Both ICU (Intensive Care Unit) nurses and ER/ED (Emergency Room/Emergency Department) nurses work very fast-paced jobs that require them to think quickly and experience patients that have very serious diagnosis’.
Differences Between ICU and ER Nursing
While there are a few similarities between the two, there are a lot more differences. Before you read a bit more about each job, let’s look at the most obvious differences between them.
Different Goals – The goal of the ER nurse is to stabilize and treat the patient and get them where they need to go. This can mean treating them so they go home or stabilizing to admit them to another unit. The goal of the ICU nurse is to give detailed continuous care to critically ill patients.
Patient Load – An ER nurse might see anywhere from 8 – 40 people on a single shift. However, an ICU nurse will typically only oversee 1-3 patients per shift (if they don’t have any transfers/admissions).
Protocols – ER Nurses have lots of standard algorithms and protocols they must follow for patients who walk through the door. These include things like chest pain, abdominal pain, stroke, etc. And while an ICU nurse does have protocols to follow, they are different and not as frequent.
Critical Patients – While critically injured or sick people do arrive at the ER, that isn’t all that come in. ER/ED nurses experience a wide variety of acuity levels – from minor injuries to life-threatening ones. An ICU nurse only manages critical patients.
These are the major differences between ICU nurses and ER nurses. Now that you understand how they are different, how do you decide where you want to work?
Let’s look at each one individually and discover what they do and what their regular responsibilities are.
An ICU nurse has specific roles and responsibilities during each shift. I explained this job in detail in my post “What do ICU Nurses Do?” It’s a really in-depth look at what a normal shift is like for this job, from beginning to end.
To sum it up, a critical care nurse works in the Intensive Care Unit (also referred to as the Critical Care Unit). This nurse provides nursing care to critically ill patients. They are responsible for direct bedside care, monitoring, and responding to changes in condition.
In addition to that, this nurse is also responsible for communicating with providers and other healthcare team members, as well as families about their loved one and the patient themselves.
In fact, communication with everyone can be trying and difficult. An ICU nurse explains complex medical conditions to laypeople, many of whom have little experience or previous understanding of healthcare.
ICU Nurse Responsibilities
There are some responsibilities that are specific to ICU nurses.
The responsibilities of an ICU nurse include:
Monitor the patient’s condition, which becomes very complex as patients become more unstable
Oversee and provide care to the patient
Communicate with the patient and family and provide support them
Assess the patient’s and their response to treatment, suggesting changes as necessary
Use high-tech equipment to provide quality care for the patient
Stay educated on the latest evidence
Document appropriately
Also, ICU nurses are typically specifically caring for one patient population. This could mean all adults (a general ICU), or neuro patients (neuro ICU), patients recovering from organ transplants (transplant ICU), cardiac issues (cardiac ICU or coronary care unit), pediatrics (pediatric intensive care or PICU), and more.
What Does an ER Nurse Do?
If you have ever wondered what a typical shift looks like for an ER Nurse, take a look at what does an ER nurse do. It shows you what a typical shift is like.
It all starts with assessments. They have to assess patients quickly and accurately. During this process, they have to make some tough decisions, such as which patients need to be seen sooner than others.
This job is all about focused assessments, stabilizing the patients, and sending them where they need to be. Also, effective communication with providers while working elbow-to-elbow with them is paramount. Quickly identifying an issue and rapidly implementing a plan of care requires effective teamwork.
ER Nurse Responsibilities
ER Nurses have a long list of responsibilities. As varied as this job is, these are the main responsibilities:
Triage – assess and decide which patients will be seen first and in which order
Take vital signs and complete focused assessments
Administer medications
Emergent life-saving measures like assisting with rapid sequence intubations, cardiopulmonary resuscitation, and more
Provide medical treatment
Monitor patients
Charting – take full histories of patients so the physicians can diagnose them easier and accurately.
Educate patients and family members – help them understand the importance of the doctor’s orders and repercussions of not following them.
Discharge – send patients on their way after they are treated
Communicate with providers, colleagues, and patients
Transfer – getting patients safely admitted to a nursing unit for further care and evaluation
One of the biggest differences between ER and ICU is the patient population. Unless the hospital you work at has a specific emergency department for kids, most ER nurses must be able to care for patients of all ages (from birth to geriatrics), while ICU nurses have a more specific patient population under their care.
Fast-Paced and Critical Nursing
Both ER nurses and ICU nurses work in stressful environments that will tax them and require quick-thinking and problem-solving skills.
Deciding which to be is a tough decision. Think about how many patients you’d like to see on a given shift. Also, consider your comfort level with medical technology and communicating with physicians and family members.
The best place to go for information about these jobs is directly from the nurse. Find a mentor who can give you real-life advice and tips for how to prepare for a job in this field.
More resources for those interested in ICU or the ER:
Is it possible for a new nurse to work in the ICU? Yes, but it is the exception and not the rule. I want to encourage all new nurses and nurse grads – if your goal is to work in the Intensive Care Unit (ICU), that it might be possible right away, but it’s not easy and not for everyone.
Let’s look at what an ICU nurse is, and dig a little deeper into the challenges new grads face when they are trying to get a job as an ICU nurse.
What does an ICU Nurse do?
The very first thing you need is a real understanding of what an ICU nurse is and the responsibilities of this job. I explained this job in detail in my post “What do ICU Nurses Do?”
It’s a really in-depth look at what a normal shift is like for this job, from beginning to end.
Basically, a critical care nurse works in the Intensive Care Unit (also referred to as the Critical Care Unit). This person provides nursing care to critically ill patients. You are responsible for the direct bedside care, monitoring, and responding to changes in condition.
And there’s more to this job than just that. You are also communicating with providers and other healthcare team members, as well as families about their loved one and the patient themselves.
This communication can be stressful and tough. You will have to explain complex medical conditions to laypeople, many of whom have little experience or previous understanding of healthcare.
ICU Nurse Responsibilities
As opposed to floor nurses, ICU nurses normally only care for one or two patients since they require almost constant care.
The responsibilities of an ICU nurse include:
Monitor the patient’s condition, which becomes very complex as patients become more unstable
Oversee and provide care to the patient
Communicate with the patient and family and provide support them
Assess the patient’s and their response to treatment, suggesting changes as necessary
Use high-tech equipment to provide quality care for the patient
Stay educated on the latest evidence
Document appropriately
Can A New Nurse Get a Job in the ICU?
Now that you know what an ICU nurse is and what that job requires of you, do you still want it as your first job right out of school?
If so, keep in mind that getting this job right away is going to be really difficult. It is one of the hardest jobs to obtain and even more difficult for new nurses.
Yes, it is absolutely possible, but getting this job can feel as life-consuming and challenging as the job itself.
Why Is Getting A Job in the ICU So Difficult?
Yes, becoming an ICU nurse is a very selective process. The hiring managers have to be selective and choosy. There are a lot of reasons that this is a competitive job and tough to land.
First, this job requires a lot mentally from nurses. So people that are hiring to fill it must make the process rigid and difficult to pass, especially for new grads.
Another reason it’s tough to get is that the training is so costly. There are so many high-tech pieces of equipment and lots of critical situations for which to train. They don’t want to invest all of this money and time into someone that isn’t ready mentally or emotionally for it.
The ICU is the Deep End of the Pool
I like to compare learning how to become a nurse to learning how to swim. And the ICU is the deep end.
First, you start out in nursing school, which is the kiddie pool. It’s safe and you have lots of support.
Then, med-surg is a bit more difficult but still manageable. This is comparable to the 3-foot area. Patients are typically stable, and while it still is very challenging, you can still put your feet on the floor and touch the ground.
But then critical care is the deep end of the pool. And when you try to get this job right out of nursing school, it’s as if you are jumping from the kiddie pool into the deep end.
You’re learning how to swim while trying not to drown. For some, they can pull it together and learn how to tread and keep their head above water. But for most (myself included), they need some time in the shallow end before heading out into deeper water.
It Is Possible for New Nurses to Work in ICU
After reading all of this, do you still want to go for ICU as your first job? If so, that’s awesome! It’s going to be exhausting and challenging and push you to your limit.
Here are a few tips that will help you get that ICU nurseICU nurse job:
Nail the interview – I have a guide just for you. It explains how to ace the interview and what things will set you apart from the competition.
Bring glowing references – While you are in school, network and make connections. Their recommendations will speak volumes.
Job shadow – Ask ICU nurses if you can shadow them on your day off. Then use this experience in your interview.
Once you land the job, get ready! Life will be quite hectic and centered around becoming acclimated to your new role. You’ll need to study at home about disease processes, meds, labs, diagnostics, and more so that while you’re at the bedside you’re focused on practical preparedness.
Chat with your loved ones about your orientation time, as it will be very draining both mentally and physically. You will need support and grace from your loved ones as you navigate this new challenge. If possible, find a mentor who is also a critical care nurse. They can provide valuable perspective and support that you preceptor (even if they’re awesome!) won’t be able to do while training you.
What to do if ICU isn’t for you?
This happens. A new nurse is super excited and works really hard and gets the job in ICU. But after awhile discovers this isn’t the right job for him or her. When I was working in critical care, for every 10 that started, only about 3-4 made it through orientation and stayed long-term.
If you go home and realize it is draining you too much and you don’t think you can be your best in the ICU, then tell someone. It’s admirable to ask to be reassigned to a different unit or floor rather than suddenly quit. Then you can work hard and maybe even try to apply for that job again someday.
It’s better to know your limits and find a job that uses your strengths than to keep working in a place that is either over your head or so difficult that you don’t have enough to give. Management doesn’t want you miserable.
There is a place for everyone and a job for you. It’s ok to realize that maybe you have some more areas to grow in or perhaps this is just not a place you enjoy working. You’ll be a better and stronger nurse when you work in a place that utilizes your strengths the most.
Discover everything you need to know to become an Intensive Care (ICU), nurse. From the interview to the job, this is your complete guide.
What is an ICU Nurse?
Before you apply to work as an ICU nurse, it’s important to understand what they do. In my post, “What do ICU Nurses Do?” I explained their responsibilities and duties. It’s worth a look. You’ll be able to see what a normal shift is like from beginning to end.
A critical care nurse works in the Intensive Care Unit (also referred to as like the Critical Care Unit). This person will provide nursing care to critically ill patients. You are responsible for the direct bedside care, monitoring, and responding to changes in condition.
You are also communicating with providers and other healthcare team members, as well as families about their loved one and the patient themselves. This can become quite tricky, as you are trying to explain complex medical conditions to laypeople, many of whom have little experience or previous understanding of healthcare.
ICU Nurse Responsibilities
ICU nurses normally only care for one or two patients since they require almost constant care. The responsibilities of an ICU nurse include:
Monitor the patient’s condition, which becomes very complex as patients become more unstable
Oversee and provide care to the patient
Communicate with the patient and family and provide support them
Assess the patient’s and their response to treatment, suggesting changes as necessary
Use high-tech equipment to provide quality care for the patient
Stay educated on the latest evidence
Document appropriately
How To Become an ICU Nurse When You are a New Nurse
Let’s look at some tips that will help you become an ICU Nurse. It’s one of the most difficult jobs to obtain and even more difficult for new nurses.
Becoming an ICU Nurse Right Out of School is Tough
Please understand, becoming an ICU nurse is a very selective process. This job requires so much mentally from nurses that the entire hiring process is rigid and difficult to pass, especially for new grads. In fact, to get a job in the ICU right after graduating from nursing school is the exception and not the rule.
If you want to get a job in the ICU as a new nurse, there are a few things you can do to prepare and give you a competitive edge. But the best thing you can do is give yourself time to grow professionally and personally.
Becoming a Nurse is Like Learning to Swim
I like to compare learning how to become a nurse to learning how to swim.
Nursing school is like learning how to swim in the kiddie pool. Jumping into the 3-foot area is like jumping into med-surg. Patients are typically stable, and while it still is very challenging, you can still put your feet on the floor and touch the ground.
Starting in critical care right out of school is like jumping from the kiddie pool into the deep end. You’re learning how to swim while trying not to drown. For some, they can pull it together and learn how to tread and keep their head above water. But for most (myself included), they need some time in the shallow end before heading out into deeper water.
How to Land a Job as an ICU Nurse
Now that you understand how difficult it is, if you are still wanting to apply, here are some tips that will help you nail the interview. While these tips won’t necessarily get you the job, they will set you apart from the rest of the applicants and make you that much more hirable.
1. Show Your Experience – Even as a New Nurse
The very first step is to graduate from an accredited nursing school, pass the NCLEX®, and get your nursing license from the state board of nursing you wish to practice in . This is the minimum expectation and you must be a registered nurse to work as a nurse in ICU.
Experience always speaks volumes on a resume and in the interview. But how do you show experience when you are a new graduate?
While you are in school, try to get as much critical care experience as possible . This can look like ensuring you get into critical care units during clinical rotations or selecting this environment for a senior year internship. t’s also a good idea to network during clinicals by building rapport with the nurses on the unit and any leaders you work with . The more you can get people to vouch for you and say, “Oh, I remember Sarah – she was a great student to have. I’d definitely love to work with her!” – those are the kind of references you want!
You can also gain experience by becoming a CNA and working in an ICU during school . This shows that you want to get some good experience in the environment and also demonstrates that you’ve seen how difficult working in critical care is, yet you still desire to work in that unit. It is very helpful to the hiring team if they know that you’re aware of what it’s really like.
If you can’t be a CNA in ICU, try to volunteer at a hospital and get into the ICU . If you can show any kind of familiarity with the environment, it will help you stand out.
Keep in mind that nothing can replace floor experience as a nurse. You can figure out how to be a nurse first without being responsible for patients who are unstable and need constant interventions.
If you do decide to work on a nursing floor first, make sure to keep track of your accomplishments on the floor. You’ll want to highlight any times that you worked in stressful situations and how you handled yourself.
Success and professional development while in the med-surg environment is looked at positively. Your experience is a vital component that could help you become hired.
2. ACLS Training
You will also need Advanced Cardiac Life Support, ACLS certification as a critical care nurse. If you are thinking about applying to work in the ICU, be proactive and obtain this certification. When you include this on your resume, you will stand out from the rest of the competition.
This is not required to land the ICU job. But if you already have it on your resume, you will be even more hirable.
This organization will provide you with exceptional support and education. Plus, it will make you stand out among the other applicants and show your dedication to the field. They publish journals regularly, and if you mention a recent interesting article or finding published by the AACN in the interview, that looks really awesome and like you’re in the know.
After two years of working at the bedside in critical care, you can obtain your CCRN certification. You can mention that this would be a professional goal of yours as you grow in your role as a critical care nurse.
Medications – anticoagulants, antiplatelets, dysrhythmics, vasoactive medications, and more!
ACLS tidbits
Specifics for the emergency department, ICU, and cardiac nursing floor
If you’re able to include professional development activities on your resume and speak to them in the interview, it looks awesome and like you care about becoming the best nurse you can be. It shows that they don’t have to motivate you to grow in your profession; that you already care enough about improving that you’ll seek out opportunities independently.
ICU Nurse Interview Tips
Now that you know what an ICU Nurse does and how to become one, let’s talk about the interview. This is probably one of the most important pieces of the puzzle. If you want to become a critical care nurse, you’ll have to ace the interview, and this is how you do it.
The most important thing is to realize the challenge that’s ahead of you. Do not take it lightly. You must be willing to do what’s necessary to be successful in the role. Once you understand this, you just have to express it in the interview.
1. Highlight Your Experience
Working in the Intensive Care Unit is a huge learning curve. You’ll have to provide concrete examples of how you grasp new concepts quickly. Are you able to pick up on new charting systems fast? Or learning pharmacology, pathophysiology, or even picking up on personalities and reading the emotional climate of a situation well?
It’s also helpful to reference any experiences with death and dying, navigating tough situations with families, and various intensive care equipment like arterial lines, central venous catheters, continuous renal replacement therapy, ventilators, extraventricular drains, and so forth.
The more you can speak to specific examples of your experience in critical care, the better.
2. Express How You React Under Pressure
Next, the ICU is a very difficult and fast-paced place to work. Discuss with your interviewer other times that you thrived under pressure and kept up with a nonstop shift.
This is a fantastic time to bring up any praise you’ve received from management about your ability to keep up with a busy, nonstop floor.
You’ll need to prove that you can keep your cool and maintain emotional composure during times of stress.
3. Highlight Your Experience with Technology
Finally, express your comfort levels with new machines and equipment. Someday you could be working with very high-tech and sensitive equipment. You’ll need to communicate your desire to stay educated about new pieces of equipment, which means you’re aware that you’ll be coming in for training on your days off to stay up to speed.
Critical care nurses must use high-tech equipment that evolves rapidly. There are updates to new IV pumps, new charting requirements, new devices to monitor various patient data, and more. Expressing your willingness to learn as well as your awareness of this aspect of the job will look great.
If you have praise from a nurse you worked with or clinical instructor about your ability to master equipment without issues, bring it to the interview. That will make a huge difference.
4. Highlight Your Experiences in the ICU
Express to the interviewers that you understand the reality of the ICU. It will help if you can describe your experiences working it – whether that was as a volunteer, CNA, or a student.
Hiring managers need to know you understand the seriousness of the job and how challenging it is – that you’re not romanticizing the role and will have reality shock and bail once you see what it’s really like.
5. Do Practice Interviews
Finally, interviews can be nerve-wracking for anyone, especially if you are fresh out of school and don’t have much experience with them.
Ask a seasoned nurse or a hiring manager that you know if they can sit down with you and do a mock interview. Glean as many tips and suggestions from them that you can. You’ll be able to learn how to present yourself confidently and with poise.
Another super beneficial course is my FreshRN ® Resumes and Interviews online course. It’s affordable and will show you common habits people have in interviews and how to overcome them so you stand out. A Director of Clinical Education and I discuss top tips for interviews, what to say and what not to say, as well as do mock interviews highlighting a good, bad, and mediocre interview. Click here to learn more.
Remember Why You Want to Be a Critical Care Nurse
This is a very difficult job to attain. Don’t let a “we chose someone else” response keep you from trying again. Use it as motivation to keep training, keep learning, and become a stronger candidate next time.
I know many who tried ICU right away and it was too much, so they did med surg for a bit and then tried again and were successful. So if you are hoping to get this job, it might be wise to ease into it by working on the med surg floor first.
Any job you obtain as a new nurse can prepare you for a future job in the ICU. Get as much out of any other job you do land as possible. Network. Build connections.
You can be successful in ICU out of school, it just takes a lot of work. You have to be at the top of your game while at work, and doing homework to better understand the patient population and pathophysiology at home. Use the FreshRN Cardiac Nurse Crash Course or Neuro Crash Course to expedite this learning.
Many hospitals, healthcare organizations, and nursing schools all across the country have begun using Becoming Nursey: From Code Blues to Code Browns, How to Care For Your Patients and Yourself to support their students and new graduates as they transition to practice. With over 25K sold since its original publishing in 2014, it has become a popular book in the new grad nurses scene. But what are some ways individuals and organizations alike have used this text?
A parting gift from nursing school
Nursing schools like Parkland College in Champaign, IL decided to hand out signed copies Becoming Nursey to their graduates as they walked across the stage. The University of Chicago (Urbana Campus) gave a copy to each of their graduates after the pinning ceremony. Another option is to provide it the last week of classes.
A welcome gift from the hospital
Hospitals have purchased this gift to welcome newbies, having it sitting at their seats upon arrival of the first day of orientation. Also, individual nurse managers have purchased copies for their new grads to present to them as they join the floor for their first shift. Some have even highlighted certain quotes and phrases, or inscribed the book to them with words of encouragement.
As a residency program text
Some organizations have even used Becoming Nursey as a text to support the residency curriculum. Novant Health Presbyterian Medical Center in Charlotte, NC gives a copy of the second edition to each resident and they discuss a chapter each week.
Each chapter begins after nursing school, are quick reads that are easily digestible. Topics include time management, delegation, code blues, working with physicians, assessment tips, and more. New grads can read the chapter at home and connect it with their experiences at the bedside. During the weekly residency meeting, approximately 30 minutes of discussion time can be centered around the text and the experiences the new graduates have had that align.
A book club
Similarly to the residency program, another option is to use it as a book club book. Don’t have a book club on your unit yet? Get one rolling! Meet monthly away from the hospital and it functions as a team building activity. While the book is a quick read, the topics are dense. The conversation would easily cover two to three book club meetings.
First meeting discussion questions:
Did your expectations meet up with what it was actually like to start on the floor?
How do you feel about how your education lined up with what you needed to know?
How’s time management going? What’s working for you? What have you tried that didn’t go so hot?
Have you had any really positive or really negative experiences with delegation? How did it go?
What’s your process with completing assessments, passing meds, and documenting?
Second meeting discussion questions:
How are relationships going with your providers? Who has been awesome, and who scares you? Why do they scare you?
What is one positive interaction you’ve had, and what was a negative one?
Have you had instances in which you were really proud of yourself (no matter how small)? Tell me about them.
What did you learn the hard way?
Third meeting questions
Tell me about a mistake you’ve made.
Who is your go-to on your unit? Why?
Think of who isn’t someone you feel comfortable talking to. Why do you think you feel that way?
Have you had a patient code, die, or rapidly deteriorate? Tell me about what happened.
From preceptor to preceptee
Because the book is so affordable ($12.99 for print), some preceptors even buy copies for new nurses they precept. Bryant Roberts, RN writes a note of encouragement for each orientee he has.
Get your copy of Becoming Nursey
Becoming Nursey is available on Amazon, with Amazon Prime shipping in both print and e-book versions. Bulk discounts are available if more than 20 copies are purchased. Send the FreshRN® team an email at [email protected] to learn more and get an estimate.
If you love Becoming Nursey, but want more check out Anatomy of a Super Nurse: The Ultimate Guide to Becoming Nursey. It is the second edition of the book, published in 2017 by the American Nurses Association. It’s twice as long and expands on each chapter, and even contains an interview with a physician about the nurse to provider communication, as well as talking points for tough situations. For bulk orders, contact the American Nurses Association directly at [email protected].
Interested in using it as a residency text?
Check out the New Nurse Master Class, available August 1, 2019! Before making a wholesale inquiry, consider the 70+ module online course inspired by Becoming Nursey! The course is designed to last 12 weeks, with four hours allotted each week to complete modules. Lectures include interviews with a residency director, physical therapist, provider, and counselor. There is a heavy focus on skills that are tough to perfect at the bedside like self-care, assertiveness, and confidence building.
Clickherehere to check out the curriculum. Email the team at [email protected] for information on bulk enrollments and the educator package!
Happy Nurses week to all my favorite nurses. After the success of last years giveaway, we are back with the 2019 Nurses Week Giveaway and Freebies. Be sure to check out all the great freebies you can score and enter to win one of these amazing giveaways.
If you need Ideas for Nurses Week it is not too late to do something special for those nurses in your life.
Now on to this year’s goodies:
2019 Nurses Week Giveaway and Freebies!
This list will be updated with more freebies and discounts as we get closer to the start of nurses week.
It’s been a couple of years since Chipotle offered a Nurses Week Freebie. But at participating Chipotle’s, every Wednesday is the medical professional day with BOGO 50% OFF!
Disney loves their nurses. They are offering discounts to nurses at the Swan and Dolphins resorts. Be sure to also mention you are a nurse and use promo code DREAMS!
What was the best Nurses Week gift you ever got? Far too many nurses see the entire week go by with not even a thank you. We want to change that with this amazing giveaway. Check out what you can win.
HeathcareWings is a database of over 100,000 healthcare jobs that adds 2,000 postings each day. They hold recruiters to account with a code of values and allows you to rate recruiters’ conduct and professionalism. You can see recruiters ratings before you decide to go with them.
The platform empowers you to find your dream job in a heartbeat! You can actively search within your specialty, desired location, and interests, or sit back and enjoy customized matches and tailored job alerts. Once you’ve joined, you stay in control of your visibility and can pause your profile whenever you want.
Enter to win one of two awesome HealthcareWings mugs with Starbucks coffee cards inside.
Beyond the Scrubs offers fun ID badge reels, stethoscope tags, and keychains to show your personality. They even have great subscription clubs for customers to receive personalized toppers each month.
Since medical professionals are limited to wearing the same plain colored scrubs every day, they saw badge reels as an opportunity for nurses and other medical professionals to show their more personal side. They offer badge reels that allow you to show off things that make you, you. Whether it’s your humorous side or things you are passionate about. You will never get bored choosing which badge reel you are going to be sporting during each day!
3 lucky winners will each receive 1 Reel, 1 Stethoscope tag, and 1 Topper so you can do you!
As a nurse staying up to date on your continuing education is important. But there are often so many options that it can be hard to decide what is the best course of action. This post discusses continuing education for nurses so you can make the best decision for you.
What is Continuing Education?
Continuing Education is exactly how it sounds. It is basically education provided for adults after they have left the formal education system, consisting typically of short or part-time courses.
Most states require nurses to complete some form of continuing education every two to three years as a condition of licensure. Even if your state board does not require any education for continuing competence for renewal, you may still be required by your employer or nursing association for job-specific certifications. So all in all, continuing education for nurses is something you should count on being required.
Online Continuing Education for Nurses
One of my favorite ways to get my CE hours is online. These units allow me to take the hours when they best suit my schedule. I simply follow along with the courses, pass the quiz and evaluation and then print off my certificate. Nothing is easier for getting my CE hours.
Nursing CE is one of the best ways I have found to earn my CE hours. They make getting my hours done a breeze. I am able to filter the continuing education hours by state and my specialty so I can make sure I am taking the exact courses I need to maintain my license. They even have courses geared to individual states. Let’s say I was in Florida, I could take the Florida Laws and Rules course.
Free Continuing Education for Nurses
Nursing CE even has free continuing education courses available. With their free online CNE courses, you can easily and affordably earn credits from anywhere. Simply click on one of the free nursing CE courses, login and you’re on your way to earning your free credits. Once you’ve evaluated the course, print out your certificate and you have your credit hours. It is so simple!
Save on Continuing Education for Nurses
Do you need to get some continuing education hours completed? Nursing CE has a great deal going on right now just for FreshRN readers. Sign up for CE courses and use code FreshRN to save 20% off your total.
More Resources for Continuing Education for Nurses:
I’m a tall woman. At almost 6 feet tall, I often find it challenging to find scrub tops that fit correctly. And I know I am not alone in this. So I decided to put together a list of the best tall scrubs for women. I’ve already shared my Nurse Gear post but I wanted to focus on just tall scrubs for women in this post.
Hands down, my favorite scrub tops is Figs. Their One-Pocket Scrub top is stylish, fitted, and I don’t have to wear a shirt under it. It moves with me while still covering everything that needs to be covered. I also feel like I look pretty fly in them, NBD. However, they’re not cheap. I do believe are worth the investment. I highly recommend getting on their email list because they frequently email out discount codes. They also have a student program, where you get 20% off. These are lean and longer than others.
Comfy scrubs that actually fit well? Yes, please. Tried out Jockey Scrubs and I am impressed! I’m kind of big on having scrubs that fit me well because I think that looks professional. Too tight and it’s inappropriate, too loose and it’s sloppy. These Jockey Scrubs hit that balance perfectly. I didn’t even need an undershirt because the top was long, yet form-fitting enough for me. Score. This might be the longest and slimmest scrub top listed, although Figs is close.
Cherokee Infinity is my third choice for scrubs for tall women. They fit well and move with me. I do like to add an undershirt but that is not because I need it. I find they get really hot when you run around. I had a few shifts where we had codes and I was sweating and running around and noticed at the end of the day that my skin was irritated. I feel like I look great in them, but I realized I am not a huge dry fit fan for 12-hours. The undershirt helps to avoid any skin irritation.
I’ve worn Grey’s quite a bit in the past and they’re in my regular rotation. They’re by far the softest and snuggliest. However, if you sweat in them they get a bit heavy. I’ve had to get a size larger than usual in the tops just so they fit my longer torso, and because of that, they’re not as form fitting. They’re available at a ton of places, even the tall pants. The Grey’s do have a slightly higher price-point. I have a long torso, therefore the tops are a little short on me and I need to wear a tank top underneath. They can be kind of heavy.
Happy Nurses week to all my favorite nurses. After the success of last years giveaway, we are back with Nurses Week 2018 Freebies and Giveaway. Be sure to check out all the great freebies you can score and enter to win one of these amazing giveaways.
If you need Ideas for Nurses Week it is not too late to do something special for those nurses in your life.
Now on to this years goodies:
Nurses Week 2018 Freebies and Giveaway!
This list will be updated with more freebies and discounts as we get closer to the start of nurses week.
Discounts
Disney World
Disney loves their nurses. They are offering discounts to nurses at the Swan and Dolphins resorts. Be sure to also mention you are a nurse and use promo code DREAMS!
SocksLane
Save 25% on all orders through May 30th. Use promo code 25NURSESWEEK.
Nurses can take 35% off their purchases with license verification.
Puckett’s Restaurant & Grocery
If you’re a nurse and live in the Chattanooga area, Puckett’s will be honoring nurses with Nurse Breakfasts, starting on May 7th, for a discounted price.
NursingCE
25% off all of the CE hours on NursingCE.com – Normally, users would get 40+ CE hours with a one-time payment of just $39 but with this sale they can get all of these CE hours for less than $30. Enter coupon code NURSES at checkout to get 25% off. Sale ends this Saturday, May 12 at 11:59PM PST.
This year the title of the free webinar from the ANA is 2018 National Nurses Week Webinar: Emerging Technology and Its Impact on Nursing Practice. All nurses who pre-register and attend will receive one continuing education credit.
On June 5, with a work ID, nurses get a buy-one-get-one free on burritos, bowls, salads and orders of tacos.
Cinnabon
Cinnabon is a proud supporter of the Daisy Foundation. From May 6-12, show your name badge and get a free classic cinnamon roll, MiniBon, or four-piece BonBites.
DrFirst is giving away 1 pair of Dansko or Merrell shoes each week in May.
Johnson & Johnson
CE webinar: The recorded presentation “Substance Abuse and Women” will provide information about the unique substance abuse risk factors for women. Host Susanne J. Pavlovich-Danis, MSN, RN, ARNP-C, CDE, CRRN, will discuss reproductive concerns and other issues.
CE course:“Knocking Out Pain Safely with PCA” focuses on patient-controlled analgesia risks and how nurses can ensure patients are protected from medication errors and will receive adequate pain control.
The Nerdy Nurse, Nurses Week Giveaway. Enter to win a MDF Rosegold stethoscope, iPad and more.
Best Nursing Degree is allowing you to nominate a nurse. Then they will giveaway $300 in Visa gift cards to Inspiring, Innovative and Influential nurses who are nominated in the different categories.
Medical Solutions Nurses Week giveaway. Win one of 50 prizes like Amazon gift cards, cash, and more.
NursingCE is giving away 5 MDF MD One Stethoscopes (color will vary, approximate value is $90 per prize/person).
NurseWatches.com is a designer and retailer of fashionable and functional watches and accessories for nurses. They strive to provide customers with the latest styles and products at competitive prices. And get free shipping during nurses week with promo code NW18FREESHIP.
Two winners will receive their choice of watch from NurseWatches.com
Every so often a new product comes along that I get super excited about. Steth IO is one such product. Steth IO is dedicated to building technology to improve patient experience and outcomes. Our smartphone stethoscope uses the ubiquity of mobile phones with the power of machine learning to make the heart and lung exams more objective. Unlike traditional stethoscopes or expensive alternatives like echocardiograms, our product allows physicians to hear, visualize, and analyze heart and lung sounds for improved diagnoses.
Two nurses will win a Steth IO. *Must have an iPhone to use.
The Nurse’s Guide to Blogging was engineered for any nurse who is interested in blogging. It addresses many of the issues unique to the nursing profession including patient privacy, upholding the integrity of the profession, and understanding your unique value. If you’re a nurse and want to blog, this book is for you
Being a travel nurse is not easy. It is not for everyone. You move around a lot, have a harder time forming real relationships, and you may not always know what you are walking into. Recruiters can be helpful but how do you really know if they are just trying to make commission or if they are really trying to place you in the perfect spot? Wanderly helps take all the guesswork out of being a travel nurse. Wanderly sets themselves apart by allowing you to:
Search and compare fully detailed pay packages from leading agencies
Chat anonymously with recruiters and keep their information hidden until they’re ready to accept a job
Fill out a one-time application and use it for all jobs
Now let’s look at a day in the life of a travel nurse and see how Wanderly can help make it smoother.
Wake up: wait…where am I?
It’s your first day in a new assignment…new city, new climate, new time zone.
It’s important to give yourself a few days to settle into your new, temporary home. Who knows what hiccups you may experience (car trouble, for example). You should have some familiarity on how to get to your new job location and know the traffic patterns. Also, getting used to any time changes can be challenging so having some extra days to get acclimated will make a difference.
Get ready for work
Make sure you have your orientation paperwork ready for you first day. Make extra copies of licenses, certification, even TB and vaccine records. You never know when things will get lost in the shuffle. Get your uniform ready the day before, ensuring to consider any scrub color requirements. This will make day 1 at the hospital much less hectic and anxiety-ridden.
How do I find my way around?
Your Wanderly recruiter will have provided you with directions, a map of the hospital campus, and where you should be on your first day of orientation. Once again, it doesn’t hurt to go on a scavenger hunt the day before you start to learn your way to and from work…and also to know where orientation will begin. Sometimes, hospital orientation is not even on the hospital campus. It could be somewhere else! You don’t want to realize this 5 minutes before you show up. It will also be helpful to be provided with directions on how to get to your unit. If you can, take a moment during hospital orientation to navigate around the hospital and learn where your unit is located.
As a traveler, this is the truth. That’s why it is so important to have experience under your belt before you decide to travel. You need to be efficient and knowledgeable as a travel nurse because your orientation will be short. You need to have exposure to the disease processes that you will be caring for in your unit. Your Wanderly Recruiter will make sure you are the right fit for the job, not just throw you into one to fill a quota. Plus they are able to answer specific questions about your assignment so you don’t feel like you are walking into any major surprises.
During your brief unit orientation, you need to have lots of practice with the equipment including IV pumps, the electronic medical record, and documentation. You should learn how to look up policies and procedures. Learn how to look up providers and know how to get in touch with them for both routine and urgent needs. You know how to take care of patients but you need to know what the unit norms are in order to manage your day. Write down any questions that you think of along the way- even after your orientation. It’s important that you have any questions/concerns addressed as early as possible.
Meeting my new coworkers
More than likely, your nurse colleagues are going to be so happy to have you with them. Most travel nurses are going to work in units where the patient census is high and staffing is short. Meaning, you are going where you are really needed!
Be friendly. Introduce yourself- even to the physicians and providers. Let them know you are a traveler. Talk to fellow travel nurses- they may know the ropes a little more than you do. Ask your coworkers about popular places to eat, sightsee, visit. Most people are enthusiastic about telling people about their town. If you do come across a few negative nurses, do not take it personally. It’s important to still try and be positive. There will be some coworkers who will just be difficult. It may be helpful to just let them be. You will learn who your reliable team members are. Surround yourself with them as much as possible. Also, remember that your assignment is only temporary. If you run into any major problems, you can know that Wanderly is there to help you on assignment.
Trust your instincts
If you travel long enough, it is inevitable that you will come across a travel assignment where you find you are not treated fairly. You may be consistently assigned a patient ratio that is more than what other nurses have to take. You may be consistently given the sickest, highest acuity patients on the unit. You may find that the practices and culture in the hospital are unsafe. You will know, in your gut, when things are wrong. If you are concerned about your patient assignments and the safety of your patients, you need to speak up. Follow proper chain of command; go to your charge nurse or the nurse manager. If you feel uncomfortable with this, talk to your Wanderly nurse recruiter. Their job is to support you and they are there to have those crucial conversations if need be. This is your nursing license that you need to protect and it is ultimately up to you to speak up if you have concerns.
Make this experience an adventure
One of the reasons to chose travel nursing is you have an opportunity to get out and see the country! Wanderly shows you pay packages and benefits from leading agencies, so you can compare and choose what works best for you. Wherever your assignments take you, get out and explore the area you are living in. Learn the history, the culture, and the people who live in the area. Make the most of your days off! Talk to your colleagues about interesting places to go and things to do. This is also a great way to build a connection with your colleagues.
If the opportunity presents itself, travel with a friend. It can ease some of the anxiety and stress of traveling to a new place when you are not alone. Also, keep an open mind to learn about new practices or protocols while you are at work. You never know what ground-breaking research may be underway at your facility. Keep your eyes open and don’t be afraid to step out of your comfort zone.
Finishing your assignment
It seems as if you just started yesterday and before you know it, your assignment contract is coming to an end. If you are being offered an extension of your contract, your nurse recruiter or the nurse manager will let you know. After this, it is up to you to decide. If you decide to move on, it is important to leave on a good note. Thank your team members who helped you to feel welcome and appreciated, especially the nurse manager. You never know who you may work with in the future.
Leaving a lasting and good impression will keep opportunities open. Make sure you give yourself ample time in between assignments. Also, check with your recruiter to verify who is responsible for taking care of housing needs (ie, cancelling cable, power, etc). Make sure you are not leaving your housing a mess. Don’t be mean: leave it clean! Wanderly will even help you find furnished housing for your stay!
Start your first assignment
If you’d like to embark on your first travel assignment, check out Wanderly. Compare pay packages and benefits from agencies anonymously, fill out one application and skills checklist and then apply to as many jobs as you’d like. It’s a lot more efficient than filling out one for each and reaching out to different agencies individually. Wanderly is proud to offer affordable health, vision and dental insurance that travels with you from one assignment to the next regardless of switching agencies!
Being an ICU nurse sounds like a pretty cool job, doesn’t it? Really, any job with the word “intense” in the title sounds… well, intensely awesome. I’m here to dispel any doubt and inform you that yes, ICU nursing is pretty legit.
While it sounds cool, many are not aware of what ICU nurses actually do during a typical 12-hour shift.
From 2012-2016 I worked in a neurocritical care unit, and floated to the intensive care unit (ICU), cardiac intensive care, and step-down/intermediate care unit. I obtained my national critical care certification, and loved working there. Let’s go over how a typical shift in the critical care environment typically flows.
What do ICU Nurses Do?
Before you can take care of your patients, you have to learn about them, meet them and their families, and review their chart. Nurses share this information in a fast-paced discussion called “nursing report”. Let’s dive in!
Starting your shift – report
Report in the ICU takes 30 minutes, however you’re discussing only 2 patients during that time rather than 5-7 like you would in the med surg environment. (Interested in what a med surg nurse does? Check out my previous post on med surg nurses.)
Generally speaking, the information discussed report in an ICU consists of the following:
Name / attending and consulting physicians / Code status / allergies
Precautions like fall, seizure, infection prevention, bleeding, etc.
Chief complain / why they’re in the hospital
Past medical history and current status
For example, “the patient has a history of PAD, CAD, HTN, OSA, DM, hyperlipidemia, GERD, gout. They were admitting on 12/2 after being found down at home unresponsive. They were intubated in the field, started on Levophed, and a head CT showed a large ICH.”
Important events that have happened during the admission with corresponding diagnostics
For example, if they had a decreasing level of consciousness and the CT showed the left paraychamal ischemic stroke has increased in size from 5 cm to 7 cm, or a change in lung sounds and increase in WBC was noted so a chest xray was completed and showed pneumonia in the left lower lobe.
Assessment findings by body system
Neuro: LOC, cranial nerves, if they follow commands, movement and strength of extremities, sedation/pain medications that may impact assessment
Cardiovascular: cardiac rhythm and any changes, blood pressure and/or heart rate limits, drips/PRN meds needed, intravenous access
Pulmonary: breath sounds, O2 sats/respiratory rate, oxygen requirements, ventilator settings/ETT size and location if the patient is intubated, secretion from the oral cavity and via ETT suction catheter noting the color/thickness/frequency of suctioning
Gastrointestinal: how the patient is getting nutrition (oral vs. enteral vs. parenteral), size and location of any feeding tubes and corresponding flushes, type and rate of any tube feedings, or oral diet orders
Integumentary: any skin issues, wounds, or incisions
Genitourinary: how the patient voids, if an internal or external urinary catheter is being used, last bowel movement or if a rectal pouch or tube is required, if output it inadequate, adequate, or excessive
Activity order: strict bed rest vs. up to the chair vs. ambulation, and if therapy (physical/occupational/speech) is ordered
Pertinent and abnormal labs like the latest CMP/BMP, CBC, blood gases and trends
Questions to ask the medical or any other member of the health care team
Any psychosocial / family and support system concerns that may not be reflected in the chart
Important medication considerations
Weaning off vasoactive drips, transitioning to oral medications, electrolyte replacements, blood product administration, PRN meds needed and so forth
Pain management and goals
What are our goals this shift?
For example, getting an MRI, weaning off of a drip, transferring out of the ICU, family care conference, sedation holiday and hopefully an extubation
Another thing I do during this time is verify orders and corresponding alarms. I love my colleagues, but I trust no one when it comes to this! If the previous nurse said the goal is to keep the systolic blood pressure less than 160, but I look in the chart and it says less than 140 – we need to make sure we’re on the same page. Then, I check to make sure the bedside monitor has its alarms set to match the orders. That way, if I’m in my other patient’s room for an hour doing an extensive dressing change, bath, assessment, meds, and tubing changes, I will know if my other patient’s blood pressure is too high or too low because I’ve set my alarms appropriately.
During report, I’m checking to make sure my drips have enough volume in them for a few hours and aren’t going to run dry mid-med pass. I also check when tubing needs to be changed, and if my patients need to be changed.
As the oncoming nurse, you will be receiving all of this information and need to be aware of it throughout your shift. At the end of the day, you will provide it to the night shift.
Here is an example of me giving report to a day shift nurse in a fictional neuro ICU patient:
Once I obtain report on all of my patients, I take a second to analyze which patient is the most unstable this moment. Does someone need a drip titrated? Are vitals within parameters? Is there a time-sensitive medication? Is their arterial line leveled and zeroed appropriately so I know their blood pressure on the bedside monitor is accurate? Does someone need an intervention right now?
ICU patients are not always going to be stable and things change so incredibly quickly; sometimes, it’s moment-to-moment… literally second-to-second. And occasionally, you are receiving report in the midst of a soon-to-be code, or urgent situation. Yes, shift change codes happen. You truly have to be ready to pivot any second.
Now, let’s say my patients are both relatively stable. Once I get report, I sit at a computer to fill in any questions left from report, collect my thoughts, and get my to-do list finalized.
This list includes:
Assessments
A full assessment at least every 4 hours
A more focused assessment more frequently may be required. For example, most neuro patients require a full neuro assessment every 2, if not more frequently or a patient who just received a femoral-popileal graft may require more frequent peripheral vascular checks
My documentation requirements
Telemetry strip, education, care plan
Medications
Are all meds appropriate?
For example, if a patient is on a drip to RAISE their blood pressure, I need to see if they have any scheduled home medications intended to lower blood pressure,hold those, and clarify with the physician if they should be discontinued
If oral meds are due, can they be given orally?
Are the medications safe and necessary given the latest labs and diagnostics?
Vital signs
What are the trends?
Blood sugars
Is the patient on a drip?
Frequency of blood sugar checks, sliding scale insulin, and/or scheduled
Any time-sensitive tasks
Usually, by this time it’s approximately 0800. I am permitted to administered my 0900 medications at 0800 so I’ll grab all meds and supplies for my first patient. I then grab all of my gear(stethoscope, alcohol swabs, saline flushes, brains, Sharpie, pens) and head into my first patient’s room
PS – if you want to see all of my recommended nurse gear from scrubs, to bags, to socks, to water bottles, check out what nurses need.
Assessing my patients
After I get everything I need, I head into my first patient’s room. I say hello to the patient and anyone else in the room and then complete a detailed nursing assessment. I’m looking over every inch of skin, at every piece of equipment (ventilator, enteral feeding pump, IV pumps, arterial line, central venous pressure monitoring, bedside monitor) as well as every tube coming out of the patient (endotracheal, urinary catheter, extraventricular drain, pacing wires, chest tubes, rectal tube, JP drain, arterial line, central venous catheters, IV catheters).
I complete the assessment, check out the equipment, lines, drains, airway, and monitoring, and then give meds. Many ICU patients receive meds through a feeding tube, so it can take some additional time to crush these, mix them appropriately, and flush them down, in additional to any IV push or an IV piggyback medications. Of course, throughout this process I’m watching their vitals and drips closely, to see if they are tolerating their medications.
(Need some time management tips? Check out my book, Anatomy of a Super Nurse for an even more detailed description.)
Throughout this time, I’m talking to the patient and whomever is with them about what I’m doing, why I’m doing it, and what else to expect for the day. Providing any amount of predictiability for intensive care patients and loved ones is very valuable because they have lost all control over everything with their loved ones hospitalized, being taken care of by strangers.
Once I see this patient, I head in to see my other patient and follow the same process. In the med surg world of nursing, I would spend approximately 10 minutes with each patient between the assessment, conversation, medications, education, and documentation. In the ICU, you’re looking at more like 30-45 minutes each.
Constant monitoring and evaluation
ICU patients can change in a matter of moments, therefore it is the ICU nurse’s responsibility to keep a vigilant eye on them. One must know their vital sign and assessment trends to know when they’ve deviated.
Like I said before, instead of assessing a patient once per shift, an ICU nurse must complete a head to toe assessment on the patient typically at least every 4 hours. If changes occur, another one must be completed. If a procedure was performed or the patient went for surgery and came back, then assessments occur more frequently.
The ICU nurse must know their patient backwards and forwards. I’m talking vitals, labs, assessments, meds, history, lines, airway, equipment… everything. It’s crucial to know these things because when things go downhill, you don’t have time to put the clinical picture together in that moment.
You’re constantly asking yourself questions about the patient, whether the goal is to get them more stabilized and figure out what’s going on, or to progress them out of the ICU.
You will find yourself asking…
Can we wean this drip?
Is this patient suffering from ICU delirium, or is this a neuro change?
Should we switch this drip to a different one?
Do we need another CT scan, set of labs, MRI?
Is this medication even working?
Is this patient working harder to breathe?
Should we get another ABG?
Where’s respiratory? [spoiler alert: if you’re an ICU nurse, you’re going to become BFF’s with respiratory therapy]
What are our goals here? Is what we are doing in line with the patient’s advance directives?
Who is the next of kin?
Do we need an arterial line?
Do we need to get a central line?
Do we need to start dialysis?
Can you call respiratory again? I know they were just here 3 minutes ago… but, I need them again 🙂
Physicians round once per day and many times the ICU physicians are housed within the unit for constantly changing needs. However, it is still up to the bedside nurse who is constantly monitoring the patient to update the physician as needs change.
Codes
It’s no surprise that codes happen more frequently in the ICU. ICU nurses quickly become acclimated to those adrenaline-filled scenarios. ICU nurses know when a patient starts to not look so hot that things are about to go down. You become familiar with a code cart, the various roles within the code (chest compressions, meds, considerations, ACLS algorithms, and the person running the code). ICU nurses also know that some people will help with the code, while others have to continue to care for the rest of the unit who is not actively dying.
These happen unexpectedly, so ICU nurses must always try to stay caught up on their tasks because you never know when you, or your coworker, will be dealing with a coding patient for 2 hours. And, should the patient pass, once they have been taken to the funeral home or downstairs to the morgue, you’ll be open for the next admission… which, consequently, could be another code from a nursing floor or the emergency department.
That brings me to my next point: ICU nurses have to be ready to receive any patients who may code out in nursing units or stepdowns. (A patient who codes on a regular med surg floor has to be emergently transferred to an ICU bed once they are ready to move.) Because of this, a bed in the ICU must be ready for this… and it’s typically called “the code bed” because it’s reserved for that unexpected patient.
As you can imagine, documentation for an ICU nurse is incredibly detailed. In addition to all that the med surg nurse must document, you’ve got to document even more in the ICU. Some patients get vitals every 15 minutes (or even more frequently), you’ve got more detailed assessments which occur more often. Some patients change frequently, and these changes must be reflected within the documentation. Also, patients typically have many invasive lines and it is paramount to prevent infection. Therefore, you’ve got to meticulously document what you’ve done to clean and prevent infection, as well as that you’ve reviewed its necessity.
After working on both med surg and the ICU side, I can confidently say that the amount of time it took for me to document on one of my ICU patients is equivalent to 2.5-3 med surg patients.
Furthering the care plan – working towards transfer
While the med surg nurse’s goal is discharge, the ICU nurse’s goal is transferring the patient out of ICU. We’ve got to note the medical diagnoses, consider our nursing diagnoses (yes, you actually use these whether you realize it or not!), and progress them to a point in which they don’t need constant monitoring.
Do we need to increase their cardiac output? Do we need to transition them from drips to oral medications? Do they need some fluids, or do they need a beta blocker to increase the efficiency of their cardiac contractions? Is there an electrolyte imbalance that needs correction? Will that help with our cardiac output? [Spoiler alert: yes.] Do we need to increase gas exchange? Does that mean we’ve got to do some pulmonary toileting and increase activity to attempt to wean the oxygen down?
There is a lot to consider, all at once, in a very fast-paced, constantly-changing environment. Being a new grad nurse in an ICU can kind of feel like…
But it’s okay, it gets better! (Overwhelmed? Check out tips for aNew Grad Nurse, it might help.)
It’s also important to get them out of the ICU as fast as possible because of something called ICU Delirium. Basically, when a patient is critically ill, in a different environment, receiving many different treatments, medications, and interventions, hearing many different alarms, buzzes, and sounds while being cared for by strangers, it is terrifying and people become delirious. People who seem totally fine neurologically can suffer from this, and it may impact individuals years later and result in long-term cognitive impairment and PTSD. This is another reason why it is crucial to transfer patients out of the ICU as soon as it is medically appropriate.
Rounding
Physicians and their support staff round on their patients once a day, but it’s a little different in the ICU. Because things change so quickly, ICU nurses are chatting with the providers more frequently than on the floor. In addition to rounds, you’re updating the physician whenever the patient declines or new needs arise.
In the ICU environment, it’s a bit more realistic to be present for when physicians and their APP round because you’re balancing 1-2 patients rather than 4 or more. It’s also really helpful to do this because you hear what the physician is telling the family, so you can reinforce this information throughout the shift.
Like med surg units, this rounding is done during day shift, which means routine order changes, transfers, and scheduled post-op patients arrive during day shift. New orders will typically only come through on night shift when acute changes occur.
Interdisciplinary rounds occur daily as well in many facilities. The attending physician, the nursing staff, therapy services (PT/OT/ST), chaplain, dietician, pharmacy, case management, social work, and nursing leadership typically go through each patient and their needs.
Patient flow
While discharges are a big focus for med surg nurses, admissions are more of a focal point for the ICU nurse. An ICU admission is typically an unstable patient who needs the typical tasks completed like (good IV access, admission documentation, med administration), a very solid baseline assessment, labs/diagnostics, and so forth. But they also need to be stabilized FIRST! Stabilization is the key!
In the med surg world, a patient coming to that unit must be stable enough for the nurse to patient ratio, only having 1 assessment per shift, and vitals that are [typically] only done every 4 hours. This is not the case in the ICU. Your next admission could be an actively coding patient, one who was just coded, or someone on the brink of a instability. The patient could have very little going on, or they could be hooked up to 8 IV pumps, a ventilator, CRRT (continuous renal replacement therapy) machine, an arterial line, and more. For the level of unpredictability you may have in med surg nursing, it’s significantly increased in the ICU.
In addition to transfers when patients are ready, there’s another piece to the puzzle. Sometimes, the ICU is full and there is no room to admit another patient. However, you get a call that there is a patient who needs to come who is incredibly unstable and must be in the ICU.
What do you do?
Well, what happens is one patient must be transferred to another ICU with open beds, or the nursing staff (or medical staff if it’s a closed unit) must analyze which patient is most appropriate to transfer out to either stepdown or the floor to make room for this new patient. You may be in the situation in which you have to urgently give report to another unit to get one patient out, only to get a much sicker patient back.
Dealing with death
Patient die in all areas of the hospital, but it’s a bit different for ICU nurses. It’s more frequent than many other units (with the exception of possibly oncology and hospice, respectively), and can be pretty… well, ugly and traumatic. Patients die after long and brutal codes, after sudden injuries, at any age, both expectedly and completely out of the blue.
In nursing school, we learned a lot about advanced directives. I remember thinking to myself that the likelihood I’d ever need to pull one out for a patient to actually follow it was slim to nothing. When I started working in neurocritical care, I realized how often this is actually done. You may find yourself, as an ICU nurse, pulling up a patient’s advanced directive to have a difficult conversation.
Dealing with trauma and death on a routine basis does take an emotional toll on an individual. Therefore, if you’re considering ICU nursing, I highly recommend getting set up with a counselor to emotionally process work in a healthy way. I know many ICU nurses, myself included, who see a professional to work through all of the tragedy with someone objective and also to develop healthy coping and processing techniques.
Finishing up
After 12 hours of assessing, monitoring, pivoting, stabilizing, tweaking, educating, and documenting, it’s time to give report to the next shift. Sometimes, you feel like you’ve run 20 miles all around the unit, and you get to report and feel like it looks like you’ve done nothing all shift. It can be a little defeating. But, what’s important is that the tasks that needed to get done for the patient are completed. Documentation is important, but it’s not more important than providing the in-the-moment, time sensitive care to the patient. So, if someone tries to make you feel bad for not getting that admit navigator done when you’ve been running around drawing labs, hanging fluids, starting IVs, and getting CT scans, don’t trip. Rest in the reassurance that you’ve done the tasks that needed to be done for the patient in that moment and you are only 1 person who cannot do 50 tasks at once.
Another thing that I felt was unique to my experience in ICU versus med surg nursing was the shear amount of adrenaline and how it took time for me to calm down after a shift. Med surg was challenging and exhausting, but when you’re regularly dealing with urgent or emergent situations, it’s hard to just turn that off after you clock out.
Like a workout, it’s helpful to have a post-work cool down routine.
Nurses typically get off work at 7:30 pm at the earliest and may have to be up again at 5:00 am for the next shift. The sooner you can relax and calm down post-shift, the better you will sleep, and the more mentally prepared you will be for your next shift.
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.
Use code ICUskills for $20 off!
Need more in-depth cardiac info? Check out the Cardiac Nurse Crash Course brought to you by FreshRN® where we discuss essential topics like hest tube and arterial line care, cardiac nursing report for the ED/ICU/floor, CABG patient care, in-depth discussion on atrial fibrillation, diagnostics like stress tests and caths, and much more!
YouTube has tons of great free videos (Khan Academy, for one), or check out your speciality nursing organization. The American Association of Critical Care Nurses has tons of great resources for critical care – I HIGHLY recommend becoming a member, or you can check out the NRSNG Academy.
NRSNG Academy is primarily an NCLEX resource, but there is a ton of information applicable for the new ICU nurse. The EKG, Lab Course and MedMaster Course are particularly applicable to this group. 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 Coursedoes a deep dive into specifically what each lab is measuring, why it’s important, and more. You can even get a 7 day trial of NRSNG Academy for only $1. It includes all these courses and more.
Maybe you’re trying to figure out if you want to go to nursing school… maybe you’re in school and not sure of where you want to work… or maybe you’re an experienced nurse looking to change things up. Many have heard of med surg nursing, but are not sure what med surg nurses actually do during a typical shift.
Well, you’ve come to the right place! Let’s walk through a typical shift on my [cardiac] med-surg unit.
What Do Med Surg Nurses Do?
Starting your shift – report
Like many other areas of nursing, the med surg nurse will begin his or her shift in report. The off-going nurses share information with the oncoming nurses about their patients. The number of patients a med surg nurse nurse will care for during the shift will vary depending up the state and facility in which you work.
A good nurse to patient ratio on a med surg unit, in my personal experience at the bedside, is 4 patients to 1 nurse. With 4 patients, I can keep information about them straight easily, have enough time to see each one and not feel rushed through interactions to get my other patient’s medications and tasks addressed. I’ve seen ratios as high as 1 nurse to 7, 8, and 9 patients on med surg units, however. Therefore, if you’re looking to become a med surg nurse, make sure you ask about the nurse to patient ratios in the interview because they can vary widely.
Report typically lasts about 30 minutes, so around 5 minutes per patient plus some time to have a short huddle of the entire shift of nursing staff members, and some time to find each nurse to obtain report from.
Here is a video example of me giving report on a fictional med surg patient:
Generally speaking, the information discussed report on a med surg unit consists of the following:
Chief complain / why they’re in the hospital and important things that have happened during the admission
Pertinent history (it’ll take time to figure out what pertinent and not, don’t get hung up on this one. You’ll also figure out, with time, shorthand/abbreviations for history)
Abnormal assessment findings from body systems (do not waste time going through normal information)
If they’re on oxygen and how much via which delivery method and if that’s changed recently (nasal cannula, face mask, non-rebreather, etc.)
Any tubes (feeding tubes, foley catheter, rectal tube, etc.)
Intravenous access (IV, central line, port, etc.)
IV fluids / drips / anything continuously infusing
Activity level / how they go to the bathroom
Pertinent / abnormal labs
Questions to ask MD / questions for any other member of the health care team
Any psychosocial / family + support system concerns
Important meds (you can look up this stuff in the chart, but they may mention some meds)
Any tests, procedures, transfers, etc. that need to occur during this shift
General discharge plan / what are our goals this shift? (get out of bed 3 times, eat, pass swallow evaluation, transfer out of ICU, etc.)
As the oncoming nurse, you will be RECEIVING all of this information and need to be aware of it throughout your shift. At the end of the day, you will provide it to the night shift.
It’s a lot of information in a short amount of time. A good report sheet is really helpful as well because you will not memorize all of this information! Here’s a great resource of 33 free PDF’s ofnursing brain sheets. (Yes, the one I use is in there!)
Once I obtain report on all of my patients, I need to collect my thoughts for a few minutes. Provided everyone is stable and no one needs anything urgently, I’ll find a computer and start looking up additional information in the chart. I look up any questions from report about missing information (for example a lab value, if a certain test has come back yet, if a scan scheduled later, if physical therapy is ordered).
I also spend this time organizing my to-do list for the day.
This list includes:
My documentation requirements
Assessment, telemetry strip, education, care plan, IV and pain assessments
Medication due times
At this time I also am ensuring all medications are appropriate to give and if any need to be held
Vital signs
How often they’re ordered and their trends
Their ordered parameters for vitals (keep their systolic less than 160 and use PRN meds to keep it below that)
Blood sugar checks
How often, if there is sliding scale or scheduled insulin, how they’re been running
Follow-up labs based off a drip, continuous infusions, and weaning parameters – below are some examples
PTT or Anti-Xa for a heparin drip
Cardizem or Amiodarone drips, noting their heart rate, blood pressure, and cardiac rhythm
Enteral feedings, noting the ordered goal rate, residuals, bolus vs. intermittent feedings
TPN, noting its necessity, access point, and blood sugar monitoring
Questions for the rounding provider(s) – below are some examples
The patient is eating and drinking well, would you like to discontinue their IV fluids?
The patient has 20 mEq potassium PO BID scheduled, but her K+ on her BMP this morning was 5.5, would you like to discontinue it?
The patient has not had had cardiac events in 5 days, may we discontinue the order for cardiac monitoring?
The patient does not seem to be tolerating their diet and I’m concerned about aspiration. Can we order a speech evaluation?
The patient has refused their Nicoderm patch for the last 5 days, can we discontinue the order?
The patient’s IV antibiotics have been completed and appears to have decent options for peripheral IV access. Would you like to remove the central line?
This takes around 10-15 minutes to get everything together. I make sure my brains are well organized with information and to-do checklist for each patient, I have what I need in my pockets (alcohol swabs, saline flushes, Sharpie, pen, brains, unit phone), and a full bottle of water, and get ready to begin my day!
(If you want to see all of my recommended nurse gear from scrubs, to bags, to socks, to water bottles, check out mynurse gear master post.)
Seeing my patients
After I’m all geared up, I decide which patient I will see first. What influences this decision depends on if anyone has a time-sensitive medication (like insulin) or needs to get off the unit ASAP (for something like dialysis or some other off-unit procedure). If someone is leaving the unit, I’ve got to visit them first.
Basically, I need to see every single patient and complete a nursing assessment on them. This consists of a basic assessment of each body system, focusing on areas of concern if needed. This only takes a minute or two, depending on what’s going on with the patient. I’ll start with asking basic orientation questions, listen to heart/lung/bowel sounds, look at skin, feel pulses, look incisions/wounds, ask about pain, elimination, ambulation, and a few more things.
After I’ve completed my assessment, I then administer their scheduled medications and see if any as needed (or PRN) medications are needed. These meds can be things like pain meds, nausea meds, stool softeners, and more.
I then see if the patient needs anything specific from me, and discuss the plan of care / plan for the day with them and their loved one(s) briefly.
Example:
“So, I’d like to go over the plan for the day with you. Currently, the plan for today will be to not eat or drink anything until the cardiologist comes by and takes a look at you. He or she will determine if we need to go for that ultrasound called a transesophageal echocardiogram later today to get a better look at your heart. Your labs should be back for them to look at, and they will look at that ECG that was just taken as well as the heart monitor that was on overnight. I will give you your normal medications with sips of water this morning, but that’s about all you can have to drink until we hear more. I know that was a lot of information. What questions do you have for me?”
Assessment, medications, education, repeat
I basically do this routine with my entire patient load. If I find something alarming or concerning in my assessment, labs, monitoring, or in talking to the patient, I alert the physician or the advanced practice provider (abbreviated as an APP, meaning a nurse practitioner or physician assistant).
Pro-tip: don’t call nurse practitioners or physician assistants midlevels or physician extenders. Some don’t care, but many really don’t like that. Here’s an articlewith a little more information about why.
As the nurse at the bedside, I’m the one who’s responsible for monitoring the patient all day. While the provider (physician, physician assistant, nurse practitioner) rounds once a day for a few minutes, I’m there the rest of the time. They are relying on me and my clinical judgement to communicate any concerns promptly.
As you can imagine, I have to be somewhat speedy when seeing all of my patients to make sure everything is completed on time (4 people have 9:00 am medications due and I am one person who is responsible for administering them all before 10:00 am). Not only do I have to assess, give meds, and education, I have to document it all.
I have a love-hate relationship with documentation. I loathe documenting because it takes up so much time and is frustrating. However, when I’m trying to figure out what’s going on with a patient, I rely on documentation to do so. If the previous nurse didn’t chart the meds, blood pressures, or assessment findings, I can’t compare it with what I’ve done or my current issues and concerns.
Sadly, documentation is a necessary evil.
Furthering the care plan – working towards discharge
In addition to rocking out awesome assessments and safely administering medications, med surg nurses are also focused on furthering the patient’s care plan and getting them safely discharged.
During my time in intensive care, discharge was not a big part of report or my hour-to-hour tasks. While we took note of potential discharge needs, it was not a focal point because their needs were still pretty up in the air due to current circumstances. Med surg nursing is different – we are pretty focused on discharge about when and how we are going to do so safely.
Discharge can be smooth as silk or pretty tricky. Some patients have great support systems, some don’t, some have significant financial concerns, transportation issues, health literacy issues, and more. There can be quite a few things to get into place when trying to get a patient home. Med surg nurses work closely with case management and social work to help facilitate discharge to help address concerns or get patients to another facility if needed.
Med surg nurses are also working even closer with physical, occupational, and speech therapy because their assessments recommendations are required for insurance purposes to get things covered (like nursing home stays, rehab, home health, medical requirement) by insurance.
Rounding – the entire team
The typical routine during day shift is that the attending and consulting physicians and their support staff round on their patients.
What are rounds? When a physician and/or advanced practice provider sees, assess, write orders, and document a progress note on their patients
This means that most patients are being seen by their provider during day shift. This is typically when most orders changes occur. Patients may be discharged, medication changes, activity order changes, procedures, new dressing changes, removing tubes or lines, and so forth.
This is an important time because you know the providers will be rounding, so you can address non-urgent needs at this time, provided they touch base with. Because you have 4+ patients, it’s not a guarantee that you’ll be in the patient’s room when the providers round. You know you’re working with an awesome and efficient provider when they take the time to call/find you during rounds to update you and see if you have any needs.
If you work in a teaching hospital, you may also work with residents. They may “pre-round” early in the morning to see their patients and get themselves ready for rounds with their attending (the physician they report to during their training). They may come by and ask you questions and touch base at this time, and then again later with the rest of the team.
Any other consulted member of the health care team may also round. This means physical therapy, occupational therapy, speech therapy, case management, pharmacy, social work, dietitians, chaplains, and so forth.
You may have to participate in interdisciplinary rounds as well. This is when the entire health care team gets together and rounds on the patients in the unit. From the med surg perspective, rounds are typically more discharge-focused than in the critical care setting. This means that you have to manage your time appropriately to be available for these rounds also.
As you can imagine, it’s a lot to coordinate for one patient – let alone 5 or more. I have to carry a phone with me throughout the shift so people can speak to me as needed without searching the entire unit for me. I feel like it rings every 5 minutes. If I have 5 patients and they all have a medical team, PT, OT, and case management, that’s at minimal 20 calls right there.
But let’s be realistic – it ends up being much more than that!
Admissions, transfers, discharges, oh my!
Another important aspect of the med surg level of care is discharge planning.
Things med surg nurses do in regards to discharges:
Work closely with case management (CM), social work (SW), therapy services, etc., to ensure the patient is safe to go home
Provide detailed discharge instructions and teaching
Ensure patient can obtain discharge prescriptions
Facilitate transportation (typically with CM/SW)
Facilitate obtaining getting any financial assistance (typically with CM/SW)
Ensure all needed discharge orders are placed
Ensuring all core measures / required documentation / required education has occurred
Facilitate transfers to other facilities like nursing homes, skilled nursing facilities, rehab (again, typically with CM/SW)
Teach the patient about wound care, taking meds, eating, bathing/showering, follow-up appointments and lab draws, contact information
Oh, and documenting ALL OF THAT.
Once you get a patient out the door, typically there’s another one waiting to come to your unit. There is quite a bit of turnover on a med surg unit. As patients are discharged, others fill their place. While I may start a shift with 4-5 patients, I may discharge 2 and get different 2 back.
Admissions have their own set of documentation requirements, assessments, medications, and orders. Transfers (typically a patient who was in intensive care who no longer needs close monitoring is “downgraded” to a med surg unit) also occur, but typically have less paperwork because it’s all been taken care of in critical care or another unit.
It is a safe assumption that if the unit you’re working on a unit with a 4:1 or 5:1 nurse to patient ratio, that you will most likely always have 4-5 patients. Nursing units have to adjust their staff based on the amount of patients on the unit. So, you won’t have days where you only have 1-2 patients because if that were the case, they would either send a nurse home and give the other nurses the additional patients, or send that nurse to another unit who needs another nurse.
I wish we always had the same number of nurses every shift so nurses weren’t always constantly busy, thus enabling us to do things like check our email, complete education and trainings, and simply be more present… however, that’s not the case.
Towards the end of the shift (a mere 11 hours later…) you start to consider concerns for night shift (or the next shift) and make sure all routine needs for the physician have been addressed.
Pro-tip: it is not cool to call a physician or APP at midnight for a non-urgent need that could have been addressed during the day with the attending physician. They will almost always tell you to wait until the next day when the patient’s normal physician is on because it is much more appropriately addressed by them. Nursing school teaches you to notify and clarify about many things with the physician, but doesn’t necessarily go over when. I dive deep into this topic in my book.
The end of the shift includes ensuring all tasks and required documentation were completed. This includes care plan documentation, education, and incident reports if they were necessary. Nurses must document how they educated their patients and how they furthered (or attempted to further) the patient’s plan of care safely towards discharge.
You also begin getting ready for report. Now that your shift is coming to a close you will provide a short, yet detailed, report to the oncoming nurses caring for your patients. Nursing care is a continuous process. Some days you’ll have a crazy shift and won’t have finished that admission navigator, discontinued that non-essential order, remembered to ask that one question, or perfectly tucked and fluffed all of your patients. Some days, you’ll be thankful to have everyone’s meds passed and bare minimum documentation completed… while other days, you’ll be early or on time with everything and have all of your patients ready to go for the next shift.
Each shift if different, patients are dynamic, and things in an instant. Ah, the nurse life.
Clocking out
Alright guys, my work here [for the last 12 hours] is done…
Need more in-depth cardiac info? Check out the Cardiac Nurse Crash Course brought to you by FreshRN® where we discuss essential topics like hest tube and arterial line care, cardiac nursing report for the ED/ICU/floor, CABG patient care, in-depth discussion on atrial fibrillation, diagnostics like stress tests and caths, and much more!
ADN vs. BSN – a nurse’s thoughts on the New York bill requiring a BSN in 10
In December 2017,New York State signed a bill that requires all newly licensed nurses with their Associates Degree in Nursing (ADN) to obtain their Bachelors of Science in Nursing (BSN) within 10 years of their initial licensure. (Here is a link to an article explaining this in more detail.)
When this news hit, the nursing community had a pretty polarizing response across social media. While some were excited for the education advancement, others were pretty upset. As an experienced nurse, I’d like to explain a little of the background and offer my thoughts.
Why (some) people are happy about it
Many feel that requiring the BSN degree continues to legitimize and increase the professionalism of nursing.
When you look at the health care team, nurses have the lowest educational requirement for an entry-level position next to respiratory therapy.
See below for the entry-level requirements for the other health care team members:
Physician – medical degree
Advanced practice provider (NP/PA) – graduate degree
Pharmacist – doctorate degree
Physical therapist – doctorate degree
Occupational therapist – master’s degree
Speech therapist – master’s degree
Chaplain – bachelor’s degree for entry-level, but to work in a hospital most have a Master’s of Divinity with additional certifications in crisis support
Social work – bachelor’s, many with master’s
Case management – bachelor’s (in some instances, an ADN-prepared RN)
Many feel that if the nurse is the leader of the health care team, that there should be only one option for entry-level practice. And given the complexity of nursing care today, many also feel the minimum requirement should be a bachelor’s degree.
Without getting into the research of why a BSN should be required, the legislation in New York noted several reasons. Supporting literature noted that because of increasing complexity of the American healthcare system, and rapidly expanding technology, the educational preparation of the RN must be expanded. – Jennifer Mensik, PhD RN FAAN
There is also research to suggest that hospitals with more BSN-prepared nurses have better outcomes as well.
Why (some) people are really not happy about it
Many individuals feel that the ADN who is fresh out of school is not more clinically-prepared than the BSN-prepared nurse. Many health care facilities also do not pay nurses more for having a BSN. Rather, they offer a clinical ladder option which enables the nurse to be paid more for achieving certain professional development goals, and this typically includes a BSN.
Therefore, the argument is: why should anyone spend more money and more time to get a degree in which it doesn’t appear to put them ahead of the curve clinically, nor does it offer more money?
Many bedside nurses also work elbow-to-elbow with incredibly intelligent and amazing nurses who have their ADN. It can also feel pretty insulting to someone who has been an awesome nurse for the last 20 years with an ADN only to be told they have to go back to school on their own dime… when a fresh newbie nurse with a BSN who doesn’t know the basics yet is just fine.
And finally, the main difference between the ADN degree and the BSN degree has to do with the additional credit hours. These additional courses tend to be more research-based or increased requirements in pre-requisite (IE not nursing) courses. Again, why pay thousands of dollars for a research course, community health course, and some pre-req’s that have nothing to do with nursing?
Oh, and did I mention the whole nursing shortage thing? We’re already struggling for nurses, and now we’re going to up the requirement to become one? Humm…
Also, the inflation of higher education, and how it is substantially higher than the increase in personal incomes and the general inflation rate. It is becoming more and more expensive to have a bachelor’s degree, and for many – they simply cannot afford to to take on additional debt… especially when it will not necessarily increase their pay.
How I feel about it
First, I want to give you some background on myself… I’m a BSN-prepared nurses working on my MSN, who has worked at the bedside in both critical care and floor nursing with ADN, BSN, and even MSN-prepared nurses at the bedside. I never started with an ADN.
When I think about this ideally
I think it makes sense for the minimum requirement of a bedside nurse to at least be a bachelor’s degree. With the amount of information I need to know to be successful at the bedside, as well as the fact that technology and research will continue to advance as patients become more complex… a 4-semester / 70 credit hour degree isn’t going to cut it. Especially when I think 10 years down the line.
When I think forward, to 2030… 2040… 2050, do I believe should we make some progress towards more education for entry-level for into our continually evolving profession?
Yes.
I also can’t deny the research that has come out over the years, nor the efforts of organizations to have this come to fruition.
I think it makes sense… ideally.
When I think about this practically
Now, when I sit down and think about the fact that we’re in the midst of a nursing shortage… that college is becoming more and more expensiveeach year, while income and inflation don’t hold a candle do it… and that we don’t have enough nurses as it is today… how can we start get picky now?
I think about the nurse with 3 kids, a mortgage, a car payment, and student loans from the associate’s degree… the nurse who works overtime, is the head of committees, the best damn nurse on the unit, who has saved countless lives, and works himself to the bone just to make ends meet. Should he have to take on more debt, and spend less time with his kids, all to just have 3 different letters behind his name and not make a dime more?
That doesn’t seem fair to me.
While I think we need to progress in our educational requirements, I don’t know how we can do so while we’re barely holding our heads above water. I feel like some facilities are struggling so much for nurses that by upping the entry-level requirement to BSN, we’re handing them a 20 lb weight. And they’re just going to start sinking.
However, the longer we wait, the more difficult it will be.
A solution offered to me by another experienced nurse was to simply grandfather everyone in now and give all prospective nurses a decade-long heads up that the requirement will change in 10 years.
But… I don’t think that’s where all progress should go. I think we need to step back a bit as well.
What I think the BSN should look like
If an individual knows they want to become a nurse, I believe the core curriculum should change.
As I mentioned before, a typical ADN program is approximately 4 full-time semesters or 70 credit hours. A typical BSN program is approximately around 120 credit hours. The difference in the courses is usually a few nursing courses (like a research course and maybe community health) but also more requirements for pre-requisites.
Now, that seems just silly to me. More pre-req’s? Some of my pre-req’s were… well, completely unnecessary to my career as a nurse. I took a music theory course, film appreciation, and some computer courses.
I personally don’t believe that the first two years of a BSN should look like another major. While the core prerequisites (microbiology, anatomy and physiology, chemistry, nutrition, sociology, psychology, developmental psychology, and so forth) should remain, I think there should be different courses required for the nurse seeking a BSN.
I also believe the BSN courses should be less NCLEX-focused and more centered on practical-preparedness.
I would love to see courses like:
Health care policy and law – because it is constantly changing
Evidence-based practice – one course on what it is, another on how to evaluate and implement it
An entire course on lab values
An entire course on just anatomy and electrophysiology of the heart and cardiac medications
An entire course on the respiratory system
Equipment management
Time management / delegation / prioritization
Theoretically, if a nursing school had 6 full-time semesters to prepare a someone to become a registered nurse (and let’s just say 2 semesters of those science-pre-req’s) they wouldn’t be so pressed for time to ensure the graduate passes the NCLEX and would be able to spend more time preparing the student for actual practice.
I feel that nursing education has strayed from truly preparing students for practice and focused more on NCLEX pass rates. I get it – the school must be able to demonstrate that graduates of their school can pass boards… and while that is an admirable focus, it’s not all there is.
Hospitals now have residency programs to facilitate the transition to practice for a graduate nurse because the learning curve is so steep… but why is that the case? Why is the nurse who has graduated from an accredited nursing school, with thousands and thousands of dollars in debt, not practically prepared? I believe in residency programs, but I also believe in more of a partnership between nursing schools and health care facilities to make this transition smoother.
To summarize
I believe the that requiring a BSN as an entry-level degree for the profession of nursing is a good thing, provided that there are improvements to the existing BSN educational requirements that would enable the graduate to not only pass the NCLEX but also feel confident providing patient care after graduation.
Lofty goal?
Probably.
Better for our patients and our profession?
In my opinion – absolutely.
What are your thoughts about this new legislation?
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.”
Unfollow.
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.
Register Now
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!
Quick Facts:
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!
This post has been sponsored by Aurora University.
Please see my disclaimers page for more information on our partnership.
Instant messages, email, video conferences – these and other forms of technology now allow patients to access their health care providers via a new field known as telehealth, created by the demand for greater access and convenience in health care, according to Hospitals & Health Networks.
What is Telenursing?
Nurses are now able to interact with patients remotely, thanks to advances in technology, thus the terms “telenursing” or “telehealth nursing.” According to the American Telemedicine Association (ATA), this is defined as “the use of telehealth/telemedicine technology to deliver nursing care and conduct nursing practice.”
Telenursing is not a specialty area of nursing. In nearly all practice settings, a nurse is able to provide some care at a distance. Due to the rapid rise and demand of telenursing, experienced nurses as well as new graduates may expect growing career opportunities in this field.
Growth and Benefits
Some form of telemedicine is now in use at more than half of all hospitals in the United States, according to the ATA. A survey demonstrates the development or implementation of a telemedicine program among 90% of health care executives.
Other signs reveal the growth of telenursing and telemedicine. State lawmakers now support legislation for telemedicine-related reimbursements; both private and public insurers are accepting these changes. The ATA reports that more than 200 academic medical centers across the United States offer video-based consults across the globe.
Telemedicine offers primary benefits, including the following:
– Cost Savings. According to the American Hospital Association, a cardiac telemonitoring program resulted in eleven percent cost savings, with a return on investment of $3.30 in cost savings for every dollar used for program implementation. Global professional services company, Towers Watson, states that U.S. employers could save an estimated six billion dollars by offering telemedicine.
– Flexibility. Americans residing in rural areas comprise about twenty percent of our population without ready access to primary or specialty care. Greater than forty percent of hospitals surveyed have opted to invest in telemedicine tools for the purpose of filling the gaps to these remote communities. Software Advice, a company that compares electronic health records, conducted a survey of patients. They found that twenty-one percent of their consumers most value telemedicine for its ability to deliver care without long travels.
– Quality Care. The aforementioned cardiac telemonitoring program saw a drop in patient readmissions by forty-four percent over a thirty-day period, and thirty-eight percent over ninety days, when compared to patients not enrolled in the program. A patient-care study of eight thousand outcomes showed no difference in the virtual appointment vs. an in-office visit. In a Humana Cares remote health management and monitoring program for congestive heart failure patients, at least ninety percent of patients report feeling more connected to their nurse, found ease of use with the virtual care suite and were willing to recommend the program to friends.
For those patients who have not experienced a telemedicine visit, seventy-five percent showed an interest in using one rather than an in-person office visit, says the Software Advice survey. Sixty-seven percent of those patients who have used telemedicine state that it “somewhat” or “significantly increases” their satisfaction in the care received.
Careers in Telenursing
“Telehealth nursing is practiced in the home, health care clinic, doctor’s office, prisons, hospitals, telehealth nursing call centers and mobile units,” the ATA says. “Telephone triage, remote monitoring and home care are the fastest growing applications.”
The popularity of telehealth has created new telenursing areas of practice:
Telehealth is transforming health care, even in the ICU. “Although the role of the bedside care-giver can never be replaced or diminished, it can certainly be augmented, enhanced, and facilitated,” according to Critical Care Nurse. “The key to the long-term success is the continued consistent collaboration between the bedside team and the tele-ICU nurses, which can transform how critical care nursing is practiced.”
The creation of the teleICU has improved outcomes for critical patients by shortening hospital and ICU stays, reducing ICU mortality, increasing compliance rates with evidenced-based best practices, decreasing patient care costs and improving cardiopulmonary arrest patient outcomes. By simply clicking a mouse, a nurse can access medical records, laboratory results and diagnostic images, as well as standard monitoring including hemodynamic values and electrocardiography.
A teleICU nurse will shoulder important responsibilities, such as regular rounds via camera and assessing all patients, which may include equipment checks for safety, assessing the patient’s physical well-being and appearance, verbally verifying infusions and speaking with the staff, patient, and patient’s family. The teleICU nurse is a vital resource for the bedside nurse, able to quickly retrieve data and information, and compiling detailed, complete admission notes should the patient arrive in the unit.
Future Opportunities
“As the US healthcare environment continues to evolve due to changes in reimbursement, legal issues, and shrinking healthcare resources, the expanding role of telehealth nurses will continue to evolve,” says the ATA. “Leadership and collaboration among international nurses is needed to outline the uses of ehealth/telehealth technologies to provide nursing care in an interdisciplinary manner to patients, regardless of staffing, time, or geographic boundaries.”
Those pursuing telenursing opportunities should have a strong educational background. More hospitals across the country already require nurses to hold a BSN degree, indicating educational standards are on the rise. Aurora University’s online RN to BSN programs prepare graduates with the knowledge and skills required to pursue advanced career opportunities. The program boasts an online learning environment, which allows students a convenient and flexible schedule to complete their degree while maintaining a work/life balance.
Interested in Telenursing? Aurora University provides a strong foundation in this specialty. Aurora’s RN to BSN degree Completion Program prepares students for management-level positions and other nursing specialties. The program offers a convenient and flexible online learning environment, accommodating the personal and work schedules of students. For more information on telenursing, check out Transforming Health Care: The Emergence of Telenursing .
Nurses end up feeling short changed, as another year goes by when their hours of overtime, staying late, and switching their schedule last minute is merely recognized with a cookie platter delivered to the unit on their day off, and a water bottle with a logo that rubbed off in about a week.
This year instead of wishing you a happy Nurses Week and calling it good, I decided to try and put together a fun giveaway. It is pretty simple. There are different prizes given away each day. Some will have multiple winners, some will just have one. Use this simple form to enter:
Unfortunately I cannot giveaway a car but I do have a list of what I think are some fun nurses week prizes.
Badge Blooms
5 winners will each receive their choice of a Badge Reel from BadgeBlooms.
Not only do they offer a huge selection of Badge Reels but they are also giving 30% off orders of $10 or more thru May 12th with Promo Code BLOOMSNURSES2017
While Lynn Visser was not the main author, she does have a couple of chapters in Fast Facts for the Radiology Nurse. One nurse will win a copy of this book also.
Becoming Nursey, What’s Next, and Admit One
I’m also going to sweeten the deal by offering a signed copy of all three of my books. One winner will receive a copy of Becoming Nursey, What’s Next, and Admit One.
Explore the world of natural nursing solutions with Soothing Scents
Developed by a nurse anesthetist, Soothing Scents makes 100% natural and earth-friendly essential oil inhalers to combat PONV and ease patient anxiety – without pills, unwanted side effects, or the need for a doctor’s order. Our flagship product, QueaseEASE, is used in over 1,000 hospitals and clinics across the country, and is a go-to essential for medical professionals who are looking for natural but effective ways to help their patients.
Each giveaway kit contains:
1 x QueaseEASE inhaler for general nausea and travel-related queasiness
1 x Expecting designed specifically for morning sickness
1 x Focus for mental clarity and stamina
1 x Still for relaxing the body and mind
10 sample-size Quick Tabs that can be given to patients and last for up to 72 hours.
Don’t forget to enter and share the giveaway with other nurses.
This post has been sponsored by Alvernia University.
Please see my disclaimers page for more information.
Traditional healthcare settings, including hospitals, operate under a hierarchy of nursing to define the structures of order and organization. Nurses are ranked according to levels of license and education, and by years of experience. This can be kind of confusing to the new nurse walking into the hospital (“Uhhhh he just told me he was the DON and I don’t really know what that means…) , so I’ve outlined a typical hierarchy of nursing below.
Understanding the Hierarchy of Nursing
Chief Nursing Officer (CNO) The CNO, also known as the CNE or the chief nursing executive, is found at the top of the hierarchy pyramid, and reports directly to the chief executive officer (CEO) or the hospital or agency. The CNO functions in both administrative and supervisory roles and is responsible for the delivery of all nursing services across the hospital or healthcare unit. A CNO or CNE will generally have a minimum of a master’s degree and previous experience in nursing leadership positions.
Director of Nursing (DON) The director of nursing acts as an administrator, providing leadership for the department and/or service line, which ultimately directs patient care. They can be a director of the entire hospital, service line, or single department, depending on the size of the facility. As an administrator, duties may include budgeting, record keeping, decisions on how different educational requirements are met, dealing with regularly issues, working with physician groups and other departments nursing works with, and so forth. Related positions at this level may include director of nursing services or director of patient care services. A DON will generally have a minimum of a master’s degree.
Nurse Supervisor or Nurse Manager Nurse supervisors and nurse managers function as a part of a leadership team, taking responsibility for various units. A nurse manager may be the manager for one nursing unit, or a group of them. They are the step between administration and the bedside staff, and communicate changes back and forth. They typically are holding or coordinating staff meetings to update the employees they are responsible for, as well as attending facility leadership meetings to touch base with who they report to. Generally, they arrange for nursing care to be provided to patients (however that may look at the facility), in addition to many (and I mean many) other tasks including hiring, scheduling, and budgetary needs of the unit, . The nurse supervisor or nurse manager will typically be required to have a bachelor’s degree, and a master’s degree is recommended. The nurse manager typically is not providing direct patient care, but rather coordinating things for the nurses who are.
Advanced Practice Registered Nurse (APRN) An APRN offers treatment services and patient care, typically in direct collaboration with a physician. However, in accordance with the laws of each state, they actually may practice independently with complete authority, and without a physician’s collaborative agreement. (Pretty awesome, right?) They may diagnose and treat patients, and in some environments, be the primary healthcare provider to their patients. There are four different types of APRN’s, including: Nurse Practitioners (explained below), as well as Certified Nurse Midwives (CNM), Certified Registered Nurse Anesthetists (CRNA), and Clinical Nurse Specialists (CNS). An APRN must currently hold a master’s degree and their specialty training in one of the four aforementioned areas, but many APRNs are seeking terminal degrees (DNP, PhD).
Nurse Practitioner (Certified Registered Nurse Practitioner, CRNP) A CRNP, or more frequently abbreviated as a NP, is a type of advanced practice registered nurse. A nurse practitioner may work with patients of all ages and their families, providing useful and important information to help in decision making regarding lifestyle and healthcare. The nurse practitioner practices in accordance with the Nurse Practice Act, as prescribed by the state in which they work. The majority of nurse practitioners chose an area of specialty in which to be nationally certified. The areas of specialty recognized by the American Nurses Credentialing Center are: Acute Care, Adult Gerontology, Emergency, Family, Neonatal, Pediatric, Psychiatric, and Women’s Health.
Staff Nurse or Bedside Nurse (RN) A staff or bedside nurse is typically a registered nurse providing direct patient care, by directly assessing, monitoring and observing patients as the first point of contact. They coordinate care for the patient within the entire health care team. Today, to practice as a registered nurse one must pass the NCLEX-RN after graduating from a diploma or associate’s degree program. However, many hospitals and other employers, however, now require a bachelor’s degree to comply with the IOM’s recommendation for the nursing workforce to be 80% bachelor’s prepared by the year 2020.
Licensed Practical Nurse (LPN) or Licensed Vocational Nurse (LVN) An LPN/LVN will often provide basic medical care and assistance, however depending on the facility and state, the LPN/LVN may provide care in a very similar scope to the RN with the exception of a few tasks (like hanging blood, for example). These tasks may include dressing changes, catheter insertions, administering oral medications, obtaining vital signs and so forth. Most LPN/LVN-prepared nurses work in the long term care setting, but can work in many different areas. To be an LPN/LVN, one typically completes 1-2 years of training and takes the NCLEX-PN exam.
Other Nursing Positions and Career Growth
The nursing hierarchy includes many roles and titles not listed here. Johnson & Johnson’s website Discover Nursing lists 104 areas of specialty positions in nursing, describing some great employment opportunities.
Nursing career development potential is highlighted by the growth and size of the profession. Nursing employment is projected to grow 16 percent by 2024, which, according to the Bureau of Labor Statistics, is much faster than the average for all occupations.
“Nursing is the nation’s largest health care profession, with more than 3.1 million registered nurses nationwide,” says the American Association of Colleges of Nursing. “Nurses comprise the largest single component of hospital staff, are the primary providers of hospital patient care, and deliver most of the nation’s long-term care.”
Pursuing Nursing Opportunities
So many advanced career opportunities are available for nurses and can advance the quality of patient care. Alvernia’s online RN to BSN degree Completion Program prepares students for management-level positions and other nursing specialties. The program offers a convenient and flexible online learning environment, accommodating the personal and work schedules of students. Alvernia also offers a Post-Master’s online DNP Clinical Leadership Program. Check out Alvernia University for more information on nursing hierarchy.
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