I would just like to take a moment to express my deep appreciation for my trusty dusty clamps. I never set foot onto the unit without a pair or two hanging from my scrub top, and I’ve never gone a whole shift without needing them. Whether they are kinking off IV tubing, twisting off a cap that is waaaay too tight, helping me find a leak in a chest tube, or simply holding closed a rip in my uniform, I love them so. I don’t think any nurse should ever be without them.
What’s one thing that you couldn’t do your job/clinicals without?
i feel honored to be followed by you! ;)
I really enjoy what you post. keep up the good work! ;)
—————————————- Aw, nutella93, I’m flattered! It’s an honor to be followed by you as well. I shall try my best to continue supplying useful clinical information, my own experiences, and a bit of humor to my fellow new and student nurses. Thanks for reading!
I had a patient this week, a woman with metastatic cancer recovering from major sepsis which admitted her to the intensive care unit.
I was told in report by the day nurse, “Please medicate this patient with pain medications around the clock per families request” because the “patient will not ask for it”.
I understand that some patients may be reluctant to take pain medication or be hesitant to admit their true level of discomfort. However, this patient did not verbalize any pain. She did not appear to be in any pain. The patient denied having any recent pain and was resting comfortably upon my assessment.
Then…the family arrived. They stormed to the nurses station and demanded to know when the last time the patient was medicated for pain (which was over twelve hours ago).
They were incredibly upset with me, believing that I was neglecting the patient and her “pain”. I felt a lot of pressure to administer pain medication to calm the situation. Although the patient had not verbalized pain a few minutes earlier, the daughter coaxed her by asking over and over again till the patient finally broke down and agreed. I didn’t want to administer the pain medication, as I knew it would add to the patient’s already increasing lethargy and confusion, but at this point I had to. Pain is whatever the patient says it is, after all.
I tried to educate the family on the fact that pain medication is given as needed. I explained that we will give the patient as much pain medication as needed until she is comfortable, but that our goal is to not give her more than she needs. What I really wanted to say was “I know you are having a hard time dealing with the sickness of your loved one, but controlling me and the timing of medications does not mean that you are controlling her hospital course or her health”.
So many times I have seen families become fixated on one thing - thinking that if they can control something in the hospital, they can control their loved one’s stay.
I can understand that desire - the hospital (and especially critical care) is a chaotic, unfamiliar and scary place. To acknowledge this, I do my best to educate families and patients on medications, protocols, equipment and even the sounds of the hospital. When families and patients are more included, they tend to feel more comfortable with you and gradually become less controlling.
It’s always nice when doctors and nurses have a mutually respectful, appreciative relationship. Remember that half of the mutuality comes from you! You represent nursing in the way you act and treat others— patients and colleagues alike.
Thanks for reading, I hope this blog helps student nurses and new nurses out… I’ve been there, and I’m still making the transition from student to novice. I know as well as anyone that once in a while you just need a good laugh or a prod in the right direction!
I’m a fledgling critical care nurse in the Surgical ICU. It’s my first job out of nursing school (I just started in January) and so far I love it! I’m learning so much and every day is something new and challenging. What about you? Any ideas about specialties yet?
Hi! just now i thought of using tumblr for nursing school purposes and i found you! =) so my question is, how important are summer externships? My school has been putting a great emphasis on it and sadly enough, none of the hospitals i have applied to has gotten back to me yet, thinking that summer is almost here! what do you suggest do I do? Would it GREATLY affect my ability to get a job after I graduate
My suggestion to you would be to make the most out of this summer. Call up some hospitals ASAP, tell them you are a student nurse and when your anticipated graduation date is, and ask if there are any opportunities available for you. Paid or unpaid. See if you can volunteer somewhere or shadow a nurse, especially if you can find an opportunity in the clinical area you’re interested in. Or look for a position as a nurse’s aid that you could possibly continue into next semester. I did a summer externship, and the skills and concepts we were taught reinforced things I’d already learned in school… Externships are valuable because they expose you to the nursing environment, and steer you towards connections and contacts that may benefit you later. These are things you can certainly accomplish without the official title!
In terms of finding a job, it all depends on where you live. I live in New York City, and it was hard enough to get anyone to read far enough into my resume to find out I’d even done an externship. In the end, the thing that got my resume noticed was not my summer externship, but my GPA… and of all things, the format. When I interviewed with my current nurse manager, she complimented me on the way my resume was put together and barely even asked about my externship. Meh, c’est la vie. But job hunting and interviews are another entry entirely, gingaaaaa my friend.
Bring on the rapid responses and codes, I’m ready for it!
A few tips:
-Regardless of the situation, the first priorities in ACLS are O2 supplementation, IV/IO access, and cardiac monitoring. As a team leader, make sure all 3 are established as you assign individual roles.
-Once a patient is found without a pulse, DO NOT do regular pulse checks until an organized rhythm appears on the monitor. This wastes valuable time. The basic pattern goes: 2 minutes CPR (or begin with defibrillation ASAP if needed), stop CPR for rhythm check, defib if needed, immediately resume chest compressions (NO PULSE/RHYTHM CHECK!), administer medications if needed.
-High quality CPR is necessary after med administration!! Without chest compressions and limb elevation, that medication is staying exactly where you put it, and it ain’t moving. As much as possible, have the team member in charge of medications prepare doses ahead of time, and administer in the beginning of the 2 minute CPR cycle.
-First line medications in PEA and Bradycardia depend on the first vowel: PEA (Epinephrine), Bradycardia (Atropine)….. This trick also used to include Asystole (Atropine), but Atropine is no longer recommended for Asystole. Dammit.
-Epinephrine first for any rhythm without a pulse. You may give an unlimited number of 1mg doses, but they must be 3-5 minutes apart. This means if you alternate with something else after 2 minutes of CPR (i.e. Amiodarone), after another 2 minute cycle you’ll be ready for another epi.
This is one I haven’t heard before! I heart mnemonics, I wouldn’t have graduated from nursing school without them. My favorite has to be the one to remember which cranial nerves do what:
"Some Say Marry Money, But My Brother Says Big Boobs Matter More."
I. Sensory (Olfactory) II. Sensory (Optic) III. Motor (Oculomotor) IV. Motor (Trochlear) V. Both (Trigeminal) VI. Motor (Abducens) VII. Both (Facial) VIII. Sensory (Auditory/Vestibulocochlear) IX. Both (Glossopharyngeal) X. Both (Vagus) XI. Motor (Spinal Accessory) XII. Motor (Hypoglossal)
What’s your favorite? Send your reply via submission, and I’ll post them to be shared!
Allow your heart to dream, for God has a plan for you, but don’t forget where you are now and what your job is for today. Love with all you can and forgive more than you did yesterday. Hold on to those who truly love you, they will be the ones who will be with you for the long run, without a…
Ahh, the smell of fresh clostridium difficile in the morning. Contact precautions with no hand gel allowed, needing a new chux every five minutes, and being elbow deep in poop… I think the only thing worse than having a patient with c.diff is probably being a patient with c.diff. Before Fecal Management Systems (FMS) like the Flexi-Seal rectal tube, having c.diff or any other form of incontinent liquid stool more than likely meant that you’d be sitting in it for most of the day. As a nursing student, I didn’t really find that an FMS could make much of a difference. In fact, the other day was the first time I actually saw a FMS that was not constantly leaking all over the place. After taking report on a patient whose diarrhea had been unmanageable throughout the previous shift despite his Flexi-Seal and the nurse’s best efforts, I was speaking to one of my mentors on the staff and expressed my opinion of FMS’s as a big waste of time, money, and hope. She brought me to the patient’s bedside, taught me the following, and changed my views on Flexi-Seals forever. Using her advice, I was able to keep the patient and his bed clean and dry for the entirety of my shift! Though these are anything but secrets, and are in fact the manufacturer’s recommendations, not many nurses know about or do them. Maybe next time you hear a fellow nurse complaining about FMS’s as I did, you can teach them a thing or two and do The Night Nurse proud.
The patient requiring a FMS is the same patient at extremely high risk for skin breakdown. Good old fashioned turning and positioning from left to right should be done constantly throughout your shift—the key and the challenge to incorporating a FMS into this regimen is that in order for the device to work, it must be unobstructed from where it exits the body to where it enters the collection bag. The easiest way to do this is to place support pillows at the patient’s side and between his legs to provide a clear path for the tube, and hang the collection bag on the side of the bed that the patient is facing.
Milk the rectal tube frequently to prevent backup—at minimum, this should be done every time the patient is repositioned. If the tube is obstructed by dried or thick stool, it can be irrigated as per the manufacturer’s instructions.
If these steps have been taken with no success, there is a good chance that the balloon is improperly inflated. The Flexi-Seal balloon is intended for inflation with 45cc of WATER. If it is filled with air, it may deflate over time. If it is underinflated, liquid stool may leak around it. Filling the balloon to its maximum may not be appropriate for patients of all sizes. Think about it—too large an object in the rectum would send anyone’s bowels into hypermotile-mode. To find out if an improperly inflated balloon is the source of your FMS woes, take a large syringe and aspirate its contents. If it is filled with air, fill it with water. If it is filled with less than 45cc, try filling it to capacity. If it filled with 45cc, try removing 5cc and reevaluating for leaks.
There are few words in the English language that adequately express my loathing for writing Nursing Care Plans— at least the ones we had to make in school. Even the simplest of interventions required peer-reviewed validation. I’m pretty sure it’s common sense that if someone is dehydrated, you give them water to drink… but you wouldn’t be able to write that down on a care plan without someone doing research on the relationship between dehydration and drinking water in the acute care setting. Bleh.
That being said, invest in a good care plan book! I waited one whole semester to get one, and once I did it was like learning how to do long division and then buying a calculator. When choosing a care plan book, make sure it is up-to-date and evidence based— this way, you can use it as a source for all of the common-sense interventions it dishes out. As a bonus, a good care plan book will also cite its own sources, pointing you in the direction of additional reading material.
Individualization is the difference between copying a page out of a care plan book word for word and actually doing what is expected of you as an RN or student nurse. Make sure your goals and interventions are realistic, appropriate, and acceptable to both you and your patient. Ask your patient what he or she wants to achieve, both in the short term and long after discharge— their answers can be used as direct quotes to form a highly individualized plan of care.
When planning care for your patients, always prioritize. Actual problems take precedence over risks, and as our friend Maslow reminds us, physiological issues trump emotional needs.
When I first read through the NANDA list of official nursing diagnoses, I was like, “you’ve got to be joking.” Someone in my class muttered that we were dealing exclusively with “the fluffy stuff,” and that’s certainly what it seemed like to me. All those arguments defending myself against idiots that asked me why I had to go to school to learn to give sponge baths came crashing down on my head. But once you start putting your care plans into action, you see that there’s more substance and purpose to it all. Even the simple act of turning and positioning a patient diligently can prevent a pressure ulcer that could cause infection, then sepsis, then death. What you do matters— that’s why nursing care plans are so important. As annoying as they are to write, they supply evidence that the choices we make as nurses, both innovative and derived from common sense, can improve someone’s quality of life.
What's your advice on test anxiety. I'm a level 1 student and I have test anxiety. I can't help it, I flip out during every test.
My first suggestion to you, dear Anon, is to be well prepared. Give yourself at least a week and a half, depending on the amount of material, and DO NOT TRY TO MEMORIZE THE TEXTBOOK. There are a million ways to study, and one of them works the best for you. Find it. My technique was to make a standardized flashcard (diagnosis, risk factors, signs and symptoms, diagnostics, treatment, possible complications, related nursing diagnoses, nursing interventions), print out a few dozen copies of it, and fill one out for each diagnosis or surgery as I read through my notes and books.
My next word of advice is to try to recreate your studying conditions for the test. Do you wear sweatpants, a t-shirt, and sneakers to the library? Don’t doll yourself up in tight clothes and heels for the test. Do you like to study by yourself and avoid crowded places? Try sitting in the back of the classroom. Do you like to snack while you study? If your professor allows, bring something to munch on (but nothing too noisy! ;) ). Make yourself as comfortable as possible.
During the test, read through each question, and stay calm. If you have no clue, skip the question and come back to it. If the material sounds familiar, try to muscle your way through it using critical thinking and memory association (can you remember what the page of your textbook looks like that contains the information? When did you read it and where were you? What were you eating at the time?….. it’s weird, but it works for me. Maybe it will work for you, too.). If you know the answer without even reading the choices, let yourself be happy about it! Save up that energy, and call upon it when you have to skip three questions in a row and start to feel nauseous.
My last word of advice is something I say everytime I see people frantically sifting through their notes, asking their neighbors obscure questions two minutes before the test is distributed. Put it away!!!! First of all, you are making me nervous. Second of all, if you have followed my first suggestion to be prepared, these last thirty seconds will make little, if any difference. Take a deep breath. Close your eyes. Relax, and whether or not it’s true, believe you can ace this test!
“We nurses drain ourselves to master caring for client’s lives and often lose time to live our own. We don’t whine because we’ve heard about it since in nursing school and we’ve learned to accept that it comes along with the RN package. We just patiently wait for the next day off when we can be selfish again with friends and beers.”—(via aojr)
Tomorrow is the day - Catheter Comp - I'm nervous, any suggestions? ♥
I’m assuming urinary catheter?
I don’t know how your school works, but for mine, one of our 5-6 teaching assistants (usually an RN from the school’s NP program) would demonstrate a procedure during lab using SimMan. Then, each of us would have an individual appointment to perform this procedure for a pass or fail. The problem was, each TA usually had a different method which he or she used to grade us. The lesson I learned from all the hoopla was not to get caught up in the procedure itself, but just to get the job done safely in whatever way made sense to me.
Practice setting up your sterile field! If you will be catheterizing SimMan (hopefully they don’t have you catheterizing each other…), this will be the most difficult part of the comp. If you have an extra kit, practice opening it up, putting on your sterile gloves, setting up while maintaining sterility, and fold everything up again so you can repeat the process.
Once you’ve mastered setting up the sterile field, take a look at all the equipment you have. What is each item used for? It’s hard to forget a step in the process if you take a deep breath and realize all the steps are staring you in the face. Identify them all, and then do them in whatever order you please, as long as you work from most sterile (working on the field: test the balloon, open up your sterile packets of lube and antiseptic) to least sterile (touch the patient: remember to keep one hand sterile once you reach this step!)
***Remember the principles of a sterile field! Before you even open up the kit, make sure it is in a clean, dry, convenient place— once you open it up, it will be near impossible to move it. Avoid reaching over the field, turning your back on the field, or placing your hands below the level of the field once you don your sterile gloves.
A general tip that I have for any comp is to talk your way through it! I’m a nervous person myself, and describing what I was doing through each part of the process helped my nerves, as well as helped me realize if I was forgetting something.
Whoa. You're a Filipino? That's greaaat! Hang in there because I might ask some questions since I'm a freshman in Nursing. Hihi. I just passed my second sem (Thank you Lord :') and it's time for summer classes :)
Yup! I grew up in NY though, so when my parents speak Tagalog to me I usually answer in English. Hahaha ask away… I just started my first job as an RN in Surgical ICU, so I’m still learning myself and I still remember a thing or two about the horrors of nursing school. Good luck with your summer classes!
I had a tough day at work today— nothing crazy, just very very busy and exhausting. This is what I thought of to make myself feel better, I hope it works for my fellow RNs out there!
Another nurse on my unit is currently in a Nurse Practitioner program. She says that LIP courses require very accurate assessment skills, and that some programs even hire live professionals to act as standardized patients. The assessments conducted on these patients by student LIPs are extremely thorough, and INCLUDE RECTAL AND PELVIC EXAMS.
If you’re having a bad day at work, just think: at least you’re not one of these standardized patients!
Being a nurse isn’t about grades, it’s about being who we are.
No book can teach you how to cry with a patient. No class can teach you how to tell their family that their parents have died or are dying. No professor can teach you how to find dignity in giving someone a bed bath. A nurse is not about the pills or the charting. It’s about being able to love people when they are at their weakest moments.