Pharmacology is challenging in nursing school, but it doesn’t have to destroy your life, soul, and all that you hold dear. If you take a few steps in organizing yourself before you tackle this class, it will make it easier to learn and recall later down the line.
Pharmacology tips – just for nursing students
The way nursing school approaches teaching pharmacology varies widely, but the subject matter remains the same. There are different pieces of information to know; some require straight memorization and repetition (dosages, names, antidotes), while others require some deeper understanding (like the mechanism of action, applying it to a clinical situation).
Know that while you’re starting to learn pharmacology, it’s not one method that works for all aspects of this course. One must leverage both memorization and deep thinking to fully comprehend all that encompasses medications. You can’t just take one study tactic and think you can use that to understand each aspect. The information is just different. Also, what further complicates things is that different professors teach this process different ways. Therefore, take some time to develop a routine that works for you and carry this method across different courses.
Whatever it takes, learn the mechanism of action inside and out. If how your professor has explained it doesn’t click, find some good videos, podcasts, or other explanations. Understanding this is helps you to predict side effects, adverse reactions, antidotes, and more. If you understand the mechanism of action, you have a solid understanding of that class of medications, and be able to troubleshoot questions easier.
Here’s an example of a great, free YouTube video of the mechanism of action behind NSAIDs.
Once you think you get it, try to explain it to someone else. If you don’t have someone to explain it to, explain it to yourself on your phone and listen back to it to see if it makes sense.
Memorize with intention
There is no short cut around a few things like prefixes, suffixes, generic and trade names, and dosages. You can create flashcards with pen and index cards, color-coding along the way… or, you can download an app. The wonderful things about apps are that you’re saving paper, can change them easily, organize into categories, and use them on the go.
Some examples of (free and not) apps you can get to create your own and use on the go are:
Whichever method, devote time to memorizing these things and doing flashcard drills. While you’re memorizing, it can be helpful to make up ridiculous things to help jog your memory. For example, beta blockers are funny so they always make me LOL, or ARB’s are what pirates use for their hypertension because they make them go arrrrrr(b)ggg, or lisinopril has a license to always throw an ACE (inhibitor) down in cards … you get the picture! The more ridiculous, the better. I found that if I could connect something to my favorite books/TV shows/movies, I remembered it better.
Check out the MedMaster podcast on NRSNG – it’s a helpful way to reiterate topics on the go.
Don’t just try to cram it all the night before – that’s too much to retain at once. If you know you have a med quiz in 7 days, use today to create your flashcards and your first time going over the mechanism of action. Schedule yourself for one focused hour tomorrow; part of the time diving into the mechanism of action over again, take a 5 minute break, and then spend the rest of the time drilling cards.
During downtime throughout the day (on the bus, in the elevator, waiting for your doctor’s appointment, whatever) go through some more cards. Bonus if they’re on your phone and you don’t have to remember to bring them everywhere.
If you can devote a specific amount of time each day to this, it makes the task much more manageable than trying to understand and remember it all within a day or two.
Save your notes
Medications come up over and over again and may be applicable in multiple courses. You’ll learn about magnesium sulfate in your OB/women’s health course, but see it again in med-surg and/or critical care as well. Keep track of notes, paper or electronic flashcards, and memory devices. Even if they’re ridiculous or inappropriate – if it works for you, it works.
And don’t make the mistake of forgetting the awesome memory device you created – make sure you write it down! That way when you go back to studying for another course, you can pick up where you left off rather than trying to think of another way to remember the information.
NCLEX® tip! Chances are if you get a medication question on the NCLEX, it’ll be the generic name of the medication and not the trade name. Make sure you know these, which can be a bit challenging since they’re typically longer.
Do what works best for you
Pharmacology doesn’t have to suck. Be intentional and organized with your study time. Focus during this time – close your apps, your phone, and focus. Do this for 20-25 minutes at a time, followed by a break. Repeat for a few hours, then take a long break.
Leverage resources that work for you, not your friends, your classmates, or your instructor – you! That may look like listening to the MedMaster Podcast during your commute, a flashcard app while you’re waiting for class to start, and the Khan Academy free YouTube vides to solidify the mechanism of action… or that may look like the textbook for the mechanism of action, paper flashcards, writing things out, and quizzing yourself. Figure out your unique recipe for success and stick to it!
There are quite a few different options here from podcasts to blog posts to courses and even a subscription services.
However, my favorite and one with the most bang for your buck is the NRSNG Academy. Their medication resources built into each course, and it’s pharm course, are incredible. You can use it throughout your entire nursing school journey, not just for pharmacology. Every single module has NCLEX® points, they also have a simulation NCLEX exam, a massive database of NCLEX practice questions in addition to a huge content review in Fundamentals, OB, Peds, Med-Surg, EKG, Cardiac, Pharmacology, Labs, and my favorite… Test Taking.
Epocrates – a really popular medication resource used by many clinicians and hospitals
Micromedix – expensive to purchase yourself, but many hospitals have this available. Check it out, it is incredibly valuable. At my last hospital, there was a Micromedix link within the Medication Administration Record (MAR) of the Electronic Health Record (EHR) and I used this reference everysingleshift.
Please see my disclaimers page for more information.
Student Loan Forgiveness and Management for Nurses
Most nurses can rely on two things once they earn their degree:
1) they’ve found a lucrative and rewarding profession and
2) they’ll have years of student loan payments to endure.
Because of the growing expense of attending college and earning a nursing degree, that second part of the equation can be a real downer. Fortunately, an array of student loan forgiveness options exist and even some specifically for nurses.
Student Loan Forgiveness Options for Nurses
With average student loan debt hovering at around $35,000 for the class of 2015, current and future nursing graduates would be wise to explore loan forgiveness options sooner rather than later.
Here are some of the most popular student loan forgiveness options for nurses and what it takes to qualify:
Federal Perkins Loan Cancellation and Discharge
Since Federal Perkins Loans were created to assist students with serious financial need, they offer one of the best loan forgiveness options. If you work full-time as a nurse, you could get 100 percent of your Perkins loans discharged after five years.
Qualifying for this program is fairly easy. First off, you must have Federal Perkins Loans and be in good standing. Second, you must apply through your school that disbursed the Perkins Loans or through your loan servicer.
NURSE Corps Loan Repayment Program
The NURSE Corps Loan Repayment program was created to incentivize nurses to work in critical shortage areas. To qualify, most nurses need to commit to a two-year work agreement in a critical shortage area as defined by their state or municipality.
Nurses who work at least 32 hours per week in their new role can get 60 percent of their existing loans forgiven. By adding a third year to their commitment, they can qualify to have another 25 percent of their loans forgiven.
Applicants are only accepted once per year and nurses must have earned their degree at a school with proper and government-recognized accreditation.
Public Service Loan Forgiveness Program
The Public Service Loan Forgiveness Program, commonly referred to as PSLF, was created to reward college graduates who commit their lives and careers to public service. Through this program, college graduates can have 100 percent of their student loans forgiven after working in a qualified public service position for 10 years.
After 10 years of working at least 32 hours per week in a qualified position, loans under the Direct Loan Program can be wiped off the map. This program is an especially smart option for nurses who may lean towards work in public service anyway.
The best part is, unlike forgiven loans under some income-driven plans, loans forgiven through PSLF will not count as taxable income, and therefore, won’t result in a hefty tax bill.
In addition to loan forgiveness programs offered on a federal level, 33 states also offer local loan forgiveness programs that can help nurses.
For example, the Wyoming State Loan Repayment Program offers up to $20,000 in loan forgiveness after two years of employment in a critical shortage area. Also on the list is the Colorado Health Service Corps program, which doles out up to $50,000 in loan forgiveness for nurses who work full-time at a qualifying organization for at least three years.
Different states offer their own versions of loan forgiveness for nurses, with unique requirements and payouts depending on the type of the program and the criteria that must be met.
Managing your Student Loans – With or Without Forgiveness
Even if you decide not to work in public service, which often means a lower salary and less-than-desirable locale, there are options for reducing your student loan burden.
If you have good credit, a solid employment history, and are willing to forgo federal protections such as PSLF and income-driven repayment options, refinancing might be the way to go. Private lenders like Earnest and CommonBond might be able to give you a much lower interest rate, saving you thousands of dollars over the life of your loan.
Whether you’re a nurse who is tired of struggling with student loan debt or a future graduate who is already stressed over your future payments, it’s smart to research different repayment options to see if one might be right for your situation.
With some research and planning, you could escape a lifetime of student loan debt and instead focus on growing your career as a highly valued medical professional.
About the Author:
Andrew Josuweit is the CEO of Student Loan Hero, a company that combines easy-to-use tools with financial education to help the millions of Americans living with student loan debt manage their student loans smarter. Student Loan Hero is helping 150,000+ borrowers manage and eliminate over $3 billion dollars in student loan debt.
Most posts about social media for nurses focus on don’ts and the fear factor…
OMG YOU’LL GET FIRED! DON’T’ DO IT!
But, let’s be real. Most nurses use social media. Most people use social media. Heck, try to walk down a hospital hallway and NOT see someone in scrubs on some form of social.
Instead of telling you all of the scary you’ll-get-fired-scenarios, I want to chat about ways to use social media to enhance your professional experience.
Tips to Maximize Social Media for Nurses
But first, like everything in nursing… we’ve gotta look at the policy FIRST!
Look at your facility’s social media policy
Would you ever administer intrathecal vancomycin, administer tPA in a central venous catheter, or insert an internal urinary drainage device without looking at a policy? I hope not! Using social media is the same, especially if you’re using it while at work.
Social media is a POWERFUL tool. It can help bring new research to light faster, disseminate information, inspire, encourage, educate… but, like most things, there is the potential for harm as well. HIPAA violations is a major potential for harm, as well as lateral violence.
Hopefully your facility has a social media policy. If they don’t, propose one!
If they do, make sure you look at it closely. You don’t want to do anything that may violate this. All social media policies are not created equal. I’ve seen various policies with big differences and it’s important to be aware of these things. For example, some may say you can’t post while at work while others don’t outline that. Some may say you cannot post on social where you are employed. Many say you cannot take and post photographs, violate HIPAA, or communicate with patients/loved ones via social media.
Basically, if you have concerns about getting fired, it is essential that you are well aware of the specifics of this policy.
Essentially, the message from the professional nursing organizations isn’t don’t use social media. Their message is use social media responsibly.
Follow interesting medical and nursing accounts
I believe a lot of people think social media is just for entertainment, but there is a ton of professional value that can be extracted. Have you ever checked out Figure 1 on Instagram?
It’s incredible. They upload various medical conditions and cases. You can download their free app and discuss it with other healthcare professionals all around the world within the app, and follow them on social media as well. I love that when I’m scrolling through my IG feed that some cool and interesting medical case comes up. I’ve actually learned a few things that I’ve used in practice when discussing the clinical picture with the physician.
There’s no need to wait until the next major nursing conference to see what major medical facilities are up to. Go follow Cleveland Clinic, Mayo, John Hopkins, or whomever you think is awesome. It’s great when Cleveland Clinic tweets out some nursing research they just published, or a news article from John Hopkins about a new procedure… but what’s even better is when this is weaved into your existing social media that you’re already looking at.
I’m also really interested in neurosciences, so I follow various neuroscience accounts on Instagram and Twitter. I love seeing a random head CT in my Twitter feed! I also follow quite a few emergency department/critical care physicians and EMT’s who regularly post really short videos of ultrasounds with interesting findings, ECG’s, telemetry monitors, CT’s, MRI’s, and more. Seriously. Amazing.
Go check them out! I promise you will learn something new!
Pro-tip! if I’m not sure who to follow, I go to someone who I like and enjoy and see who they are following. Unless they’re following over 2K people, I tend to go look closely at who they’ve chosen to get updates from because clearly I trust their judgement.
At the end of this blog post, I have a long list of people I recommend following! Or you can just check me out on social and see who I’m following. That’s basically how I came up with that list. Follow me on:
One of the best ways to find interesting things that are specific to you is by checking out a hashtag on that particular social media channel. For example, if I wanted to see some examples of ECG’s with ST elevation, I could hop on Twitter and search #STelevation. Go and do it right now. Seriously.
You can do that on Instagram as well. Facebook isn’t so awesome for hashtags, but you get the picture. Hashtags are essentially a way to group things. So, think about something you’d like to see and search the hashtag (nurses, nursing, nursing school, nurse authors, neuro ICU, neurocritical care, etc.)
Share with colleagues
When you find something cool, share it! You can share things privately or publicly. Some of my neuro buds will find a great neuro article and tag me when they tweet it out. Or, you can share it on your Facebook timeline and tag people, or directly on another’s timeline, both ensure they see it. It’s a great way to quickly share information where people are already looking.
Some of you may even have a unit Facebook Page to share it to – bonus points! If it’s not a policy violation, I recommend creating one. On Facebook, you have the option of creating secret groups. You can create a secret group and invite the employees one by one. You can post education updates, when you are in need of staff, when a due date is coming up, cool events in town, interesting articles related to your patient population, staff life updates (having a baby, birthday, moving, promotions). It’s just important that someone is monitoring the page diligently. You don’t want people posting anything inappropriate, a HIPAA violation (“Is Mr. Jenkins in bed 4 still there!? UGH!”) or anything that may be lateral violence. You also want someone in charge of revoking access if someone leaves the unit and adding newbies.
Everyone is watching
And make sure to keep in mind, everyone is watching. How many of you seen someone post something reckless on social, but didn’t say anything?
Most of the time, people don’t say “Heyyyy Kati… that wasn’t cool” – their opinion of you just changes. Your credibility just changes. You reputation just changes. You don’t feel it, but it happens.
And even if you have great privacy settings, someone could screenshot and share what you’ve said (seriously… seen this happen). Even if you don’t mention someone’s name specifically, but describe a scenario in a detailed manner, you may be engaging in lateral violence or a HIPAA violation.
Pro-tip: have the mentality that anyone could see what you’re posting… from your nurse colleague, to your manager, to your chief nursing officer, to the physicians, to your patient, to your patient’s mother, to the CEO of your hospital… literally everyone… and consider if you would be okay with them seeing that, and using that as a filter, then you should be safe (provided you’re not violating policy.)
Yes, it’s your social media outlet and you technically can do what you want from it. What you choose to post however, impacts your reputation and what people think about you. And if you publicly identify as a nurse, what you say reflects on our profession… and what the public thinks about our profession.
Have no shame in your unfollow game
One of the great things about social media is that it is customized to you and what you want to see. You follow who you want to follow. It is your timeline, no one else’s. Therefore, I am very unapologetic about unfollowing. If someone posts something really mean, inappropriate, gross, or whatever… CLICK unfollow. I don’t need to see that on my precious timeline.
Facebook tip: for those of you tired of seeing the very polarizing or rude posts of various friends, but don’t want to unfriend them and deal with that… simply “unfollow” them. They will not get a notification, you just won’t see their posts in your timeline anymore. Winner winner, man now I want chicken for dinner…
Personal story: a friend would post really polarizing biased political posts multiple times a day. I was considering unfriending because it was just too much. It was pretty disrespectful and clear this person wasn’t taking time to chat with people of the opposing viewpoint, trying to look at unbiased sources as best they could, or just have a consideration for those that didn’t agree. Once, this person posted a picture that said something along the lines of, “If you don’t like what I post, then don’t read it.” I thought to myself… “Alright, I won’t.”
I’m not trying to consume negativity, even if it’s just through scrolling down my Facebook timeline. Continually seeing and consuming negativity, even if it’s somewhat passive, does take a toll.
An easy way to decrease negativity or bad influences is to unfollow them on social media. Remove it from your space. It does not get to be there. It’s like when you’re trying to eat healthy and removing the junk food from the house. Out of sight, out of mind.
I decided to remove bad influences, people that made me cringe, people who were frequently complaining/venting from my timelines. I started to be very intentional with who I follow on Twitter, FB, IG, Pinterest, and Tumblr. It’s been wonderful. I want people who will challenge me, enlighten me, encourage me, educated me, humble me. This is my social media, my timeline. I’m not going to keep negativity on there because I am worried about what someone would think if I were no longer following them.
More social media tips and blogging advice
Over the past few months, Brittney Wilson BSN RN (The Nerdy Nurse) and I have been writing a blogging and social media guide book for nurses. At over 200 pages, it’s full of practical help, our experiences, recommendations, and major mistakes to avoid.
We truly want nurse bloggers to have a successful experience and also empower them to know their worth. In addition to the book we’ve written, we are also developing an in person 5-hour seminar during the 2017 NNBA Conference in St. Petersburg, Florida.
We’re elated to work with the NNBA (National Nurses in Business Association) because they offer a huge network of support… support I could have used when I was going through this whole mess. It would have been helpful to already be in a network of people to bounce ideas or situations off of that just didn’t seem right, but I couldn’t really specify why.
The NNBA consists of over several thousand nurses, leaders, and mentors. Growing a successful business, balancing life, and making sure to consider our profession as a whole can be challenging. If you’re a nurse business owner, or considering starting a membership, an NNBA membership is truly an investment in your success.
In addition to being a member of the American Nurses Association and the American Association of Critical Care Nurses, I’m also a member of the National Nurses in Business Association, and I highly recommend becoming a member. Join me.
Registration for our 5-hour seminar is officially open. Take this opportunity in professional development, earn some continuing ed, and come hang out with us!
Pro-tip: use the trip as a tax write off!
What: Nurse Blogging 101: Growing a Profitable Business and Community at the 2017 NNBA Conference Where: Sirata Beach Resort in St. Petersburg, Florida When: September 8-10, 2017 (our seminar is on the 8th!) Why: Grow your brand, positively impact the nursing profession, and make money doing what you love How:Register Now!
Pre-conference seats are limited and filling up fast!
At the start of the year I asked on Facebook what some of your best Nurse Hacks were. As usual, the responses were amazing. They were all so valuable that they just had to become a blog post!
Nurse Hacks From Experienced Nurses
When removing tegaderm stretch it and it releases from the skin like one of those 3m hooks on the wall!! It’s amazing!!! *Bre Harris
I always keep a post-it note card on my badge–then when I’m in a patients room and I notice things like tubing due to be changed, fluids running low, pain meds are due at such time I write it down and look at my badge before coming back…helps cut down on my trips! *Ryann Elder
Signal boost these!
Mark the vein where you are going to stick with the IV needle cap. Just gently press and it leaves a non permanent mark for a couple minutes that doesn’t go away when you wipe with alcohol. If the vein is prone to rolling this will also let you see which direction it will go when it rolls. *Taylor Rutherford
Instead of writing on skin, stick a tegaderm to the inside of your wrist and then write on that. Doesn’t come off when you wash your hands. Erase with an alcohol pad. *Taylor Rutherford
A good attitude. Period. There is no mishap that can tear apart a team or a shift like a person who shows up pre-grumpy. And multicolored pens. Always have multicolored pens. *Ju D Anjos
To save time and money, I bring all three of my lunches at the beginning of the week. Usually three frozen meals and then a lunch bag of healthy snacks. Keeps me healthy and away from vending and cafeteria on stressful days. *Julia Williams
Always keep flush, alcohol swabs and caps in your pockets. You WILL need it and if you don’t guarantee a co-worker will. *Angela Cbey
Use a basin as trash bucket. It is amazing how much trash is generated when starting an IV or hanging IV meds. *Sarah Miller
Words to live by y’all:
Never pass up a chance to pee. Even if you don’t feel the urge. You may not get another chance that shift. *Katherine Enderby
Make sure there’s a spare sick bowl in every room at start of shift. Quick easy access is a lifesaver! And saves the sheets too… *Josh Ditte
A culture of negativity is not something very obvious and apparent. Nurse bullying can actually be quite subtle. A comment here, an eye roll there, gossip in the dictation room, or a passive aggressive sigh. It can be really hard to navigate this at any point in your career, but it is especially difficult for people who are new to the profession.
I think one of the most important ways to survive working in a negative unit culture and dealing with nurse bullying, and maybe even potentially shift the culture, is this:
Be outside of the negativity, not within it.
I’ve outlined some practical tips for those of you who find yourselves in the thick this situation:
When people around you start being negative, don’t participate
Simply be silent. It’s a little awkward at first, but people will soon learn that they can’t go to you to talk about people or complain. It’s kind of like getting used to the awkward silence that’s necessary when supporting your patients. I’ve done this. It takes time, but it works.
When people start talking negatively, provide a positive point for every negative one
So if they’re talking about how stupid an employee is, bring up times when they were smart or did something great. Counteract the negativity… soon, it won’t be fun bringing up the things they think are funny because you’re forcing them to think about the positive things.
Learn about some things the informal leaders enjoy that is NOT negative, and spark up conversations about it
Be engaged and interested when they start talking about that, and completely disengage when they start to be negative.
Be unapologetic about being positive
If you’re doing something the informal leaders think is lame, like pulling a policy they think you should know, or giving you heck for being involved in shared governance, just be you and do what you want. Talk about it with others positively in front of them; show that you’re not scared to go against the negative grain.
Be all business when it’s black and white clinical stuff
If they’re simply not doing their job, in an all-business way, call them out.
“Hey Mary, your alarms keep going off for no reason. Can you go adjust them so we don’t keep thinking it’s our patient?”
“Hey Joanna I love you but, I’ve answered about 19 of the last 20 of your call lights while you kick it here in the nurse’s station.”
“Hey Joe, I’m going to need you to quit calling out last minute! You really left is in a bind!”
**Everyone is sitting at the nurse’s station and Sarah’s patient is alarming again and she’s not getting up to address it, hoping someone else will** “Sarah, looks like your patient is going off again!”
But don’t stop there – the most important aspect of this is not shunning them after you say something like this. Call them out respectfully, but don’t treat them differently. “Hey Sarah, your patient’s alarm is going off again. What did you bring for lunch?”
Only bring a manager in when absolutely necessary
Part of professional accountability is holding each other accountable, not having to bring in a 3rd party who wasn’t there. It merely turns into “he said she said” and minimal progress is made. We are professional nurses; we should be able to speak to each other when someone isn’t pulling their weight. The manager should be brought in for serious things that can’t be mediated between one another. A lot of people just want the manager to step in and fix something, but the manager isn’t there to see the subtle behavior; you and your colleagues are. Some people also don’t want to “get involved” but they want to complain. If you’re frustrated enough to complain about it, be professional and speak to them about it.
Don’t always assume it’s laziness or malicious
Maybe someone seriously doesn’t know what they’re supposed to do and whenever they’ve asked for someone to explain it, they get brushed off. If someone keeps forgetting to chart something, or doesn’t adjust their alarms, take a second to show them how and answer any questions before assuming they’re being lazy.
Be quick to admit when you’re wrong
Set an example of it being okay to be wrong and to not be perfect. Many times, mean and negative coworkers set this unrealistic example of what they expect people to be like. Showing fault or flaw in themselves is unthinkable because they must maintain their tough exterior. Fear is one of the biggest motivators! Take ALL the power from that and make it okay to be wrong and to ask for help. Model that mentality. Be the change you want to see in others.
I hope these practical steps and talking points will help you the next time you find yourself in a negative situation. Remember, just because other people are negative does not mean you need to be. You can still be a positive, joyful person. Bullies and negative people do not get to dictate who you are. Be empowered to be you!
We can never change someone else’s behavior, but we can change how we perceive it. We can take away the power they think they have. So what if they think I’m lame because I go to committee meetings? I enjoy them. I enjoy my job. I enjoy my life. That’s what matters, not what some negative person thinks about me.
If someone is being negative or demeaning to you, do not give it any power or make you think less of yourself. Release the power that has on you. You are way too awesome to let a complacent and negative person take that away from you!
Need more nurse-motivation or tips on communicating with people who aren’t happy?
But, there is no shame to my organization and preparedness game. This results in less stress and therefore more time to enjoy life and relax.
If you’re anything like me, whenever something unknown is on the horizon, you do all that you can to get a head and be prepared from the moment it begins. Nursing school is one of those big unknown scary things. I’m going to go over a few things that will help you stay ahead in nursing school despite how overwhelming and demanding it is day to day.
Start preparing for the NCLEX on day 1
Don’t wait until senior year to start thinking about the NCLEX. The way this exam is structured and the format of questions is very different from other exams. It’s what’s called a computer adaptive exam, which means it’s different for every single person. It is not like nursing school exams.
Here’s a book I highly recommend for test taking skills in nursing school
Because it’s so different, I highly recommend picking your NCLEX review plan early (I go over options in that in the Preparing for the NCLEX post), start getting into a routine of taking NCLEX prep questions immediately (just a few a day) even if you don’t know the content behind them yet, and getting your test taking skills down early for both general nursing school exams and the NCLEX
The sooner you start to build that NCLEX foundation, the better.
Merely skim chapters beforehand
Don’t get all in-depth and try to fully comprehend a chapter or concept before lecture. Merely expose yourself to the content. Get a general idea of what you’ll be going over. Understand some basic definitions. Don’t make the mistake of trying to read the entire chapter, word for word, highlight 75% of it, then get frustrated when you answer sample questions wrong.
Conversely, don’t make the mistake of not reading anything beforehand either. Going in cold to a lecture will leave you behind, as you’re trying to look up the basic definitions to terms that professors just whiz by.
Get an idea of what’s ahead so lecture isn’t the first time you’re hearing the term percutaneous endoscopic gastrostomy, which the professor keeps referring to as a PEG tube and you just spent the last 10 minutes silently figuring that out while he’s now describing an EGD.
In between my junior and senior year, I completed a 10-week nurse residency program. I basically shadowed another nurse. It was incredibly helpful. I was able to physically see the things we were talking about in theory that I didn’t have a chance to see in nursing school clinicals simply because there wasn’t a patient there with that particular issue, procedure, or medication. I remember specifically wanting to see a ventilator because I knew my critical care course was in the fall. I learned about so much respiratory equipment over those 10 weeks, which seriously enhanced my understanding. If you don’t have the opportunity to complete an internship – volunteer.
Most facilities use volunteers, and while you won’t be physically doing procedures, you’ll at least be able to observe. I volunteered in an emergency department in college and learned so much by simply being there. I saw how they dealt with a combative patient who overdosed… I saw how they ran codes… I saw how they dealt with death… I saw how the team functioned.
Don’t look at your reading assignments as just a to-do list
When you’re trying to get ahead, it’s easy for it to turn into something to just check off as done on your to-do list. But in this situation, you really need to try to learn and understand things deeply, not merely get things done to be successful in nursing school. Switch the mentality from getting it done to truly understanding it. Look for “ah-ha” moments in the text. Understand the concepts, don’t just memorize the text. If you don’t finish every word of a reading assignment, but now you really understand the pathophysiology behind atrial fibrillation, count that as a win – not an incomplete.
When I was in school, I didn’t look for the “ah-ha” moments in the text – I just tried to get it done. I personally got pretty bogged down by all the fluff in the textbooks because I didn’t know where to focus. It can get pretty tough to identify the information that will lead to your “Oh, now I get it” moments. When you find them, make sure you take note and focus there.
It’s not about checking off a to-do list, it’s not about getting a certain grade. It’s about understanding the information so that when you are taking care of patients, you’re making the safest decisions at every turn.
How to connect the dots
Finding those aspects of the content that really turn it from something textbook to something that really makes sense is challenging, especially when you’re responsible for reading so much information for each exam.
So, what do you do?
Here’s a nurse pro-tip: look for the linchpin.
What’s a linchpin? It’s an “ah-ha” moments… the most important concept of a complex concept or situation. It’s what connects the dots.
So how do you find these within a 400+ page reading assignment… every single week?
Another nurse pro-tip: don’t.
Someone else has already done that for you.
A former nursing student realize this and got together with some other nurses to create a hub of resources that consistently only of these linchpin moments. Concise courses of content review along with practical study tools.
10 different courses that are only the linchpins – presented in a concise format. And this includes a Test Taking course.
If there is one thing I recommend completing BEFORE the first day of nursing school, it’s taking the Test Taking Course. You’ll begin nursing school with test taking skills I didn’t figure out until junior year.
I went to nursing school from 2006-2010. I am a terrible test taker. I wish I had this course in 2006 to get a foundational test taking knowledge before beginning nursing school. It would have made a WORLD of difference, and I wouldn’t have wasted so much time doing things incredibly inefficiently.
You can try the NRSNG Academy, access to all 10 courses, the a bank of 3,500+ NCLEX practice questions, the simulation NCLEX (SIMCLEX), Flashcard App, image and audio database, and cheat sheets in every course – for only $1.
My advice – try for $1, but go straight to the testing taking course and complete that course within your 7-day trial. That course is just the tip of the iceberg within the academy, and sets you up for success in nursing school with exams, studying, note-taking and the NCLEX.
I recently started a hashtag on Twitter asking experienced nurses for their input on clinical tips for nursing students. I thought the response was incredibly helpful and valuable and I wanted to to share these clinical tips with you!
Experienced nurses – What other tips for nursing students just starting clinicals do you have?
Starting nursing school can be pretty intimidating, let alone surviving nursing school. You don’t know your classmates or their experiences. You just assume everyone else knows more than you and they all know exactly what they’re doing.
Well, I’ve got a secret for you. Lean in a little closer because I need to whisper this – a lot of people don’t want me to let this one slip..
((None of us know what we’re doing. Some of us are just better pretending than others.))
This post is going to provide you with some study tips, life tips, things I liked to use as a nursing student and practicing nurse, as well as explain some of our well known resources and communities. So let’s dive into how to survive nursing school.
The bottom line is that getting into nursing school is tough, nursing school is tough, and so is being a nurse! But remember, you got into nursing school for a reason. Don’t doubt yourself now!
Nursing isn’t one of those majors you can just read up on the information the night before the exam and expect to do okay. It takes a lot of strategy to manage your time appropriately. Each exam is over so much information that you must have a plan of attack!
After your first day, get all of the syllabi together and write out every single due date on a calendar that you actually will look at daily; ideally one that you carry with you (whether this be on your phone or an actual print calendar/planner). After all of those dates are written out, then plan out when you will study for these exams in reasonable blocks of time. This means 2-3 hours here and there, not 6-8 hour chunks of time. No one can pay attention and absorb information in those longer periods of time. It’s an inefficient and ineffective use of your time.
After you plan these study times, then plan when you will write your papers. Schedule short-term goals (I’ll find 2 sources on this date, write my intro this date, edit on this date, etc.) so you’re not sitting down to write an entire paper the night before its due. Schedule yourself to finish this paper 1-2 weeks before the due date, so if you run into any roadblocks (not understanding something, changing a section, clarifying with the professor) you’ve got some wiggle room.
Get a folder and/or notebook for each class. Keep notes together and organize them so they’re easy to find. Have a folder on your desktop for nursing school, with subfolders for each class, then subfolders for each section. I realize this sounds a little organization-crazy but bear with me..
If you have to spend 10 minutes looking for a document on your computer, or 15 minutes looking for a hard copy of something around your dorm room, and you do this a few times a week, you’re losing 30 minutes – 2 hrs roughly just searching for things. That’s an absurd amount of time completely wasted. Think about how much quality studying you could give yourself in 2 hours. Or what if you used that time to nap? Naps are amazing. I would much rather nap than waste my time searching.
Something that is important to remember is YOUR TIME IS VALUABLE. Look to maximize it at every turn. Try to look for and eliminate inefficiencies or wasted time (searching for books, notes or documents because your desk is a mess, taking forever to get your paper formatted because you haven’t taken time to learn how to write in APA, forgetting about a deadline and scrambling to meet it).
Don’t just study hard. Study smart AND hard. Don’t say “I’ll just study the whole day before the test” because that’s not going to work. People can’t focus for that long at a time. We retain information best in 20-ish minute increments. Block out everything for those 20 minutes, then take a 10 minute break. Do this for 2-3 hours and it will be MUCH more effective than a full day of staring at your text half asleep. Turn your phone on silent and put it in a drawer. Close all of your tabs. Put your tablet away. Have a snack and a drink near you so you don’t get up.
Break time? YYYYAAAASSSSSSSS!
Try to understand whole concepts, like try to understand and explain the renin-angiotension system to someone else. Do not make the mistake of just trying to memorize the material. There is way too much to try to memorize for this study technique to be worthwhile.
Learn your professor’s teaching style
Let’s be real here; just like people learn differently, people teach differently as well. Some professors are more relaxed and care more about understanding the big picture, while others want every little thing in an incredibly specific way, and many are somewhere in between.
Learn each professor’s style.
This will take some time. If I had one professor that was a stickler for details, I made sure to pay really close attention to that with assignments. But if I had another that was more big-picture, I wouldn’t stress over minute things they didn’t really care about anyway.
You really won’t learn this until you get back some of your first assignments. You may miss some points here and there. You may have wasted your time worrying about things you thought they’d care about when they actually don’t. It’s okay. There’s a learning curve at the beginning. Put in what you think each class requires, see how some of those first assignments come back, and adjust your time and efforts accordingly.
Learn your learning style
I really didn’t figure out my learning / studying style until nursing school. Up until nursing school, I didn’t have to be as regimented about it because I didn’t have to be. Then nursing school came and smacked me in the face. Some people are auditory, some visual, some more hands-on, or a combo. I figured out that I learned best if I took handwritten notes in class, then typed them and added supplemental info from the books, then went back over them and highlighted. Some classmates taped their lectures and listened in the car or while working out. Figure out what works for you and stick to it.
Learn your resources
The quicker I learned how to use APA formatting for my papers, the better. Again, less wasted time is key. Have your books flagged to frequently used sections. Have them next to your desk for quick reference. Learn how to use your school’s online library and databases. The quicker you can utilize your resources, the better.
Make sure you know where you’re going. If you’re nervous, do a test-drive there the night before. Walk up to the unit. Get your bearings so come game time, you know what to expect.
Have good scrubs (I talk about which ones I use later on). If they’re white scrubs, make sure you have the appropriate eh-hem.. undergarments. Have a back up set in your car in case you get puked/peed/pooped on. (Seriously). Pack your lunch. Have a granola bar or quick snack you can grab if you start to feel woozy.
*Note – I’ve seen so many nursing students pass out that I’ve lost count, make sure you grab a snack
If you got your patient assignment the night before, look up the disease processes and chief complaint of the patient so you’re aware of what they’re experiencing. Get all of your paper work done.
Don’t just arrive on time, be early. If you’re showing up right on time, you’re late.
Clinicals are scary, but don’t be so worried about getting all of the answer correct that you’re not mentally present. Engage with your clinical instructors, nurses on the unit, patients, loved ones, nursing assistants, doctors, nurse managers. Ask questions. Watch procedures. See how you can help. Don’t be that student that stands in the hall, leaning against the wall, waiting to be told to do something.
Make sure you’re also allowing your other classmates to get in on everything too. Find the balance of being helpful and engaged but not so much that you’re taking up all of the instructors time and the other students don’t have a chance to try or see anything.
Also, don’t complain about the patients. Even if someone is rude, or decides they don’t want a nursing student today… please don’t complain about it to the staff. It doens’t look so hot.
Listen during report. Wait to ask any questions until they’re done giving report, as they may end up answering your question later. It’s a nurse pet-peeve when you’re trying to give report and the person receiving report is continually interrupting with questions. They may speak really quickly. If you don’t know an abbreviation or diagnosis, write it down quickly and ask the nurse or your instructor after.
Get a report sheet that you like. Give it a few shifts before switching to a new one. Click here to download 33 nursing brain sheets for free.
Things to write down when getting report (this is incredibly general and will vary if you’re on a specialized unit):
Nobody’s perfect. You’re not going to know everything. No one expects you to know the answer to every question or handle every situation perfectly. You’re there to learn how to do things, not show everyone how much you already know at every turn. So take a breath, and relax. It’s okay if you don’t know something.
If you don’t know something, just say you don’t know it. If a patient asks you a question and you don’t know the answer, say, “You know, I don’t know the answer to that but I will find out.”
I do understand that need to try to avoid saying you don’t know something because you don’t want to be ostracized in front of your classmates. Some instructors will take this opportunity to make you feel bad for not knowing something, but most will just be glad when you say you don’t know something because it lets them know what they still need to explain.
The sooner you get used to being honest about what you don’t know, the better. This will continue to benefit you throughout your career.
Also, if you screwed something up, own up to it. We can usually tell if you’ve messed something up and are trying to make it seem like you didn’t. Once I saw a student go to hang an IV antibiotic on a secondary line. Normal saline was the primary line. She had forgotten to do something (it was so long ago I can’t remember what) and the antibiotic (which was green) backed up into the bag of normal saline. The instructor came in and saw it and asked what happened. She said that the saline bag came like that.
If normal saline came to you green, that’s a problem and it shouldn’t have been hung in the first place.
However, she held firm to it coming from pharmacy like that. We were all pretty sure she was lying, but no one had physically seen it so we couldn’t refute her.
So we had to do the appropriate incident report, call pharmacy, etc. etc. Basically, we had to do a lot of things that we really shouldn’t have had to if she had just owned up the mistake. And honestly, the mistake wasn’t a big deal. We could have easily taken time to educate about what should have happened, grabbed a new bag of saline and antibiotic and that would have been that.
It’s not just about your patients
Not only are you learning about disease processes and how to care for people, you’re also learning time management. Watch the time management styles of the various nurses you’re following. Once you get to your first real nursing job, you’ll have to figure out how to manage your time and it will be helpful to see how various nurses do things. You can learn how you would like to do things and also how you would not like to do things. I’ve observed how people have done things and learned ways to avoid managing my time because I noted they were always behind or flustered. There’s no perfect, textbook way to do this. You’ll develop your own style.
this is my style
Pay attention to not only the tasks they choose to delegate, but how they delegate them. How do they work with nursing assistants? The NCLEX® will teach you which tasks to delegate, but that’s the easy part! The hard part is delegating tasks to nursing assistants that have worked on the unit for decades. Developing rapport with your team is another piece of the learning how to be a nurse puzzle and you can learn a lot from watching how everyone interacts. Every does this a little differently, so if you hear verbiage or talking points that you like (“Hey I really like how she asked that CNA to take that patient to the bathroom.. I don’t want to forget that”) write it in a small notebook that you keep in your scrub pocket (I’ve got a link in a later section for said notebooks). Or talking points / responses to nurses dealing with tough situations.
Once I heard a nurse firmly respond with a, “I know you’re frustrated but I am your nurse and you will not curse at me,” and I was like..
DANG – RESPECT.
**quickly ran to the nursing station to scribble it down on a piece of paper so I wouldn’t forget it**
(That patient immediately apologized and connected with her about what was really bothering him and requested her for subsequent shifts.)
It’s really important to treat everyone you encounter with respect. From the housekeeper to the physician to the case manager to the physical therapist to the nursing assistant. Even if you never want to work in that particular unit, you need to treat the people that have chosen to work there with respect. So if you know you want to be a NICU nurse but you’re starting your med-surg clinicals, make sure you treat all of those nurses, nursing assistants, etc. with respect even though you know you’ll most likely not need to know that information for your potential job. Just because it’s not important to you does not mean it’s not important.
Let me say that again.
Just because it’s not important to you at this particular point in your life, does not mean it is not important.
Nothing frustrates clinical instructors, nurses, and nursing assistants more than that “I never need to know this so it’s not important” attitude. I’m actually getting hypertensive thinking about it. Even though it’s not information that will be practically important to you in the long run, it is still important to someone.
Student nurse-life tips
Being a nursing student and nurse is not just a major and a profession, it’s a lifestyle. There are certain things you can do to prevent burn-out, minimize stress and maximize your personal and professional life satisfaction. Let’s discuss…
(This is how nurses say cheers)
Take control of your environment
It’s hard to study and retain information in chaos. A desk in the living room, family room, dining room or in the common area of your dorm is not ideal. Try your best to secure a consistent and quiet place to complete focused study. Keep the area clean and organized with your resources nearby. Every semester, I wrote down all assignments on a piece of paper and taped it above my desk. As I completed things, I would cross them off. That provided a sense of accomplishment that boosted my mentality.
I like to diffuse essential oils while I work / study. I’ve got a diffuser on my desk and will use lemon, wild orange, or peppermint. I mainly use the
Doterra brand, but there are others. I also bought this diffuser from Amazon for about $23 and I keep it on my desk.
I also like to classical listen to music. Piano Guys radio on Pandora (does anyone still use Pandora? Just me? Ok, great…) is an go-to of myself and my husband.
Figure out what puts you in that game-time, get it done mentality. That eye of the tiger, coming down the tunnel for the Super Bowl mentality.
And just do it.
(Ugh.. sorry for the lame Nike reference but it really would have been a missed opportunity if I didn’t.)
Communicate with your loved ones
Nursing school takes up a ton of time. Unless you’re in it, it’s hard to understand the magnitude of things to do and learn. Therefore, be proactive about communicating your needs to your loved ones. Doing things last minute or the night before an exam won’t be the best thing for you during your nursing school journey. You may have to say no to some things you really want to take part in. The, “hey I want you to know that nursing school is my priority right now and I’ll probably not be able to do as much but it’s not a permanent thing” conversation is better to be had before school starts, not mid-heated argument about why you can’t go to another night out, dinner with friends, family event, etc.
Also, make sure to communicate about your needs while studying. If you need to be interruption-free, focused and alone, communicate that. “Ok so if I can be interruption-free for the next 2 hours to really focus, I’ll be able to go to dinner… or hang out with the kids.. or go to that work out class”. I have a feeling there will be some miscommunications and hiccups. Even the best communicators don’t do this perfectly. Be slow to anger and quick to forgive
Prioritize your sleep
I read a quote recently (and please forgive me, I do not remember who said it)… but this person said:
Being tired is not a badge of honor.
I love that. Sleep deprivation is NOT a badge of honor. I feel like whenever I would get to work or class that it was a competition about who got the least amount of sleep. I started to feel like it was another way of saying, “I’m really tired so expect less of me today.” But if we’re chronically exhausted, when can those around us actually have normal expectations of us and not have being tired as an excuse?
We must prioritize our sleep – even if that means going to bed embarrassingly early because you know you think better early in the morning. Or working late into the night because we know we can get the sleep we need the next day. Or taking a power nap in the afternoon.
Do what you can to get the best sleep possible. For instance, I like to get into a made bed, so I make my bed after I get up. I like to shower at the end of the day to relax before bed. I occasionally diffuse lavender or put a drop or two on my pillow. I get ready for bed about an hour before I actually want to fall asleep. I like to take my time getting ready for bed. I’ve got a memory foam pillow, Sleep Number bed, black out curtains, and nice sheets. I read a few chapters of Sherlock Holmes, Harry Potter, or some other fiction book before bed.
I recently readthe 4 hour Work Week by Tim Ferris and he recommended reading fiction before bed and its made a big difference. I used to read non-fiction, but for some reason reading about a story or situation that didn’t really happen.. that takes you to another world, really relaxes me and gets my mind ready to rest. (Update: I’ve been doing this for months and it’s really working to help me get to sleep faster)
Class. Study. Eat. Sleep. Repeat.
Class. Study. Eat. Sleep. Repeat.
Class. Study. Eat. Sleep. Repeat.
You can start to feel like a zombie. Make sure you’re making time to exercise. You’ll sleep better. You’ll feel better. You’ll be healthier.
At the least, look up some You Tube yoga videos do some good stretches. This is my favorite YouTube yogi bear. This stuff really helps so much, especially when you spend so much time sitting at a desk / computer. You can do it in the privacy of your home in as little as 10-20 minutes. Straighten out your neck and back, do some back hyperextension, work your core, do some deep breathing and meditation.
It’s also nice to have something to completely focus on that is not related to nursing. Get your favorite work out music and just escape. I enjoy doing some cardio and lift weights.
Try your best to eat well. If you’re eating a lot of take-out, quick meals, sugary drinks, etc. it can leave you not feeling as full, then to more snacking. You also aren’t putting the best nutrition in your body either. Plan your meals. Occasionally indulge. Eat naturally.
I also reviewed Butter Soft Scrubs from Uniform Advantage, Greys Anatomy, and Infinity by Cherokee in this blog post.
I use the Littmann Master Cardiology stethoscope, but I really like MDF scopes as well. MDF is definitely more affordable, yet still high quality. They’re just a lot heavier but I think for the price difference and quality, it’s not that big of a deal. When I was in nursing school, I purchased a $20 cheap scope and it was not worth it. I ended up getting a more expensive one after a semester because I just could barely hear anything.
Nurse tip! Get your name engraved on your scope so no one steals it!
I’ve heard rave reviews about WhiteCoat clipboards. I know many nurses, physicians, medical students, and nursing students who love these. It folds in half so you can stick it in your pocket, has bunch of nurse-related info printed on it, and folds out to a full-sized piece of paper. Click here to check it out on Amazon.
NRSNG also has some great clipboards and nursing school packs available on Amazon that are awesome.
I always, always get asked about nursing shoes. I’ve tried a lot. My current favorite are Work Wonders® by Dansko. I used to wear the regular ones but these are lighter, tighter and cheaper. I did a review on my blog of these as well. Here’s the link!
I also get asked about compression socks a lot. FIGS compression socks offer 20-30 mmHg compression, are long enough and sturdy enough to stay put for 12-hours, and I’ve washed them quite a few times since I got them a few months ago and they’ve withstood the washings and have not faded. They come in the pictured cranium pink, grey pills, or a slick black and grey.
My previous top compression socks were Cherokee True Support, and I wore them with each shift, but since switched them out for FIGS.
Planners and notebooks
I love planner and notebooks. Papersource has some AMAZING notebooks and planners and I want all of them. We live near one and I just like to go in and look at them all and pretend they’re mine. Here’s a link to their planners. And there are some that are more feminine and some that are more masculine – options for all! They also have a great selection of mini-notebooks, which I love. They fit in your scrub pockets so you can use them to take notes in if you clinical instructor doesn’t want you using your phone. Here’s a link to their notebooks.
After a few years in the field I’ve learned a lot of different resources. Here we go!
The big companies are Hurst, ATI, and Kaplan. You purchase these when you finish nursing school. They are all comparable in price and performance. Some nursing schools will host a review post graduation on-site, which is convenient. The main downside is that they come into play at the end and they’re quite pricey.
You can use a question bank only as well. This would be for people who don’t want/need a content review and simply want to take practice questions. Options include:
My nursing school NCLEX prep long-term recommendation and plan
My ultimate nursing school resource is by far the NRSNG Academy. It’s an NCLEX prep course, 10 additional content course reviews, a question database of 3500+ questions, cheatsheets, a private Facebook group for support, a Flashcard app, simulation NCLEX, and more.
They offer a $1 trial that’s 3-days.
My plan to maximize your bang for your (literal) buck: get the free trial and complete their Test Taking course within that three days. I’ve personally taken the course. It’s doable in 3 days and is so incredibly valuable. You’ll begin nursing school with test taking skills that I didn’t figure out until junior year. I went to nursing school from 2006-2010. I am a terrible test taker. I wish I had this course in 2006 to get a foundational test taking knowledge before beginning nursing school. It would have made a WORLD of difference, and I wouldn’t have wasted so much time doing things incredibly inefficiently.
It’s priced at $59, so you get this awesome course for $1 and a chance to check out the rest of the Academy and its plethora of NCLEX resources to see if it’s the right fit for you.
If it’s not, you’ve only spent $1 and gotten to take a crazy valuable course.
If so, you’re beginning nursing school with an NCLEX prep plan from day 1, not day 958. Think of NCLEX preparedness as a foundation of nursing school, not the last minute touch.
Once you’ve taken the Test Taking course, take a peek at all of the resources. Look at your nursing school class schedule and plan time to go through each NRSNG course while you’re going over that same material in class. Use this all through school as a support and supplementation to your coursework.
I’ve personally gone through each course with a fine-toothed comb. There is nothing more superior out there, guys. Nothing.
Some of these are nurse-related, some are life-related, some are medicine-related.. basically this is a list of books that I believe are helpful in the practical and emotional work it takes to become a successful nurse. I went to Twitter and asked people which books they think that nursing students should read and here is the list! All links are for Amazon.
** Prices may have changed – please click on the links for the most up to date price
I again asked my Twitter buds which apps they recommended for students. Please touch base with a clinical instructor before pulling out your phone and using it during clinical time. When I asked online if clinical instructors were okay with using phones as a resource, I got a bunch of different responses. They ranged from “absolutely not” to “yes” to “only if we were looking at apps for clinical and patients/family could see” (so in a break room, bathroom, med room, etc.). The take home message: don’t use your phone in clinicals unless told that it’s okay.
Here is a list! They are free unless otherwise noted.
ScrubCheats App – a free app by the NRSNG team designed specifically to be used at nursing school clinicals containing relevant quick reference material
Medscape – a free medical app with tons of information about varying disease processes, drugs, etc.
Figure 1 – a free app of medical cases for health care professionals. This one is fun to flip through randomly to see interesting cases and read physicians, nurses, and students chatting about what they think is going on and potential treatment courses.
Micromedex – there is a free version and a $2.99 version. I love this one. My hospital actually has it within our electronic medical record so I can access it within their med list, so I rarely use the app. The information is awesome though. I use this most frequently to quickly look up indications or IV compatibility.
Nursing Central – a free app with drugs, definitions, diagnoses, and test info.
Nurse Grid – a free calendar app that helps you schedule your shifts. (You’ll quickly learn that regular calendars aren’t ideal for shift work.. especially night shift)
RN Crush – a free NCLEX® review app from the NRSNG team
David Drug Guide – multiple options from free – $39.99 of a comprehensive drug guid
Epocrates – a free medical app that has a ton of great information
LabGear – a $2.99 app that describes various labs in depth (OMG YESSSSS)
MedPulse – a free app that is the news portion of Medscape
SmartFOAM – a free app that is Free Open Access to Medical Education
iTriage – a free symptom checker
iStethoscope Expert – a free app that allows you to hear heart, bowel, and lung sounds
As someone working their way to becoming a nurse, I just want to say WELCOME to the nursing community. I want to encourage you to connect with others walking through the same journey and find people who are where you want to be and connect with them as well. It can be incredibly encouraging when you’re having a rough time. It can also be really educating as well! You can do this in so many ways. Twitter, Facebook, Tumblr, Instagram, professional nursing organizations, student nursing organizations, volunteering, etc.
I want to conclude by saying welcome to the team. Getting into nursing school is no easy task, so congratulations! Nursing school is going to challenge you mentally, physically, and emotionally but in the end, it will be worth it. Something I want you to remember is that while in school you’re learning about disease processes, care plans, procedures, delegation, prioritization… but at the end of the day, you’re taking care of people. When you are so focused on learning that other stuff it can be easy to get distracted and forget that those are mothers, fathers, brothers, sisters, wives, husbands, daughters, sons, grandmas, grandpas, aunts, and uncles all sitting in those hospital beds.
They’re sad, scared, nervous, in pain, nauseated, frustrated, fed up, exhausted, and ready to go home yesterday. Don’t forget to also learn how to feel with patients.
How to be present.
How to empathize with whatever they’re feeling.
At the end of the day, they may forget your name. They may never know you caught that med that should never have been ordered or that lab value that was out of range. They won’t know you skipped lunch to help them get their bed bath done. They may forget that you brought their pain pill right on time.
But they will remember that you made them feel safe. Their loved ones will remember that out of all of the other nurses, they trusted you. They felt so comfortable with you that they finally went home to do a load of laundry and take a shower.
Years later, when recalling the day their dad died.. they won’t be able to picture your face, but they’ll remember how comforted they felt when you gently lifted up his head and turned over his pillow so he’d feel the cool side – even though you knew he was brain dead. They’ll remember how they felt when you grabbed them some of the good tissues from the nurses station, stood next to them over looking their now deceased father and gave them a slow, reassuring “I’m really sorry” pat on their back.
Because that’s what being a nurse is. Throughout school, you’ll learn about ventilators, arterial lines, contractility, renal failure, and deep venous thrombosis prevention.
But that’s only half of it.
The other half is learning how to talk to someone who just found out their mom is going to die… how to motivate a patient who has all but given up after fighting breast cancer for 10 years who just found out she has a brain tumor… how to educate a patient with heart failure that doesn’t know how to read.. … how to empower a patient to communicate with his family that he doesn’t want another surgery, he just wants to die..
Because we do both.
In nursing school, don’t forget to also learn about the people behind the diseases because they will teach you more than you ever thought you could learn.
I will look to update this post every so often to make sure it remains current. If there is a resource you find valuable for nursing students, please comment below!
I get quite a few emails from people looking start their own blog and looking for some tips and advice. Below is my advice on how to start a nursing blog!
Before I start, I want to say one very important thing. If you’re doing this for the money you probably should not be doing this. It takes a ton of hours and investment of both time and money before you ever see a dime. Seriously. You work for hours and hours every single week and don’t make anything. There must be something more behind your purpose of starting a blog other than earning money. What are you passionate about? What do you really care about? And if you never made a dollar, would still be worth it?
Starting a nursing blog begins with your audience
Nursing is somewhat broad, so if you want to start a blog for nurses I encourage you to narrow your focus even further. Do you want to write for seasoned nurses, emergency department nurses, prospective nurses, nursing students, nurse educators.. ? There’s so many different niches within nursing! The more you can narrow your focus, the better.
Address a need / fill a gap
People should want to come to your blog because they can’t get what they need somewhere else. What need or void are you fulfilling? What value are you providing? If you want to
Do your research
Learn about what makes a good blog post good (types of posts, images, word count, formatting, etc). People tend to lose focus after a certain word count unless it’s formatted in a specific way. If you’re telling patient stories, make sure you’re writing them in a HIPAA compliant kinda way.
Be easy to find
Have a URL that’s easy to remember. Make all of your social media profiles have the same or a very similar handle. Tag and categorize all of your posts appropriately so people can easily get to what they need on your site. I don’t know about you, but I give up after searching for something specific after about 30 seconds – 1 minute and then go look somewhere else or try to find something different.
Create quality content
You want people to have a desire to come back to your blog to hear more from you. You don’t want them to enjoy one post and forget about the blog. Create post after post of valuable, sharable content. In the nursing niche, I’ve found that practical, tangible, helpful tips are shared easily as well as short yet powerful patient stories or inspirational posts are very valuable.
Be a professional and positive nurse in social media
Have a social media presence. Pick the platforms that you can do well – there are quite a few! IG, FB, Snapchat, Twitter, Pinterest, Tumblr all function a little differently and a good post on one would not necessarily be good on another just copied and pasted. If you’re awesome at a few platforms, knock them out of the park. Don’t overwhelm yourself by trying to be all things on all platforms. (I’ve tried that – it’s way too exhausting and time consuming to be sustainable.)
Interact on various platforms; engage with others that are interested in your topic. This is how you’ll get known! Find people that do social media well and see what you like and don’t like about their online presence to help you figure out what you want yours to look like. There’s not a cookie-cutter way to develop your personal online blogging and SoMe (short for social media) style.
It’s important for people to see who you are and your personality shine through. However, make sure your blog and SoMe presence is not distracting from your content. If people are looking at your blog and social handles for the latest revealing photo of you, that becomes the focus.. not your mission, passion, or content you’ve worked so hard to perfect. I bit the bullet and paid for some professional photos and have been using them way more than I ever thought I would. They were definitely worth the investment.
Remember, you’re not just representing yourself, you’re also representing the profession of nursing when you put RN behind your name online. Everyone from friends and family, to prospective and current employers, to patients and their loved ones will Google you and check out your blog. Make sure it’s something you’re comfortable with everyone reading.
Think before you post
Always make sure you are not posting in anger or frustration. This will not enhance your platform; this will make it seem like you are not in control of yourself. There is a difference between posting about something you are passionate about and posting because you are upset. Take some time away and collect your thoughts first if you are really fired up about something and wait to post it for a few days.
And please, do not use your blog as a ranting zone. People hear enough complaining at work no matter the profession and there is enough of that online as well. They won’t stay at your blog long if it is post after post complaining about work.
Never re-use or steal content
I’ve had people copy and paste my work onto their blog and not credit me. I’ve had people copy and paste my work and write an entire post about how they disagreed with me and again not credit me. I’ve had people steal my idea and make their post just different enough so they wouldn’t have to credit me. I’ve also had people steal my pictures from my various SoMe platforms to pass them off as their own, again, not giving me credit. One of the books I recommend goes into depth about handling this and I approach every situation differently, depending on the offender.
Some situations require an email from myself. And some require an email from the copyright lawyer I work with. I’ve protected myself by copyrighting Nurse Eye Roll® as well as forming the Nurse Eye Roll LLC. I am well within my rights to send a cease and desist letter in all of the aforementioned situations, however … like nursing, you want to use the lease invasive intervention first! Ha! I use that as my last resort if people are not responding.
What you don’t do is call them out on SoMe – you’ll end up looking not so great and draw negative attention to the situation. Handle these situations quietly, professionally, respectfully and privately.
And most importantly – NEVER do this yourself. Even if you’re just screen-shotting a pic someone else took, a Pinterest pic, or whatever. Always, always ALWAYS give credit. That is basic blogging etiquette.
Earlier this month, Brittney Wilson over at TheNerdyNurse.com wrote a great post about the practical process of creating a nursing blog. You can check it out here!
Blogging platform I recommend: WordPress.COM is a great place to start. It can be confusing for those that have never made a blog before, so take the time to do the tutorials. WordPress.COM is a good starting point, but if you want to have more options for layouts and advertisements, then you’ll need to look at switching to WordPress.ORG later down the line. The book Platform and Brittney’s postI mentioned before discusses this more in depth.
Images: I’ve used PicMonkey and Canva in the past. Right now I’m currently loving Canva the most! Do not make the rookie mistake of Googling an image and uploading it to your blog. You typically don’t know who owns the rights to those images, therefore if you’re repurposing them to your blog, you can ultimately receive a bill or creating copyright infringement. I know someone who did that, not realizing it was an issue, and received got a $1500 bill from Getty Images for unknowingly using one of their pics that they found on Google. Be smart about images. Pay for stock images. Don’t use anything you find on Google.
Learn How to Blog From the Experts
I hope these tips and my experience were helpful.
Over the past few months, Brittney Wilson BSN RN (The Nerdy Nurse) and I have been writing a blogging and social media guide book for nurses. At over 200 pages, it’s full of practical help, our experiences, recommendations, and major mistakes to avoid.
We’ve been there. The patient is incredibly rude, demeaning, or even saying sexually explicit things to you. Patient satisfaction has been preached to you constantly.. but what do you do when the patient crosses the line?
I’ve had quite a few experiences of all of the above. I felt helpless until I figured out the best way to handle this. I no longer feel helpless. I feel strong. I feel empowered.
Bring it on, people. I can handle it.
I have a few key phrases I am ready to drop with firm confidence.
I usually say…
That is inappropriate.
You will not speak to me in that manner.
Do not curse at me.
I am here to help you as your nurse, not to be disrespected.
I use one or a combination of two, or all three. It usually shuts the rudeness or the sexually inappropriate stuff down. You usually don’t need to elaborate any more because it snaps them out of their rudeness. They usually profusely apologize.
I find it really important for, as a nurse and human being, to know this:
Even though someone is ill or going through something really tough, it does not give them an excuse to be rude, demeaning, demanding, or inappropriate to you. You deserve respect. And sometimes when people are being rude as an unhealthy way of dealing with their situation, you need to command respect from them. There is absolutely no excuse or reason to treat you poorly. You do NOT deserve it.
Sometimes when people are going through something tough they lash out at those that are helping them. It can be a natural way for them to deal with something that’s totally out control. While that may be how they’re instinctively dealing with something, it does not make it okay. They may just need a little firm, but respectful, reminder that there are better ways to deal with difficult situations.
Telling these people to stop is step one. Step two is how you treat them the rest of the shift. You must still provide great care. You drop the “you must respect me” bomb, but then you still take really good care of them.
(This also applies to the patient’s loved ones/support system AND coworkers, people!)
You’re basically saying to the patient that’s taking their situation out on you,
“Hey – don’t treat me like that. It’s cool if you were frustrated with everything and taking it out on me.. that’s okay if that was your instinct, but you need to know that it’s not okay to talk to me like that and we’ve gotta change how you’re dealing with this. I’m still going to take really good care of you, even though we had this little bump in the road. Being sick sucks. I get it. And if you want to talk about it, I’m here.”
Now there will be your patients that are just mean and going to be disrespectful and demeaning anyway. Those patients will get very short and sweet interactions from me. I will say and do what I need to do and nothing more. Patient satisfaction is important, but not so important that you get treated like garbage. Honestly, in my 6 years of nursing.. I’ve had one guy that was just super mean despite what I did and said. One. The rest changed their behavior once I identified the rudeness and asked to be treated more respectfully.
When the patient is confused and mean
When I have patients that are confused and mean, I maintain an extremely strong (strong, not mean!) presence. I am respectful, but I am extremely firm in every single word I say. I am the nurse, I am in charge. I am going to re-direct behaviors, identify and correct abusive language, and provide good care. These patients need a really strong, yet kind, presence. I provide structure, try to joke with them, and know when to just exit the situation and try again later.
Know when to call security
If a patient is seriously being abusive (cursing, threatening) – call security. I will do this quickly and swiftly. I don’t play games, people. If I drop my “treat me with respect” bomb and they come back at me hostile or cursing, I immediately lean out of the room and loudly asking to whomever is at the desk to call security.
This person needs a firm reminder about the expected behavior of a human being by someone in a uniform.
Usually the act of me requesting security communicates the “it just got real” message and they chill out. However, I still talk with security and ask them to explain to the patient how to treat the staff. I also do this for confused patients that are extremely mean and abusive that I’m unable to control myself. Even in their confused state, if they see a uniform, it can still get through to them.
I know what you non-nurses/non-CNA’s may be thinking here.. is all of that really necessary? Yes, good Lord, it is. I have experienced multiple “call security” situations. People can go really off-the charts (ha!) in the hospital when they are upset. These situations happen and we must be empowered to deal with them appropriately to ensure everyone’s safety from both physical and emotional abuse.
Also – shout out to security officers. I sincerely appreciate you and the support you provide to us nurses. It means a lot to and I feel very safe because of you.
I hope this helps you as you have those tough patients. I remember feeling so bad and beat down when patients were mean and treated me like the lowliest of the low. But once I got my mind around the situation, I felt empowered. I began to feel armed to deal with these situations and therefore didn’t try to avoid them. I now take them on immediately and address the behavior. It makes the shift go much better and typically the patient and I have a much deeper, trusting relationship because they know I’ll call them out when they’re being ridiculous and still support them.
Craft beer this week: Coffee is for Closers, an iced coffee stout by Fullsteam Brewery in Durham, NC.
The ICU is dynamic and things change constantly and quickly. Patient conditions and staffing change significantly in an instant. No two shifts will be the same. However, it is important to know what your routine would be if you are adequately staffed, have an appropriate assignment, and nothing happens that changes your plan (which happens q3years, I know!)
Remember, these are suggestions. Time management is not the same for everyone. Adapt as you see fit. As long as tasks are complete and needs are met, you’re good to go. This is a starting off point.
Assumptions: this is day shift, you have two patients, and a CNA is working with you
Maximize this time
Look at orders (what needs to be done immediately, sooner, later)
Look at meds (make sure none are overdue, look at what is due 0900 and before and if you need to get it from pharmacy/is it very time sensitive)
While they’re talking, look at all of your lines
What needs to be changed, when?
How much is left of your fluids/drips? Do you need to get new ones sooner rather than later?
Mentally plan your day
When will you change your lines, do you have any procedures/scans/tests?
Learn to give and receive report efficiently
30 min is MAX for report
Speak concisely when giving report, don’t ask questions until the end when receiving report
It’s not a time to catch up with buds – it is precious time
When you’re done – LEAVE! Don’t linger!
Complete meds, a turn, assessment, and chart all at once
Spending slightly more time in a room and completing more tasks at once is much faster than one task at a time with each patient. You’ll be constantly chasing your tail. It’s better to complete tasks slightly early or slightly late than everything is late.
If an MD is rounding and completing an assessment, complete one then as well and save yourself another trip
Be proactive with educating patients/families while in the room to cut down on questions/call bells just to answer questions
Move quickly at the beginning to get everything done. Beginning of shifts are busiest between meds and getting that first assessment charted
Even if you are ahead or don’t have anything pressing going on, move fast to get these things done. You never know what’s about to happen.
When the chaos ensues…
Immediately think: “who needs me most right now?”
Stop and breathe. Ask a coworker for help prioritizing if you don’t know.
Everyone may try to make you think that what they are worried about/asking about is a priority, but only YOU know the needs of both of your patients. Be unapologetic about this, even if someone is mad. You can’t make everyone happy when patients are unstable/have immediate needs.
Delegate to your coworkers the task-oriented things, not the things that require you to provide information about your patient that would take too long to explain
If you are pressed for time, chart the ABNORMAL things only and go back and fill in the “chart this same basic thing on everyone” stuff later. So if their assessment was normal except for their lungs and their peripheral pulses, just chart those things in real time and then go back later. It is really, really easy to forget this stuff.
If you don’t have time to chart anything at all, at least chart “reassessment” or at least one thing at that time so you have a time stamp.
Learn shortcuts. The faster you can chart, the more efficient you will be. The less time spent charting, the better. This doesn’t mean chart LESS, this means chart more EFFICIENTLY. Focus on less clicks, learn the shortcuts, read the updates or tips and tricks sent out by IT via email.
If deemed appropriate, copy and paste your assessment and change what needs to be changed (saves a LOT of time)
Sample morning of time management
Before report: print telemetry strips
0645-0700: Report on patient #1, quick intro, and “I’ll be back shortly after I get report on my other patient.. do you need anything before I come back?” Check to see if you need to bring any replacement drips/fluid when you return.
0700-0715: Report on Patient #2
0715-0730: With patient #2, introduce, educate, assess, chart (only a few things.. stuff you would easily forget), give any meds (typically minimal at this time), level your lines check your alarm settings, see if you need to replace any fluids/drips. Before leaving the room, check to see your 0800/0900 meds for patient #1 and get those on your way back to #1’s room. Be quick and efficient.
0730-0800: Back to patient #1 and educate, assess, chart, turn, level lines, check alarms. Once 0800 hits, scan and administer all 0800 and 0900 meds and replace fluids/drips. Before leaving the room, check #2’s chart to see what you need to bring in to that room for 0800/0900.
0800-0830: Back to #2 and medicate, turn, finish charting
0830-0845: At nursing station, interpret/chart tele strips and double check orders/chart to make sure you haven’t forgotten anything
If nothing happens, which is rare, you’ll be done with everything at 0900. It is essential to be as caught up as possible constantly because you never know who is going to be unstable and what’s coming through the door.
Learn both hard and soft skills about ICU nursing care. From vasopressors to emotional support, this comprehensive ICU skills workshop covers topics applicable to every nurse working in critical care, as well as those sending patients to, or receiving patients from, intensive care.
Disclaimer: this is a short and sweet explanation of a nursing assessment of an unconscious neuro patient.
References are included at the end with supplemental information.
Always refer to your hospital’s policies and procedures to guide your practice.
This post contains affiliate links.
I was a neuro ICU nurse for four years and worked with some amazing neuro ICU nurses, neurologists, neurosurgeons, and physician assistants. Below are some of the tips I’ve learned along the way!
Education for the family is critical
Before you even touch the patient, let’s chat education.
Let the family know about painful stimuli before you perform it. It can be pretty shocking for someone to see this, so please warn people beforehand.
Another thing that’s really important is to educate them about the importance of the frequent neurological assessments. Family members frequently want their unconscious loved one to do as much as possible (squeeze their hand, raise a finger, wiggle toes, etc.). This is a normal desire. They want them to do well. However, it’s critical that the family allows their loved one to rest between assessments. I’ve just finished bathing, turning, and assessing a patient who needs to rest until I come back in 2 hours to assess them all over again… and before I walk out of the room I start to hear someone scream, “COME ON SWEETIE, SHOW ME HOW YOU CNA SQUEEZE MY HAND!” Please let them know how essential it is for the patient to save their minimal energy for your assessments.
Encourage and educate them about the importance of maximizing rest between assessments because these assessments. This is essential because when changes in brain occur, they are evident in the assessments, not vital signs.
There are lots of beeps and buzzes in the neuro ICU. Educate them about monitors, equipment, and when to worry. Some don’t realize that most of the equipment is connected to a monitor at the nurse’s station and will put on their call light with every beep (which would mean A LOT of call lights!). Some will freak out with each beep, and some will even try to get the beeping to stop by themselves and press buttons they shouldn’t press. Proactively educate.
Unconscious neuro patient assessment tips
Here are some essential neuro ICU assessment tips!
Pause sedation! You must pause sedation for each assessment unless an order tells you not to, otherwise you cannot accurately assess their neurological status
Do your assessment the same way every single time – like your golf swing or how you would shoot a basketball… there should be a very specific routine you go through
Look at CTs and MRIs and compare them to diagnosis
Change in level of consciousness is usually the earliest reliable indication of a change in intercranial pressure (ICP)
Vital signs / pupillary changes are LATE. If you’re just watching vitals and checking pupils, you’re missing something and your intervention will be too late.
Do your first neuro assessment with the off-going nurse to compare
Temperature can profoundly affect your assessment and increase ICP
For each degree increase, the normal metabolic demand is increased by 10%. They increase cerebral edema and infarction!
Temp changes does not typically signify a change in the neuro injury, but requires prompt intervention
Keeping the head of bed at 30 degrees is ideal, unless contraindicated. This keeps head midline, promotes venous return, which decreases ICP. However, make sure this isn’t contraindicated in your patient before implementing
Avoid shivering and agitation, as this also increases ICP. Notify the MD if you’re noting either of these, as they’ll likely order something to decrease it.
Don’t try to interpret your assessment in your documentation, just write what you see (so don’t write “seizure”, write what you’ve observed specifically, like “rhythmic twitching”)
Know your acceptable forms of pain:
Sternal pressure – not rub
Nail bed – can elicit a spinal reflex and be reproduced in a brain dead patient.. I only do this if I’m not getting a response
How to go through your neuro ICU patient assessment
Alright, now that you’ve gone through some basic tips, let’s go through a systematic way to approach assessing an unconscious neuro patient.
Look at vent – are they breathing over the vent before you stimulate them? What’s their respiratory pattern?
Look at them before you touch them – are they making any movements? (Remember, your sedation is paused at this point.) Is this movement purposeful? Are they going for the ventilator, scratching themselves, picking at bed linen, and so forth? Does their face look symmetrical? Note their hemodynamics before you start getting them all riled up.
Level of consciousness – this is super important, people!
Awake / alert: do I really need to explain 😉
Confused: disoriented, agitation, poor memory
Lethargic: awakens, but takes some effort and is kind of cloudy when they wake up
Obtunded: needs repeated stimulation but falls back asleep
Stuperous: minimal movements, pain or vigorous stimulation needed
Comatose: no response to anything at all, not even pain
Eyes, eyes baby
See if they’ll open them by themselves (“Sir, can you open your eyes for me?”)
If they will follow that command, see if you can get them to look in all four quadrants (look up here, down
here, over here, etc.)
Walk from one side of the bed to the other, see if they’ll follow you
If cannot open eyes, do so for them and note that
Close them frequently for them during the assessment
Check pupils for size, shape, level of reactivity (brisk, prompt, sluggish, nonreactive, hippus).
Check blink to threat reflex by pretending you’re going to poke them in the eye, but don’t!
If blink isn’t present, check corneal reflex by using cotton or saline
Oculocephalic reflex/Doll’s Eyes: briskly move head with eyes open. If eyes stay fixed, that indicates loss of brainstem.
I always do this one with the doc, I’m not so great at telling this unless it’s painfully obviously
Cough and gag reflex
Perform oral care, then touch back of throat with oral care kit and observe
Suction patient to elicit cough reflex, note facial response to further assess facial symmetry
Can they follow commands?
“Grip my hand, show me two fingers, give me a thumbs up, wiggle your toes”
Must be repeatable and consistent
Educate family about reflexive movement
Assess all 4 extremities for commands
If no commands.. must elicit pain
See beginning for acceptable forms
Use your pain stimuli on each arm
Progression from best to worst..
Follows commands (yay!)
Localized pain: attempts to stop painful stimulus
Withdraws from pain: pulls away from stimulus
Flexion: flexes arm, note how far (midabdomen, nips), legs will extend
Extension: you’ll know this when you see it! Some will extend and then flex, legs will extend
No movement/response to pain at all (most ominous)
Plantar stroke – we do not want to see their greater toe fan
Lift hand and drop. Rapid drop = coma, slow drop = consciousness
Bend knees; put heels on bed and release
External rotation and drop = coma
Slow extension to bed = consciousness
Video demonstration of the above assessment
As part of a short series of videos, I performed a demo of an unconscious neuro patient on my husband. Here is the video!
More neuro resources
Need more in-depth neuro info? Check out the Neuro Nurse Crash Course brought to you by FreshRN® where we discuss essential topics like essential neuroanatomy and disease processes, primary and secondary injury, neuro nursing report, meds, time management, mastering the neuro assessment, and more!
Today we have a guest blog post from Nick Angelis, CRNA MSN, about a topic that is near and dear to my heart – financial planning. I know it’s a weird thing to be passionate about, but I believe any and everyone should be able to get a higher education without going into financial ruin – which is pretty difficult today! With the appropriate planning, we can attempt to lessen the blow as much as possible. Check out these awesome and practical tips from someone much more experienced than myself – Nick!
1. Live Poor
At what point should you start denying yourself the simple pleasures of four dollar coffee or blowing a hundred bucks every weekend? When do you really need to start saving? The truth is, it could take decades to dig yourself out of debt if you don’t take the necessary steps now. There is absolutely no point in putting yourself and your loved ones through years of essentially monastic living if you’ll still be living paycheck to paycheck with a higher salary once you graduate. Currently, student loans are at such low rates that financing your life with them (and skipping the next few rambling paragraphs) is a viable option. I previously recommended that students pay off their undergraduate loans before starting anesthesia or nurse practitioner school, but it’s an individual decision. As much as it depends on you, keep your other debts to a minimum. For example, don’t make illegitimate children—child support really adds up. Chronic illnesses tend to be expensive too, although avoiding carcinogens may be more difficult than wearing seat belts, selling your motorcycle, or resisting the urge to sled down an icy hill on a skateboard. The last time I had such an urge, I at least had the presence of mind to increase my life and disability insurance first–which is a must if you have a family, once you get that MSN or whichever degree you’re striving for.
2. Get Grants
If you have a high GPA or an interesting characteristic (e.g. Navajo and Guatemalan heritage), the first step is to look for scholarships and grants. Regardless of the angle I tried, no one accepted my Greekness as any race or ethnicity other than Dark White. My GPA and essay skills were good enough to justify the time I spent submitting scholarship applications instead of working at “Niko’s House of Gyro and Lamb”. There really is no such place in my hometown, but if there were, I’d eat there twice a week. To be honest, I never did find a single grant or scholarship to fund anesthesia school, and all my undergraduate scholarships combined were laughable had I gone anywhere but the local public university. That brings up my third point.
3. Consider Cheaper Schools
The prestige of your alma mater is at best a tiny variable for your success in healthcare. A more affordable education is not like buying generic, one ply toilet paper. This isn’t business school, where networking is more important than what you learn. You’ll take the same boards after you graduate as someone at a more prestigious school, so the cost difference between graduate nursing programs is a major factor. The luxury of choice is admittedly rare unless you have a high GPA and the ability to skillfully articulate your clinical skills during interviews. Look at the value of a school, taking into consideration your personal support system, and the school’s cost and reputation. Talking to previous graduates will also illuminate whether you’re getting a great deal or if the school resembles that fabulous Groupon to a restaurant that gave me food poisoning. Just like warmed milk of magnesia mixed with prune juice matters more than a handful of raisins, a nursing school’s reputation from previous students matters a great deal more than US News and World Report rankings or any other comparable data. A small school can’t offer you the cutting edge research, tools, and surgeries found at a large academic institution. A large school is less likely to expose you to the autonomous experience of a practitioner in rural America without any backup. So, if you’ve always dreamed of practicing in the heart of New York City, the University of Iowa’s program might not be the best fit.
4. Know your Financial Needs and Goals
If you’re already a nurse while reading this blog, what are ways that you can maximize your income and experience while you prepare for even more school? My program encouraged us to take core graduate nursing classes before being accepted into the program. The unreliable hours but better pay of an agency nurse (the healthcare equivalent of a substitute teacher) allowed me to learn adaptability and get more studying done when I couldn’t find a shift to work. None of your financial plans should take into account “the money I’ll make while I’m in anesthesia school”, because it’s just not going to happen, although some nurse practitioner school and other graduate degrees may afford some part time work.
5. Invest Wisely
So what should you do with your money? Transferring loans from one 0% interest credit card to another can work for a while, unless you make a single. life-altering mistake at 30% interest. Once you run out of public and private low interest loans, websites such as lendingclub.com have much better terms than credit cards and also work well as high interest (and high risk) investments if you are fortunate enough to save money. Obviously, risking money you need for next semester’s tuition or next week’s canned soup is a bad idea once you’re in school, on par with investing all your money in foreign stocks the day before you retire. Some research on your part is necessary to avoid investing in the “Anesthesia Student Wire Transfer Fund of Northwest Potiskum”. I lived on 20% of my income as a nurse and saved the rest for anesthesia school, but my quality of life was only slightly above a vegetative state. For 2016, a high yield bond ladder is my latest advice, as it can replace what certificates of deposit did for me ten years ago. You’ll need some advice to avoid companies with bankruptcy risks, however.
6. Explore Side Gigs
A friend of mine still works part time as a fireman because of the health insurance and pension plan, while another nurse I know works at an upscale restaurant on the weekends because his large tips exceed the money he’d earn working those hours as a nurse. I don’t intend to imply that jobs in healthcare pay poorly until the initials “CRNA” or the words “Nurse Manager” follow your name. Many of my fellow nurse anesthetists started as paramedics, radiology technicians, and similar careers before becoming ICU nurses and applying for anesthesia school. Still others paid for school by funneling student loan money into rental properties (this is also a great way to immediately lose all of your money) or developing ways to make passive income, since time is so precious during graduate school. That said, you can’t type out your thoughts on a blog or book and expect the level of success that Kati has had by rolling her nurse eyes. Despite the multiple books and articles I’ve written, I’m typically more likely to donate blood than buy a book off the Internet.
7. Win the Lottery of Tuition Reimbursement
In fact, you can spend your entire working career at one institution, using tuition reimbursement programs each step of the way as your education and paychecks increase. This method never appealed to me because I knew exactly where I wanted to go and didn’t have any debt, but it’s a brilliant method to compare multiple careers in healthcare at little expense. Signing up for the military after high school is another way to do this. I tried using tuition scholarships from my various places of employment, but I always barely missed qualifying because of some technicality or other. Stay focused on your goals because few people in American culture have a concrete idea of exactly how much money is enough. The love of learning may dim when it contributes to your debt but not your paycheck!
Nick Angelis, CRNA, MSN, is the author of How to Succeed in Anesthesia School (And RN, PA, or Med School) and regularly writes or presents continuing education articles on a variety of dry and dreary topics like this one. Thankfully, he also has a thing for fiction, non-fiction guides for students and clinicians, and satire closely resembling non-fiction. Nick works as a nurse anesthetist in the Florida Panhandle and enjoys playing several sports poorly. You can connect with him on Twitter, Instagram, or behavewellness.com.
Everyone has their own forte’, and for some, providing emotional support to people in crisis can be an OMG WHAT DO I DO moment. It can be uncomfortable. It can be weird. It can be scary. It can be one of those situations you avoid at all costs.
But it doesn’t have to be! Some of the best nursing care you can provide can be in these moments. I learned some things that are very valuable when I started to find myself in this typical situation more frequently that I want to share with you.
Whenever people used to get emotional in front of me, my natural response was to try to make it better. I wanted them to stop being upset. I wanted to fix it, STAT. I felt inadequate if I could not say the perfect thing to them to remedy the situation. This left me feeling like a bad nurse and desperately avoiding emotional patients and family members. However, after I learned some things I realized how wrong that thought process was.
It is really important for you to know this: even if you have the most perfect response to them, you’re not going fix it. You’re not going to make it go away. You’re not going to take the pain away from their terminal cancer diagnosis. You’re not going to heal the anger in a family’s heart for their father not taking care of his blood pressure and ending up with a massive stroke and who is now dying. You can’t fix that with words. That pain is there and you cannot remove it. But you can comfort it.
It’s also important to know that they don’t expect you to fix this massive tragedy with words. They’re not sitting there, crying and waiting for their nurse to have the perfect verbal response to put them at ease. What they are yearning for is support. They are in desperate need of someone to just feel with them.
So, how does this look practically?
The first step is to let go of that natural urge to fix the situation. Take a deep breath and let that go – you cannot fix this.
I know it can be awkward, but being okay with silence and just being with someone who is hurting and not rushing them or yourself means a lot to someone. Many times, these patients or family members don’t want to burden others with their emotions. But they need to experience them. They need to feel them. You just being there, allowing silence and providing support that’s not rushing out of the room lets them know that their emotions are valid. They are important. They deserve time. And you are an awesome and supporting nurse, so you will provide that.
Acknowledge the situation.
Sometimes, people just need to hear that what they’re going through is tough. Hearing a nurse acknowledge how tough a situation is, that they’re going through a lot, can really validate someone. It can let them know that it is okay to be upset, sad, angry, or whatever emotions they’re going through because this is a hard situation. And we see and recognize it.
“I’m really sorry this happened,” with a hug or hand on the shoulder is much more supportive and powerful than people realize.
“I’m so sorry this is happening but I’m really glad you told me. I’m here to support you and your family. I’m here for you.”
Or even just grabbing a box of tissues, patting them on the back, and saying you’re sorry and allowing silence and support can be enough.
Take really good care of them or their loved one.
If they really trust you to do a good job with their loved one, that will put them at ease and support them by taking one big stressor off their plate. I don’t mean all of the technical stuff like getting all of your charting perfect, interpreting lab values, giving all of your meds precisely on time, or consulting with the interdisciplinary team. I mean the more basic stuff. Things like taking extra time to comb their hair, getting their favorite flavor of Jello, or trying to connect with them and make a joke to get them to laugh…that can really mean the world to someone. If they trust that they or their loved ones are safe and cared for in your hands, that itself provides emotional support.
I have taken care of patients where I did the above things. It didn’t feel like much to me because I wasn’t fixing anything, I wasn’t physically making anything better. I couldn’t actually see the impact I was having. However, when I did these things, I received the most emotional responses later in the shift or the next day. Tearfully, patients and family members have told me thank you for my love and care. Once I let go of fixing and started supporting, somehow my patients and their loved ones felt even more cared for.
My next post will be an example of how I went through these steps. Stay tuned!
What kind of small, seemingly insignificant things have you done for a patient or their loved ones that you later found out meant the world to them?
So you’ve just started your new job as a new graduate nurse. You have a great preceptor, you like your unit, and your manager seems pretty cool. But you dread going to work. You get report and you’re already an hour behind. You’re already an overwhelmed nurse. There are so many things to do right this second that you shut down. You can’t do this. It’s too much. You struggle through each day, just trying to get to the end of the shift. You are elated for days off. You dread going back. Is this really what you signed up for? Will this EVER end?
Been there. Felt that. And I want to tell you that – yes… dear Lord, yes – it does get better. I also want to tell you some ways to work through this because you can do this.
Let me repeat myself.
YOU CAN DO THIS.
Take Your Thoughts Captive
When you are already overwhelmed and discouraged before you’ve even clocked in, it’s important to stop those thoughts before they take over. And they can take over your mind pretty quickly. So, before you clock in.. before you drive to work.. before you get your coffee ready.. before you put your scrubs on, remind yourself that you can do this. Continue to tell yourself this during your entire commute.
And if there are thoughts in there trying to creep in, going over all of the worst-case scenarios or trying to freak you out, actively tell those thoughts, “No – that is a lie. I can do this. I can handle this.”
This continues when you get to work and when you get report. The most important time to maintain this thought process is after you get report and are suddenly faced with 900 things to do (one needs to pee, one wants to be discharged immediately, one needs a heparin drip, and a doctor is rounding in the last room) right this very second.
Tackle Your Tasks With a Plan
Ok, what is the most important thing to do? What fires can I put out immediately? Remind yourself that you can tackle everything appropriately, just do so in chunks. Don’t think, “Oh man there’s 5 new things I need to do and I haven’t even assessed my patients yet!” While yes, that’s true.. but you can combine these new tasks with the ones that you know you must perform (assessments and charting for example).
Typically, while you’re working on completing new tasks, you can combine them with others. So if a patient has to pee and no one is available to delegate, I’ll go grab their morning meds and knock my assessment out and give meds all at the same time and chart it in the room while they’re peeing. So when I walk out of that room, I’m done for about two hours.
Remember: you are perfectly capable of dealing with all of this AND you will have an awesome day.
What Are MY Priorities?
Many people will act like absolutely everything is a priority right this very second (from therapy, to management, to the doctor, to the PA, to radiology tech, to the family member..), but you as the nurse must look at your task list and prioritize everyone’s priorities.
“Everything is a priority to everyone, I need to decide what is a priority for me right now. I am the nurse, the common denominator. I see the big picture. What needs to be done right now?”
I feel like a lot of my day is reassuring people and calming them down because things don’t happen as quickly as they want them to. It is totally okay to make people wait, when appropriate. You’re the nurse, your the one whose time is absolutely precious (not saying other people’s time is not, but you are the gatekeeper for your entire patient load and can only do one thing at a time for each of them).
Remember: you get to dictate what order you will do things.
While your patient’s mother is livid that the scheduled Colace is 10 minutes late on her 54 year old son who is being discharged today, she doesn’t know that your other patient next door just flipped into atrial fibrillation with RVR and a rate of 167.
So, for those aforementioned patients above.. you can think, “First, I’ll let the guy know that he’ll be discharged as soon as the paperwork is completed by the doc. It’s not in yet I’ll tell him to enjoy his breakfast and I’ll be back with his morning meds after breakfast. Then I’ll delegate the patient who has to pee to the CNA. Then, I’ll make sure the doc has all he needs, as I’m walking to the med room to grab the heparin bag. On my way to grab a pump, I’ll let another nurse know I need a dual sign-off and BOOM all of your fires are out.” Then you can proceed to your normal day.
At the beginning, I thought I had to do everything one everyone else’s timetable. Every time someone came to me with something they needed or wanted, I thought I had to drop everything and immediately address it. WRONG! Only you know all the things you need to get done for your entire patient load in the next 1, 2, 4, and 12 hours. You can make the call of what is now the priority (unless there is a legit drop everything emergency).
You will start to develop your “Ok I know I need to do this first” skills as well as your confidence in yourself and your patient/coworker interaction. Soon you will be able to confidently communicate, “I hear that you need _______ right now and I will address that as soon as I finish with this priority. Thank you for bringing that to my attention.” Say it with confidence.
(Neuro ICU meaning I typically have two critically-ill neurologically compromised patients, as do all of my other coworkers. On most days we have one CNA. My patients must be assessed neurologically at least every 2 hours, fully assessed every 4 hours, all lines needs to leveled and zero’d, turned every 2 hours, vitals as often as every 15 minutes, oral care every 2-4 hours, scheduled meds passed on time as well as monitoring to see if PRN meds are needed to maintain stable vitals, address nausea/pain/seizures, etc. There’s more we’re responsible for but this is the basics of what I expect to complete once walking in the door.)
I walk in, get report, and see all of my tubing is out of date and my Neo drip is about to run dry. Their arterial line needs to be leveled and zero’d, their BP is too high, and their ventriculostomy drain needs to be leveled and dumped. My patient needs to be turned, his mouth suctioned, he needs SCD pumps on, both need to be assessed, they have meds due, a family member is on the phone wanting an update and the neurosurgeon is rounding on my next patient.
What do I do? This seems like the perfect time to get overwhelmed. But nope – I’ve got this, guys.
I’ll have someone tell the fam member to call back in 45 min, I’m with the patient and the doctor and will give them a more detailed update shortly. That is not my priority right now. I quickly level and zero the art line and make sure the BP is accurate before I titrate my drip. I then titrate my drip accordingly and chart it. Then quickly level my ventric drain, dump, make note of amount of drainage. I touch base with the neurosurgeon on my way to get my Neo drip and his other due meds, I can’t let that run dry! I complete my neuro assessment along with the neurosurgeon of my other patient so the patient doesn’t go through it twice and it saves me time. I remember their assessment and jot down anything that might be hard to remember on my brains (AKA my report sheet). On my way back to the first patient’s room, I let the CNA know I want to turn the patient and ask him to grab SCD’s before he comes in the room. I can see if my titration of my Neo worked on my BP, if not I titrate again. I switch out my drip and when he arrives with the SCD’s, we turn the patient, I clean out his mouth, assess him, etc. I re-level my drain and art line. I then pass the meds that are due. I chart my assessments and meds and deal with all my tubing later in the day because that can wait until I’m totally caught up. Now he’s good to go until the next meds and assessment (probably about 2 hours) and will go grab meds for patient number two.
It sounds like a lot, but that can be done in probably a total of 15 min or less (if my drip is in the med room, my CNA can come help, etc.). This will all become second nature to you. You’ll be completing tasks and prioritizing without even realizing it. You’ll be calming people that are making a big deal out of something that really isn’t. Like the tubing, people will say “Your tubing is out of date by 3 hours, you need to change that right now!” Um, wrong. I have a lot of other things to do that are a much higher priority like making sure both patients are okay and my drips aren’t dry. People can chill out. I got this.
And so do you.
For specific educational needs
If you’re in a specific unit and you’re struggle with various medications you give frequently spend some time on your days off going over some concise and helpful information. This makes a world of difference and helps connect the dots sooner. You can focus on practical steps at the bedside, while filling in the why at home when you have a little more time to process the information.
NRSNG Academy is primarily an NCLEX resource, but there is a ton of information applicable for the new nurse. The EKG, Lab Course, and MedMaster Courses are specifically what I’m thinking will be particularly helpful for the new grad. You can get all these course and more for a 7 day trial for just $1!
They go in depth on mechanism of action, nursing considerations, contraindications, and more within MedMaster. The EKG Course dives deep into each rhythm, nursing considerations, pathophysiologically and electrically what’s occurring, and more. The Lab Course does a deep dive into specifically what each lab is measuring, why it’s important, and more.
NRSNG Academy works like a monthly fee, so once you feel like you’ve extracted the value and knowledge you need to be more successful at the bedside, you simply cancel. There is a ton of information in the entire academy that would be applicable to the newbie nurse and it would take a few months of membership to equal the cost of purchasing each individually.
Being a nurse, working shift work, it can be tough making sure you eat appropriately. A few years ago, my husband and I got into a pretty regular routine to offset the nutritional challenges that shift work presents.
I’m going to outline our weekly routine in addition to a sample menu.
Here we go!
Most Saturdays (or Sundays) John and I sit down and plan a week of meals. We then make our grocery store list and head over to stock up. I like to do this together because it’s more time spent with one another, and we both know what we have and what we need.
To give you some background to our choices, we are meat eaters. John likes to eat low carb, so whenever we have rice, I typically only eat the rice myself or make him quinoa. Our go-to proteins are chicken and ground beef. John doesn’t like pork and I don’t really know how to prepare it, so we never buy pork. We rotate in an additional meat option (chicken sausage, tilapia, etc.) to break things up. I buy chicken and ground beef in bulk and freeze it.
We look at our work schedules to see who will be home when, and then whoever gets home first that day typically makes dinner. I make dinner approximately three days per week, John three days, and we either go out or make a meal together. We write down our dinner list for the week along with who will be preparing it and put it on the fridge.
All of these are linked to the actual recipes on various sites! I try to use natural or organic ingredients when possible (IE for the ketchup in the meatloaf, we use organic).
Monday:Honey-baked chicken I use 2 teaspoons of curry powder, 5 tablespoons melted butter, and 2/3 cup honey), brown rice (just follow directions on bag, I make 1 cup for the two of us and have leftovers), sautéed peppers
Tuesday:Chicken tortilla soup (crock-pot meal!) I chop up fresh tomatoes instead of canned because the BPA (from the canned diced tomatoes that the recipe calls for) leaches out into the food from the can, and because tomatoes are highly acidic it is worse than other canned items. Depending on the size, I’ll get 5-6 smaller tomatoes and add a cup or two of water. I add more liquid to make it into more of a soup, but you could use less and put it over rice.
Wednesday:Mexican Pile-Ups. This one is super easy. Just make some ground beef with taco seasoning, cook some rice, and get some Fritos (or some other crunchy yummy chip), and grab your favorite taco toppings. I put rice on my plate, top with ground beef, lettuce, tomato (or salsa!), avocado, sour cream, cheese, and put chips on top. DELICIOUS. Easy to prepare (basically just making meat and rice) and everyone can customize their own.
Thursday:Tilapia fish tacos. Really, it’s just sautéing some tilapia and using a fork to break it up and putting your fav taco stuff on top.. or you can make the awesome slaw in this recipe! Super easy. I watch sales and try to get some wild-caught tilapia for a good price.
I like to take leftovers to work for lunch, so when cleaning up I just throw the leftovers into my glass Pyrex lunch containers.
If I know both of us will be busy the next day and am able to do some meal prep the night or morning before, I make sure to do so.
I really enjoy trying new recipes, so if on Saturday I see that I have some more time during one of the days I’ll check Pinterest for a new recipe to try and make sure I put any additional ingredients I’ll need to purchase on my grocery list.