In nursing school one is expected to learn nursing skills. This should be self-evident. By graduation, there is an entire catalog of skills you are expected to have mastered. Now, nearing graduation, I feel compelled to make something of a list, both of those skills I actually HAVE, and ones I only have in THEORY. The reason for this dichotomy is that, shockingly, there is never a guarantee that you will be able to practice a skill in nursing school on a real patient while still in school. You have to be assigned a patient who NEEDS you to perform a given skill, and that's never a given. It does, however, keep you on your toes, as you never know if THIS will be the day you need to perform a skill you learned a year ago and performed once, on a dummy, in a lab. Also, most of these skills tend to be "sterile field" skills, just to make you even more sure you'll kill someone.
1. Catheters- The Theory- a nurse should be able to catheterize just about anything
In Reality- I am comfortable placing straight-caths for urine, in women. I have NEVER placed ANY catheter in a man, and I've never actually done a Foley. This is because the only patients available who NEEDED Foleys were men, chronic foley-users, who had some sort of obstruction or problem with said Foley, and no-one wanted me mucking around with it. Therefore, I live in fear.
2. Suctioning- The Theory- A nurse should be able to do oropharyngeal, nasopharyngeal, and, I assume, MAGIC suctioning with any kind of tube set up, through trachs, ET tubes, adjunct airways, etc.
In Reality- I can do non-emergent Yankauer suctioning and trach suctioning with one of those in-line setups relatively well, and have done it on many occasions. I have yet to do emergency-Yankauering outside the ambulance, and have NO idea if my technique is ok. I have never suctioned an ET tube, and still am convinced I'm going to cause a lung to collapse.
3. Wound Care- The Theory- Nurses, armed only with a set of vague orders "cover with dry sterile dressing (DSD)" should be able to come up with a spiffy dressing setup that prevents infection, decreases healing time, and makes the patient look like a rockstar. The nurse should also apparently be familiar with all sorts of epiffy expensive gear.
In Reality- I can actually do a dry sterile dressing job pretty well, if the wound is fresh (like a recently evacuated pilionidal (sp?) cyst, or on a patient whose wound has been previously dressed by someone competent, so I can just re-create their work of staggering genius. I have NO idea, however, how to choose which kind of dressing, aside from the general theory of "if it's wet, dry it. If it's dry, wet it", and "DONT EVER LET IT LEAK EVERYWHERE". Given the option, i will cover everything with 4-by-4s and tape. Lots of tape.
4. Assessment- The Theory- Nurses should be able to complete a physical assessment on just about anyone, note minor as well as major changes, bring all this to the attention of the proper physician, and catch tiny warning signs before the patient even knows they're sick. They should always be thinking 4 steps ahead to the implications behind each test result, and have plans in place for contingencies.
In Reality- I can do a pretty kickass physical, if I do say so myself. I'm good at details, and I've gotten REALLY good about asking history questions for clues to possible Very Bad Things. I cannot, however, think more than 1 step ahead, and still regard Real Nurses with superstitious awe.
So that's where I am!