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Top 10 things nursing school CAN’T teach you

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New nurses hit the floor running and panicked, often wondering why they feel like they know NOTHING straight out of school. The reality is, grad nurses really don’t know it all. What a let-down for them, huh?

I’ve been out of nursing school 3.5 years now and it has come to my attention that not only did nursing school minimally prepare me for this job, I don’t think there was a way ANY school could have prepared me for nursing. So, here are MY top 10 things they didn’t teach me in nursing school:

  1. How nursing will change you. My instructors failed to convey that becoming a nurse would change me in every way: nursing is not just a job because it becomes a part of our personality. That’s hard to explain to students. You have to live it.
  2. How to give a good report. Then there are the basics like giving report. No, I did not learn how to give a good report because I just “played SBAR” with my instructors and the nurses I was paired with on the floor. It was only as an RN that I learned how to give/take report, use a “brain” and communicate effectively with docs and other members of my team. It was not easy and I got a lot of grief when I gave a crappy report.
  3. The truth about nurses eating their young. Nursing school made me wary of experienced nurses and taught me that “nurses eat their young.” I was in no way prepared for the reality: Nurses don’t have time to eat their young. We have time for team work, excellent patient care, and a whole lotta charting. If other nurses can’t keep up, well, the ship is sailing without them.
  4. Time management. Charting efficiently, quickly and thoroughly enough and still getting out at the end of the shift was not a skill I learned in NS. That came later with time management–another hard-earned ability that can only be learned in time.
  5. Multitasking and prioritizing. These are also things that nurses learn to excel in OUTSIDE of the classroom. Multitasking is easy-peasy when you have one or two patients in clinical. Yet prioritizing is really critical for an RN who has 6 patients all going down the tubes at once.
  6. Healthy modes of stress management. I ate my way through nursing school as a means of coping and stress relief because frankly, we were being weeded out and the pressure was enormous. Eating a bag of Doritos relieved stress faster than going to the gym, okay? I admit it! But nurses can’t live that way after they graduate. RNs learn to cope with stress in a healthy way or they get really sick, gain lots of weight, burn-out or worse.
  7. How to deal with death. Can you really be prepared for it? No, and it takes a lot of time to learn how to deal with death in a healthy, professional way. They just can’t teach you that in two years of clinicals.
  8. How to deal with feelings. Adrenaline is crazy, and there is nothing like being a new nurse and having to act under pressure in serious situations with adrenaline coursing through your veins. In nursing school, our hands would shake, we would laugh it off, make silly mistakes, etc. With practice, RNs act quickly in emergency situations without regard to their personal reactions — physical or emotional.
  9. How to deal with doctors. How to communicate with grouchy, mean doctors was not taught in pathophysiology, people! I was prepared for dealing with people on a professional level during daylight hours, who were not stressed out and in life & death situations. I was not ready to deal with docs who hate their jobs, never sleep, and frankly see me as the bane of their existence. Ok, I’m generalizing here, yet the truth remains: I had little contact with REAL docs and was blown out of the water by the working relationships I would form with them.
  10. Unexpected friendships. Lastly I was not prepared for the rich relationships and camaraderie I would form with the doctors and nurses I work with and the patients I care for. We nurses are in a business of people: good, bad, beautiful, ugly, functional, dysfunctional, alive and dead. People are our vocation as RNs and nothing is more rewarding than that!

No, nursing school can’t teach students this stuff–we are LIFETIME learners. Nursing school gives us a very basic foundation of knowledge and we build, build, build on that knowledge from the ground up. The rule of thumb is 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. The reality is that RNs see it all–but it takes an entire career to do so!

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Amy Bozeman

Amy is many things: a blogger, a nurse, a wife, a mom, a childbirth educator. She started her journey towards a career in nursing when she got pregnant with her first child. After nursing school and studying "like she has never studied before" she entered the nursing profession eager to get her feet wet. The first years provided her with much exposure to sadness, joy and other complex human emotions. She feels that blogging is a wonderful outlet and a way for nurse bloggers to further build their community. Traditionally, midwives have handed down their skill set from midwife to apprentice midwife. She believes nurses have this same opportunity: to pass from nurse to new nurse the rich traditions of this profession.
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29 Responses to Top 10 things nursing school CAN’T teach you

  1. Beth

    I agree with all your points except one. I think it depends on where you work if “nursing eats their young”.

  2. Lisa

    In my experience, nurses do eat their young. That was the main reason that after I went to work I regretted ever becoming a nurse. And I vowed that when I gained experience I would never treat anyone the way I was treated.

  3. king

    i didn’t get that thing “…eating their young”

  4. Carla

    Awesome. Agree with all of it. Except some nurses need to get out and the perception is that they do eat their young. It was done to.me and it will never happen by me. Being a nurse is who I am. I love it.

  5. Arlene

    If Nurses “eat their young”, it is the dumbest thing to do. These young people can be so much help to the experienced nurses and I always found it nice to be able to help them and teach them as I worked along side them. It never hurts to be kind and remember the days you first started in Nursing and how frightening it was.

  6. YVETTE

    NURSING SCHOOL ALSO DOESNT PREPARE U FOR THE REALLY HORRIBLE NURSES U MEET. SO SHOCKING IT LEAVES ME SPEECHES. I WISH SOME ONE WOULD EXPLAIN WHY WOULD SOME ONE BECOME A NURSE IF U DONT CARE BOUT SICK PPL AND U DONT LIKE OTHER CULTURES?

    • Steph

      It’s because they go into nursing for the $$$$ I’ve seen this a lot with newer nurses!! So sad!!

  7. Kate

    I have always tried to encourage & help the new nurse, I remember how frightening it can be.

  8. Maureen Myhre

    I like to share with new nurses the information that was not shared with me, that I wish had been conveyed when I was a new nurse. I like the idea of trying to make someone’s experience as a new nurse just a little bit better than my own experience as a new grad. I vividly remember how stressful it was to be a new grad in a large urban, county hospital. I had never experienced that level of stress in my previous career. The stress of being new just seemed to continue for such a long time, and I know that a lot of new nurses had that experience because they told me about having those same levels of persistent stress. We owe it to the new nurses to try to alleviate, at least some of this stress by being friendly, light-hearted, and generous with our knowledge because (let’s face it) it will be in our own best interest to help these new nurses to become experienced, knowledgeable, and seasoned. To do anything contrary to this approach is self-defeating to the profession of nursing, in general.

  9. elaine

    i’ve been an LPN for 20 years….nursing school provides the basis to start your career…but nursing is a lifelong learning process. School can never give everything…just gives you the tools to get off to a good start…everything on that list applies to all in the healthcare field…not just RN’s!

  10. Sheila

    I agree with everything mostly, but not ALL nurses eat their young. We are supposed to be mentors for each other. I think the key is that nursing school does NOT teach you empathy: not for your patients, and certainly not for your peers. It must already be part of who your are, or your have to be mentored by someone with empathy.

  11. jackie

    That was a great list! EXCEPT for the fact that nurses do indeed eat their young, and it is becoming a huge problem in nursing. Have you not heard about Lateral Violence? It was wrong to downplay this huge issue.

  12. Amy Bozeman Scrubs Blogger

    I did not state that that lateral violence (nurses eating their young) doesn’t occur–just inferred that perhaps the impetus for such behavior (or perceived behavior) is the stress incurred by nursing on the whole–which in no way excuses anything! In all honesty I have not personally seen this happen with *new* nurses or student nurses–though I have heard about other peoples experiences with this huge problem. I was not downplaying the significance of the problem–just illustrating a point–I’m sorry if I was unclear. I agree, there is NO place for lateral violence in the workplace!! Thanks for your thoughtful comments–Amy Bozeman (author)

  13. Karen

    In response to nurses eating their young: I do think this does happen, but I think there is more happening here. Inexperienced nurses need guidance – but not everyone has the patience to be a teacher. To expect that all nurses are able to teach is like saying all adults are able to parent. Yes, to some form and fashion it happens but not always positively. Nurses who can teach and enjoy it should make themselves known to their supervisors – and if you are assigned to a nurse who is having a bad day, help them. Don’t expect to be shown anything. Just watch and help. The next day ask for someone else. I was assigned to a nurse one time who had the patience of a gnat. But in some ways she was one of the best nurses I had ever seen. I made beds and cleaned rooms all day – but I watched and learned what I could. Learning is a two way street – and everyone needs to assume some responsibility in it.

  14. vicki a widener

    Having worked in both hospital and geriatric facilities. I have found that the nurses who ” eat their young ” seem to have serious ego problems. As if they are afraid you are there to take their jobs away. I have encountered it many times and that always seems to be the problem. The thing I have learned is , do not step on their toes and learn to fight back without them knowing your fighting back. There are certain things you have to take and alot that you do not have to take…… Choose your battles and do not back down !!

  15. Toni

    They forgot how to snap those darn hospital gowns!

  16. Cathy Carrick

    When I graduated from a 3 year diploma nursing school back in 1975 they had taught me it all. I was a fully functioning RN with hundreds of clinical hours under my belt. I was hands on all the time. The push for more education did away with this wonderful form of learning. I am of a dying breed. Most diploma nurses have or will retire soon. I work in an OR and my lack of a BSN has not held me back or ever prevented me from getting a job. I spent 3 months of school in an OR. New nurses today can’t say that. Us OR nurses are also a dying breed. I will say I love my job. Oh and by the way… nurses DO eat their young!

  17. margo haq

    I so agree with Cathy above. I also graduated from a 3 year school and the education we got doesn’t seem available today. Times do change but I wouldn’t trade my experience over a degree school, although I often wish I’d gone on and gotten a BSN later.
    After our first 6 mos. in the classroom we were on the floors learning firsthand and had clinicals for theory.

    • healthygina

      I don’t understand what everyone is writing about that schools aren’t now teaching clinical skills. I too came out of school as a fully functional RN, and started in the ICU. Several nurses on my unit DID try to “eat me”. I survived and now I am thankful that they were so hard on me. But to say that nurses eating their young doesn’t happen isn’t true at all.

  18. I am a RN for 23 years and eating our young does happen. But my experience have been that after you have shared and mentor another student nurse they learned from you but afterwards if they meet you on the corridor of ER they don’t even know you.They believe they are better than you and they don’t remember who taught them how to survive in the field of nursing .At least acknowledge the person, and remember who help you during those hard times.LOL

  19. Nan

    I, like Cathy C., am a 3 year nursing school graduate, 1973. I graduated and started working at the same hospital I trained at. I was fully functional as a nurse from day one. I became a head nurse (boy, is that an ancient term or what?) within 3 years of graduation.
    Having moved from Illinois to Minnesota, to California and now Colorado, as years went on, I encountered more and more prejudice against 3 year grads. I was and still am pround of being a 3 year grad, and no amount of coercion made me want to get my degree.
    As the years went by and I moved around, I felt that my clinical skills were what kept me alive and able to work. I was treated as a second class citizen by those with BSNs or MSNs. Nurses not only eat their young, they also eat the older ones also.
    I’m now disabled and unable to work at all. I worked as an RN for 36 years, and for the most part, I loved what I did. It had been a dream to become a nurse from the time I was 5 years old. I miss it terribly.
    Nursing is the most noble job in the world. I’m proud to have worked as an RN for so many years, and will always consider myself an RN.

  20. Bonny

    Yes, nurses are, as a rule, pretty horrible to each other….I have learned to develop a thick skin working as perdiem/agency at times,….You are always the “agency nurse” and the regular nurses hate you because you are making double what they make….Get over it , you too, could work perdiem or agency. We need to learn to work as a cohesive unit to protect the patient and make sure they recieve the best care we can give. And if an agency nurse makes an appearance, help her/him, show them where important items are kept and remember…we are all nurses, Let’s be proud of our profession.

  21. Jeanne Vacca

    I’ll agree that SOME nurses do eat their young.Most of us who have been Nursing awhile love it and really feel rewarded doing the jobs we do.I want to help new nurses starting out by feeling like part of the team.My advice is do the best you can,find a “battle-buddy”-an Army term,I am really dating myself,to bounce questions and concerns off of.And realize that you never get used to death.If you do,then you need to find another job quick,preferably not in Nursing.Death is sad.We all need to support ourselves as much as possible.

  22. nurse ratchett

    Well said!

  23. nefleury CNA

    As someone who is in the middle of changing careers from IT to Nursing, I can honestly say that Nurses don’t eat their young… The Old eat their Young!!! Everyone is guilty of doing it at some time in their lives, and you will too, no matter how much you say you won’t!

  24. Pingback: Old School vs. New School Learning | A Lust for Learning is a Lust for Life

  25. bradblogger

    You’re awesome for sharing these awesome tips, Amy… love all of the experiences you’ve included that you would never get in school… my favorites being “unexpected friendships” – I think as humans, we really yearn for those types of strong relationships, not ones we have to constantly work on every single day – great stuff!

    (Brad’s latest blog entry: http://www.dolcesf.com/online-rn-to-bsn-programs

  26. EHRTutor

    #9 is huge! I’ve talked to so many new nurses who feel like half the struggle is figuring out how to deal with doctors. Not just stressed out, angry doctors but also doctors who look down on them as nurses or make mistakes the nurses catch. But no hate on the doctors – there are a ton of great ones out there, too! It’s a shame the difficult ones have a chance to make such a negative impact on new nurses.

    As for #2, hopefully that will change now that a lot of schools are getting Academic EHR/EMR systems where they teach reporting in tandem with critical thinking rather than just focusing on one or the other at a time.