The Best Stethoscope

So as a clinical instructor I am often asked what type of stethoscope should the students invest in? Personally, this comes down to budget constraints, especially as a student. However, keep in mind that picking out your stethoscope is a pretty important decision. This will be one of your go-to tools in assessing your patients. I hate to sound cliche, but a patient’s life may depend on it. So chose wisely and carefully! Here are the one’s I personally have tried and the one that has been my work horse for over 15 years.

The Best Stethoscope

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Seven Secrets for Nursing Students to Manage a Challenging Nurse

So you arrive on time to clinicals – good job! You are in dress code – awesome! You have all your supplies, a pen, your stethoscope – ready to go save some lives! You get up to the floor, find your patient assignment and BAM – you find out you have to work with “Nurse Ratchet” today! So what do you do? Run for the hills? Cry? – no, there’s no crying in nursing school (at least not in public)! Instead, you are going to figure out how to manage a challenging nurse!

Nursing Students

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What is Ebola?

This post was originally posted on Aug 2, 2014 and has since been updated.

As this emerging disease continues, I plan to update this page as pertinent information becomes available, so please check back often.

Updated Aug 4, 2014,  Aug 5, 2014, Aug 15, 2014 & Oct 4, 2014

So a few months ago I wrote a little piece on the MERS virus that showed up in the United States. (You can read about it here.) What caught my attention at the time was that this previously isolated outbreak of a new, little understood virus was now in my back yard. So, I started to do some research, educated myself and then shared it with you all. What I have learned is I have an uncanny enjoyment in learning about these new and evolving disease and probably should have been an epidemiologist…. that being said, as I was reading up on MERS, I also started coming across reports about the small Ebola outbreak in Africa. At the time, there was very little information about it in the media and it appeared to be contained. Well, we all know now how that turned out…. So, again, here I am reading anything I can get my hands on and learning all that I can. And again, my attention is heightened as the first case of an infected patient arrived in the US today. Ok, crazy diseases…. you have my attention again! So, here is what I have figured out, learned and can ascertain from all that I have read. Again, I am not an alarmist by any measure, but I do believe in being educated, so here is what I know this far.

Ebola, Nursing

Aug 4, 2014, the CDC did a Twitter chat with their leading Ebola expert. Updates have been incorporated for what was learned.

Current statistics according to the WHO – 1603 confirm, probable or suspected cases and 887 deaths = 55% mortality rate as of Aug 1, 2014. Countries involved are Guinea, Liberia, Sierra Leone and now Nigeria. A patient is being isolated and tested at Mt. Sinai Hospital in NYC as well as a patient in Saudi Arabia.

The second infected American, a nurse, arrived today at Emory Hospital in Atlanta for treatment.

Aug 15, 2015 Updates – As of Aug 11, the WHO reports 1975 cases with 1069 deaths = 54% mortality rate.

Oct 4, 2014 Updates – As of Sept 23, the WHO reports 6553 cases with 3083 deaths = 47% mortality. More alarming is the rate of mortality among health care workers – 375 cases with 211 deaths = 47% mortality.

 

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The Patient’s Perspective

I had an interesting time this past week in clinicals. I have always said that each week, a theme or lesson seems to prevail and that is what I usually end up talking about in post-conference. I kind of let the day’s experiences dictate our discussions. Those lived experiences are usually the most powerful, so I try to capitalize on them. Often times they are the more “soft subjects” that are not always easily learned from a book. This week was no exception and the lesson clearly was about the patient’s perspective.

Patient persepcitve, nursing

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Recent published nursing articles

Sorry I have been a little quiet, but have been out of town for a wedding.  However, I wanted to share some articles that I have recently had posted in various areas of the web. Hope you enjoy & please feel free to share or click the like/share links on the sites to show support!

Six Signs You are Really Into Your Job

Five Reasons Why Nursing Students are Afraid to Graduate

The Four Basics of Medical Malpractice

Thanks for the support!!


Avoiding Caregiver Fatigue

Avoiding Caregiver Fatigue

Caregiver fatigue has been a well recognized situation with families of long term illnesses such as dementia and Alzheimer’s disease. However, it hasn’t been until recent years that caregiver fatigue has been recognized in health care workers, such as nurses and sometimes physicians. It is often referred to as compassion fatigue when applied to health care workers. Nurses are especially vulnerable to compassion fatigue especially due to their close care and relationship with patients each and every day. Those nurses especially at risk are nurses who work in high acuity areas such as intensive care units and the emergency department where outcomes are not often considered “positive”.

Caregiver fatigue is often characterized by depression, poor work attitude and general lack of empathy to their patients and the peers. The persons tend to be very irritable and demonstrate periods of poor coping with periods of outbursts. Suffers often describe difficulty falling asleep and staying asleep. Some found that doing something as simple as a new mattress from somewhere like Leesa might help to improve their quality of sleep. However, the symptoms often creep up on the sufferer and is usually recognized by those around them before the person themselves. You know that cranky nurse you hate getting report from… she may be suffering too.

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What if we put CARE back in healthCARE?

care in healthcare

As a nurse, I am often asked what I think is wrong with healthcare? How can it be fixed? Can it be fixed? I always quickly retort with, “The problem with healthcare is that no one seems to care anymore. Remember, it is called health CARE?”. Although it usually gets a chuckle, I really do mean it. We are at a critical time of change in healthcare here in America – new electronic medical records being mandated, Core Measures, HCAHPS, “never events”, Obama-care being implemented, medical malpractice claims on the rise. It just all seems out of control…  and kind of silly if you really sit down and evaluate some of these new measures. For example, one of the HCAHPS questions is regarding medication teaching. As nurses and healthcare providers, don’t we want our patients to know about their medications? If we really cared about our patient, we would. Or how about the noise level – another favorite survey question. If we really cared about our patients getting rest so they could heal, we would be quieter. We would want it to be quiet so we could get some rest if we were a patient.

I know all the problems in healthcare can not all be solved by such a simplistic answer. But what if? Imagine, if we all went into work tomorrow and actually CARED about our patients…. took the effort we would expect if we or our family members were a patient. What if we put CARE back into healthCARE?? What would it look like if we took ownership of our patients – really advocated for them when the system really did not seem to be in their favor? I believe each of us has the power to make an impact -we see it every day in the smiles of patients and families we touch.

Call to action!

I challenge you to start to care! There are a lot of things we can’t change, but we can change ourselves! Lets get our there and put the care back into healtCARE! I can’t wait to see what it will look like! Remember, change starts with you, so be the change!!

 

 


Five Things to Find Immediately When on a New Nursing Floor

Survival Series

 

Most nurses would admit it is hard to have to float to a new unit, especially one you have never been to before. Imagine being a student on top of that! I try to keep my students on the same floor at least a few weeks, but I also want them to experience as much a possible during my short time with them. My group of students this quarter have been at the same hospital for the past few quarters, but are now starting to explore new units with those skills under their belts! Taking it up a notch! It got me to thinking, what do you need to find on each floor to have smooth and successful day? So here’s a quick list to try to ease some of the stress of spending the day on a new floor!

 

Five Things to Find Immediately When on a New Nursing Floor

1. Where is the bathroom?

Let’s just cut to the chase – you know you are going to have to go eventually – might as well locate it now! The last thing you need is to be searching when its an true personal emergency. Make sure you know where it is – you WILL need it eventually! Plus, you might learn something, this is where all the educational material is posted!

2. Where is the code cart?

Again, this is not something you want to be frantically searching for in a time of need! It should be easily found – file it away in your head. It’s one of those things – if you know where it is, you may not need it?? We could hope – for you AND your patients – you won’t need it. (But, if you are like most students, you probably want that experience!)

3. Where is the nutrition room?

According to Maslow’s hierarchy, someone, likely your patient, will need to eat or drink. Take quick inventory of what is available on that particular floor. I was fortunate for may years, we shared our nutrition room with the Pedi ICU – we had great stuff to offer! Maybe you’ll get lucky.

4. Where is the clean and dirty room?

Hopefully between these two rooms, you will have found most things to get you through the day. The key – try not to get them confused – that could be awkward! Again, take note, what is in each room – is the linen here or on a random cart in the hallway. Where do they keep their bags? They are like gold in some hospitals – find the special stash or make friends quickly with the environmental staff – they have everything!

5. Where is the medication and supply room?

Take inventory of what is actually in the medication room – do they have all the supplies you will need or is it all stored in a separate supply room? Open the cupboards and drawers. I floated a lot as a traveler, and the staff was always amazed at how I know where they hid random things – I was VERY nosy, but I knew where everything was! The supply room, if it is a separate room, can be particularly challenging. It seems each hospital has their own “logical” way of organizing everything. Unfortunately, their logic never matched mine and I just had to remember where things were located. Take special note of common care items – IV start supplies, tape, dressing supplies, etc.

Hopefully, this will give you a place to get acclimated to each floor you visit! Make the best of it – be helpful and you will be amazed at how much you will learn if you are just willing! Good luck, take care & don’t get lost!


Five Tips to Survive Nursing School Clinicals

Tips for nursing school

You get your assignment for the day and go out to find you patients. Your stress level and anxiety is through the roof. What if the nurse assigned to my patients does not like me? What will my instructor think of me? And what if my patient yells at me?? Or worse, doesn’t like me? Ahhh… the joys of a nursing student!

As a clinical instructor, I am always trying to find ways to calm down my students, motivate and engage my students. Here’s a list of my Top 5 tips I always give my students. Hope it helps make the best of your time!

Five Tips to Survive Nursing School Clinicals

  1. Set goals for the day – each week my students have to have three goals. This not only allows the student to self reflect on how they are doing and what they still need to accomplish, but it gives the student and the nurse a starting point. Most days the student is greeted with, “What can you do?” After letting the nurse know, the student can also let the nurse know what the goals for the day the student hopes to accomplish. Some examples of daily goals would be to hang more IV medications. One student told her nurse this goal and the student hung almost all the IV medications for the whole assignment and then some. One of my all time favorite student goals… to see a code. Only a nursing student would wish such ill-will on another human – but, hey, they gotta learn!
  2. Get some sleep – often this is easier said than done. The night before clinicals is NOT the time to go out on the town. Be well rested so you can be engaged. Remember, peoples lives (and your future) depends on it.
  3. Seek out opportunities – when you find that RARE moment you might be idle, find something to learn. There is so much to see, do, hear, learn – you just have to be willing to find it! Most students are skill hunters – always looking for practicing those elusive skills. But really, the one skill most lack is interviewing and the art of conversation. It is not easy to ask total strangers personal questions, but the only way to get better is to practice. Also, this goes back to setting goals – ask around to the other staff, maybe they can help you meet your goals. They can’t help if they don’t know!
  4. Play the “student card” – this has been a controversial tip with some students. I am always preaching to them that they need to own what they know, but then, I tell them to “play it dumb” when the time comes. Essentially, if someone is willing to teach you something – let them! This works especially well with the physicians. When they come in to talk with your patient, introduce yourself as the student – you will be amazed at how much they might want to share – and the patient will benefit too! I had worked at a large teaching hospital for many years and knew who most of the friendlier doctors were. I was surprised one day when one of my students got a whole mini-lecture about cardiac cath interventions from one of the less friendly cardiologist. I made him point out the physician to me in the nurses station because I had never heard this particular physician speak so much! “Student card” well played!
  5. Be confident, but don’t be afraid to ask reasonable questions – Even when playing the “student card”, you can still be confident in what you know. In fact, you probably have a better recall of more information than most of the staff because it is still fresh for you. But know your limitations and ask questions when appropriate. Make an effort to seek out information instead of just expecting to be spoon-fed. Your resourcefulness will be refreshing. Plus, most of the world’s information is on your phone!

Well, I hope this helps you out a bit as your continue your journey through nursing school – it definitely is an adventure! Do you have some other tips for clinicals – something that works well for you – I would love to hear it! Please leave a comment.

Also, don’t be afraid to share/like this post on Facebook, Pinterest or Instragram because sharing is caring!

Be safe, study hard and wash your hands!

 



Daily NCLEX Questions

NCLEX Mastery

Here is another fun NCLEX Facebook page – but this one gives you daily questions! They are very random and the answer with rationale is posted usually at the end of the day. The questions are really random, so they do get you thinking. You can also scroll back through their FB page to past questions.
They also have an app that has some good reviews. They offer a lite version with about 80 questions to give you an idea how their app works. (I have downloaded it and will give you some feedback.)  The “full” version is $29.99 – which is a steal as they are raising their price to $39.99 according to their info on iTunes. If you do purchase the app, I would love to hear from you – maybe you could be my guest blogger – or at least give your review!!
Enjoy and remember –  practice makes perfect!!

NCLEX Mastery Link