RNs update nursing skills during a refresher course

Last November, 16 other RNs and I walked into Alexian Brothers Medical Center in Elk Grove Village, Illinois, wearing pristine white uniforms and shoes. We carried the tools of our trade – stethoscopes, Kelly clamps, bandage scissors and flashlights – together with a slight hint of hysteria and dose of butterflies in our stomachs.

For the following two months, we were neither nursing students nor hospital nursing staff. Instead, we were affectionately often known as “nurse refreshers” – RNs enrolled within the Current Nursing Practice Update CE certificate program at Harper College in Palatine, Illinois.

Nurse refresher courses are designed to refresh nurses who haven’t practiced in a hospital setting for a very long time. The goal is to “make them competitive” with recent nursing graduates, said program manager Sue Hughes, RNC, who has directed the continuing education course at Harper since 2005. “We want to give them bragging rights among nurse recruiters so they can confidently say they can use Pyxis, computers and Meditech.

My classmates are women ranging in age from 30 to 60, and most of us fall somewhere in between. We haven’t worked in nursing for four to 25 years. One classmate and I had been out of medical care for the longest time – 25 years. But we have one thing in common: we took this course to find a job in hospitals or other clinical settings.

I also wanted to see if, after thirty years as an editor and nurse writer, I could still cut it at the bedside. Although my clinical skills were rusty, I was well-versed in health care and nursing trends, such as the use of rapid response teams and electronic health records.

Still, one big question remained: Are the clinical skills that once came so naturally to me still there, buried deep in my gray matter?

Barb’s lab? watchful eye

The first seven weeks of the course were conducted in the classroom. We spent time reviewing various body systems and the most common diseases and chronic conditions we encounter in the hospital, as well as discussing nursing case studies.

At first, my colleagues and I were overwhelmed by the amount of reading required. We also had to obtain medical examinations, proof of vaccinations and cardiopulmonary resuscitation certificates; pass a criminal background check; and complete hospital-required online safety programs.

After classes, we held informal reports in the hallways and parking lots. Our anxiety levels skyrocketed when Hughes informed us that we had to pass a simulated drug administration test in the school’s simulation hospital.

We learned that there are currently seven drug administration laws, not five, and these must be checked three times before we can administer drugs to our simulated patients.

During the test, we trembled under the watchful eye of “Lab Barb” – nursing lab coordinator Barb Gawron, RN, MSN – as she watched us behind the one-way mirror of a simulated hospital room and served as the voice of a simulated patient who answered our questions during necessary checkups. Despite our fears, we all made it through.

We spent Saturday in the college’s simulation labs practicing placing Foley catheters and nasogastric tubes, performing physical assessments, and discussing how to care for various peripheral and central lines in simulated patients. In other classes, we discussed chest tube care, use of an intravenous pump, and insertion of an intravenous line.

These tasks were a challenge for each of us. I encountered difficulties using safety syringes and administering injections with gloves. This was so foreign to baby boomers like me who remember cleaning up blood and urine with our bare hands.

Rust removal

We were finally ready to apply what we had learned to real patients. Hughes assured us that once we were in the hospital, the cobwebs would disappear and our old nursing instincts, knowledge, and skills would resurface. We hoped she was right.

At Alexian Brothers, clinical instructors Judy Singh, RN, Rita Hall, RN, and Kathy Walasinski, RN, gently introduced us to clinical practice. We spent our first few shifts shadowing nurse teachers. We were then assigned one patient and a preceptor, with the ultimate goal of training a maximum of four patients. This number seemed to many of us an elusive, perhaps even unrealistic, goal.

We quickly discovered that the quality of our learning depended on the teachers assigned to us in shifts. The best teachers were born teachers. They would explain the rationale for their patient care actions and tell us how they organized themselves at the beginning of the shift or why they checked the patient’s lab results. Quite naturally, others felt less comfortable as teachers.

I discovered that many things in the hospital stay the same: the sound of the patient call lights, the ringing of the nurses’ phones? at the station, mess in the break rooms and the comings and goings of other medical staff. Most importantly, patients and their families continue to require emotional support and comfort.

I discovered that the human body still responds to disease and injury in the same way, despite the extraordinary advances in medicine and nursing over the past two to three decades. Temperatures, blood pressure, and lab results continue to rise and fall in response to infections, injuries, and medications. Foleye and pools still need to be emptied, and the smell of feces and bodily fluids is still noxious.

Changing times

Of course, there are also amazing differences. I noticed that every patient – whether they were 20 or 90 years old – had a cell phone in bed, on the pillow or by the bed. Patients are more knowledgeable and more assertive about their rights and care.

And of course there was technology like the Pyxis machine and intravenous pumps. The nurses’ fingers moved over the keys and prompts of both. I often tripped and sometimes pressed the wrong keys. Speed ​​would come with practice, my teachers assured me.

If patients are more competent and assertive, so are today’s nurses. Are they no longer solely focused on following doctors? orders, but on understanding patients? disease processes and anticipating their needs. A series of protocols enable nurses to make treatment decisions, order lab tests and adjust medications, all without calling doctors.

The disadvantage of nursing independence is that less time is spent at the bedside of the patient and family and more time is spent in front of the computer. Most hands-on care is provided by certified nursing assistants, whose skills have also become more advanced.

Connecting with each other

Hughes was right. Eventually, the cobwebs fell away, long-unused nursing knowledge surfaced, and our nursing instincts returned. Our group of refresher nurses became closer as we shared common challenges and experiences.

The course ended in December, but we communicate by e-mail and meet for dinner from time to time. When we are together, we update on our job searches and share job search tips. But most of all, we enjoy the camaraderie of nurses and the satisfaction of achieving a goal that once seemed so intimidating.

As my classmate Jeanne Malter, RN, aptly said, “It felt good to complete the course. I know I am a good nurse and now I can continue my career.” •

Janet Boivin, RN, BSN, BA, is a contract author, former editor of Nurse.com, and nurse practitioner on the Family Health Partnership Clinic in Woodstock, Illinois.

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