Monday, July 27, 2015

ADN, AAS, Generic BSN, RN-to-BSN...ACK! HELP!

It has been a long while since my last post, but it is because I have been very busy with my career, school, and family. I hope my previous posts have been helpful to you all. I am happy to be back!

I remember when I first thought about entering nursing school (back in the day). My university had a generic BSN program only, so that is what I applied for. I did not realize until I was admitted and actually taking course work that there are many different types of programs. Now that we have the ability to easily research things on the internet, I felt it would be nice to provide a brief explanation of the most common pathways to becoming a nurse all in one place. This list is not all-inclusive, nor exhaustive. If you have a suggestion for a different program to be included, please send a message or comment, and I will do my best to make updates to this list. Also, please note that this only includes undergraduate designations within the United States. Remember, always look at the application requirements for any program you are applying to, as each program will be different.

Practical Nurses

Licensed Practical Nurse (LPN) or Licensed Vocational Nurse (LVN)

To become a licensed practical nurse, one must first attend approximately 12-18 months of practical nursing coursework. Coursework can be delivered through a community college, university, or freestanding program. Coursework is generally approximately 50% clinically-based. Some programs require applicants to complete non-nursing prerequisite courses before they can be considered for entry. Some common prerequisites are math courses (like college algebra) and biology courses (such as fundamental biology or anatomy and physiology). Other practical nursing programs will have these courses built into their curricula, where they teach students what they need to know as they progress through the program.

Upon successful completion of the practical nurse educational program, LPN program graduates receive a practical nursing certificate (not a degree) and must then take the National Council Licensure Examination for Practical Nurses (NCLEX-PN). Upon successful completion of this national licensure examination, the graduate is then licensed and receives the title of Licensed Practical Nurse. LPNs work under the direction of registered nurses and physicians.

The LVN program is very similar to the LPN program, with only a name difference. Only a few states use the LVN designation rather than LPN. Graduates from this type of program must also take the NCLEX-PN, but have the title Licensed Vocational Nurse when they pass the licensure examination.

Licensed Psychiatric Technician Nurse (LPTN)

This type of nurse is trained in nursing, but with an emphasis on mental health. Graduates from this program also take the NCLEX-PN. Once they successfully pass the licensure examination, they are given the title Licensed Psychiatric Technician Nurse.

Registered Nurses

All nurses in this section are registered nurses (RNs), but the focus is on the different program types. Registered nurses work under the direction of physicians and/or advance practice nurses.

Diploma Program

Diploma programs are disappearing as research shows that higher education for nurses results in better patient outcomes. However, there are still some diploma programs scattered across the United States. Students in this type of program generally must complete some non-nursing prerequisites or take those courses while in the program. Diploma programs tend to focus on the clinical aspect of nursing, and are most often hospital-based. A graduate from this type of program will receive a diploma in nursing, and must sit for the NCLEX-RN to receive their nursing license. After successfully passing the NCLEX-RN, the graduate becomes an RN.

Associate Degree in Nursing (ADN)

This is the first nursing program listed in which graduates receive a degree from a college or university. The college or university may or may not be affiliated with a hospital. Students must complete some non-nursing prerequisites prior to entry in the program. Many programs of this nature are designed to allow nursing students to complete other non-nursing required courses while also taking nursing courses. Coursework generally takes 2-3 years to complete. Graduates from this type of program receive an associate degree (AD) in nursing or something similar, such as an associate degree in applied science (AAS) or associate degree in applied science in nursing (AASN). The actual degree name is based on curriculum design and how the department of higher education denotes such a degree in each state. Graduates sit for the NCLEX-RN in order to become licensed.

Bachelor of Science in Nursing (BSN)

This type of program may also be called a "generic BSN" because it is a higher-level degree (Bachelor degree instead of Associate degree) but one does not have nursing experience before entering this program. Many BSN programs require their applicants to have completed most or all non-nursing prerequisites before applying, so that all the time spent after being accepted into the program is devoted solely to nursing coursework. The total time it takes to complete this degree can vary widely, but it commonly takes 4 years to complete. While this type of program does focus on clinical nursing, another major focus is that of nursing theory, along with leadership and management skills. Graduates from this type of program receive a Bachelor of Science in Nursing (BSN) or a Bachelor of Nursing Science (BSNc.), and must sit for the NCLEX-RN to obtain licensure.

Other Program Options


This type of program allows LPNs or LVNs to take additional coursework (both non-nursing and nursing) to achieve an associate degree in nursing (there may also be some LPN to RN  programs where the graduates receive diplomas). Students are generally required to have most non-nursing coursework completed prior to entering the program. Once in the program, students will learn about the difference between LPNs and RNs and how they must change their roles with their newly found knowledge. Basic nursing is generally not covered in this type of program because it is assumed that LPNs and LVNs have prior knowledge. Programs of this nature generally take 12-18 months in addition to the time it takes to achieve LPN or LVN licensure. Upon graduating from this program, graduates must take the NCLEX-RN in order to be licensed as an RN.

Paramedic to RN

This type of program is interesting because it takes someone who is not a nurse (a paramedic, not an EMT) and lets them skip some of the basic nursing courses, or allows them to accelerate through those courses because they do have medical knowledge. Students are usually required to have most non-nursing coursework completed prior to entering the nursing program. Students learn the new role of the RN, which is typically different than that of the paramedic, though both are in the health care field. This type of program generally takes anywhere from 12-18 months to complete, and students usually graduate with an associate degree in nursing. Graduates must sit for the NCLEX-RN to become licensed as an RN.

RN-to-BSN Completion or RN-BSN Program

In order to enter this type of program, the applicant must already be in possession of an RN license, so he or she must have a diploma in nursing or an associate degree in nursing. Students will have additional non-nursing requirements to complete, which can usually be taken along with the nursing courses. These programs generally take 12-24 months to complete. Graduates from this type of program receive a BSN or BNSc., and are NOT required to retake the NCLEX-RN, as they are already licensed. However, students must maintain RN licensure throughout the program. This type of program helps students gain a higher education in nursing to meet personal educational goals or the requirements of the facility where the student works. Students can fully expect to be able to work full time as an RN while completing the requirements of this type of program.

Accelerated Programs

Program curricula and length will vary from state to state, and even within the state (or even the same town, for that matter). Program design is based on a multitude of factors, including the number of faculty employed and the number of clinical slots the program has secured. With that being said, some programs are fortunate to be able to offer accelerated options to their nursing students. Accelerated programs allow nursing students to work through the same curricula in a shorter period of time. That does not mean that curricula is cut out or abbreviated. Students in an accelerated program must complete the exact same requirements as students in the regular program, so they can expect to be very busy. The way programs can achieve this can vary greatly. Some programs require accelerated students to work through the summer months while "regular" students are off during the summer. Other programs may require "stacking" of courses, where "regular" students take one course at a time and accelerated students take multiple courses. Be sure to research this option completely because there are often some financial aid issues involved, and the number of slots available may be limited, and, therefore, competitive.

Saturday, July 23, 2011

Entering Nursing Later in Life

A reader recently requested that I cover some tips on how to manage family and course-work for the student who is coming to nursing school later in life. Since this page is all for you, readers, I am happy to oblige!

Keep a Calendar

You will have tons of reading, homework assignments, clinical days, and meetings. On top of this, you will have appointments, family affairs, errands, etc., etc., etc. Begin with a calendar, preferably a small one you can keep with you. Many people choose an electronic calendar, such as one on a smart phone. However, a paper calendar can give you a quick glance of the entire month, rather than switching from day-to-day. On the other hand, your phone can alert you to important engagements. Whichever one you choose, start out by putting in the most important appointments, the ones you cannot or should not change. This will include class days, clinicals, and assignments for school. Additionally, you want to make sure you put in any doctor's appointments, dental appointments, etc. For the time being, nursing school will have to come first many times. You won't always have to sacrifice, but I recommend putting it high on your priority list. Which brings me to my next topic...

Family is Always Important, But... want to succeed, so don't push nursing school to the side. I know this sounds terrible, so let me explain. I'm not asking you to forget about family and friends at all. However, I AM asking you to let your friends and family know how important nursing school is to you so that they won't push you to spend unrealistic amounts of time away from your studies. Nursing is intense (you will have lives in your hands upon graduation), so you have to know your stuff. This leads to my next point.

Create Study Time

Some people do well just by asking their family members to give them some time to study. However, this doesn't always work. Just ask my old classmate. She had 5 children, and when mom wasn't around (she was in her bedroom studying), they missed her so terribly that they would knock on her door until she let them in. Talk about distraction. Yes, love your children, and please don't ignore them. Spend good quality time with them. Actually build that time into your schedule. Write it on your calendar. But also schedule in study time. My old classmate put a sign on her door that let her children know that it was study time and that they were not to disturb her unless (insert emergencies here). This was difficult for her husband, however. He ended up having to deal with all of the "smaller" catastrophes.

Let Your Spouse (or Significant Other) Deal With It

That is....if you have a significant other (SO). If you do have someone living with you, nothing says your husband, wife, or SO can't handle some problems without your input. Many of you have handled "it" often enough that your spouse can take the wheel for the moment. My advice? Talk to your spouse or SO. Let him or her know that you have to have so much time of uninterrupted studying, and ask if he or she would please handle things until study time is over. Yes, you will still contribute to the household, but don't let your spouse or SO think he or she can't handle some things alone. Let your family know specifically what you need, and it will cut down on a LOT of frustration and irritation. I cannot stress how important it is to have support from your SO. If you do not have the support of your SO while going back to school, there is an underlying problem that must be dealt with, and that is beyond the scope of this blog. Professional help is likely in order. If you do not have a husband, wife, or significant other, your situation will be a little different, and is not really the focus of this post.

Use Study Time for Studying

This should go without saying, but I had to say it anyway. Why? Because some people have taken advantage of their alone time. If you want your family to respect your alone time, you must respect them by showing them that you are doing just what you said you would do with that time. If you have set aside time for studying, then study. If you set time aside for writing a paper, then write the paper. Another reason why this is so important is that if you use your study time for something else, will end up needing more time to do your actual studying. This means you will be taking time away from your family that is NOT study time, so you can study or write your paper. That isn't fair to your family. Everyone around you will have to make sacrifices, so please don't make it harder on them than you have to.

Study Tips

Find a nice, quiet, comfortable place to study. If possible, make your study environment away from the rest of the family. Nothing is worse than trying to study in the kitchen surrounded by bored kids. Make your study spot your own by finding a comfortable chair, a desk or table, and study supplies (e.g., pens, pencils, highlighters, sticky notes, markers, tape, stapler, paper clips, etc.). Make sure you have adequate lighting. You don't want to get a headache from trying to read in dim lighting.

Schedule your study dates and times. Actually put them on your schedule, and stick to it. Make studying a priority and do not deviate from your plan unless it is an emergency.

Take breaks often while studying. If you're feeling "antsy", get up and walk around, go get something to drink, or just relax for 15 minutes. But then go back to your studies. You will have to have a lot of willpower, but you can do this!

Eat healthy foods and don't neglect your body. Your brain works much better on healthy foods and when your body is in good shape. So many people give up everything while they are in nursing school, but it just makes things harder. You may have to cut down on the time you exercise if you used to work out for hours at a time, but 30 minutes a day is adequate to help you stay in shape.

Get plenty of rest. Don't stay up until 4 am every morning. It will start to wear you down, and you will be irritable and forgetful. Those are two things you don't want to happen to you in nursing school.

Think about what is important for the nurse to know. Is it really important that you know what is happening on the cellular level? Probably not. Get a good general understanding of the disease process and what signs and symptoms to look for. Then know the usual meds given, nursing interventions, and what will tell you if the things you are doing are working to help the patient. That's all the nursing process is. Study by the nursing process and you have it!!

In Summary

The best thing you can do is sit down with your family and friends and tell them what is expected of you and what you need from them. DON'T neglect them, but make sure you take time for yourself as well. It take a lot of willpower, organization, time management, and inner strength, but with your family and friends behind you, you can make it through with support, caring, and understanding. Best wishes.

Thursday, July 7, 2011

Have a Question About Nursing or Nursing School?

Have a question about nursing or nursing school? Leave your question in a comment. Is there a topic you would like to see on this page? Leave your suggestion in a comment. This page is all about you!

Saturday, June 25, 2011

Nursing 101: Introduction to Nursing

"Intro to Nursing", "Essential Nursing Skills", "Fundamentals of Nursing". These are all common names for the very first nursing course you will take as a nursing student. During this course, you will begin to learn nursing skills, learn some health care lingo, begin working with simple medication calculations, and gain some invaluable insight into nursing.

The Check-Offs

Oh...the dreaded check-offs! While some schools do not hold these student return demonstrations (boy, those students are missing out!), many schools continue to torture students by forcing them to demonstrate their ability to perform simple psychomotor skills safely. That was a bit of satire, by the way! In all truthfulness, students do believe we professors love the thrill of torturing students, intimidating students, or whatever the current complaint is these days.

The whole point of skills checks? To make sure you can perform them before you go into clinical. The intimidation factor? We try not to be intimidating, but you DO have to ensure us that you're not going to fall to pieces in front of a client, or perform something in such a way that it is unsafe to a patient. Is that unreasonable? I don't think so, but I might be biased because I may be a patient some day! You will be in clinical before you know it, and you will have to perform these tasks on a real-live person. Can you handle that? Will you run away screaming? Some of the things we have to do are things you wouldn't normally do in day-to-day life. Think about it. How often do you insert a catheter into someone's bladder? My guess is never. We want you to be able to do it quickly, efficiently, painlessly, and without humiliating the patient. That is all we ask. Yes, it is intimidating to have someone watching over your every move, scrutinizing every move you make with a fine-toothed comb. We have to be sure you're maintaining the basic principles for patient safety, so that when you DO insert that catheter, you won't increase the patient's risk for infection more than the usual risk.

I've found that most of the intimidation comes from the students themselves. YES, you read that correctly. Students have the amazing ability to place so much pressure on themselves that they become anxious, scattered, and sometimes utterly dysfunctional. I have had students make one small mistake and begin sobbing, totally unable to complete the task. Here's a little factoid you might enjoy: Most instructors will give you multiple chances to make up for your mistakes by just saying what you did incorrectly and then stating what you would have done to prevent or correct the mistake OR have you perform that step one more time. So lighten up on yourself. Relax before you come into the room. If you've practiced the skill correctly 100 times, then you know what you're doing. Prove yourself. Walk in with confidence and pretend the professor isn't right there. It will do you good.

The Lingo

Students love the lingo, for the most part. It is amazing to see and hear the transition happening! The first week, students are asking questions about some of the most common lingo. After about 4 weeks, the students have absorbed a lot of lingo and even work it into their own conversations. I love going around while students are sitting in groups, just to hear how they are using medical terminology without even flinching. Students don't even realize how much they have learned in those 4 weeks until you point it out. Four weeks ago, you didn't know what HOB, ROM, BP, BPM, BR with BRP, or PRN meant. Now you use it in everyday conversation. WHOA!

The Math

Medication calculation. Those are two dreaded words for many nursing students. Some nursing students are determined to make it harder than it has to be. I think it has to do with the fact that many people have had difficulty with some or all types of math in the past, and they have become afraid of it all. I am telling you right now that I had trouble with math in school. Algebra, geometry, trig...they all intimidated me and I had to study so much just to learn the basics. But, med math is very simple for the most part (it does get more difficult later). We also give you specific formulas. The key is plugging the information into the formulas correctly. Once you get that down pat, you're good as gold.

The Insight

Your instructors often will tell you stories about their own experiences in certain situations. Often, these stories will lighten the mood, hit home a serious point, or serve as a lifetime reminder to you. I still remember many of the stories my instructors told while I was in nursing school. I gained insight into nursing through those stories. ( instructors are real people who really worked as nurses, and they figured out how to do things better because of this situation right here. I think I will remember that for future use!) One story I tell my students (when we start talking about medication administration) is about the time I made a medication error because I took for granted that the pills in the box were what the label on the outside of the box said they were. I neglected to look at the actual package of the single pill. I tell this story for several reasons. One, I am human and I make mistakes. Two, it was my mistake because I didn't look at the individual package to ensure I had the right medications. Three, I wrote myself up because I made the mistake and no one was around to write me up for it. Four, I helped to create a safer work environment BECAUSE I wrote myself up. The pharmacy had labeled the box as 0.5 mg, but had stocked the box with 1 mg tablets. The sign-out sheet still had 0.5 mg written on it. In the past, when the change was made to 1 mg, the pharmacy and all the nurses knew about the change, and the sign-out sheet had been blacked out and 1 mg was written in. However, on this particular night, someone forgot to mark out 0.5 mg and replace it with 1 mg. I was new and didn't realize that someone usually did this, and I knew nothing about how the box was previously stocked. So, in haste, I grabbed a pill, didn't look at the package, didn't think twice about it, and gave it. Oops. It could have been a BAD mistake, and although the box wasn't labeled correctly, it was MY duty to read that package before administering. Nurses are the LAST LINE OF DEFENSE prior to medication administration. Go back and read that line one more time. Yes, I mean every word.

When I wrote myself up, the form asked what occurred, why I thought it occurred, and what my suggestions were to help prevent it from happening again. Of course, my first sentence was, "I was very busy, and in my haste, I neglected to read the package." After that, "The box and sign-out sheet were both labeled with 0.5 mg, though I should have read the individual pill package." Note what I wrote there. I took responsibility for my own actions. I wrote it exactly as it occurred. No blame on anyone else. I did write about the mislabeled box and sheet, but those things, even though they played a small part in my mistake, didn't change the fact that I didn't read that individual package. I then wrote, "In the future, to prevent this from happening again, I will be SURE to read individual packages to ensure I administer the correct medications and dosages. Also, all boxes and sign-out sheets should be updated immediately so that the labels correspond to the respective medication. So, the committee that reviews those things took my write-up and investigated. The result? I was lauded because I wrote myself up (showed integrity) and the box and sheet labels were replaced with the correct labels. They use those write-ups to help improve patient safety, NOT to get someone in trouble. Turns out, even if I HADN'T actually given the wrong dose, but ALMOST gave it, I should have written that up, too. Because if I nearly gave something or performed something incorrectly, others would do the same thing. Patient safety is our #1 priority, so you can never be too cautious.

So...that is a story I tell every single one of my students. You can see all of the different reasons I do this. Also, it's shocking to students to hear that I made a mistake when giving medications, and for such a stupid reason as not reading a medication label. Of course, we pounded it into their heads, "ALWAYS READ THE MED LABEL!!!!!!" about a million times. But when you get out there in the real world, you DO get busy. You get swamped. You get tired. You have so many patients with so many medications. It's actually easy to make a mistake. However, if you do the right thing the right way everyday, you're good as gold.

My point to this long, drawn out story? Listen to your instructors. Learn from their mistakes. Learn from their triumphs. Remember those helpful tips and hints. I promise you, when you are faced with a similar situation, you will be able to think back and remember those stories. It may even make you a better nurse.

Thursday, May 26, 2011

5 Common Misconceptions Held by Nursing Student Hopefuls (and the Reality)

These days, it seems as though everyone wants to get into the medical field. I've hypothesized that it's more about a stable job environment than the desire to help others, but I have done no real research on the matter. Everything you read below is based solely on my observations and real-life encounters.

5. "I've never had to study before, so I won't have to study in nursing school."

 Whoa, Nelly! I'm definitely not knocking any other courses out there, but many courses taken before nursing school are considered 'core' courses. These courses are meant to provide you with a base of knowledge that you will build on in nursing school. Many times, these courses involve a lot of memorization and a moderate amount of application. Nursing school involves a lot of memorization and a lot of application. If you read 200 pages and think you're only going to have to memorize everything, I hate to break it to you (honestly), but you're wrong. Much of what nursing is depends on how well you can prioritize, manage time, delegate, and critically think. For example, not only must you know what you can and cannot delegate, you also have to know to whom you can delegate specific tasks, what information the person you are delegating to must know, and what outcomes you want. You have to pull information from many different sources and put them all together to come up with solutions. Studying and test-taking skills are a huge asset in nursing school.

4. "Everything I need to know, I have already learned from [insert TV medical show or movie here]."

I don't hear these exact words come out of student mouths, but I do often hear, "Well, I saw this on [insert medical show here] and this is what they did." That is wonderful that you can recall specific episodes and details, but you must remember that television shows and movies are not real life. They are made for entertainment purposes only. For every real life situation depicted in a show or movie, there are 5 more situations that are very unrealistic.

3. "I don't need to know this. The doctor will tell me everything I need to do."

I can definitely relate to this one. I had this same misconception when I began nursing school. (Boy, was I wrong!!!) Some of you are shaking your head, thinking, "How could anyone ever think that?" while the rest of you are thinking, "Yeah! I don't need to know this!! The doctor tells nurses what to do!" Things couldn't be as far from the truth as this.

Yes, physicians and advanced practice nurses do give orders for nurses to follow. However, there are so many facets to nursing that are not outlined by the physician's orders that a nurse without critical thinking skills will not be able to keep his or her head above water. Nurses are the eyes, ears, and hands of the nursing profession. In hospitals, nurses provide patient care 24/7. When a problem arises, it is up to the nurse to assess the situation, figure out what is going on, implement certain nursing interventions, or actions, reassess the situation, call the physician when needed, and even provide suggestions on what should or could be done to solve the problem. There are also many times the nurse doesn't even call the doc. The nurse intervenes and gets things done so that the patient recovers faster. Go nurses!

2. "I work in a [hospital, clinical, nursing home, outpatient center, etc.] as a [CNA, scrub tech, secretary, housekeeper, etc.] so I already know most of this stuff."

I hear this one a lot, especially from new students. Don't get me wrong. The things you learned (and are still learning) from your workplace can be invaluable. But please don't underestimate what nursing is. Nursing involves so much more than people often think, some of which I've already covered in previous paragraphs. In order to learn something from nursing school, you have to open yourself up to learning. 

1. "I need to perfect my nursing skills while in school."

You are probably thinking, "Well, YEAH!" The reality is that this isn't 100% true. Nursing school provides you with a foundation of knowledge. You then build upon that knowledge with your experience. It is next to impossible to become an expert at all the skills you will need while in nursing school. However, you do learn the correct procedure in school, so that you can perfect it once you do it a million times at work. So, take a deep breath and relax. Get the basics down, and you'll get better with time and practice. I promise.

Tuesday, May 24, 2011

It's Been Awhile...

It's been really hectic at work lately! I had hoped to update more often, but I just couldn't get around to it. In the meantime, I have been thinking about what I should write about. Since I haven't gotten any feedback or special requests, I thought I would try to answer some frequently asked questions (by nursing students). I hope this will help out any current or future nursing students out there.

Q: Do I really have to know this?

A: YES. We wouldn't teach it to you if we didn't think it would be valuable to you for one reason or another. I often get asked this question about medications. Medications are so important to what nurses do that they are ingrained into the curriculum. We choose only the most common medications, so there is a big chance that you will see that medication repeatedly in clinical (or on tests).

Q: Do I really have to practice my skills? Can't I just get better at the ones I'm going to use in practice?

A: Yes and No. You do have to practice all the skills you are assigned because you are very likely going to need them in clinical. Nothing is more disappointing that finding a skill opportunity at a hospital and then finding out that the student cannot remember one bit about how to perform that skill. Additionally, learning one skill can help you to become better at other skills. For instance, you might not have to insert a Foley catheter much in your OB clinic position, but you may have to obtain multiple in-and-out caths. The same principles apply - sterile technique. We teach the major concepts so that you can carry them with you throughout your career. There were many skills I thought I would never have to use because I was going to work in a certain area. However, I have worked in many different places and I have used every single skill I learned in school. One example is checking dilatation. I NEVER thought I would work in labor and delivery. However, one part of my job as an ER nurse was checking dilatation on anyone coming in who thought they were in labor. Thankfully, I had paid attention in class!

Q: Why do I have to wear this uniform? Can't I just choose my own scrubs to wear?

A: Your nursing school uniform is how everyone identifies who you are in the clinical setting. Health care professionals can tell at one glance what school you are with. Also, it looks very professional.

Q: Why can't I wear more jewelry during clinical?

A: Jewelry can spread microorganisms as well as tear fragile skin during care. I recommend wearing only a plain wedding band (this means no jewels in it at all) and SMALL stud earrings. I have seen students wear large studs, and they have lost them when taking the stethoscope out of their ears. They could fall into a patient's bed, which could cause injury to the patient, or they could fall on the floor, causing someone to slip on them. Necklaces can get broken so easily, so I do not recommend them at all in the clinical environment. Remember, the priority is the patient; it's not a fashion show. You can wear your jewelry to class all you like.

Q: Will I survive this?

A: Yes...but only if you really want to survive. Nursing school is tough. I've probably said that more times than I can count, but it's so true! The school you go to for initial licensure is going to be the toughest thing. Any higher nursing degrees obtained after that will be tough, but nothing like that initial school. The reason for this is that when you come in, you must learn everything from scratch. You have to build a foundation upon which to learn. Higher degrees simply build upon what you already know. Don't get me wrong...grad school is tough, but a different kind of tough.

Q: Should I try to get a higher nursing degree?

A: YES! While there is a nursing shortage all around, the largest shortage is of nurses with higher degrees. You can still become an RN with a diploma or Associate degree, but many hospitals are looking for nurses with a Bachelor's degree or higher, especially those hospitals seeking magnet status. I fully support getting a diploma or Associate's degree first, but I really urge students to seek a higher degree. It opens up so many more job opportunities and possibilities.

If you would like a particular topic covered, please comment below.

Sunday, February 20, 2011

My Bones are Weary

It's been one of those days (or nights). You hit the floor running and even had to stay late to catch up on charting. You never once had time for a lunch break, much less a bathroom break. You had three total-care patients with extensive dressing changes, two patients in severe pain, and one patient who could not stop vomiting, regardless of how many antiemetics you gave her. You finally made it home and all you want to do is use the bathroom and go to bed. But the kids and husband (or wife) are wanting to spend time with you. Do you, A) tell them you are too tired and fall over into your luxurious bed, or B) push yourself to spend some much-needed time with the family?

This is a question that many nurses (and nursing students) are having to ask themselves. With the onslaught of higher acuity patients, nurses are becoming more and more tired at work. One recent study found that more and more med-surg nurses are not as happy with their jobs as they were 10 years ago. Why is that?

Sicker Patients

The patients we are seeing in the hospitals are much sicker than in the past. People are waiting until they are deathly ill before they see a doctor due to the rising health care costs. Also, they are being discharged earlier, so there is an increased need for patient teaching in a short period of time.

Money is Tight

Money is tighter, so hospitals are forced to slack off on the amount of nurses on each unit. Even having one less nurse per shift can cause the amount of work to be done to increase for those left behind. I remember some years ago, when I worked on a med-surg floor. We were all scurrying around, trying to get everything done. We were all sweating, turning patients, cleaning patients, giving meds, giving patients cold washcloths, cleaning bed pans. We all finally got to sit down to chart and the CNO came around. She said that since we weren't doing anything, one of us would have to go home. We tried to tell her that we couldn't manage, but all she saw was us sitting down. One nurse had to go home and we would have to take up the slack. None of us sat down for the rest of the shift, which caused us all to stay late to finish up charting...which caused us all to have overtime. Was that overtime less than what the other nurse would have been paid, had she been able to stay? I don't know the answer to that, but I can tell you that our morale was zapped. We were unhappy campers.

More Demanding Patients?

Patients are becoming more and more savvy. That is a good thing. They know more about their health issues than ever before. However, some of these patients feel as though they should be treated like they are guests in a hotel. Is that so wrong? Maybe...maybe not. Patients do deserve to be treated well, with kindness and respect. So when you follow a nurse who hasn't been all that respectful and kind, the patients can already be in an uproar when you come onto your shift. It seems like an endless cycle. When I come across an angry patient, I try not to become discouraged. I see it as a challenge. Can I get this patient settled and happy before the end of my shift? If I can do that, I will have done my job.

All of these things, and more, all lead up to some very tired nurses. So what is the solution? Nurses should start thinking about the upcoming shift more. When you use the last of an item, replace it immediately. If you write on the last line of the nurse's notes, put in a new sheet. Keep your patients happy so the next nurse isn't land-blasted.

Another thing you can do is work in teams. Teamwork is so helpful on a med-surg floor because you can all share the work. When it is time to go bathe patients, get a cart ready with everything you will need and park it outside of the patient's room. Everyone can get in there, clean up the patient and the room, including placing new linens on the bed, in less than 10 minutes. Move on to the next patient, and before you know it, everything will be done.

When you work in teams, you begin to read each others' minds. I have had some great teams in the past, and I keep reinforcing teamwork with all of my students. Don't ever say you won't help someone, because you may be the one needing help someday. It MUST be a give-take relationship. If everyone gives, then no one has to feel guilty about taking from time to time. Just don't be the one who is always taking and never giving. Anger can grow quickly!

Start out your shift with a smile on your face. This may sometimes feel impossible, but studies have shown that if you force yourself to smile, your brain is tricked into thinking you're happy. In recent years, I have never seen more scowls as I have when I walked onto a med-surg floor. However, I smile at everyone, and before I know it, others are smiling back at me. Are smiles contagious? I don't know the answer to that, but I do know that one can certainly affect the moods of why not have a positive effect?

Don't forget about your family or yourself. You give yourself over to your patients every day you are at work. But don't forget that you have a loving family at home. Make just a small effort to spend time with them. It doesn't have to be anything big. Come home, take some ibuprofen, and allow yourself to relax. Having a supportive family is crucial, but they won't be supportive if you always come home in a negative mood. Leave your work woes at work, and turn that smile on again when you walk through your door. You never just might brighten your family's day as well.