My practice evolution: an appreciation of the discrepancies between the idealism of nursing education and the realities of hospital practice.

Newly graduated registered nurses face a barrage of physical and mental challenges in their first few years of practice, especially in the hospital setting. This article explores discrepancies between student nurse practice and professional nursing practice and the challenges that new nurses face in bridging the gap between idealistic theory and realistic practice. The author's subsequent graduate nursing education and continued practice in the field resulted in a personal evolution of practice that elicited a profound sense of appreciation for the field and a desire to share these experiences with other practicing nurses and students. Clinical nurses are well aware of the current nursing shortage and its implications for nursing practice and patient safety. Those of us in academia are concerned about the aging nursing faculty workforce and consequently the limited capacity for enrollment into nursing programs, further worsening the shortage. However, my perspective and practice relative to the nursing shortage has evolved because of my experiences of excitement, disappointment, and determination relative to the ideal clinical practice taught in nursing school versus the reality of actual clinical practice a.. er nursing school. I suspect that those who taught me in my undergraduate program had similar experiences in their own careers, and, in addition to learning about the ideal clinical practice, I would have been grateful to also have learned about the sometimes harsh realities of clinical practice from those who served as role models and mentors to me. THE REALITY My first year as a new registered nurse, I worked on a busy telemetry unit at a large hospital in New Orleans. Before accepting the position, I was warned by several nurses in the community not to work at this particular facility because "they work you like a slave." I, in my youthful optimism, told them, "Hard work has never scared me and never will." Armed with my degree and idealism about clinical practice, I accepted the position. That a.. itude lasted approximately .. months before I seriously began to question my decision to become a nurse. Every night when I clocked out, at least 2 hours late, I felt fear that I was forge getting something important and guilt over having done little more than keep my patients breathing. My nursing practice was not even close to the way I had been taught in nursing school. One of the most difficult aspects of this job was the nurse-to-patient ratio which at times was as high as one to eight. There was scant ancillary support staff , which translated into a lack of assistance with patient transportation, phlebotomy, EKGs, and respiratory therapy. The nurse-to-patient ratio, coupled with the high expectations of the charge nurses, made the job nearly impossible for a novice nurse. Our manager did not make our jobs any easier. Her style of management did not allow for input or collaboration about problems on the unit. She did very li.. le to assist us when we were stretched dangerously thin. Many nights I wondered why I tolerated working at a facility that did not support my needs as a new graduate. Every 2 weeks, I was reminded why I endured such poor working conditions: the paycheck. The pay I received more than adequately covered my student loans and credit card debt from nursing school. In time, I realized I needed change, but I was very hesitant about going to another hospital because my nursing school classmates didn't have many positive comments about their places of employment either. This turning point led me to a career-altering decision: I began graduate school a.. er only .. months of practice. If asked at that time about the nursing shortage, I would have said that the working conditions at some of the nation's hospitals most certainly contributed to the shortage. LET THE EVOLUTION BEGIN I entered graduate school with a desire to recapture the passion for nursing that I had experienced as an undergraduate student. …