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“Thank God I finally passed NCLEX. Now I don’t need to study any more!”
Every time a recent grad calls or emails to share their happiness at passing NCLEX, my reply is the same. “Congratulations. Now the real learning begins and it is a lot harder than what you learned so far.”
Okay, I have never seen a prescription for gillyweed in a hospital
But gillyweed might have some medical applications….
What you learned about pharmacology
today’s blog will be short and to the point. What you learned in nursing school was about drug action, typical dose, side effects, nursing implications, and the Five Rights. Most pharmacology courses are a survey of drug categories, an inventory of all the possible drugs, some of which are very interesting and intricate but which are also specialized and you may never administer in real life. Pharm is generally taught as one of the “hard sciences,” often by a pharmacist who may not necessarily have done much clinical pharmacology.
The faculty job
You can do the Five Rights and still not exhibit the best judgment, giving a drug that ought to be clarified with the doctor or pharmacist based on something you found during the physical exam. The job of the faculty is to make sure you consider all these things before you give a drug. As you might expect, a student never ever gives a medication, not even an aspirin, without a faculty person present.
What you learn in real life
The trends include learning not just about meds (the most important category of medical errors) but medication systems, and also studying errors made by others. For example, we all know what potassium is and what it does; but do they teach you why we never keep vials of it on the nursing wards? or why hemocult developer is never kept in the med drawer?
We all need to become systems thinkers – Like at Hogwart’s School!
People sometimes call me a pessimist because I sometimes share stories about bad things we want to avoid. Most of the time, we want to focus on what to do, as opposed to what not to do….. if you dwell on the negative case all the time, the theory goes, students gets confused and will not develop confidence. Finding a balance between these things is part and parcel of developing the judgment expected of a skilled professional person. We need a healthy respect for the side effects and adverse effects of medications, and for that reason I share war stories.
One of the brilliant things about the Harry Potter books is that JK Rowling included something like this in the Hogwarts curriculum – Harry Potter and company spent time “studying the defense against the Dark Arts…”) meaning that they had to learn about all the possible bad things that might happen. (to them). Of course, this makes for a very engrossing plot. (being a teenaged muggle is bad enough without the extra element….) Frankly, when most pharmacology courses just cover drug action and pharmacokinetics, there is not enough space and time in the course to spend as much time studying systems in any detail…. I think more attention needs to be devoted to this, all along the way.
Two things every student and new nurse can do.
First, go to the Joint Commission website and read about error prevention and sentinel events. The Joint Commission publishes free podcasts and email newsletters. plan to subscribe. They are up to issue #47 lately – read the back issues.
second, subscribe to the FREE NEWSLETTER from the Institute for Safe Medication Practices.