Nursing school is a floor, not a ceiling

"Everything I need to know I learned in Kindergarten"...or perhaps "nursing school", right?

Not quite.

One fundamental problems with some new graduate nurses is the fact that "they don't know what the don't know", and yet practice as if they have nothing else to learn. Being eager to step in there and get your hands dirty is an admirable quality. Experience is the best teacher, after all. But we must make sure we are careful not to overstep our professional boundaries when we pursue these great learning experiences.

For instance, a new nurse...on orientation perhaps...should probably not make independent adjustments to ventilators or other complex equipment. We gain some exposure to this sort of thing in nursing school, but it is not a "see one, do one, teach one" concept. Making adjustments to the ventilator does much more than change a few numbers here or there. It controls the patient's physiology...and anatomy. We must make sure that we know that some equipment surrounding a patient is actually an extension of that patient...and to manipulate the equipment is to manipulate the patient...and we must be ready to anticipate the effects of the changes we make. We have a duty to the patient, which extends far beyond the legalities of a patient assignment. We have an obligation to know what we are doing, why we are doing it, what the effects (good and bad) may be, know what we are monitoring (and why), and most important of all, know what we don't know.

Nursing school prepares you with basic education and training necessary to sit for the respective licensing exam. I prepares you with knowledge and experiences in a variety of settings, and with a variety of patient populations, so that you may begin practicing as a competent generalist nurse. Although some new graduates do enter specialty areas such as critical care or the emergency room, many start in a "med/surg" unit, where they will gain valuable experience in delegation, time management, communication, and organization....among others. Wearing a badge that identifies you as a "critical care nurses" or an "emergency room nurse" doesn't do anything more than just that. You do not gain immediate competence in the necessary areas of knowledge necessary to practice independently. It does not grant permission to "cut corners" and skip steps along the way. I am not picking on the CCU or ED by any means. I am using these highly specialized areas of nursing merely as examples of where new nurses may find themselves in situations they are not trained or experienced to handle alone... and must be readily aware of knowledge and training they do not possess just as much as that which they do. Of course, this applies to us all.

I say, seek out every educational opportunity you can. Learn as much as possible. Every tool you have in your belt will be necessary...only time will tell. You should never say, "I don't need that...I'll never use that..." How do you know? You don't. You never know when something you learned a while back...that seemed totally unrelated to your current job...could actually be of great benefit to you, but more especially to your patient. As nurses, we must accept the fact that our care is not as "siloed" as we might think. Patients carry everything with them at all times...their diabetes, respiratory disease, mental illness, social drama, etc... we don't get to pick and choose how we care for the patient...it's all or nothing. We could all gain from any education we can get. Do not limit yourself...and certainly do not wait for your employer to provide everything you need to know. They offer what they must so they can have documentation of training. That's it. Sure, they want to have safe patient care as well...but they are in a business, and they have limited funds. We must seek out the opportunities if they are not readily available to us where we are. Attend conferences, workshops, webinars, at-home study, etc. Read a journal! There's a wealth of information in there, you just have to start reading.

So, I say to everyone, young, old, novice, expert...keep on learning. If we truly want to provide patients with the safest care possible, we must take control of our own practices and be ever aware of what we don't know! Keep chipping away at it...you will be amazed at what you have to gain!

Thank you.

Steve