June 2017 ~ Nursing Art

Friday, 30 June 2017

Question Of The Day: Neurosensory Disorders

Q. Which of the following is an early symptom of glaucoma?

A. Hazy vision.
B. Loss of central vision.
C. Blurred or "sooty" vision.
D. Impaired peripheral vision.

Correct Answer: D

Explanation: In glaucoma, peripheral vision is impaired long before central vision is impaired. Hazy, blurred, or distorted vision is consistent with a diagnosis of cataracts. Loss of central vision is consistent with senile macular degeneration but it occurs late in glaucoma. Blurred or "sooty" vision is consistent with a diagnosis of detached retina.

10 Differences: Textbook Nursing vs Real Life Nursing

I don’t know about any of you, but as a nurse-in-training, I was not told of the differences between “textbook nursing” and “real world nursing.” Oh sure, I got the occasional forewarning: “it won’t be like this in the real world.” This statement could not be more correct! There are several tips and tricks that are learned in the field of nursing that can save you precious, life-saving minutes. And, other times, we, nurses, often find ourselves cutting corners a little too closely. Either way, here’s a list of real-life nursing situations or issues that are different than the way the textbook way of doing things!

1. Bath Blankets

In our first semester of nursing school, we’re always trained to keep our patients modestly covered while bathing them by using “bath blankets.” I have never seen a “bath blanket” in all my nursing years. Chances are, if you ask for one, the staff will look at you like you have three heads. Use a towel or sheet.

2. Double-gloving

I learned the hard and smelly way that wearing multiple pairs of gloves in certain situations is a good idea. Two situations that I find this technique especially useful for are: C. Diff code browns and dressing changes that involve the use of betadine.

3. Mitered Corners

Be honest. How many of you have mitered a corner since graduating nursing school? Seriously, tuck it all in under the mattress and move on.

4. Hand Washing

Hand hygiene isn’t where we need to cut corners. Fortunately, the proper use of alcohol-based hand sanitizers has saved us. But I, like many others, am guilty of not singing the entire “happy birthday” tune every single time that I wash my hands. It just doesn’t happen all the time. But I try!

5. No tourniquet!

What? But that’s step so-and-so on page 312 of Introduction to Nursing Skills! Not all intravenous therapy can be started using a tourniquet. In some cases, it will cause the vein to blow.

6. Patients are always compliant…

…NOT! As a student, it seemed our patients were always compliant with treatment. Whether it be a heart healthy diet or taking medications as prescribed, our patients were the picture of health. Unfortunately, many times it is the opposite in real life, and that makes caring for our patients difficult.

7. Foley catheters

Foley catheterization is one skill that is nothing like the books tell you. Catheter insertion on a female is seriously difficult sometimes. Do yourself a favor, and have an extra kit at the ready.

8. There is no black and white.

Absolutely nothing in nursing is black and white–not even lab results. Everything is a shade of gray. Textbooks make it seem simple, but it isn’t. The human body and mind are very complex; therefore, nursing is too. Keep an open mind and learn to think critically.

9. Short-staffing

Textbook scenarios are based in a perfect world with perfect nurse-patient staffing ratios. Unfortunately, this means that, sometimes, mistakes are made. Medications are late, ice isn’t passed promptly, and patients become disgruntled. It isn’t a perfect world with perfect staffing.

10. You will not be 100% prepared for an emergency…

…because you will never have the same scenario play out twice. And that’s okay. No two people are alike. This is how we learn and grow as medical professionals. With our experiences, we gain the knowledge we need to become better nurses and save lives more efficiently the next time around.

Question Of The Day: Gastrointestinal Disorders

Q. A client with a bleeding ulcer is vomiting bright red blood. The nurse should assess the client for which of the following indicators of early shock?

A. Tachycardia.
B. Dry, flushed skin.
C. Increased urine output.
D. Loss of consciousness.

Correct Answer: A
Explanation: In early shock, the body attempts to meet its perfusion needs through tachycardia, vasoconstriction, and fluid conservation. The skin becomes cool and clammy. Urine output in early shock may be normal or slightly decreased. The client may experience increased restlessness and anxiety from hypoxia, but loss of consciousness is a late sign of shock.

How Nurses Can Deal With Flirty Patients and Co-Workers

Inappropriate behaviors, whether they are from your patients or co-workers, can affect the way you perform your work. If theses are left unresolved, it can even lead you into trouble. To avoid getting into uncomfortable circumstances or put your safety at risk, here are some of the ways you can diffuse the situation.

Maintain a professional stance

One of the most efficient ways to set boundaries is to show professionalism. If you show a serious stance, your patients and co-workers will know that you won’t take any flirtatious actions seriously. Make it known that your interaction with them is purely work-related.

However, you also shouldn’t dismiss any friendly gestures. Keep in mind that not all people who are friendly towards you are flirting with you.

If you are unsure about another person’s behavior towards you, make sure to ask and clarify first.

Be honest and acknowledge it

If you are dealing with a flirty patient, you have to be straightforward in telling him that you don’t have any plans of dating patients. Let him know that his actions are making you uncomfortable, and if he doesn’t stop, you’ll get another nurse to assist him.

In case it’s a flirty coworker, you need to confront him about how his actions are affecting your work. Make the impression that if he continues to flirt, you’ll be willing to report him to the management.

Although it’s easier to ignore flirtatious gestures, not doing anything to address them only encourages the person to go on. Instead of being mom about the situation, be honest and open about how you’re feeling. If you think the situation is starting to get out of hand, don’t hesitate to reach out to your management.

Don’t be alone with your patient

If you are sure that your patient is hitting on you, make sure that you aren’t alone when you are assessing him. Ask a relative or one of your co-workers to accompany you during the assessment or the procedure. It’s best that you ask someone who is the same sex as the patient to ensure his comfort and your safety. If it isn’t an invasive procedure, you can leave the door slightly open.

If you’re not comfortable with the patient, you can ask another person to be with you when you see your patient.

Ask to be assigned to a different area

In case your co-worker has crossed the line, you can ask your supervisor to assign you or him to a different area. You can also ask another colleague to switch cases with you in case your patient has shown an aggressive or unacceptable behavior.

“There’s this patient who always asks to be assigned to one particular nurse every time he goes to the clinic. At first, we thought that the patient was just fond of the nurse because of how well she treats him. One time, the nurse reached out to me and asked if she can refuse to see the patient. It turns out that the patient was frequently going to the clinic to invite the nurse out and get her number,” a nurse manager said.

Take control of the situation

If you don’t find a joke funny or if you get another person’s statement offensive, don’t laugh. If your patient or your co-worker started telling you personal stories that are intimate in nature, change the topic or steer it back to a subject that’s work-related.

Take control of the situation before it controls you.

Another good way to tame their flirty side is to use humor to your advantage. Be witty and lightly point out how they are flirting with you and how you find it unattractive. When you slightly drag their ego down, they are likely to retreat and never repeat their innuendos.

Question Of The Day: The Neonate

Q. Nurses teach infant care and safety classes to assist parents in appropriately preparing to take their neonates home. Which statement about automobile restraints for infants is correct?

A. An infant should ride in a front-facing car seat until he weighs 20 lb (9.1 kg) and is 1 year old.
B. An infant should ride in a rear-facing car seat until he weighs 25 lb (11.3 kg) or is 1 year old.
C. An infant should ride in a front-facing car seat until he weighs 30 lb (13.6 kg) or is 2 years old.
D. An infant should ride in a rear-facing car seat until he weighs 20 lb and is 1 year old.

Correct Answer: D
Explanation: An infant should ride in a rear-facing car seat until he weighs 20 lb and is 1 year old.

7 Secrets To Achieving Better Work-Life Balance As a Nurse

Having proper work-life balance is essential if you want to be happy and healthy. However, as a nurse with an extremely busy schedule, it can take more than just good time management skills to achieve that.

In line with this year’s Nurses Week, with the theme “Nursing: the Balance of Mind, Body, and Spirit”, here are some great tips you can use to keep up with the demands of your work without compromising your well-being.

1. Know your situation

One of the first things you have to do is to assess your situation. Evaluate where most of your time goes and where you want to focus more. Busyness is something you choose and you can always make a different choice.

Be honest about yourself so you’d know exactly which areas you’re paying less attention to. Remember that you won’t be able to work on all areas of your life at once so know how to prioritize depending on your age, situation or status.

2. Address conflicts

Relationship conflicts can drain your energy. They can take off your focus and concentration at work and these can spell problems for your patient and the hospital. Medication errors, for example, can easily happen when you are distracted.

To solve the issue, don’t hesitate to engage in necessary conversations with your co-worker or your family. Don’t judge into conclusions and be open to what they have to say. Talk about how you feel and what you can do to ease the tension.

Conflicts at work can affect the way you care for your patients. Settle your differences as early as possible.

If it’s your co-worker, be open for feedbacks. Ask for some help if you need to and don’t hesitate to offer a hand when you’re free. Fulfill your duties and responsibilities as much as possible. For your family, make sure to set aside some time for them. Go out and treat them to lunch once in a while.

3. Learn how to say no

Whether it’s the supervisor or your co-worker asking you extend your working hours, be comfortable in saying no, especially if that is what you really mean. Saying yes when you really don’t feel like doing it can only make you regret the decision later on. Worse, it might even affect the way you deliver care to your patients.

“One time, a patient came up to me to complain about one of the nurses. The patient was extremely dissatisfied that the nurse was frowning the entire shift and was looking annoyed each time the patient asked questions. It turned out that it was the same nurse I asked earlier that day to work an extra 4 hours to cover a sick nurse’s shift,” a nurse supervisor shared.

4. Schedule rest

No matter how busy you get or how often you do night shifts, it’s essential that you get enough rest and sleep. Remember, you are a nurse and you need to be fit physically, mentally, and emotionally when dealing with patients.

Although going out with your friends and engaging in a hobby can help you achieve better work-life balance, it doesn’t mean that you have to sacrifice your sleep. If you need to go out, schedule it after you’ve rested.

5. Do something that makes you feel good

Do something you’ve always wanted to try. Discover your passion one step at a time.

Whether it’s soaking in a warm bubble bath or gardening, if it nurtures your soul, just do it. Schedule it in your week and prioritize it during your free days. Take care of not just your body, but your spirit, emotions, and intellect, too. It’s one of the best ways to combat stress and burnout.

6. Pay attention to your body

When you’re a nurse, it’s quite easy to neglect your own health. You can skip lunch, drinking water or taking your vitamins when you’re too busy making sure your patients are full, hydrated and healthy.

If you feel like a cold is coming or you feel pain on your back or feet, take the necessary interventions. See a doctor when you need to and make sure that you give yourself the tender, loving care you freely give to other people.

7. Exercise

Exercise is one of the easiest and cheapest ways to get rid of depression and stress. You can enroll in a Pilates or Yoga class. If attending a special class isn’t your cup of tea, you can always do a 10-minute walk or run outside your home or on your way to the hospital. If budget permits, you can invest in exercise equipment and do your workout at home.

Exercise can help you recharge and clear your mind, especially if you are feeling overwhelmed. Apart from that, it can also help you shed off some extra weight.

Question Of The Day: Postpartum Period

Q. The nurse is caring for several mother-baby couplets. In planning the care for each of the couplets, which mother would the nurse expect to have the most severe afterbirth pains?

A. G 4, P 1 client who is breastfeeding her infant.
B. G 3, P 3 client who is breastfeeding her infant.
C. G 2, P 2 cesarean client who is bottle-feeding her infant.
D. G 3, P 3 client who is bottle-feeding her infant.

Correct Answer: B
Explanation: The major reasons for afterbirth pains are breast-feeding, high parity, overdistended uterus during pregnancy, and a uterus filled with blood clots. Physiologically, afterbirth pains are caused by intermittent contraction and relaxation of the uterus. These contractions are stronger in multigravidas in order to maintain a contracted uterus. The release of oxytocin when breast-feeding also stimulates uterine contractions. There is no data to suggest any of these clients has had an overdistended uterus or currently has clots within the uterus. The G 3, P 3 client who is breast-feeding has the highest parity of the clients listed, which—in addition to breast-feeding—places her most at risk for afterbirth pains. The G 2, P 2 postcesarean client may have cramping but it should be less than the G 3, P 3 client. The G 3, P 3 client who is bottle-feeding would be at risk for afterbirth pains because she has delivered several children, but her choice to bottle-feed reduces her risk of pain.

10 Effective NCLEX Test Taking Strategies and Tips

Before you step into the real world of nursing, you must pass their licensure examination first to prove that you’re a safe and effective nurse! Reviewing board exam questions are just a way of further enhancing your knowledge and confidence for one of the most important test in your life. What you must remember is that you are already knowledgeable about cores of nursing, but this knowledge would be futile if you cannot apply effective test-taking skills during your exams. You have a substantial amount of knowledge about nursing, but how do you really know how to use this knowledge during exams?

Researches suggest that an examiner who fully understands test construction and familiar with appropriate test-taking strategies score higher than those with similar level of knowledge but with inadequate test-taking skills.

Multiple choice tests are different from tests such as essays, identifications and true/false. In multiple choice exams, the question is called the stem. The stem is followed by four alternative answers. One answer is correct, and the other three are called distracter because they distract your attention from identifying the correct answer. Note also that these distracter are not necessarily incorrect answers but rather they may not be as correct as as the one you are required to choose.

Here we have 10 effective test-taking skills and strategies that can help you during your examinations:

1. Extra meaning need not apply!

Test questions are made to be direct and to the point so you don’t need to read extra meaning to the question. The question asks for one particular response and you should not read or add other information into the question.

Often you will find questions that require “common sense” answers and that reading into these questions may give you another interpretation. You should not search for subtle meaning about the questions or answers.

Ask yourself “What is the question asking?” Look for keywords and phrases to help you understand. Interpret the question correctly first before reading into the choices.

2. Understand the question

Make sure you read the stem correctly and notice particularly the way the question is phrased. Is it asking for the best response or the initial response? Understand what the question is asking before considering the distracter.

3. Rephrase

Rephrasing technique requires you to interpret or translate the question into your own words so that it is very clear in your own mind. Rephrasing the stem of the question can assist your read the question correctly and in turn choose the appropriate response.

Placing the question into your own words would help you in removing extraneous data and get into the core of the stem.

4. Isolate

When analyzing the distracter, isolate what is important in the answer alternatives from what is not important relative to the question. In a good test construction, all of the distracter should be feasible and reasonable, and should apply directly to the stem. There should be a commonality in all of the distracter.

Also, all of the distracter may be correct but not the right choice for the specific question that is being asked. The technique here is to ask yourself whether each possible alternative is true or false in relation to the stem.

5. Recheck

Many test-takers fail to recheck the answer with the stem, and they answer the question incorrectly. After choosing the correct answer alternative and separating it from the distracter, go back to the stem and make sure your choice does, in fact, answer the question.

An effective strategy is to judge all four alternative choices/options against the stem and not against one another. Read the stem, then check option 1 against the stem, then check option 2 against the stem and so on. This process will eliminate choosing an alternative that does not fit with the question.

6. Process of Elimination

When a question contains multiple variables as alternative choices, use the “elimination of variable” technique. Each question may pose different alternatives with several variables. Use the process of elimination.

Study the question first and ask yourself what variable fits with this condition, or after examining the distracter underline the symptom that you know is correct. Now ask yourself what variable is not present with this condition. Again examine the distracter and cross out those variables that are incorrect. By this process you’ve probably eliminated at least two distracter even without taking the time to consider the other two.

7. Go back to the basics

When you come across a difficult question and you cannot immediately identify the answer, go back to your body of knowledge and draw all the information that you do know about the condition.

If you are unfamiliar with the disease or disorder and cannot choose the right nursing action, try to generalize to other situations. For example, if the question asks about dog bites, and you’ve never learned the course of the disorder, go back to an area of knowledge that you do know, for example, circulation and body response to toxic substances.

Even though you do not know exactly what to do, you might know what not to do. Eliminate distracter to increase your chances of arriving at the correct answer.

8. Educated guesses

The ability to guess correctly is both a skill and an art.

The board exams is not a “right minus wrong” type. It is important for you to answer every question even if you have to guess. Guessing gives you only a 25% chance of getting the correct answer.

Try to eliminate at least one (or more) distracter as this will increase the percentage margin of chance for guessing correctly.

Examine the distracter and if one is the exact opposite of another (e.g. complete bed rest is different from activity as tolerated; both cannot be correct since they are of opposites), choose the one that seems to be most logical.

Try to identify the underlying principle that supports the question. If you can answer the question, you might then be able to guess the correct answer. This strategy is especially true with a psychosocial question.

Look at the way the alternatives are presented. Are there two answers that are very close? Often when this occurs, the ability to discriminate will show evidence of judgement. Check to see if one, more than the other, is the best choice for the question.

Are there any distracter that are presented not logical (which are correct in themselves but do not have anything to do with the question)? Eliminate these and focus on other alternatives.

Use your intuition. If you cannot choose an alternative from a logical point, allow yourself to feel which one might be right. Often your subconscious mind will choose correctly (based on all the conscious knowledge you have of course) so simply let yourself feel which alternative might be right. Remember, its better to choose one answer than none at all.

9. Choosing answer from a hunch

There comes a time when you are faced with a certain question and you have a hunch that this particular choice is correct. Do we depend on this “hunch?”. Current studies supports that hunches are often correct, for they are based on rapid subconscious connections in the brain.

Your stored knowledge, recall, and experience can combine to assist you in arriving at the correct answer. So, if you have an initial hunch, go with it! Do not change the answer if and only if, upon reflection, it just doesn’t seem right. On the other hand, if later in the test you find relevant information or make new connection of information and you feel that your answer was incorrect, do go back and change it.

10. Choosing the best answer from a strategy point-of-view.

Frequently, the most comprehensive answer is the best choice (Longest the best!). For example, if two alternatives seems reasonable but one answer includes the other (i.e., it is more detailed, more comprehensive), than this answer would be the best choice. If an answer focuses on medical knowledge, be wary, for this alternative might be just a good distractor. Remember, this is a nursing test and questions are designed to test your nursing competency and safety.

It is unlikely that a question would require a medical action for the correct answer; it may, however offer these actions as distracter.

Question Of The Day: Antepartum Period

Q. A pregnant client in her third trimester is started on chlorpromazine (Thorazine) 25 mg four times daily. Which of the following instructions is most important for the nurse to include in the client's teaching plan?

A."Don't drive because there's a possibility of seizures occurring."
B. "Avoid going out in the sun without a sunscreen with a sun protection factor of 25."
C. "Stop the medication immediately if constipation occurs."
D. "Tell your doctor if you experience an increase in blood pressure."

Correct Answer: B
Explanation: Chlorpromazine is a low-potency antipsychotic that is likely to cause sun-sensitive skin. Therefore the client needs instructions about using sunscreen with a sun protection factor of 25 or higher. Typically, chlorpromazine is not associated with an increased risk of seizures. Although constipation is a common adverse effect of this drug, it can be managed with diet, fluids, and exercise. The drug does not need to be discontinued. Chlorpromazine is associated with postural hypotension, not hypertension. Additionally, if postural hypotension occurs, safety measures, such as changing positions slowly and dangling the feet before arising, not stopping the drug, are instituted.

5 Ways You Can Deal with Lazy Nurse Co-Workers

Working with lazy nurses is, perhaps, one of the most annoying things you can experience on the floor. This goes particularly true when you’re running a very busy shift. With your co-nurses pretending to be “busy” reading the paper, disappearing for a few minutes to a full hour and leaving empty coffee cups and candy wrappers almost everywhere, it’s hard not to feel annoyed and frustrated.
Although tattling might be able to relieve some of your frustrations, the truth is it won’t really get you anywhere. In fact, telling in on your co-nurses might even result in more issues. You could be subjected to bullying, jealousy and receive the cold treatment.

If you are dealing with the same issues at work, here are a few tips on how to handle nurses who are just plain lazy.

1. Refuse to cover for your lazy co-worker.

If your co-worker frequently takes brakes, don’t agree to cover for her. You can tell her that your hands are full and that you have a lot of patients to look after.

If your co-worker doesn’t have anyone else to attend to her patients or administer their due medications, she’ll be forced to do the job herself. A bad behavior will continue if you tolerate and allow it.

2. Don’t allow them to distract you.

When you’re a nurse, the last thing you want to happen is to get distracted while performing your duties. Remember, medication errors can easily happen when you’re not focusing or your concentration is divided.

Medication error can compromise not only your license but your patients’ lives, too. Remain focused on your work and limit distractions as much as possible.

If you find your co-workers chatting in the nurse station, excuse yourself and find another quieter spot to finish your paperwork. If you are in the middle of preparing your patients’ medications, don’t hesitate to ask them to leave the area. Don’t put too much energy focusing on what your co-workers aren’t doing. Instead, just concentrate on your tasks.

3. Give guidance than doing the work.

If you are finding it hard to say no when someone asks for help, set limitations on how much help you can give. You can always provide guidance but never do the work for your co-nurses.

“ALWAYS PROVIDE GUIDANCE BUT NEVER DO THE WORK FOR YOUR CO-NURSES.”

Remind them of their tasks and deadlines. Organize their duties for them or give tips on how you’re able to accomplish more things in the same amount of time.

4. Don’t make them change your attitude.

It’s incredibly frustrating to see your co-nurses slacking off and leaving the other nurses to pick up after them. No matter how frustrated you get, don’t let it affect your attitude, especially the way you interact with your patients.

“I’ve been in this ward for several years already and I’ve been able to work with nurses with a wide range of attitudes. One thing I learned is that no matter what they do, you are you. If you let them affect you, it’s your patients who will ultimately bear the effects. And with their poor health, that won’t be of any help. Always consider your patients first,” an 8-year surgical ward nurse shared.

Don’t fall into the trap of following their lead, too. Don’t get stuck into the long hours of chatting and the frequent trips to the restroom.

5. Know when to speak up.

In case you are at the point that you’re too stressed out about the situation that it’s negatively affecting your work, consider speaking with your co-workers first.

Your co-workers might not be that lazy after all. Perhaps, they just lack proper management and organizational skills that they miss out on deadlines and tasks. It could be that they’re distracted with personal issues, too. In essence, there’s nothing that a good, respectful conversation can’t solve.

Talking to your co-workers about your issues with them can give you a clearer understanding of their behaviors as well as possible solutions.

If for some reason, they still can’t change their ways, you can communicate your frustrations to your superior. Be honest with your report. And if your superior failed to do something about it, you can discuss it with human resources.

As much as possible, don’t whine or share your sentiments with your other colleagues. This can only create misunderstandings as well as hurt feelings.

Quwstion Of The Day: Foundations of Psychiatric Nursing

Q. A client was talking with her husband by telephone, and then she began swearing at him. The nurse interrupts the call and offers to talk with the client. She says, "I can't talk about that bastard right now. I just need to destroy something." Which of the following should the nurse do next?

A. Tell her to write her feelings in her journal.
B. Urge her to talk with the nurse now.
C. Ask her to calm down or she will be restrained.
D. Offer her a phone book to "destroy" while staying with her.

Correct Answer: D
Explanation: At this level of aggression, the client needs an appropriate physical outlet for the anger. She is beyond writing in a journal. Urging the client to talk to the nurse now or making threats, such as telling her that she will be restrained, is inappropriate and could lead to an escalation of her anger.

Nurse CE and CEU : Continuing Education for RNs

Becoming a nursing professional (whether it’s an RN, or an advanced nurse practitioner) requires a strong educational foundation. Nurses earn a bachelor’s or advanced degree and pass the required certification exams before seeing their first patient. But once you’ve put on your scrubs and entered the working world, the learning doesn’t stop.

In fact most states require nurses to complete continuing education every two to three years in order to keep their licenses and special certifications current and active. This continuing education – sometimes referred to as CEs or CEUs – are designed so that nurses can keep their patient care skills fresh, stay on top of any industry changes, and learn about new nursing techniques and practices.

The amount of required CEUs vary widely. Some states including New Jersey, California, Arkansas, and Iowa require 30 hours every two years. In other states like Montana and Ohio, requirements are a bit less -- just 24 hours every two years. In Washington, there is a 45-hour requirement, but it must be completed every three years.

In other words, each state board of nursing varies when it comes to CEU requirements, so it’s important to understand what you’ll need to do to continue practicing nursing in your state. What is more consistent is that every 50-60 minutes of participation in a CE-approved activity is equal to one CE contact hour. For nursing-related courses taken in a college program, a semester course will earn you 15 contact hours, while a quarter course will count as 10 contact hours.

There are so many different options available to nurses when it comes to earning CEUs (continuing education units), and as you can tell, the requirements will be different depending on where you work. With a busy nursing work schedule, fitting in CE might seem like quite the challenge. Luckily, there are lots of options that make CEUs accessible and manageable. And because you do have a good period of time to complete your requirements, you can space out the hours so that they can best fit into your schedule. This guide will have you navigate CE for nurses so that you can keep your credentials up to date with as little hassle as possible.

Finding ANCC Approved CE

Let’s start with a quick explanation of what CEs and CEUs actually are, since you might be wondering if those terms can be used interchangeably. CE is just the abbreviation for continuing education, so it’s really more of a generic term. On the other hand CEU (a continuing education unit) refers to a unit of credit equal to 10 hours of participation in an educational course or approved activity. The key here is choosing approved or accredited programs. In order for a CEU to count toward your required hours, it must be administered by an approved CE provider. Usually, if it’s nursing CE coursework from a college or university or a nursing school, you should have no issues with having such credits approved. However, the study hours must be related to nursing in some way, so taking a liberal arts course, for example, wouldn’t count.

That being said, you don’t have to earn all of your CEUs in a college classroom. On the contrary, there are professional seminars, online webinars, correspondence courses, and other industry events that can count toward your continuing education hours. It is also possible to complete CE hours out of state as long as they are given by a provider that is approved by an ANCC (American Nurses Credentialing Center) regional accrediting body.

When in doubt, the best way to confirm that an activity, conference, course, or seminar will be counted toward your required CEU hours is to check with your state board of nursing. For easy access, you can find your state board’s website via the National Council of State Boards of Nursing .

Along those lines, some states do expect some portion of your continuing education to be on specific topics. For instance, in New York, nurses must take an Identifying and Reporting Child Abuse course and an Infection Control course as part of their hours. In Michigan, one hour of Pain Management education must be completed. The remaining hours can be decided by you.

The other thing to keep in mind is that CEUs must be earned within a specific renewal period as identified by your state. So if you need to earn X number of CEUs every two years, you can’t double up and apply extra hours to the following two years. They do not carry over.

What is the easiest way to earn CEUs?

If you’re employed by a large hospital and are part of a union, it’s quite possible that your employer will pay to send you to conferences and training sessions that can help fulfill your CEU requirements. Of course, every institution is different, but check with your employer to see if any such opportunities are offered.

If you’re completing your CEUs independently, there are lots of options for completing CE hours online or at your own pace. The American Association of Colleges of Nursing and the Commission on Nurse Certification lists nationally accredited CE providers on its website. Again, just be sure to double check with your state board before you start randomly signing up for courses from one of those providers. The few minutes it will take to confirm that a course is accepted is worth it to avoid wasting time and money on ones that don’t count.

Paying for CE

CEUs can usually be completed without having to spend a large sum of money. Some hours can be done for free, or for minimal costs under $50. Some providers offer the option to pay a flat fee to take as many courses as you want. And as mentioned above, sometimes your employer will sponsor a portion of your continuing education and training. For those nurses who are non-union or who work for a smaller health care provider that doesn’t have the resources to sponsor training, the costs for CEUs can usually be included as a tax write-off when you do your tax returns.

Getting credit for your hard work

After completing CE hours, you want to be sure that your time and effort will be recorded properly. Usually, the provider will give you a certificate of attendance. If it’s done online, you will likely receive an electronic notification that you completed the course, but you can request a hard copy as well. In most cases, the acronym BRN should appear on the completion certificate, signifying that it is an approved “Board of Registered Nursing” continuing education provider.

Be sure to keep paperwork or digital copies of your CE completion records for a few years in case your credentials are ever called into question.

Keeping your RN and specialty nursing licenses up to date is something that all nurses have to do in order to keep working in the field. However, don’t overlook the other benefits that CEUs can provide, namely staying on the cutting edge of new innovations in the industry so you can thrive professionally. In other words, choose your CE hours carefully so that you can get the most out of the experience, whether it’s networking with fellow RNs at a conference or learning a new skill that can be directly applied in your day-to-day job.

Nursing Degrees: Which one is right for you?

There are so many pathways to becoming a nurse from earning a diploma to a master’s, and every degree in between. As with most professions, usually the more nursing education credentials you earn, the more opportunities for advancement you’ll afford yourself. What’s great about nursing, however, is that you can be a part of the workforce – and be well compensated – after just a year or two of schooling.

Many nurses do end up heading back to the classroom at their own pace as they look to advance or specialize, while many others are content with remaining a staff RN for the duration of their career.

Take a look at the educational pathways you can pursue in nursing to decide which degree level is right for you and your career goals.

Diploma/Associate Degree for LPN

Licensed practical nurses (sometimes called Licensed Vocational Nurses) are a step below Registered Nurses, but often perform the same types of patient care. Like RNs, they must complete a state-approved program of study and take a licensing exam, in their case, the National Council Licensure Examination for Practical Nurses (NCLEX-PN). LPN training can be found at community colleges as well as technical and vocational schools, and usually take about one year of classroom study and hands-on patient care.

Pros

Earning an LPN license can get you into the field quickly so you can begin earning valuable hands-on experience in nursing. This will come in quite handy should you decide to keep moving forward with your studies, not to mention give you something to list on your resume when you begin looking for RN jobs in a couple of years.

Cons

LPNs don’t have the same amount of job opportunities as they once did. More and more nursing employers are looking for RNs these days with lower level positions going to medical assistants. You can still find work, but if you hope to stay competitive, striving for an RN license down the line might be wise.

Associate Degree in Nursing

The minimum education required to become an RN is an associate degree, so in reality, you can enter the nursing profession in as little as two years. Graduates need to pass the NCLEX-RN national licensing examination in order to begin practicing.

Pros

With an associate and the RN designation, it’s one of the few high-paying and well-respected positions that does not require a bachelor’s degree. Many people choose to begin working while they continue on for their bachelor’s, but you don’t necessarily have to go that route.

Cons

Some more competitive nursing positions will give preference to those who have a bachelor’s degree from the get-go, and in order to pursue advanced positions, you’ll most likely be locked out without a four-year degree.

Bachelor of Science in Nursing (RN to BSN)

Whether you begin your nursing career with a bachelor’s degree from the start, or go back later on to earn it, a bachelor’s degree is becoming the standard for most RN jobs these days. That’s why one of the most popular educational options for working nurses is to enter a bachelor’s degree in nursing program after having already having completed a diploma or associate degree program. They’ve already been working in the field, but have come to find that employers are seeking those with four-year degrees, and not having one has prevented them from changing jobs or advancing. These kinds of programs are referred to as RN to BSNs, and are offered by most major colleges and universities.

Pros

Bachelor’s degrees for RNs are the way to go if it’s an option for you. Not only is it a minimum requirement for some jobs, but in other cases, it could mean a boost in salary to the tune of a few thousand dollars.

Cons

Earning a four-year degree is a big investment of time and money, which can be especially challenging for adults who are already in the workforce. If you’re in that situation, you have to try to figure out if the return on investment is worth it for you – such as if it could lead to better paying opportunities or make you more marketable.

Master of Science in Nursing (MSN)

For nurses who want to take on a specialized track or pursue a management position, earning a master’s degree can really help set them apart. In fact, for some advanced nursing practices - like Certified Registered Nurse Anesthetist or Family Nurse Practitioner - a master’s degree is a requirement.

Pros

Becoming an Advanced Practice Registered Nurse (APRN) can lead to huge salary increases in the tens of thousands range, so investing in a master’s program can pay for itself in a couple of years.

Cons

Master’s programs are intense and challenging, and usually take about two years to complete. In other words, you need to be prepared to dedicate a lot of time to your studies. This can be tough to do if you’re working full-time, but many nurses do just that.

Adding specializations to your nursing career through advanced education can truly open up a lot more career doors and give you additional job security. By weighing the pros and cons of each degree type and thinking about your personal goals, you can choose the program of study that’s right for you.

Q. A 7 year old with a history of tonic-clonic seizures has been actively seizing for 10 minutes. The child weighs 22 kg and currently has an intravenous (IV) line of D5 1/2 NS + 20 meq KCL/L running at 60 ml/hr. Vital signs are a temperature of 38 degrees C, heart rate of 120, respiratory rate of 28, and oxygen saturation of 92%. Using the SBAR (Situation-Background-Assessment-Recommendation) technique for communication, the nurse calls the primary healthcare provider with a recommendation for:

A. Rectal diazepam (Diastat).
B. IV lorazepam (Ativan).
C. Rectal acetaminophen (Tylenol).
D. IV fosphenytoin.

Correct Answer: B
Explanation: IV ativan is the benzodiazepine of choice for treating prolonged seizure activity. IV benzodiazepines potentiate the action of the gamma-aminobutyric acid (GABA) neurotransmitter, stopping seizure activity. If an IV line is not available, rectal Diastat is the benzodiazepine of choice. The child does have a low-grade fever; however, this is likely caused by the excessive motor activity. The primary goal for the child is to stop the seizure in order to reduce neurologic damage. Benzodiazepines are used for the initial treatment of prolonged seizures. Once the seizure has ended, a loading dose of fosphenytoin or phenobarbital is given.

Question Of The Day: Infant

Q. A 10-month-old child with recurrent otitis media is brought to the clinic for evaluation. To help determine the cause of the child's condition, the nurse should ask the parents:

A. "Does water ever get into the baby's ears during shampooing?"
B. "Do you give the baby a bottle to take to bed?"
C. "Have you noticed a lot of wax in the baby's ears?"
D. "Can the baby combine two words when speaking?"

Correct Answer: B
Explanation: In a young child, the eustachian tube is relatively short, wide, and horizontal, promoting drainage of secretions from the nasopharynx into the middle ear. Therefore, asking if the child takes a bottle to bed is appropriate because drinking while lying down may cause fluids to pool in the pharyngeal cavity, increasing the risk of otitis media. Asking if the parent noticed earwax, or cerumen, in the external ear canal is incorrect because wax doesn't promote the development of otitis media. During shampooing, water may become trapped in the external ear canal by large amounts of cerumen, possibly causing otitis external (external ear inflammation) as opposed to internal ear inflammation. Asking if the infant can combine two words is incorrect because a 10-month-old child isn't expected to do so.

How to Make Technology Work for Your Nursing Career

Gone are the days when nursing was just about hands-on patient care and manually filling out medical charts all day long. Today’s nurses are not only skilled health care practitioners, but they must also be tech savvy in order to keep up with medical advances, unique patient care solutions, and communications tools.

The good news is that such technological improvements have made it possible to spend more time caring for the actual patients, have helped limit human error (such as mixing up charts), and have even helped ease some of the physical demands of being a nurse.

Take a look at some of the ways that nurses are using technology including apps and software to advanced equipment, so you know what to expect when you head to work in a health care setting.

Nursing technology at a glance

With more and more technology enhancements being used in health care institutions and hospitals – from electronic health records and GPS-tracked medical equipment to tech-driven drug dosing and smarter alarm and alert systems – nurses are expected to know their technology. And that doesn’t only go for advanced nurse practitioners. Staff RNs must be able to learn and adapt quickly so they can begin implementing various tech updates into their daily work.

Here are some of the popular nursing technologies that are becoming more commonplace:

▣ Smart phone apps are being used more often to stay in communication with one’s health care team. This will eventually replace the old pager systems that are not always 100 percent reliable.
▣ Mobile access to information about drug interactions and other reference materials allows nurses to pull up information on the spot, rather than having to lug around heavy books, or step out to search for information.
▣ Electronic patient records are becoming the norm so that patient medical histories can be instantly accessed, and their progress can be tracked in one centralized database. Expect this to be a major part of your nursing training when you begin a new job since it will be a big part of your daily responsibilities.
▣ Non-invasive diagnostic tools are being introduced to help evaluate patients. This means less sticking, prodding, and probing, which is easier for patients, plus it reduces the risk of infection for everyone. Learning how to properly use these tools and equipment is key to making accurate diagnoses.
▣ Implantable devices that administer medication to patients with complex dosing needs is helping to eliminate human error, and freeing up nurses’ time.
▣ Patient-lifting equipment is an advancement that is slowly being adopted by some medical and nursing facilities. However, it is one that nurses who have to lift and move patients surely appreciate as it will help reduce their chance of injury.

How technology is improving patient care

Although learning new technologies can sometimes be intimidating – especially for the nurses who are on the frontlines of patient care and have to get up to speed right away – in most cases, everyone benefits in the long run. For patients, when nurses have better monitoring tools and easy access to their medical histories, they are more likely to get the best course of treatment for their specific situation, and in a timelier fashion. In addition, technology can help streamline nursing tasks so that RNs have more time to focus on the patients themselves, rather than chasing down equipment, or waiting long periods of time for medication to arrive so they can administer them.

Technology in advanced nursing positions

The good news is that by developing health technology skills, many nurses are able to not only thrive in their roles, but also explore new career opportunities in a variety of nursing specialties. For instance, Genetics Nurses use cutting-edge software to analyze patients’ genes in order to determine their risk for various diseases and conditions. Radiology Nurses must be comfortable working with high-tech equipment to perform radiation therapy, MRIs, and other diagnostic exams. And Cardiac Nurses have to love technology in order to keep up with advances in implantable cardioverter-defibrillators (ICDs) and pacemakers.

Keep in mind that all such specialized positions in nursing will require advanced education, certifications, and/or licenses. What they have in common, however, is that they all involve getting schooled on the technologies that are used in the field.

Perhaps no other industry benefits more from technological advances as the medical field. It improves patient care, introduces more effective solutions and treatments, and literally saves lives. That’s why as an aspiring nursing professionals, your success in the field is directly related to your willingness to keep up with technology trends and stay ahead of the curve.

Question Of The Day: The Nursing Process

Q. A client complains of severe abdominal pain. To elicit as much information as possible about the pain, the nurse should ask:

A. "Do you have the pain all the time?"
B. "Can you describe the pain?"
C. "Where does it hurt the most?"
D. "Is the pain stabbing like a knife?"

Correct Answer: B
Explanation: Asking an open-ended question such as "Can you describe the pain?" encourages the client to describe any and all aspects of the pain in his own words. The other options are likely to elicit less information because they're more specific and would limit the client's response.

Disney Nurse: The Happiest Career On Earth

When Cheryl Talamantes moved to southern California in 1987, she saw an ad in the newspaper for nurses at Disneyland.

“I was intrigued and did a quick look at it but never pursued it. Being married to a Marine meant frequent moves. When we moved back to the area in 1999, a dear friend of mine was working as a Disney nurse and encouraged me to apply,” she says.

Soon after, Cheryl applied for the position and embarked on her nursing adventure with Disney. This month marks her 17th year as a Disney nurse.

As an RN-BSN for over 34 years, Talamantes spent the first half of her career in all types of departments and specialties including med-surg, telemetry, oncology, pediatrics, orthopedics, home health, and even case management for a large insurance company.

All of those positions gave her a great foundation and the versatility needed for serving employees and guests at Disneyland.

Unique Patient Care

Now the Guest Health Services manager at the Disneyland Resort in California, Talamantes gets to work with princesses, cartoon characters, and people from all walks of life.

“We are fortunate to meet guests from all over the country and the world, and there are situations where we are working through language barriers as well as cultural traditions when it comes to medicine,” she says.

In addition to having First Aid locations in all of the parks, they also offer care at state-of-the-art urgent response clinics to the hotel guests.

“We are the primary medical first responders at the resort, and can be dispatched to anywhere in our parks, hotels or parking lots,” she adds.

The resort is open 365 days out of the year, and the nurses work in all types of weather and physical locations.

“You could find yourself climbing down into a submarine or up the stairs to a treehouse. We work around entertainment like parades and support four, half marathons a year,” she adds.

They provide basic First Aid. But if the situation warrants it, the nurses assess and assist guests in getting to a higher level of care. Having a large population of people in the resort on any given day means the medical staff can see and respond to just about anything.

“So, our nurses need to have strong assessment skills and be comfortable in the first responder role and working with all age groups,” she says.

The Magic of Working at Disney

Talamantes feels the biggest highlights of being a nurse in a place like Disneyland is first, the cast members.

“In our own department, we truly are a second family. In my entire career, it's something I have never experienced to the level we have here. We are fortunate that we work alongside so many other departments who truly respect our team and are willing to assist us as needed,” she says.

They do their best to turn around a guest’s day when an unexpected situation arises which could impact their visit or vacation. But mostly, the nurses realize they are fortunate to work in a place that is rewarding on so many levels.

How To Apply for a Disney Nurse Position

When a position opens, it is posted on the Disney careers site for a certain location, as is true for all of the parks’ roles, said Melissa Britt, manager for media/external communications public affairs, Disneyland Resort.

“We have Disney Nurses at each site: Disneyland Resort, Walt Disney World Resort, Disneyland Paris, Tokyo Disney Resort, Hong Kong Disneyland and Shanghai Disney Resort. We hire year-round for various roles at the Disneyland Resort,” she says.

Qualifications for Disney Nurses

To become a Disney Nurse, one needs to be a Registered Nurse with a minimum of 5 years of experience, CPR/AED certified and have a valid driver’s license, says Talamantes.

They look for someone who has a calm, friendly demeanor, and an outgoing personality in order to engage guests of all ages. Helpful traits to have include kindness, patience and empathy.

A Disney Nurse needs to have strong critical thinking, problem solving and assessment skills, is confident working autonomously in a first responder role, and is energetic in order to be able to manage the physical nature of the job.

Salary range for Disney nurses
Britt says that they don’t typically provide salary ranges, since it varies by experience, location and responsibilities. For information on average salaries by state.

There are definitely perks when working for an international company like Disney. Some employees receive free entrance to theme parks around the world and discounts on hotels and merchandise.

“I don’t know of any other type of nursing specialty you can work and be able to have Mickey Mouse or a Princess come by to make an ill guest feel better. Disney nurses understand the magic and do everything they can to provide it for our guests,” she says.

Superbugs, Nurses, and Antiobiotic Resistance

The news of a 70-year-old Reno woman dying from a pan-resistant “superbug” has swept through medical and nursing communities in early 2017. Nurses, physicians, epidemiologists, public health officials, and others are scrambling to respond to public concern and make plans for the future.

What does this watershed moment mean for the nursing profession in relation to antibiotic resistance? From nurse researchers and educators to nurse practitioners and acute care nurses, being informed and prepared is no longer an option; nurses are the largest contingent within the healthcare workforce, and our voices, hands, and brains are needed. Nursing students and seasoned nurses alike must be brought to the table; after all, information is a powerful seed of understanding and evidence-based action.

The Superbug Strikes

The woman from Nevada who recently died from a strain of Klebsiella pneumoniae resistant to 26 antibiotics had spent a considerable amount of time in India, a country known for bearing the epidemiological burden of a large share of pan-resistant organisms. Having broken her femur while in India, she was treated in the hospital and rehospitalized a number of time for a bone infection.

When she fell ill again back home, it was found that no antibiotic available in the United States could treat her infection; she subsequently died. Apparently, there was a slight potential for susceptibility of the bacteria to fosfomycin, but that drug is not currently approved in this country for that particular infection.

One can only imagine what the doctors and nurses were thinking and discussing when the reality became painfully apparent: there was nothing they could do to save the life of this unfortunate patient. The medicines that have kept us all safe from bacterial infection for decades were clearly not up to the task, and there is no doubt that this scenario is bound to repeat itself sooner than later.

The likelihood of highly resistant superbugs has been discussed for years, and the CDC has a number of online resources dedicated to the issue. Other cases have indeed surfaced, but this particular case has clearly struck a nerve with the wider medical and scientific communities; the sirens are blaring, and perhaps we’re all now listening.

‘Superbugs’ is a term used to describe strains of bacteria that are resistant to the majority of antibiotics commonly used today. Resistant bacteria that cause pneumonia, urinary tract infections and skin infections are just a few of the dangers we now face.

“Antibiotic resistance is a naturally occurring phenomenon that can be slowed, but not stopped. Over time, bacteria adapt to the drugs that are designed to kill them, and change to ensure their survival. This makes previously standard treatments for bacterial infections less effective, and in some cases, ineffective.” ( Mayo Clinic )

Nurses Must Educate Themselves

For nurses who work in any clinical environment, being fully educated about antibiotic-resistant bacteria is now crucial. Meanwhile, nurses who work in non-clinical roles are also an important resource for neighbors, colleagues, family members, and friends.

Nurses are, of course, looked to as honest, ethical, educated professionals in whom the public places great trust; thus, when news like this breaks upon the shores of American society, nurses will continue to be seen as resources for level-headed, fact-based information. The media may not normally have the habit of reaching out to nurses for commentary about salient health issues, but the public certainly does on an individual basis.

The CDC offers a series of web pages dedicated to providing education to healthcare providers regarding antibiotic resistance in healthcare settings . As nurses, our foremost responsibility is to protect our patients from otherwise preventable harm; understanding how to shield them from pan-resistant bacteria should be at the top of the list of nursing priorities.

If a facility or employer lacks a plan for the prevention of pan-resistant bacteria, nurses can take responsibility for bringing this crucial public health issue to light. Likewise, a hospital without procedures and protocols for the treatment and isolation of patients infected with such organisms must be brought into alignment with the latest CDC recommendations.

Antibiotic resistance is not limited to the inpatient setting; outpatient clinics, ambulatory care centers, and other settings where nurses treat patients all deserve a concerted effort by the nursing community to educate, inform, and protect both patients and staff. Nursing homes, assisted living centers, home health agencies, and clinics must also be prepared to educate patients and staff, as well as respond to the presence of such bacteria in their environments.

Facts For Nurses About Antibiotic Resistance

For the inpatient setting, the CDC has many recommendations for healthcare providers ; each facility must decide which recommendations are most salient for their particular milieu.

When transferring a patient infected with a resistant organism between units or facilities, nurses and other providers must alert the receiving unit or facility regarding the presence of the infection before the transfer takes place.

All providers and staff must be aware of what pan-resistant organisms are present in a given facility, and proper training must be in place so that staff can respond accordingly within established procedures and protocols. Confusion and miscommunication can often stem from a lack of procedural uniformity, thus a clear mandate for the handling of such situations is paramount.

Nurses Taking Action

For nurses who are in the position of directly educating patients, this is an opportunity for delivering the message that patients’ demands for antibiotics for illnesses that are most likely viral (eg: the common cold, the flu, etc.) do indeed contribute to growing bacterial resistance.

Rather than simply giving in to patients’ demands, nurses can support doctors and nurse practitioners in ordering confirmatory lab tests in order to identify the presence of a bacterial infection; this can prevent the unnecessary prescribing of antibiotics in cases where they will obviously be ineffective as anything but a placebo for an anxious patient.

Nurses can actively move their places of employment forward when it comes to the development and implementation of progressive policies on antibiotic resistance; potential actions a nurse can take may include:

▣ Joining the Infection Control committee at your facility
▣ Reviewing and understanding your facility’s infection prevention and control standards, policies, and procedures
▣ Becoming involved in your hospital’s Antibiotic Stewardship Program (ASP)
▣ Seeking increased education on the prevention of antibiotic resistance
▣ Encouraging your facility to become involved in regional or statewide efforts to curb antibiotic resistance
▣ Ensuring that cultures are ordered prior to antibiotics being prescribed
▣ Actively educating patients regarding the dangers of antibiotic resistance and the overprescribing of antibiotics

When nurses speak, change can indeed occur; patients, doctors, nurse practitioners, physician assistants, and others can be influenced positively when a nurse is able to make a strong case for a particular course of action. Nurses who understand the risks of pan-resistant bacteria can act as powerful change agents, educators, and advocates.

Organisms resistant to antibiotics are not going away; in fact, their presence will continue to increase over time. Nurses can and must play a role in stemming the tide, preventing more widespread pan-resistance, and advocating for sensible, evidence-based policies that protect healthcare providers and patients from these frighteningly virulent superbugs.