8 things I Wish I Was Taught in Nursing School

Your early shifts often feel tiresome, with alarms blaring, families questioning, and orders dropping mid-rounds. You might have thought, “I wish I had been taught this in nursing school.” And you’re not wrong. Nursing school teaches theory, assessments, and technical basics, but often leaves out the real-life, on-the-floor wisdom you only gain through experience.

This post outlines eight essential lessons new nurses wish to learn before starting their first job. Each section covers why it’s necessary, actionable tips you can apply immediately, a Personal Story that brings it to life, and a trusted resource to learn more. Whether entering the profession, mentoring others, or simply seeking a smoother transition to practice, these insights will help you build confidence, competence, and resilience.

1) Real-World Prioritisation & Time Management

Why it’s important:
In school, you cared for one patient at a time. In practice, you deal with multiple lives, shifting priorities, and unexpected interruptions. Mastering real-world prioritisation takes more than theory; it takes experience.

Actionable Tips

• Scan for immediate needs: Prioritise airway, breathing, circulation issues, unstable vitals, and fall risks.
• Batch tasks smartly: Combine meds, vitals, assessments, and IV checks in one room entry when it’s safe.
• Brain sheet your shift: A running to-do list with times for meds, labs, repositioning, or escalation points.
• Time-box charting: Chart in small bursts after each patient rather than rushing at the end of the shift.
• Do a mid-shift micro-huddle: Touch base with your tech or buddy nurse early to redistribute tasks.

Personal Story:
On my first chaotic med-surg shift, batching assessments and charting between rooms helped me leave on time for the first time.

 

2) Assertive, Respectful Communication

Why it’s important:
Nursing school doesn’t simulate the stress of paging a provider in the middle of the night or advocating during an emergency. Yet structured communication tools can prevent critical errors.

Actionable Tips

• Use SBAR: Structure your message: Situation, Background, Assessment, Recommendation.
• Deliver facts with a clear ask: “BP is 84/50 after labetalol; patient is dizzy. Request: hold meds, consider fluids.”
• Confirm orders: Repeat back orders to avoid miscommunication.
• De-escalate tension: Lower your tone and return to shared goals when stress escalates.
• Document calls: Note who you called, when, and what was decided.

Personal Story:
I used SBAR in the ICU to clarify a drip order at 2 a.m. Later, the provider admitted two orders were nearly switched; my clarity prevented a mistake.

Resource: AHRQ TeamSTEPPS Communication Modules

3) Safer Handoffs & Documentation

Why it’s important:
You learned how to chart—but not how to chart defensively or deliver handoffs that reduce risks. Communication gaps during transitions contribute to sentinel events.

Actionable Tips

• Standardize handoffs: SBAR or I-PASS, always include “goals for next shift.”
• Log the “4 W’s”: What happened, When, Who you informed, and What you did.
• Timestamp escalations: Document exact times, responders, and your action.
• Resist copy-forwarding: Reassess and chart today’s findings rather than repeating past entries.
• Stay objective: “Incision 3 cm erythema, warm, tender” is better than “looks infected.”

Personal Story:
My detailed note, complete with timestamps, vitals, and provider notification, saved a night nurse during a back-shift review and sped patient care.

Resource: IHI SBAR Handoff Guide

4) Boundaries & Burnout Prevention

Why it’s important:
Nursing education emphasises patient care, not caring for yourself. Many nurses burn out in their first few years without boundaries or strategies.

Actionable Tips

• Protect your basics: Schedule water, snacks, and short breaks—even five minutes helps.
• Use polite boundary phrases: “I’ll help once I finish passing meds.”
• Process tough shifts: A five-minute debrief with a peer or charge nurse can make a difference.
• Utilize EAP: Confidential counseling may be available for free through your workplace.
• Practice micro-recovery: Two minutes of structured breathing helps reduce stress on the spot.

Personal Story:
After multiple rapid responses one week, I started doing breathing breaks between rooms. The next shift felt calmer and safer.

Resource: ANA’s Well-Being Initiative

5) IV Troubleshooting & Medication Safety

Why it’s important:
Skills labs teach insertion but not how to respond to pump alarms, infiltrations, or med incompatibility. Real-world safe medication practices matter every day.

Actionable Tips

• Trace lines: Follow all tubing from patient to source label Y-sites.
• Check compatibilities: Use pharmacy charts. If in doubt, use a separate line.
• Troubleshoot alarms methodically: Stop pump, check site, clamps, and kinks—don’t skip steps.
• Scrub the hub properly: 15 seconds dry time is the CDC standard.
• Double-check high-risk meds: Always get independent verification for drugs like insulin or opioids.
• Escalate early: If the issue persists, document and notify.

Personal Story:
One pump alarm turned out to be tubing kinked under a BP cuff. A quick trace prevented me from unnecessarily restarting the IV.

Resources: INS Standards of Practice | ISMP Medication Safety Alerts

6) Speaking Up for Patients

Why it’s important:
You learned about advocacy ethically, but not when or how to escalate concerns clinically. Early recognition saves lives.

Actionable Tips

• Track trends, not isolated values: Subtle changes in vitals or mental status may be early red flags.
• Know your escalation path: Resident → Attending → Charge Nurse → Rapid/Code team.
• Speak clearly: “I’m worried about sepsis—lactate’s up and MAP is low.”
• Use read-backs: Repeat orders to confirm accuracy.
• Engage families wisely: Ask about subtle changes without compromising privacy.

Personal Story:
A step-down nurse triggered Rapid Response on subtle changes. I called it early, and the patient stabilised by ICU transfer that night.

Resources: ANA Code of Ethics | Surviving Sepsis Campaign Guidelines

7) Planning Your Nursing Career

Why it’s important:
Nursing school prepares you for licensure, not for career direction. Without planning, it’s easy to feel aimless early in your career.

Actionable Tips

• Write a skill-growth map: Year 1—master fundamentals; Year 2—preceptor or charge experiences; Year 3—pursue certification.
• Explore specialties: Shadow units to learn what each values.
• Get certified: CCRN, CEN, CMSRN, PCCN can elevate your profile.
• Use STAR for interviews: Prepare three stories demonstrating your work ethic and adaptability.
• Quantify your resume: Highlight achievements like “Reduced falls by X%” or “Precepted Y new nurses.”

Personal Story:
A med-surg nurse boosted her résumé with outcome data and a safety-save story. That helped her get a progressive care unit interview and the job.

Resource: ANCC Certification Pathways

8) Financial, Benefits & Liability Basics

Why it’s important:
Few programs teach the nuts and bolts of paying taxes, reading benefits packages, or understanding your liability. These shape your quality of life and protection.

Actionable Tips

• Know that your Nurse Practice Act defines your legal scope and safeguards you.
• Evaluate benefits carefully: PTO, health insurance, tuition reimbursement, and retirement options matter as much as salary.
• Track deductible expenses: Scrubs, CE, and licensure can add up. Consult a tax expert.
• Consider liability coverage: Employer insurance may not be enough; personal malpractice options exist.
• Learn union vs. non-union options: Understand contracts, staffing, and grievance processes.

Personal Story:
I accepted a higher-paying job but realised my previous job had better PTO and retirement match. Comprehensive benefits count.

Resources: NCSBN Nurse Practice Acts | NSO Malpractice Insurance

Conclusion

Looking back, these are the eight critical lessons I wish I had mastered before that first shift. Today, I wish I had been taught in nursing school how to prioritise, communicate, document, advocate, and care for patients and myself. Start with just one tip this week. These strategies are practised in action, and over time, they will help you build a safer, more confident, and truly fulfilling nursing career.

FAQ

Q1: When should I escalate a patient concern?
Trust trends—if vitals shift, mentation changes, or you feel something’s off, escalate via your unit’s chain of command (e.g., RN → provider → Rapid Response).

Q2: How can I protect against burnout early on?
Create micro-break routines: set reminders to hydrate, take nourishment breaks, debrief emotionally challenging cases, and use slow breathing to reset mid-shift.

Q3: How do I evaluate a job offer beyond pay?
When comparing offers, look at total benefits, PTO, insurance, tuition assistance, retirement match, and weigh liability coverage and shift culture.