Nursing School vs “Real World” Nursing: 6 Differences

Stressed male nurseEver wonder what it’ll really be like when you’re working as a nurse? When I was a nursing student and CNA, nobody ever really told me the details. Here are 6 things you might be doing differently as a “real” nurse.

Keep in mind: these may not be the best practices, and these techniques may receive many headshakes of disapproval. All I am stating in this post is what I have observed “real” nurses commonly doing in work settings. I am not encouraging or advocating these techniques. Every nurse has to use his or her judgement to decide how they like to work. Having said that, read on:

  1. Working with G-Tubes:Nursing School: Put each medication in a separate little cup, then add a little water flush in between each. Then you let it all go in by gravity? Consider yourself lucky if you end up working somewhere where you have 30 minutes to burn watching the medication slowly crawl down that tube.

    Real World: Mix all the medications together, dilute with water, and push it in. Everything’s going into one place anyways: the stomach. Checking placement is still a must, especially if you decide to do this!

  2. Female CatheterizationNursing School: Find this landmark. Spread this labia. Locate this, look half-a-fingerlength up, insert, and voila! You’re in! Smooth and easy.

    Real World: Females are all different down there. Not to mention, it’s not always:

    • quiet in the room
    • perfectly lit in the room
    • easily visible past the patient’s legs
    • …where it should be

    Just walk into the room with a determined attitude and do everything you can to visualize down there. Get an assistant, turn on all the lights, have a flashlight, and an extra kit.

  3. Physician’s OrdersNursing School: Nurses are strictly not allowed to change or discontinue physician’s orders without express phone, verbal, or written consent from the doctor. The doctor needs to be informed every time a patient refuses a drug.

    Real World: We use our judgement. Are you going to call the doctor at two in the morning about a scheduled moisturizing lotion that the patient doesn’t want anymore? Probably not. Do play it safe, however. If you’re not sure, always just ask. The worst that can happen is waking up a disgruntled doctor. Not the end of the world.

  4. IV PushesNursing School: Follow the drug book. Push this IV push medication over 5 minutes, looking at your watch and watching the second hand tick, tick, tick.

    Real World: Same with the G-tubes. You’re blessed if you have 5 minutes to stand there and stare at a syringe. You do it slow, but not that slow. In the words of Sweet Brown: “Ain’t nobody got time for that!”

  5. Delegation and CNAsWhen you have too many things to do, delegate to CNAs or LPNs. Give them full background information, instructions and follow up afterwards. Everything gets done and you get a great team feeling at the end.

    Real World: CNAs are just as busy as you are. If they’re not on a break, busy, or documenting, they’ll help you. If they’re nice. Sometimes, you get CNAs that aren’t so nice. And you won’t have time to formally educate them. A quick follow-up is sometimes all you have time to afford.

    Everyone just has to do their best. If time permits, teach your CNAs or explain procedures! They’ll appreciate that. What else do CNA’s appreciate in a good nurse? Read 6 Ways to be a Good Nurse (From a CNA Perspective)

  6. Patient-Nurse EtiquetteNursing School: Knock on the door loudly. Introduce yourself before entering. Close the door, close the curtains, and explain any and all procedures to patient before beginning.

    Real World: Your patient has been awake all night. They are crabby, finally asleep for half an hour, and you need to check something minor. Wake them up? No, we think not.

    Time to make like a ninja. You can get away with a pulse ox, tympanic/axillary temperature, heart rate, respiration, lung sounds, even an accucheck or blood pressure. Disclaimer: only do this on patients you know. Always use your judgement!

Do you have any more real world nursing stories or differences? Post them in the comments below. As always, thanks for reading and chat with me any time on twitter!


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