Nursing School vs. Actual Nursing

We are going to be discussing the difference between nursing school vs. nursing. Nurses always say to their students or orientees “Nursing is a lot different than clinical.” We even say it quite often. Nursing school and nursing are 2 separate things [1].

G-tubes, catheters, and IV pushes

1. G-tubes

Remember how we were told to check placement and patiency then flush. Our clinical testing consisted of our instructors observing us put each medication in a separate small cup, add a little flush in between each ned.

Then you let it all go in by gravity?

There is no time for that.

Mix the meds together, dilute with water, and push it in. Everything’s going into one place anyways: the stomach. However, remember to always check for placement.

2. Foley catheters

Foley catheters can be some of the hardest things to insert. In clinical, you were taught to find a landmark. Spread this labia. Locate this, half-a-finger length up, insert, and you’re golden! Smooth and easy.

It’s a bit harder than that.

The best advice is to get some experience. Walk in with a determined attitude, get some help, put on the lights, and always bring 2 kits and extra gloves.

Try to minimize distractions but there’s usually something going on.

IV Pushes

IV pushes in nursing school and clinical were a long process. You stand there in front of the patient and instructor, pushing the med for 5 minutes. It’s your first time and the patient’s because no one pushes meds that slowly.

Don’t get us wrong. We still push meds like Lasix slowly, but not 5 min.

Physician’s Orders and Patient Compliance

1. Doctor’s orders

As nursing students, nurses were strictly never to change or discontinue a physician’s order without expressing over the phone, verbally, or written consent from the doctor’s physician. Another one was to call and notify the doctor of the refusal of medication by the patient.

In the real world, we do not call the doctor and say a patient refused a med unless it’s something serious like a pressor or inotrope. We use our judgment. If you aren’t sure, then ask around first.

2. Patient compliance

In a theoretical textbook scenario, the patient always seems to be compliant. Mr. Thomas, have you been adhering to your heart-healthy diet, yes and I’ve never felt better.

That’s too perfect of a world; you are going to see the frequent fliers that come for the same thing over and over again.

Double Gloving and Wet-to-Dry Dressing

1. Double gloving

We were never allowed to double-glove in nursing school. If I remember it correctly, we were strictly not allowed to do it and had to always re-apply new gloves.

In the real world, some situations call for double gloving. This is in attempts to clean up c diff, and before changing a betadine dressing are good times to double glove.

2. Wet-to-dry dressing changes

How many times did you do a sterile wet-to-dry dressing change at home, before lab, during class, and at your lab practical?

In the real setting, we do not do as much as the nursing school made you think you would. We have better ways to properly clean and heal a wound.

Short Staffing and There’s No Black and White

1. When there’s short staffing

Short staffing and nurse-to-patient ratios have never been fully enforced in the US, and California comes first on the list with the best nurse-to-patient ratios.

In the textbook world, you always have enough staff, equipment, and medication. You learn nothing about short staffing and how it will affect you physically and mentally.

Due to staffing, mistakes are unfortunately made. Medications are late, labs take longer than expected, and patients become agitated. It isn’t a perfect world with perfect staffing.

2. Nursing Isn’t Black or White

Nothing in nursing is black and white–not even lab results. Everything is gray. Textbooks make it seem simple, but it isn’t.

The human body and mind are very complex, and nursing and medicine are too. Keep an open mind and learn to think critically [2].

What are your nurse expectations vs. reality experience? Check out ours here 👇😎

TIMESTAMPS:

00:00 Intro
00:53 Unwinding for a little bit
03:13 Today’s Episode
04:17 NG tubes
08:00 Foley Catheters
12:02 Do not discontinue a physician’s order without speaking to them
18:16 Patient Compliance
20:26 Double loving
22:05 Wet-to-dry dressing changes
24:52 Short staffing
30:44 Nursing isn’t black or white
35:20 Recap
35:39 End of show