First Semester Struggles

Many of you have just started your programs…congratulations! This is often a VERY overwhelming experience…I vividly remember more than one student having a breakdown in those first few weeks. Here are a few of the most common first-semester struggles and how to manage them.

The schedule
The schedule during nursing school can be insane. Here is a snapshot of my first full week of classes…notice all the lists and things to do, places to be, quizzes to take…. It was really really busy and it didn’t let up until the semester was over. I get tired just looking at it.I know people who got through school without a paper calendar, but I honestly do not see how it can be done…it’s such a hassle to make lists on a smart phone, and you can’t see your whole week (or month) at a glance. The calendar you see above is the UnCalendar…I have since designed my own planners, which you can see here (and they are amazing!) My best advice for adjusting to the schedule is to get an time-management system you can rely on and use the heck out of it. Schedule things in advance, being realistic about how long it will take to do a particular task.

For example, you can see here how I planned out a Saturday…rather than just making a list, I gave each task a time slot so I knew in advance what I could realistically finish in one day. Pretty sure the heart means I was planning to hang out with my cute husband 😉 

And here is a particularly crazy week from 2nd semester…notice how pretty much every minute of the day is accounted for. This is how I knew I could get everything done…even things like eating lunch and doing yoga. 

I think one of the biggest challenges with the schedule is understanding just how BUSY you are going to be. And embracing it.

Physical Assessment
This was one of the HARDEST skills to master, because each and every person you assess is different. Some people have nice strong pulses, others have little teeny tiny pulses…and you never know who you are going to have to partner with for your checkoffs. So, my best advice here is to practice practice practice. Take your dad’s pulse, your neighbor’s pulse, your grandma’s, your kids…practice on anyone and everyone you can get your hands on. Once you’ve got pulses down…move on to taking everyone’s blood pressure. Learn to tune out the extra sounds your stethoscope picks up so you can focus on those oh-so-subtle Korotkoff sounds. The BP check-off is one of the most nerve-wracking, so do TONS and tons of blood pressures. Going to dinner at your cousin’s house? Take  your cuff…give everyone a BP reading. Seriously. And then go work in the hospital where it’s all automated…haha.

Care Plans
To be honest, I am still on the fence about care plans. I feel like there’s got to be an easier, more straight-forward way to do it…but I can’t change the whole world at once so we’re just going to go with what we got. Care Plans are absolutely confounding to first semester students…and they should be! As a brand-new nursing student you probably don’t have a point of reference for ANYTHING you are learning. It’s like learning a foreign language by just showing up in Japan or Belgium or wherever. So, chances are your care plans will take an unbelievable amount of time to complete, especially first semester. I think the average for most people was 6-8 hours…I am shaking my head as I write this. In my mind a care plan should be super simple: list the patient’s problems and then list what you are going to do about it. But, instead of it being super direct and applicable, it has to get all “fancy” with nursing diagnoses and blah blah blah. Try not to let all that convoluted wording trip you up…get a good care plan book for reference and keep your thinking simple. What are their problems and what are you going to do about it? For example, a patient with pneumonia would have the following problems (note these are not NANDA approved…haha!):
-Infection
-Difficulty breathing
-Feel like crap and want to stay in bed all day

So…as the nurse, what are you going to do about it?
-Infection? Administer antibiotics, monitor temp, monitor WBC, collect sputum sample
-Difficulty breathing? Administer O2, encourage pt to cough and take deep breaths, administer respiratory treatments (which the RT would probably do, but you’d want to make sure it got done)
-Feel like crap? Cluster interventions so patient can have periods of rest, administer antipyretics since fever makes you feel awful all over, adjust activity to patient’s tolerance (if walking the halls makes their O2 sat drop to 80, you might stick with just dangling on the side of the bed).

Make sense? Of course, your care plan will say things much more “NANDA-y” (and if you don’t know what NANDA is yet…you will!), so it will actually say something along the lines of “Infection as evidenced by gram negative rods in sputum, elevated WBC and fever” or “Impaired gas exchange as evidenced by O2 sat 88% and consolidation in bilateral lower lobes” blah blah and blah. As an interesting side note, the care plans we use at work in no way shape or form resemble NANDA. Just sayin’.

The Sheer Volume of Information
The other thing new nursing students have to come to grips with is the huge amount of information that must be learned to perfection. This is most evident in the skills check-offs and have been known to bring more than one student to tears. For some reason our injection check off really tipped some people over the edge…I think it was the timing (a really busy week) coupled with all the minutiae (what gauge needle, what length needle, for how many ml medication, for what route intradermal, subQ, intramuscular…what are the intramuscular locations? What about the Sub q ones? and on and on it goes) UGH! For learning basic details I used gFlash and for anything related to anatomy I practiced on my friends (like locating the spots for intramuscular injections…good times!). My advice for things like skills check-offs…try like heck to pass those the first time so you can move on to the next thing. Having to keep studying and re-do a check-off just takes you away from the next item on your To-Learn list. With that said…if you don’t pass a check-off, it’s not the end of the world. Most programs give you three attempts because there is such a thing as having a really bad day. Take a deep breath. You’ll be fine. As for the rest of the studying you have to do…the best thing I can say is to stick with whatever method is tried-and-true for you. If  you are struggling or don’t have a method, I am pretty confident in the Straight A way, which I go through in detail in my book Nursing School Thrive Guide. I’ve also got all my notes here on this website to help you through the rough patches. Hang in there!!!

Lack of Sleep
First of all, this DOES NOT have to be a problem. It will, however, be a problem if you waste time on nonessentials like big study groups and un-focused study sessions. By utilizing a good time management system, being accountable for your time, and scheduling out your week you can (AND WILL) get to bed by 2300 every night. That was my goal throughout nursing school and I managed to do it without fail. “But I’m a night owl,” you say. Well, the problem with being a night owl in nursing school is that you will also be getting up at 4:30 or 5:00 in the morning for clinical, so it’s probably best that you get on an “early-bird” schedule sooner rather than later. Once you’ve graduated and gotten your dream job on night-shift you’ll never have to drag yourself out of bed at 5am again (unless you’re catching a flight somewhere fabulous…haha!). When thinking about your sleep schedule…be very protective of it. I would honestly do “sleep-math” here and there throughout the day…”if I get to the hospital by 11, I can do my pre-clinical prep until 1300, home by 1330, have lunch until 1400, do my care plan until 2100, make my lunch for the next day by 2130, relax for a half hour, in bed by 2200.” If something threw a wrench into my plan, I’d automatically calculate it into my day to make sure I could still make my goal of a 2300 bedtime. This was how I avoided wasting time and just got shizzle done. A girl needs her beauty sleep!

Lack of Social Life
Again, it all comes down to scheduling. In fact…I highly recommend that the first items you write down in your weekly schedule be things that bring you joy. It doesn’t have to be something huge, but let’s say you’re going to be studying at Peet’s Coffee from 1200-1400 on Saturday. Have a friend meet you at 1400 for thirty minutes…a friend NOT ASSOCIATED with nursing school. Chat, catch up, think about frivolous things for thirty little joy-filled minutes! Overall, I recommend you try to do ONE THING every day that brings you joy (take a walk, play with the cat, have a glass of wine, pursue a hobby, give yourself a pedicure, whatever!), and aim to see another human being in a social setting once or twice a week. I promise it is time well spent, and will help keep you balanced and sane!

I hope this is helpful and reduces some of the stress of starting nursing school. Check in with an email or comment below and let me know how you’re doing!

Be safe out there!

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