We all know nursing school involves learning a TON of content in a pretty short amount of time. It can be overwhelming to say the least. Sure, you want to do great in school but sometimes you have to choose your battles. When it really comes down to it, what do you absolutely need to focus on in nursing school?

Med Administration
Though at first blush medication administration may seem pretty straightforward (right patient, right med, right dose, etc…) it is VITAL that you learn this skill flawlessly. Not only will a med error most likely get you expelled from your program, but it’s the absolute last thing you want to happen on the job. The highest risk for a med error tends to occur when you’re in a rush and especially when you are dealing with a med administration that is contingent on some kind of assessment such as a lab value. If you’re giving mannitol, know that you’re going to be checking serum sodium and serum osmolality before EVERY dose…if it’s coumadin, you’ll need that day’s INR. If your patient is on a heparin gtt, you will be checking PTT and bolusing/changing the gtt rate based on the results (this usually requires two nurses at most facilities). Stay vigilant, stay focused, and do your five rights Every Single Time.

Memorizing lab values is something many nursing students stress about, and this very well could be because your program requires it. What’s frustrating about this endeavor is that “normal” values vary from facility to facility…while an acceptable K level might be 3.5 to 5 at Hospital A, it might be 3.5 to 5.5 at Hospital B. With that said, it is important to know some basics…like that a K of 2 is bad as is a K of 7. The MORE important things to know about lab values is why you care (how does it affect the patient’s physiology?) and what you are going to do about it. If your K is too high, what are you going to watch for, and what are you going to do about it? Depending on how high the K is, your patient may need dialysis, or they may just need a “K cocktail” which can include a whole host of goodies including insulin + dextrose, Kayexalate, albuterol, calcium and sodium bicarb. Knowing what to watch for and how to treat it is MUCH more important that just memorizing numbers.

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There’s a reason your clinical instructor probably requires you to “write-up” your drugs for each patient…dose, indication, side effects, monitoring parameters and the like. This is because you’re not expected to memorize all this information…drug references are readily available on all hospital units. What is more important is to understand WHY the patient is receiving each medication and how this affects their disease process. Knowing that your patient is getting Lasix because he is fluid overloaded and that it may cause hypotension and hypokalemia is MUCH more important than simply knowing that typical doses range from 20-40mg.

Pay close attention in your Med/Surg classes so that you can develop an understanding of physiology (and it’s dark cousin pathophysiology). Understanding how the body works when it’s out of hemostasis is going to set the stage for you being able to anticipate potential problems and plan appropriate interventions.

While hands-on skills are important, you will get loads more practice on the job than you’ll ever get in nursing school. Yes, it’s nice to know how to place a Foley, perform a 12-lead and insert a nasogastric tube, but the sad fact is that you might not get much practice doing these things with real patients…just depends on what patients are there on the days you do your clinical rotations. With that said, jump at any and all opportunities to practice but don’t beat yourself up if the opportunities just aren’t there. You’ll get tons of practice on the job, I promise. And in the meantime, there’s always the sim lab.

If you’re faced with studying for theory class or your assessment class, go with assessment. This is the most important skill a nurse learns and it means the difference between recognizing dangerous situations in time to intervene or helplessly watching your patient crump right in front of you. Fine-tuned assessment skills enable you to plan appropriate interventions, advocate for your patient, communicate necessary information to other team members and know when your patient is taking a turn for better or for worse. Invest in a decent stethoscope (the Littmann Master Classic II is a great place to start) and take your time…your patient will appreciate your thoroughness!

If you focus on these core things, you will be well prepared to take care of your patients safely from day 1. As you go along, you’ll realize that you learn something EVERY SINGLE TIME you work that makes you wonder how you got along so far without that particular nugget of knowledge. It’s an ongoing process. Try to enjoy it.

Be safe out there!


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