Do Nursing Students Learn the Names of Medications Anymore?

VENTING HERE !!!  I’m frustrated with the general group of people I used to work with.  I love nursing, and am SO thankful I’m from the ‘old school’ of nursing. I still have my license even though I’m disabled, because it means something to me.  I worked hard for it. And it was my main identity for the 20+ years I was able to work.  We still had to do things that are done by machine now, but actually had to DO them ourselves (vitals, handwritten charting, doing our own orders, etc- no techs or CNAs in most hospital jobs when I started… on an acute neuro floor, I had 14 patients on the night shift). IV pumps weren’t used much- we had to count the drops with our wristwatch, and know when the bag was due to run out BEFORE it did, so we didn’t risk a line clotting off.  We didn’t have pulse ox monitors- so we had to look at skin color, and other symptoms, and then call the doc to see about getting ABGs done.   Older nurses get mocked, but we did a lot with much less mechanical help. When something breaks down, who knows how to improvise?   When I graduated, I had to test urine to determine how much insulin to give.  Blood sugar monitors were not common, and even in hospitals, an entire floor (neuro and OB/Nursery in my situation; NICU got their own) shared the monitor when they first came out.

But my major beef when I go to the doctor’s office now is the lack of understanding and interest in medication proficiency when the nurses review my meds with me.  It’s a huge part of their job- and yet pronunciation is abysmal, and knowing what the meds are for is worse.

I am constantly stunned at how few nurses I encounter are able to pronounce the names of medications, and know the generic names of brand drugs.  It’s appalling.   I graduated from an ADN/RN program in 1985, and in order to do so,  our entire class  (standard practice in all nursing schools I knew of back then) had to memorize brand and generic names of ALL meds our clinical patients were taking, the reason for the meds, usual doses, side effects, SPELLING, etc.- and hand write them on index cards, which were checked by our instructors- no boxed sets of cards from the bookstore. No apps.  An index card and pen, with a drug reference book was our ‘app’.

Take some pride, dear nursing students- and full-fledged nurses! Make yourselves sound like you have the education you paid for (generally too much, if you started with some big  school).  Don’t stumble over the names… learn how they’re pronounced. Ask.  Sound like you’re in command of any medication review, or at least go look it up later if you don’t have to give an unfamiliar med yourself- then look it up before.  For hospital and nursing home nurses, know your patient base, and get familiar with the most common meds.  Generic, brand, what they look like, etc.   I’ve caught the wrong meds in those bubble cards in nursing homes more than once, just by knowing what they normally look like.  And hospital pharmacies aren’t perfect…. know what you work with ! Sometimes it’s just a new supplier.   Don’t be afraid to call and clarify something, or send it back to the pharmacy to be double checked.  If you give the wrong med, it’s on YOU.  Nobody else.

I’m at medical appointments more often than I care to think about because of multiple disabling diagnoses, and a routine part of each appointment is reviewing my current medications.  I have to keep track of two types of insulin, and around 10 ‘scheduled’ prescriptions, and more OTC meds that I take routinely. Then there are the routine supplements and many PRN meds- prescription and OTC (that’s ‘over-the-counter’).  And I can pronounce all of them, in their generic and brand forms.  It’s not rocket science.  It’s medical literacy.   It’s also the JOB of any working nurse who has to review or give medications.  How do nurses make notes about new orders if they can’t spell the name of the meds?   When checking meds against MARS, how do they know FOR SURE they’re giving the right med, if they can’t pronounce or spell the names ?  Or do you just figure you can look it up later and hope for the best?   Never stop actively learning (not just hearing things passively).  😉

When talking to the hospital pharmacy, do you know the difference between Xanax and Zanaflex?  Do you know which one is tizanidine and which is alprazolam?   In an emergency, do you know which one can be reversed with Romazicon (flumazenil) ?  Or do you  need a few minutes to go check, as the patient’s respirations drop to the point of needing intubation, when knowledge of the meds (and knowing where they are in the crash cart or emergency box) could save time and unnecessary procedures ?  If not, you really are not competent to give or review medications.  If it’s a weird med, or something given for a condition that isn’t common where you work, then ask the patient.  They might not know- but you might learn something if you take a few minutes after work to look it up.  Patients can be huge resources with oddball meds.

Nobody can know every last medication out there- there are times when reference books (or apps… I liked actual books when I was working) are absolutely needed and a necessary part of being  competent and conscientious.   But the medications that are commonly prescribed for various conditions typical to your work environment  should be part of any nurse’s engrained memory.   If you work neuro, know the meds for epilepsy, Parkinsons, MS, CVAs, increased ICP, etc. If you work pediatrics, know the general ‘rules’ for Tylenol and ibuprofen, and the different code meds that should be posted in the patient room with their weight and appropriate doses.  If you work drug and alcohol rehab, know the meds needed for ODs, detoxing, and what symptoms to look for during withdrawal for the various categories of drugs.  You should be able to pick up on mistakes- including those given to you when taking or checking orders.  I’ve had to call doctors back, and verify doses, when they  just didn’t seem  right when I was checking orders.  Especially when working in pediatrics, geriatrics, and with patients with renal insufficiency or outright renal failure.

I learned the most about brand/generic information during the time I worked in nursing homes (so don’t squawk if you have to take a job in a nursing home- you will learn medications in such a way that you will be better in ANY nursing job you have later on).  I learned about the fragility of doses in pediatrics- and how to dilute meds to give the precision doses required of a 2kg newborn. I always double checked my calculations with another nurse, and the pharmacy (we had a pediatric pharmacist available at all times, which was wonderful- but not having that is not an excuse to double check doses).    And, never to give any dose to any patient if it just didn’t seem right.

In general med-surg nursing, I learned about how IV drugs should be given safely (so if you think that you’re wasting time in a med-surg job instead of your ‘dream position’, consider it what your nursing school didn’t teach you- after you have to complete an ‘internship’ that didn’t exist 30 years ago).  Don’t skip the saline flush before giving the IVP, even if you know it still has saline in the lock from the last flush- you don’t know for SURE it’s patent- things shift, and meds can HURT if they go into the tissues.  My dad complained about his IV site for 2 days when he was given nausea meds, and there was never a saline flush before the med- just after.  It wasn’t an overt ‘blow’, but it wasn’t patent in a normal way. He was treated like he was clueless about his own pain during the medication administration.  SAS(H) is still protocol in any place I’ve been (check your facility P&P Manual).  Don’t be lazy.  Meds that are pushed through infiltrated veins hurt (yeah, I said that before).  Take a couple of minutes to do it right.  It takes much less time to check patency than it does to clean up a patient and full bed change from the nausea med never getting a chance to work, and the patient puking his toenails up.  And some compassion? That will go a LONG way.

If we didn’t know the information that made us ‘floor ready’ by the time we were to graduate, we didn’t graduate. Period.  Very simple. Our orientation was ‘here are the narc keys, there’s the bathroom, here’s where you punch in, and good luck’- as the off-going nurse snickered. If I was lucky, the ADON was still around until about 6 p.m.- after that, I was the only R.N. educated person in the BUILDING of 150 nursing home residents (I had the skilled wing of 30 by myself for 3-11, and another 30 dementia patients if I worked a double on 11-7).    Three to four days tops for orientation  back in the 80s.  A couple of weeks in the 90s, and then ‘babysitting’ for 6 friggin’ weeks with a preceptor in the 2000s, because nobody trusted that someone with a license actually knew what the job required. Very sad.  I had a nice preceptor who ‘got it’ that the job there wasn’t my first rodeo- and it was nice to have someone paid just to be a resource for me (my main ‘needs’ were:  how to call a code, how to deal with the abuse cases and social services when a parent visited a kid who’d been on the news for being beaten or burned, and dealing with the general procedures for dealing with new orders, which docs are user-friendly, etc).   Very sad to see the need for internships; when nursing schools do their jobs, nurses graduate with enough knowledge to not need internships.  Most places have a skills checklist that has to be completed to a respectable degree before being turned loose, but those were pretty basic.   Nursing school used to teach us how to not kill someone on purpose- and be safe upon graduation.  Boards weeded out the rest. We still had things to learn, but we could take care of a patient without a babysitter.   Now  many schools are for-profit institutions that really don’t care about your education or if you did or didn’t learn something… it’s on you to be the best you can be.  Some schools are better than others- and some still care, but it seems that actually doing procedures has gone the way of the pterodactyl.

The entire six weeks I was inpatient for leukemia (on neutropenia precautions, so isolated), not one student nurse ever did anything but follow my assigned nurse around.  Most didn’t speak.   When did this happen?  We were giving meds the second week of class (with supervision) and added any procedure from catheters and NGs to IVs and wound care as soon as we got patients who needed them.  Hands on.  School should teach you that !

Technology is a great thing.  It’s great to be able to look up various disorders and meds, but it should never be a replacement for actual knowledge.  Passing boards in 1985 meant getting at least %60 of 1000 questions (ONE THOUSAND) correct (which I thought was horribly low- that’s a ‘D’ percentage-wise), during a two-day, four-part hand answered test (little boxes were filled in for computer scoring).  There was no ‘luck’ in getting 75 questions right, and then getting a license.  We had to get 600 or more questions right. It took about 3 months to get results.   And the next chance was 6 months away if you blew it.   Three tries, and back to school if you couldn’t figure it out by then.   The way it should be.  Competence… not laziness with looking something up, and then forgetting about it.  When someone is crashing, there’s no time for the internet or computers.  You need to MOVE, and do it right.  Knowing meds is a huge part of that.

Have you been the only nurse at a code on a neuro floor who knew to ask the doc running the code if he wanted a Foley inserted BEFORE giving mannitol?  (and why?). Then have him ask YOU what the dose should be?  Have you HAD to find an IV site in a vein as proximal to the heart as possible, to give adenosine to a 13-month old who went into SVT, and had crappy veins- and knew WHY it was important to get that vein so close to the heart?  Have you known how long D50 lasts after giving it for hypoglycemia (and that every patient is different, both in how fast their sugars come up- and drop, and how ‘low’ they can be and still take something orally instead?). Do you know that D50 is unpleasant, with a warm, ‘gotta pee now’ feeling?   Do you know that D50 will wear off before the cab gets there to take the patient home from the ER if you don’t give them some protein to stabilize their blood sugar?   If you work on a floor where someone can code, could be diabetic, have reactions to meds, etc., YOU need to know the possible meds you may need to help them, and anticipate what the doc may order. And anywhere you work, there is the possibility of someone having multiple medical conditions and medications.  All medication knowledge is valuable.

Do you know that the elderly can have paradoxical reactions to things like diphenhydramine? Or that they can even get delirium from meds like cimetidine?  Or that they are not great candidates for most psychotropics, because of reactions, as well as fall risks?   Do you know that benzodiazepines that are discontinued abruptly (in anyone who has taken them regularly, but with even smaller doses in the elderly) it can very likely lead to seizures?  Do you know what meds are benzodiazepines?

Maybe things are overall better than I’ve encountered, but with my own experience with more than one doctor’s office and more than one nurse, the medication knowledge is poor.  Nursing communication websites also talk about how nursing school glosses over a lot of things.   Get the pronunciation right.  Know how to spell meds, and what they’re for- even if just a ballpark idea.  READ your nursing medication reference books (or apps).  Know what to anticipate if you have a 12 week pregnant 15 year old with diabetes,  kidney failure,  and constipation after an appy… what will you do if you get an order for Milk of Magnesia from the doc on call, if you forget to mention that she has renal problems?  Will you question orders for NSAIDs if she has any type of  pain?

Newbies, NEVER let someone rush you into giving something that you have questions about.  New nurses who don’t ask questions are very scary beings.  I’ve worked in staff, charge, supervisory, and department head positions (with an ADN).  And my first question when I was in charge or supervising, when asking the current nurses about any newbies, was if they asked questions or not. IF they didn’t I was following them like white on rice.

Be proud of being a nurse.  Knowledge is power, and it will never be anything but a benefit. It will make you a more valuable employee.   And respected by your peers and supervisors. Patients also hope that you know at least as much as they do about most of their meds.  🙂

OK.  Done venting.  It’s 6:30 a.m. and I haven’t been to bed yet… I’ll come back and be my own grammar warden later on 😉


Inexperienced/New Nurses- Give Them A Break !

That old ‘nurses eat their young’ comment from less experienced nurses gets VERY old, but there is some truth to it, depending on where someone works.  I worked in Illinois and Texas, and I would hate to have been a new nurse in Illinois hospitals; being an experienced nurse in Illinois when I returned 17 years after leaving wasn’t so bad. Being a nurse in Texas was generally positive, as they’ve had REAL nursing shortages for a long time- not just a shortage of adequately educated new graduates– for a long time.  When I moved to Texas  in 1985, employers were very thankful to have a nurse- even a new grad- because new grads had to have the basic skills done before graduating nursing school (and even being eligible to take boards)…. there were no ‘internships’ to finish schooling.  Now, hospitals have to finish educating the new nurses, and they don’t like it. They have been put in the position of paying for the ‘internships’, or running out of new nurses. It’s expensive, and finding older nurses who want to ‘babysit’ isn’t always easy; that wasn’t part of nursing school- that is part of being a nursing instructor (who may be some relative newbie who mainlined their Master’s degree to avoid working on the floor- so she has no floor experience)  I don’t blame the hospitals for resenting what they’ve been left with, but it isn’t the newbie’s fault either.  Orientation in any new job used to be two weeks maximum… if the new employee hadn’t figured out enough to be cut loose on her own in that job (with the expectation she’d have questions along the way), she was let go.  End of story.

When I graduated in May of 1985, we had to finish a checklist of skills in each class. If we didn’t pass those skills checklists in each class, we repeated the class. Period. End of discussion.  We may not be experts by a longshot, but we could get the job done without damaging someone.  Like with anything, there are always many things to learn and improve on, but we had enough learned to be safe.  We weren’t told that ‘all hospitals have IV teams’ (which isn’t true- and if you work in long term care, you are ‘IT’… there is no IV team anywhere).  You don’t know where you’re going to end up working to pay the rent and pay back those freakish student loans.  You go where the money is- and that very well may not be what you dreamed of doing.  If you have tens of thousands of dollars in student loans (instead of going for an ADN at a relatively inexpensive community college,  and getting an employer to help with further education), you work where there is work- or you never leave your parents’ basement.

I went to nursing school to work peditrics. That didn’t happen for 17 years, and I ended up finding it extremely depressing with the abuse cases, and permanently damaged preemies that got older, but never got any more  developmentally advanced than  the day they left the NICU 15 years earlier. Very few generally healthy kids ever showed up; most were absolute train wrecks. But I was glad for the experience. By the time I got a job on a pediatric floor, I’d taken care of kids on other floors that were in hospitals that didn’t have specialized peds floors.  So I’d taken care of kids; that helped me get the pediatric job- as well as having had 17 years of honing various skills that are good for any job; I just needed to work on the specific things to pediatrics- which was challenging enough to keep me interested.  I’m glad I did it, and glad I got out.  All experience is experience in something that will be useful in any other nursing job. 

So what makes an experienced nurse?  Having actively worked for over 20 years in healthcare as an RN (and a few as a student nurse/CNA), and since being disabled, having watched nurses for 8 years as they took care of me or a family member or close friend, I’d have to say that a nurse is no longer ‘new’ after about 3-5 years- but  it depends on the nurse. It takes a lot of time to integrate the information in nursing school, which generally focuses on one body system at a time, to be able to take care of a 19 year old pregnant diabetic drug addict who is in the middle of a sickle cell crisis, and is a post-op appy.  Or an actively dying AIDS patient with pneumonia, a perforated bowel, and his Port-a-Cath has clogged past the point of being ‘clot busted’, that is intense pain and has no current orders for any pain med besides an IV delivery route.  Or an elderly nursing home patient  on dialysis, a tube feeding, a trach, and has diarrhea (first thought in that situation is fecal impaction) and a UTI.  It takes time to see the WHOLE patient- not just the parts assigned to you !  You’re assigned to all of them as a nurse- new or not !

New nurses are supposed to have questions (including nurses who may have experience, but are new to a  different specialty).  The quiet new nurse is the most dangerous and the most disliked on any unit/floor. There’s always the question that she may be too dim to know what she doesn’t know, OR that she is too meek to ask. Both are recipes for wrongful death, and no other nurse is going to want to be associated with that type of nurse for anything.  They ARE the plague. Those who talk as if they’ve been nurses for years aren’t far behind. If you’re new, ASK.  If you haven’t done something very many times (like at least a dozen), it’s GOOD to just run something past someone with more experience, until the skill is something that you do without even realizing that you’re doing it automatically.  You’re not stupid for asking; you’re stupid for thinking you have it all figured out when the ink on your license is still wet.

That leaves something for the older nurses to remember. We’ve all been new.  For those of us who graduated a few decades ago, we didn’t have the horrible situation of being turned loose after an incomplete education.  We didn’t pass boards by chance of getting 75 questions that we happened to know the answers to (we had 1000 questions over 2 days in 4 groupings of 250 questions; if we got less than 600 right, we weren’t nurses; we got two tries to get it right, and after that it was back to school). We’ve been able to adjust to things as they came along (and that’s something for the newbies to remember- the older nurses know how to do things in many different ways, including the old, new, and in between). The newbies have been cut loose having to deal with medical technology AND the alive and breathing patient.  That can be overwhelming.  Older nurses have to be role models and mentors, not antagonists. Or, expect those calls on your day off when someone calls in because you’ve run all of the newbies off.  But, if you know you don’t want to be a mentor or preceptor to a newbie, tell your manager !  Don’t get paired up with someone you have no interest in helping learn the ropes 🙂

For those nurses who went into nursing for the relative job security and decent pay, leave.  Nursing needs people who are doing the job for the patients.  Yes, everyone goes to college for the purpose of getting a job.  But those who are simply in nursing for a paycheck aren’t what the profession needs. If you can’t get into someone else’s shoes and learn to appreciate what they are going through (also known as empathy) you’re not much use.  Go be an accountant or electrician. The hours are better anyway 🙂

For those nurses who will do anything to get a nursing job, consider this:  I got an ADN. Nothing else. And I worked staff, charge, supervisory, and department head jobs.  I never needed a BS.  I got to teach CNAs (which was fun!).  I had desk jobs doing assessments and care plans. But I was also willing to go where the jobs were– meaning smaller, more rural communities.  I ended up in the Texas Hill Country, and that was wonderful. I loved my different jobs- and they were glad to have an RN who was glad to have the job.  XTXRN was born in those hills…. those who have been on a specific nursing social site will know what that means 🙂

So, old school nurses, remember what it’s like to be new… newbies, remember that those who have been doing this longer than you may have been alive know a lot more than you do. Learn from them.  Lose the superiority thing.  Explain what it is you are having trouble with, and it’s much easier to help you 🙂  Never be afraid to ‘look stupid’.  The nurses that are truly stupid don’t ask questions.  They may know a fair amount, but by not asking questions they limit their potential.  And nursing as a whole.