, you'll be glad you did. Volunteer your time. It might seem like too much at first, but my Vice President while I was President of your Student Nurse's Association had three kids, a job, girl scouts, and a household to run and she's proof it's possible. You can spare an extra hour or two a week, trust me.

3. Accept support, but don't rely on it. Transitioning into the RN role is probably one of the hardest things anyone has had to do. Determine where your support comes from, and nurture those relationships. You are going to change. No matter what level of experience you already have in the health care delivery system, taking on the RN role involves a massive shift in cognition, and you may find that some of the people closest to you won't be able to deal with your struggle to take on these new patterns of thinking. Hell, YOU might not even be able to deal with it. Don't let lack of support or abandonment deter you from your goals. This is something that you will eventually need to do by yourself. Support from loved ones is a good thing, but you must be prepared for it's absence if you want to see this through. I've seen nursing school wreck a lot of relationships, and I've seen a lot of relationships wreck nursing school. Be prepared.

4. Be wary of your faculty. The sad truth is, it doesn't matter if you do a good job and you know what's going on, if the faculty don't like you, they can make your life miserable. You can save yourself a lot of grief by doing things like getting involved, like I described above, but also by sticking up for yourself. Nursing, particularly nursing education, is a field that is thick with what is called "lateral violence" or "horizontal violence" or "intraprofessional violence". There's a saying that "nurses eat their young". I'm sorry if you had to hear it here first, but that's how it goes. If you want to survive your relationships with your faculty, always tell the truth, get involved as much as possible, and don't be afraid to raise a stink and go to your administrators if you think you're getting a raw deal. Stand up for yourself, and stand up for your classmates. If you can't do that, how can you stand up for your patients?

5. Trust no one. This might sound negative at first, but I think you'll find it sound advice. Don't take anyone's word for anything. Lecturers might talk a good game, but don't accept anything as truth until you've read it in a textbook and cross-referenced it at least twice. Evidence based nursing, that's the way to go. Do you have to give a med in clinicals you've never seen before? Don't ask someone what it does, look it up yourself. Don't take anyone's word on anything. You're the Nurse, you're the professional. You're the one responsible. I don't care if it's the chief of medicine, if you're in doubt, look it up. If you're not sure of the procedure for a tube feeding, look it up. It's your license on the line, not theirs. Instructors will respect you a lot more for saying "I'm not sure, let me look that up" than for trying to BS a response.

6. Don't let them get to you. Most clinical programs have a thing similar to what we call a "clinical occurrence", something like being written up for something you did wrong or something you didn't know at the right time. Take these things for what they are intended, a tool and a guide for what you need to work on, not a punishment for something you did wrong. If your nursing school is worth their salt, they -want- you to succeed, and this is their way of helping you. Don't feel bad, just do it right next time. Don't make the same mistake twice, make new mistakes every time, and accept correction gracefully each time. They're supposed to be helping you. If they aren't, do something about it, even if it means going over their heads. Learn from your mistakes, don't feel bad about them.

7. Know your A and P. I touched on this before, but it bears repeating. Your anatomy and physiology class is the single most important class you'll ever take. Shop around and find the best teacher you can. I was lucky to have the best teacher I've ever had for this course. Your understanding of anatomy and physiology will inform everything you do in nursing school. Gain a solid understanding of this subject and you'll save yourself a lot of grief later.

8. Strive for clinical stability. Feel free to play the field and try out different clinical sites in your first two semesters, but for your last two, make sure you stay in the same place. The end of nursing school focuses more on delegation of responsibility and taking on the role of an independent practitioner. This is much more difficult if you're adjusting to a new clinical site at the same time. More importantly, if you had a clinical preceptor before, don't give it up in your last semester. Going from having a clinical preceptor back to the old method of having a clinical instructor is wildly disorienting, I don't recommend it.

9. Intern, intern, intern. A lot of the most desirable hospitals preferentially hire their student nurse interns, so take on a student nurse internship. The hours you'll spend in the clinical environment as an intern will be equal to nursing school x 1.5 (or 2.5 in the case of some four-year schools), plus you'll have a better shot at getting a good job right out of school. Do an internship. You'll have plenty of time to travel later, trust me.

10. Student Nurse, not Nursing Student. Take pride in what you do. Take on the role of the nurse, informed by the best models you have at your disposal. When you're in the clinical environment, you're not "just" a student, you are responsible for people's lives. Take that seriously and bring your best game. Just because you're a student, doesn't mean what you're doing is any less important.

11. Take responsibility for your own learning. Clinical practicum, by nature, cannot be standardized and is extremely irregular due to the randomness of patient assignments and experiences. If you see an opportunity to do something or even just overhear something that is novel to you, jump on it. On the other hand, don't obsess too much about procedures like foley caths or IM injections, you'll have plenty of opportunities to practice those kinds of things once you're an RN, the object is to practice things that reinforce general concepts, like maintaining asepsis, discharge planning, body mechanics and the like. You'll get plenty of training on specific procedures as you go.

12. Have fun. If this is a chore for you, why are you doing it? It's only going to get harder. If you're not enjoying the work that you're doing, apply your critical thinking skills and determine what's gone wrong. With the right frame of mind, this can be an exciting, fulfilling profession. With the wrong frame of mind, this can be hell on earth. It's easier to adjust your mind than your surroundings. Enjoy yourself, and the rest is easy. You might be faced with instruction and resources that you feel are incompetent and insulting, but if you can fool yourself into thinking they're wise, profound and useful, you'll fill in the gaps yourself. Keep smiling, enjoy yourself, there's no other way.

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