You are Not Alone

I often get questions from students who wonder if they are the only ones who feel like they "don't know enough". You are not alone! Even nurses who have been at it for a long time will run across situations in which they do not know what to do. This is when you rely on your book knowledge, your experience, and your gut instinct. True, when you're new, you don't have much experience or instinct to rely on. However, listening to other nurses and to your nursing instructors when they are telling you stories can add to your "experience." Additionally, if you make good friends with nurses who have experience, you will have a valuable team when in times of trouble.

Recently, I had a student tell me that while she enjoyed hearing my stories in class, she felt that the time I used telling stories in class would be much more valuable if I stuck to content only. I didn't tell her (though I probably should have) that I've chosen my stories for good reason. Thinking back to my own school days (daze?) I can still distinctly remember many of the stories my instructors told us instead of the bland lectures I sat through. Don't get me wrong, I learned a lot through lecture and I hung onto every word. However, I still remember the story that one of my instructors told us of running through a swinging door that didn't have a window in it. She knocked over a patient, the patient was injured, and the hospital was sued. Ever since that day, I have NEVER ran through a door that didn't have a window in it. I always open doors with caution. While I never actually had the experience of knocking over a patient, I learned from my instructor's mistake, and it became a part of my own experience. Over the years, I have thought of many of my instructors' stories, and based some of my decisions on them.

One of my best pieces of advice I can give is, "Don't panic." This is from my favorite sci-fi book, but it can also pertain to nursing and emergent situations. If you panic, you won't help the situation at all. Take just a second or two to take a deep breath and gather your thoughts. Before long, it will all come naturally.

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Social Networking and Nursing

With recent news-breaking stories about social networking and nursing, I felt like I could provide some guidance for nurses and nursing students alike.

One of the best bits of advice I can give is to reserve social networking sites for what they were intended - being social. What you do at work should remain at work. I know it is tempting to tell everyone that you took care of a woman who was in a car wreck and had to have her leg amputated, or to tell your family that you took care of long-lost cousin Bill. However, these are all HIPAA violations. Even if you do not state someone's name, people can infer who you are talking about, and that can lead to serious legal ramifications.

Something else to think about: even if a nurse or nursing student wins a lawsuit regarding a possible HIPAA violation, that person may be thought of negatively for a long time after the dust has settled. Why even risk the possibility of losing your job or losing your spot in nursing school, only to have it overturned in court? Don't put yourself in that position, because it can follow you for many years to come. You don't want any problems in your background keeping you from getting a new job.

Don't tweet or post to Facebook while you're at work. Even if you aren't giving out patient information, your boss could inadvertently see your posts, or someone could tell your boss (or clinical instructor) that you've been posting during working hours. While it may not affect your productivity, it does not look good for your reputation, especially if you're writing that you are bored! Any time you post to a social networking site, do so thinking that your boss is reading it. Furthermore, using a cell phone or getting on the internet may be violating hospital or school policy. This could lead to termination or severe problems for you.

Don't post pictures of yourself that will put you in a negative light. Also, don't write posts or tweets that would make others question your ethics, integrity, or honesty as a nurse. Public opinion can be very fickle, and if you're posting pictures of yourself in compromising situations, or if you're posting about playing hooky from work, that opinion of nurses could start circling the drain. The Gallup Poll has consistently shown that the public trusts nurses more than any other profession. Don't do anything that would harm that reputation that so many nurses have worked hard to attain.

In conclusion, always think about the ramifications and possible side effects of what you post online. The results may not be what you bargained for.

The Infamous Nursing Exam

If you're in nursing school, you know why I call the nursing exam 'infamous'. Nursing exams are infamous for being tricky and tough. But that's the point. Your patients will be tricky and tough! Nursing exams are there so your instructors can get you prepared for critical thinking on the job, when you're in a tight spot, and you have no supplies. So how do you tackle a nursing exam and come out alive? I have a few tips that may save you a few heart attacks, mental breakdowns, and depression.

Don't Fall Down on Your Reading and Studying

Don't ever let yourself get behind on reading and studying. The instructor will give you the MOST important information in class, but you can (and will) be tested over material that was in your reading assignment. Why? Because there is absolutely no way your instructor can cover every single detail in class. If she were expected to, classes would last forever, and you'd be in nursing school for years and years and years.  So block some time into your calendar just for reading and studying. Make sure you spend 3 hours x the credit hours for that course in reading and studying each week. So if you are taking a course that is worth 5 credit hours, multiply 5 x 3 hours, and you get 15 hours you need to study for that one course.

Study Your Notes Immediately

Take good notes during class. Make spelling errors, make them sloppy, make up abbreviations that you will understand. But...if you don't read those notes again until a week later, you won't know what you were writing about! Once you are done with class, go home or to a study area immediately. Pull out your notes and your textbooks. Rewrite your notes legibly and so you can read them and understand what they mean. Use your textbook to fill in information that your instructor didn't talk about in class. So, you covered hanging IV fluids in class, but the book says you have to check Y-site compatibility before you hang any medications with the primary fluids. Write that down in your notes. You will come away having already studied AND you have a more thorough idea of the concepts covered during class.

Take Care of Yourself

The night before the exam, DON'T CRAM. That is almost everyone's first instinct. Yes, read over material but don't cram so much info into your mind that you lose most of it. Your brain takes time to convert short term memory into long term memory. If you don't know something the night before the exam, chances are you won't know it for the test. Allow yourself time for plenty of rest. Eat well. Relax. Wake up early so that you can eat a good breakfast. Don't overdo it on the caffeine. One cup of coffee or soda - MAX. Don't try the energy drinks. Too much caffeine will make you nervous, jittery, less alert, and even nauseated. You wouldn't want a surgeon coming to do your surgery in that condition...so don't take a test in that condition. Lay everything out the night before that you will need. You might need a pencil, an ID badge, or other supplies. Put everything next to your keys and bag. Even get your clothes ready the night before. This will cut down on the rushing around. Rushing around the morning of a test will only make you more nervous. Give yourself time and you will be much more relaxed. Make sure to arrive early enough that you won't be breathing hard when you get to your seat.

Stay Away From Negative Nancy

Nursing students are always nervous about tests. A career is on the line! But don't get sucked into a situation that will only cause you to freak out and send your B/P skyrocketing. I often see students huddled out in the hallway prior to a test, chewing their lips, saying, "I'm going to flunk this test! I should have studied that more. I didn't know about that! Were we supposed to study that???" These students only get others around them more worked up. If you are nervous and worked up, you won't concentrate as well. Let your friends know that you love them, but that you have to have quiet time before an exam. Then go find a quiet place away from everyone else until the test room doors open.

Take a Minute

Before you start your exam, listen to any instructions the teacher has for you. Listen carefully! Then, before you even look at the first question, put down your pencil, close your eyes, and take a slow, deep breath, in through your mouth. Then let it out slowly through your mouth. Tense up every single muscle in your body. Then relax your body from bottom to top, relaxing each muscle group in turn as you move up your body. When everything is relaxed, take in a few more deep, cleansing breaths. Open your eyes, pick up your pencil, and begin.

READ THE INSTRUCTIONS!

I have seen more students get questions wrong from not reading directions than anything. Follow the directions to the finest detail.

Read Each Question and Answer Thoroughly

Cover up all answers for the question you are reading. Read the question thoroughly. If you are allowed to write on your test, underline all the important words, such as BEST, MOST, FIRST, etc. Then read the question again to be sure you understand what it is asking. Is it really asking about the patient's breathing, or is it asking about the sputum? Cancer or therapeutic communication? Once you understand what the question is asking, formulate an answer in your head. Then uncover the first answer. If you think it could possibly be right, put a checkmark by it. If you know it's wrong, without a shadow of a doubt, but an X beside that answer. Do this for each answer, reading each one thoroughly. When you are done, look at what you have left. Do any answers match the answer you formulated without looking at the answers? If so, that is most likely the answer. If not, what would your second guess be for the answer? Is it listed below? If you can knock the correct answers down to two to choose from, which one is the MOST correct? Don't infer anything...EVER. Use ONLY the information supplied to you in the question. If you start developing 'what-if' scenarios, you will think much too deeply and end up getting the question wrong.

Trust Yourself

Most students go back over the exam and their answers if they have time (if it's a paper and pencil test...more on computerized testing later). The thing that kills me is that many times, a student may have had a correct answer the first time, but then erased it and changed it to the wrong answer. This happens because the student begins to panic and starts second-guessing him- or herself. Yes. Look over your answers. HOWEVER...DO NOT CHANGE YOUR ANSWER IF YOU UNDERSTOOD THE QUESTION THE FIRST TIME AROUND. If you read back over the question and realize it's asking something different from what you thought the first time you read it, THEN change your answer.

Make Pretty Dark Bubbles

If you use a ScanTron, make sure you bubble in your answers thoroughly. ScanTrons are graded by running them through a machine, and if a bubble isn't dark enough, or doesn't cover the circle all the way, the machine may overlook it and count it wrong. Don't make any stray marks on the ScanTron as that could also affect your grade. If you are using computerized testing, make sure you selected the answer you meant to select. Some electronic exams allow you to save each individual answer before moving on. If so, save your answers. If a glitch occurs and your exams goes away before you are finished, you do not want to have to work on questions you have already answered again.

Breathe a Sigh of Relief

Before you turn in your test (or hit the submit button), take some more deep breaths. Turn it in and either return to your seat or leave...whichever your teacher has instructed you to do. Don't worry about it any more. There's no going back once you have turned in your test. Worrying will not do one thing. So many people want to worry and worry and then worry some more. But honestly, what does that do? NOTHING! If you have to go back to your desk and wait, put your head down on your desk if that's permitted. Or get in a relaxed position. Don't look around at what others are doing. It will only heighten your anxiety. Meditate, do breathing exercises, relaxation exercises, or fix your stare on a dot on the wall. Whatever you do, just keep your mind off of the test until needed (if your school does test review, etc.).

Have Fun

If you have to wait on grades to be posted, don't sit around and think only about what your grade might be. Go have a little bit of fun. Go down to the lake or take a scenic route home. If you have to go to work that will also serve to keep your mind off of the test. Don't sit at home hitting refresh on your browser until grades are posted. Anxiety = elevated B/P. And there's  no use worrying about it at this point. What is done is done. At least enjoy the moments in your life that you are not using to take a test.

Future postings will discuss computerized testing and different learning styles. Knowing your learning style will help you tremendously when studying, so make sure you check back soon! And quit worrying about that test after you have taken it!

How to Get Accepted into Nursing School

So many people have asked me how to get into nursing school. While every nursing school has different requirements, there are some standards things that all schools look at. So, if you're interested in getting into that nursing school of your dreams so you can get started on your career, you've got some work to do!

Don't Slack in Your Pre-Reqs

This is a mistake that I see very often. There are times in college when we all just want to relax and have a good time. But college is also a serious time. It is meant to prepare us for our careers - what we will be doing for the rest of our lives! Check out the pre-reqs that the nursing program requires, and make sure you do top-notch work in those classes. The other classes are important as well, but a 'C' in Interpretive Dance probably won't hurt you as much as a 'C' in A&P I and II.

Another thing I am seeing more frequently are multiple repeats of prerequisite courses. While the last grade you receive is the one used in calculating your GPA, repeats of courses can be an ominous sign. Nursing school slots are very limited, so applicants who are the cream of the crop will be chosen. Usually, those who have most or all of their prerequisite courses with a high GPA will be chosen.

Send in Your Application on Time...Or EARLY!

Nothing makes someone look less professional than being late. The same thing goes with the application. There are deadlines for applications for a reason. Those on the Admissions Committee must sift through literally hundreds (maybe even thousands) of applications each year. Nothing makes you stand out in a bad light than turning in the application after the deadline. The application is marked as having been turned in late, and those who submitted prior to the deadline will be chosen first. While some schools allow late application submissions, the chance of being accepted will be even greater if the app is turned in early.

Do Well on the Admission Exam

Admission Exam?!?! Who said anything about THAT? Not all nursing schools have an admission exam. However, they are proving to be more and more predictive of student success. Schools are looking for students who will be successful in their programs. Why, you ask? Many people think that colleges and universities only want students' money. That is far from the case. While colleges and universities definitely need money to stay afloat, student success is in everyone's sight. That being said, some basic knowledge is needed in order to do well in nursing school. If a nursing program requires an admission exam, it usually contains English, Math, Science, and Critical Thinking components. If the exam has a study book available, it is advisable to get it. You may be able to borrow it from your local library or even the library at the college. Or, if you are applying with a lot of your friends, you might all chip in together to buy one book. This will save you some much-needed money - nursing school is expensive!

Complete Your Application Completely, Legibly, and Professionally

You may not believe this, but I have seen some applications that looked as though a 3rd grader wrote them. There were misspelled words, missing information, and the handwriting was barely legible. Not only does this cast you in a bad light, it might be a part of the nursing program's admissions policy to place those applications on the wait list. Make sure to put your best foot forward. Your application is usually your first impression with the nursing school. Sometimes, the only thing the admissions committee sees is your application, if there is no interview process.

Attend an Advising Session

If the nursing school requires it, you must attend an advising session. The program may have you come to meet with an advisor one-on-one, or it may have you come in for a group session to learn about the program. During this session, dress comfortably but professionally. Arrive early. Call ahead for directions, parking tips, and walking distance. I say this from experience. I have had several students come in late for an advising session because they arrived to campus on time but didn't realize they had to walk a mile in from the parking lot. They came in, didn't have any time to prepare, and appeared distressed. Take your time. If you arrive too early, go to the restroom and make sure you still look presentable. You are likely meeting with a future faculty member if you make it in!

Make a Good Impression in your Interview

Some schools require you to participate in an interview. It is important to present your best, professional self during this process. Dress appropriately (ask if you are not told what the dress should be; if all else fails, dress in business attire), and work in front of a mirror prior to the interview to ensure you maintain composure. If you were asked to bring any documents with you to the interview, make sure the documents are crisp and clean. Carry them in a manila folder or envelope - do not fold them. You may elect to carry them folder or envelope in a business case or bag. This shows your organization. Arrive several minutes early (but do not show up too early). If the school has a secretary, introduce yourself and tell him or her you there for an interview with (name). When you enter the interviewer's office, introduce yourself with a firm handshake, stating your first and last name. Speak loudly enough to be heard, but not so loud that it is uncomfortable for you or the interviewer. Respond to questions with thoughtful answers and make eye contact with your interviewer when you are talking. Do not be afraid of letting a little silence fall between the question and your answer. Many interviewers appreciate interviewees taking a little bit of time to think about their answers. This shows thoughtful contemplation. Have a few questions handy you would like to ask about the program, but make sure it shows you have done your research. Once the interview is over, thank the interviewer for his or her time, and give another firm handshake. Tell the secretary goodbye and thank him or her for helping you. Exit the building with efficiency (don't run out, but don't dawdle around, either). Some people opt to send a thank you note to the interviewer (either a paper note or email). If you do decide to do this, make sure the thank you is succinct and professional. Do not repeatedly call, write, or email asking for a decision. You will only slow the process down and you will show an unprofessional side to the admissions committee.

Good luck to all of you out there who are desperately trying to get into nursing school. I have one more bit of advice: try to get as many pre-reqs out of the way as possible before starting nursing school. Once you are in nursing school, your life is pretty much consumed. So many students who are taking outside courses struggle because the weight of nursing school is so heavy. Compound that with a job, a spouse, kids, and other duties, and you are a ticking time bomb. So do yourself a favor and get those pre-reqs out of the way. I promise you'll thank me!

Dealing with the Stress of Nursing and/or Nursing School

Stress. It's everywhere these days. Our lives have become so busy that we often do not realize how stressed we are until health problems arise. There are ways to de-stress your life, even if you are a nurse or nursing student. While the following tips are mainly for nursing students, nurses can also use the advice.

Manage Your Time

One of the best ways to prevent or reduce stress is to manage your time wisely. Get a calendar or use the calendar app on your phone or home computer. First, put in appointments and meetings that you cannot miss, such as doctor appointments. For nursing students, put in your class dates and times. Next, if you're a nursing student, put in your study time. Studying should not be done in huge chunks...rather, divide your study time into small chunks of time and spread it out. Lastly, put in social engagements, time with family, etc. You may think it is silly to put time with your family into your schedule. However, if you do not put it in, you will find that you are overwhelming yourself with school or work.

Find a Release

"All work and no play makes Jack a dull boy" - The Shining. If you've watched The Shining, you know how that ends! If you haven't watched The Shining, then just know that doing nothing but work and not having any time for yourself can make you extremely stressed. So many nursing students spend every waking hour studying or thinking about nursing. You should not let it overpower your life. Yes, you are learning about the career that (hopefully) you will have for the rest of your life, but if you never balance it with other things that you love, you are setting yourself up for loads of stress. Some people choose to exercise, take a hot bath, hike, perform yoga or meditation, or punch a punching bag to release stress. Others try their hands at photography, playing an instrument, or cooking. Whatever makes you happy, make sure to make time for it (and put it on your schedule!).

Take a Few Minutes to Compose Yourself

The way my day goes depends on my mornings. If I oversleep, I rush around, forget important things at home, and it seems like I am rushed the entire day. However, if I wake up with plenty of time to get ready, drink a cup of coffee, and think about my day for five minutes, my day goes much more smoothly. One morning I overslept, and I had forgotten that I had set up appointments with students all day. I ended up getting to work late, and a student was already waiting on me. I had to rush through that meeting, and still went over time, causing my next appointment to run behind. I felt rushed the entire day, and my mind was always distracted by wondering how much time I had left in each meeting. I wasn't doing myself or my students a favor at all.

This works in the hospital as well. Take just a few minutes to think about your plan for the day. When I worked in the hospital, I would take time in the morning before I left for work, and then I would take another five minutes after receiving report to 'plan' my day. When I did that, my day went so much more smoothly, even if I had to deviate from my original plan.

Calm Down

There are times when we are just overloaded and there's nothing we can do about it. There are deadlines we cannot miss, bosses looking over our shoulders, patients yelling at us. No matter what the source of stress, take time to calm down. Someone who is anxious or stressed will do no good in any situation. Go to the bathroom if you need to. Close your eyes and take deep breaths, breathing in through your nose and out through your mouth. Before tests, I always try to calm my students down by guiding them through a relaxation technique. It takes about one minute, and the students can calm down enough so that stress and anxiety isn't plaguing their thoughts. I have the students close their eyes and tense every muscle in their bodies. I guide them through breathing in through their noses, and out through their mouths. I then have them release the muscles in their bodies, slowly, from the ground up, starting with the toes and feet, moving up to the calves and thighs, and so on. At the end, when all muscles are loosened, I then have them breathe in and out again, just as before, twice. I then have them open their eyes. Try this at home. When you open your eyes, it is almost as if you see things in a different light.

Don't Sweat the Small Stuff

I have found that nurses and nursing students who are the most stressed out are the ones who are perfectionists. These are the ones who will write and rewrite a paper until it is absolutely perfect, align corners until they match exactly, arrange objects on a desk 'just so'. They do not necessarily have Obsessive Compulsive Disorder (OCD), but you get the picture. I used to be one of these people. I was only a perfectionist when it came to school work or something I had to present for work. Okay, I'll admit that I am still somewhat a perfectionist, but I have learned when to let go. I enjoy my sanity, and I want to keep it. Sometimes I have to give examples to students about what they can stop obsessing over. Yes, while instructors and bosses want you to have legible handwriting, that does not mean that your hand has to cramp with perfection. Just write legibly, and that is enough. If you have naturally neat handwriting, that is wonderful, but don't spend hours trying to make something look perfect.

Spend Time with Yourself

People often forget to take care of themselves. That is very easy for a nurse or nursing student to do. We take care of others by nature. That is often why people choose nursing as a career. However, take the time to take that hot bath, get your hair done, or read. Whatever it is that you like to do by yourself, take a few minutes every now and then to do it. Your body will thank you for it.

What is Nursing All About?

First of all, I would like to thank you for stopping by to view my page. By coming here, you are most likely a nurse, a nursing student, or someone who is interested in the health care field. Since I meet so many people on a daily basis who are interested in nursing, but do not really know what nursing entails, I would like to shed a little bit of light on the subject here. In future blogs, I will go into more detail, answer questions, and hit on some of the more specific topics.

So...what does a nurse do? When I first began nursing school, I wore rose-colored glasses (not literally, because I would have looked silly). I thought that the doctor would tell me what to do, and I would do it. Boy, was I wrong! Yes, nurses do carry out physicians' orders, but they do so much more. I should state right now that nursing differs depending on the facility and setting in which one works.

Nurses think critically and with a certain amount of autonomy. For instance, if a patient comes into the hospital with an infected wound, and the physician has ordered antibiotics, the nurse must first determine if a certain test, called a wound culture, has been done prior to starting the antibiotics. Without going into too much detail, a wound culture is a test that can tell us what germs are in the wound, causing the infection. Why is this important, and why is it important to know before starting the antibiotics? Antibiotics kill all bad germs, right? Wrong! It is important to know if the culture has been done before starting antibiotics, because the doctor will order an antibiotic based on what he or she thinks is causing the infection, usually based on the appearance of the wound among other factors. So, the physician will start the patient on antibiotics right away to get the germ-killing underway. However, in order to make sure the patient is taking the most appropriate antibiotics, we have to know what we're up against. So, the nurse will take a wound culture, send it to the lab, and in just a few days, we will know exactly what bugs are in the wound...and what antibiotics are most effective at killing them. If the nurse inadvertently starts the antibiotic BEFORE getting the wound culture, it could affect the results, which could mean that the patient doesn't get the most appropriate antibiotic with the most efficient and specific germ-zapping capabilities.

Nurses staff hospitals 24 hours a day, 7 days a week. Nurses generally work 8-, 12-, or 16-hour shifts. These days, you are more likely to see a hospital nurse who works 12-hour shifts. Nurses in outpatient clinics may only work 8- or 10-hour shifts, and may only do so during the weekdays. However, nursing care is provided in the hospital around the clock. Nurses become the eyes, ears, and hands of the physicians. Registered nurses (RNs) perform shift assessments. This means that at the beginning of each shift, an RN will do assessments on all inpatients. If you have been a patient in a hospital, you may have noticed that the RN assessed for things that you thought were irrelevant to the reason you were in the hospital. However, this is for good reason. Our bodies can tell us things in such strange ways that the entire body must be assessed, from head-to-toe. Did you know that if your liver is failing, the white part of your eyes becomes yellow? Did you know that certain medications can lead to severe neurological damage, and can be detected early by looking into the eyes, or by having you hold out your hands? Every little thing that the nurse does during the assessment has a purpose.

Nurses document...and then document some more. Nurses generally live by the credo, "If you didn't document it, you didn't do it!" While that may seem a little strange (kind of like the philosophical question, "If a tree falls in the woods, and there is no one around to hear it, does it make a sound?"), there is truth to it. Yes, you may have started an IV, drawn blood, assisted a patient to walk in the hallway, and changed a dressing, but if you did not chart that it was done, you can't prove in a court of law that it was done. So, nurses document everything they do. They may even document some of the things their patients say, if it lends something to the documentation. For example, the nurse may chart, "Complains of abdominal pain." This is an accurate statement. However, take a look at the following piece of documentation. "Complains of abdominal pain. States, 'It's very sharp and it hurts worse than anything I've ever experienced before.' Facial grimacing present when patient changes positions in bed." The person who is reading this can tell much more about the patient than if he or she read the first piece of documentation. Nurses must learn to write succinctly, which means - give a lot of information and meaning with as few words as possible. So, nurses cut out extraneous words, but then choose the words that will have the most impact, and the most accurate meaning.

I could go on for days, but I have included some of the most basic nursing duties here. Keep looking back for more topics, musings, and must-knows!