6 Times Nurses Restored Your Faith In Humanity

As you may imagine, working as a nurse on a pediatric oncology floor comes with its fair share of difficult times and heartbreaking moments. That’s why it is essential to cherish the best and brightest memories with your patients.

I have been lucky enough to work with an amazing team of genuinely compassionate and empathic nurses. On every shift, I've witnessed their positivity and love transcend the scope of nursing and remind me time and again what being human means. There are countless memories, but here are 6 of the moments that have stuck with me the most.

A Valentine's Day Surprise

One of our 18-year-old oncology patients was hoping to spend Valentine’s Day with his girlfriend at home, but unfortunately, discharge from our unit was nowhere in sight due to complications with his stem cell transplant.

He wasn’t discouraged for long, though. The night before Valentine’s Day, a nurse on our unit excitedly offered to help him plan an elaborate surprise dinner for his girlfriend. Getting off of a 12+ hour shift and scheduled to work the next day, she scoured the shelves of nearby stores around town to buy the perfect supplies for an amazing hospital date.

On Valentines Day, our nurses went above and beyond with red and pink heart decorations, a customized playlist, and a romantically-set table for two. We were able to transform our unit playroom into a magical space for these two young people.

Playtime To The Rescue

Photo Credit: anjanettew, Flickr CC-BY-SA | via Wylio

There are often moments when blood counts bottom out, patients lose their appetite, they lose their strength, and they can no longer muster up the energy to fight…but there is always a way.

After days of a patient lying in bed, refusing to move or walk, my coworker had an idea that only a pediatric nurse is capable of imagining. She decided this patient would not do what seemed like work, but might do what seemed like play.

After arming him with an awesome Nerf gun and taping a huge bullseye target on her back, she taunted him to hit the target. As he shot, she stepped away...and then stepped further. 

Before he knew it, he was chasing her through our hallways at full speed, color rushing back into his pale face and a smile spreading ear to ear. Oddly enough, daily walks were never an issue again for this particular patient. 

Making It Festive

Photo Credit: Loren Javier | Flickr | CC-BY-ND

Creating some sense of normalcy is so important to our patients and families who lose control of life seemingly all at once.

One of our younger oncology patients had come to us from India, where cultural practices are vital to families. Every year, he looked forward to the Festival of Lights, or Diwali, as it is traditionally known. Our night shift team decided missing out on this special moment because he was in the hospital for chemotherapy was not going to happen. 

We decided to bring Diwali to him.

Just before his bedtime, six nurses burst in with party-poppers full of streamers, glow sticks galore, and traditional Indian music filling the room. As he pushed the hundreds of streamers around on his hospital bed as if making a snow angel, we looked down on his beaming face as we enjoyed our first Hindu New Year together. 

A Royal Reception

Photo Credit: Pan American Health Organization PAHO, Flickr CC-BY-ND | via Wylio

I think people assume working on a pediatric unit is a lot of dressing up, silliness and play. Well, to be perfectly honest, it is. How lucky are we to have such a job?

One of our dearest cancer patients had been on our unit for well over 6 months and we couldn’t blame him for feeling down every now and then. So on Halloween night, our nurses each picked a magical Disney princess character and committed to elaborate costumes, even covering our badge photos with princess stickers for the night.

As his nurses, Rapunzel, Anna, Elsa, Belle, Jasmine, and Snow White entered his room, a look of surprise swept his face. His open mouth slowly crept into a shy smile as he asked us all about our fantastical castles and whimsical stories. We’d be lying to ourselves if we said we didn’t enjoy it every bit as much as he did. 

Sweetest Dreams 

In addition to oncology patients, our unit also accepted neurology patients. One baby boy stole the hearts of every single nurse on the unit. He was a victim of Shaken Baby Syndrome and at only a few months old, suffered irreversible neurological trauma. 

He would cry and cry at night, and as an investigation was pending on the parents, he had no visitors.

It warmed my heart to know he never truly spent a night alone, however. Every night, when the chaos of the shift had settled and it was time to sit together and chart at the desks, we carried him to the nurses’ station - IV pole, feeding pump, and all.

We would take turns cradling him in our arms to make sure he felt that human touch. It was only when we were holding him that he would actually fall asleep. And that meant he slept every night. 

What A Difference A Tiara Makes

One of my sassiest, funniest, and most loving oncology patients was noticeably different one night. I was her nurse often and I could immediately sense that something was off. 

After sitting down and digging deep, she told me she envied all of the nurses with long, pretty hair like mine. Imagine going through the body-image pressures of high school, compounded by a diagnosis of cancer and a body that changes beyond your control. 

She was entirely bald, and entirely beautiful.

I told her I was an excellent salon artist and I had a knack for decorating bald heads with stickers. I even told her I would cover my face in stickers to match, and wear them all night even when I saw the doctors and other patients. The thought of this gave her a good laugh, and she ultimately agreed to the makeover.

After rummaging through playrooms on two different units and accruing the most stylish collection of stickers, I gathered all of the nurses for makeover night. 

My patient loved her embellishments but mostly loved hearing about all of the strange glances we got that night from visitors, especially the 200-pound male nurse on our unit whose makeover came equipped with emerald gem stickers near his eyes and a sparkling tiara for his bald head that we found. Beauty radiating and confidence beaming, my patient told me it was her best makeover yet. 

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Question Of The Day: Mood, Adjustment, and Dementia Disorders

Q. A client was hospitalized for 1 week with major depression with suicidal ideation. He is taking venlafaxine (Effexor), 75 mg three times a day, and is planning to return to work. The nurse asks the client if he is experiencing thoughts of self-harm. The client responds, "I hardly think about it anymore and wouldn't do anything to hurt myself." The nurse should make which judgment about the client?

A. The client is decompensating and in need of being readmitted to the hospital.
B. The client needs an adjustment or increase in his dose of antidepressant.
C. The depression is improving and the suicidal ideation is lessening.
D. The presence of suicidal ideation warrants a telephone call to the client's primary care provider.

Correct Answer: C
Explanation: The client's statements about being in control of his behavior and his or her plans to return to work indicate an improvement in depression and that suicidal ideation, although present, is decreasing. Nothing in his comments or behavior indicate he is decompensating. There is no evidence to support an increase or adjustment in the dose of Effexor or a call to the primary care provider. Typically, the cognitive components of depression are the last symptoms eliminated. For the client to be experiencing some suicidal ideation in the second week of psychopharmacologic treatment is not unusual.

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5 Ways to Make a Good Impression During Clinical

Every nursing student wants to make a good impression during clinical. This is especially important so that they can maximize their learning experience and develop a good working relationship with their nursing instructors.

Making good impression during clinical involves small efforts made consistently.

Since nursing is a multifaceted and often very stressful, sometimes it can be difficult for students to find common ground with their instructors and experienced nursing staff. Here are five easy steps you can take to make a strong and lasting impression:

Show up to clinical prepared

The best way a nursing student can make a good impression during clinical is to always show up prepared. This may include:

◈ arriving to clinical on time, every time
◈ studying material related to the clinical setting
◈ arriving in proper uniform with ID badge, stethoscope, pens, pencils, sharpie, dry-erase marker, highlighter, notepad, scissors, kelly clamps, pen-light and wrist watch
◈ reviewing patient history and relevant data, such as lab values, vital signs, diagnostic imaging reports, nurses notes, and doctors notes to gain a full understanding of your patients

Always ask many questions

Asking questions allows your instructor and the nursing staff to better understand what your individualized learning needs are. Since everyone learns and retains information differently, it is imperative that you seek additional clarification if you do not fully understand something. Remember, most instructors and nursing staff will assume that you already know how to do something if you do not seek out their guidance and instruction.

Offer extra help to others

Sometimes your classmates and nursing staff may get very busy with their assignments. Be sure to ask what you can do to help. Lending a helping hand can be something as simple as grabbing water for a patient or assisting during an invasive procedure. Either way, by offering help when you have down time, you will surely become recognized as a team player. Just remember that pitching in where you can is always a very good idea.

Remain professional at all times

Professional behavior and expectations thereof is often clearly spelled out in the nursing student handbook, and can also be found in most facility orientation materials. It is very important that you remain professional at all times. Avoid using slang, profanity, inappropriate joking, and personal information during clinical time. This is a great time to be recognized by potential employers, so make sure you are always talking the talk, and walking the walk of a professional nurse.

Demonstrate an eagerness to learn

Finally, nursing instructors and experienced nursing staff love students who are curious, inquisitive, and eager to learn. There is a plethora of learning experiences to be had during clinical, and students who seek out these learning opportunities are most likely to excel in their studies. No matter how you may personally feel about the specifics of each learning experience itself, be sure to immerse yourself in all possible learning experiences so that you will gain more understanding of each patient care scenario.

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Question Of The Day: Adolescent

Q. A nurse is performing a psychosocial assessment on a 14-year-old adolescent. Which emotional response is typical during early adolescence?

A. Frequent anger
B. Cooperativeness
C. Moodiness
D. Combativeness

Correct Answer: C
Explanation: Moodiness may occur often during early adolescence. Frequent anger and combativeness are more typical of middle adolescence. Cooperativeness typically occurs during late adolescence.

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Study Tips for Nursing School Final Exams

It’s that time of year again—nursing students nationwide are frantically cramming for their final exams in nursing school. With all of the sleepless nights and last-minute cram sessions, figuring out the best ways to approach studying can prove to be overwhelming.

Learning how to study for final exams in nursing school is a skill in and of itself.

To help you in reducing test anxiety and succeed on your final exams, here are five of the best study tips for nursing students:

Utilize all resources provided

Nursing educators and instructors work hard to make sure they supply their students with tons of additional resources to help facilitate learning. If you have not already done so, it is important to review all of the supplemental material, along with your course textbooks, to help validate your understanding of the content. The worst that can happen is that you might just learn something new!

Read, write, and do

When it comes to finals, you must be well-prepared to succeed. In fact, it’s nearly impossible to over-prepare. One way that you can be sure to score well is to read, write, and review your nursing content outside of classroom hours. Some practical suggestions are to read your texts and supplemental material, write out key points and concepts, and practice recalling the information. Whether you choose to use flashcards or a notebook, writing the information down, then challenging yourself to recall, it is a great way to help the content truly sink in.

Focus on your weak areas

We all have our favorite topics when it comes to nursing content, and in these cases, we usually thrive in our ability to score well on related exams. However, when it comes to cumulative final exams, there is probably a whole lot of nursing content that we are not excited about—and that should be the focus. By concentrating on the content that you did not like, or that you scored poorly on in a previous exam, you will be increasing your chances in scoring well on the final.

Teach your classmates

Teaching is the highest form of understanding, and this study technique helps to ensure that you are ready to ace the final exam. Be sure to create lesson plans with the content that is expected to be on the final exam. Try to create high-level questions to ask your classmates during your teachings, and be sure to restate the key points regularly. Some students choose to be a student tutor to gain additional exposure to teaching. Either as a tutor or part of a study group, students who adopt this technique for exam preparation often do very well on their final exams.

Frequent, short study sessions are key

Remember, studying for final exams is a marathon not a sprint. Students who participate in extensive cram sessions the night before an exam are less likely to do well. Instead of procrastinating until the night before, it is recommended that you study in frequent intervals for no more than three-to-four hours per session. You may hold study sessions two or three times per day for several weeks leading up to the exam, but be sure to keep the sessions limited to only a few hours. During the time in between studying, make sure to partake in activities that are healthy and relaxing, such as sharing a meal with family, exercising, or getting out of the house.

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Question Of The Day: School-age Child

Q. A 10-year-old with glomerulonephritis reports a headache and blurred vision. The nurse should immediately:

A. Put the client to bed.
B. Obtain the child's blood pressure.
C. Notify the physician.
D. Administer acetaminophen (Tylenol).

Correct Answer: B
Explanation: Hypertension occurs with acute glomerulonephritis. The symptoms of headache and blurred vision may indicate an elevated blood pressure. Hypertension in acute glomerulonephritis occurs due to the inability of the kidneys to remove fluid and sodium; the fluid is reabsorbed, causing fluid volume excess. The nurse must verify that these symptoms are due to hypertension. Calling the physician before confirming the cause of the symptoms would not assist the physician in his treatment. Putting the client to bed may help treat an elevated blood pressure, but first the nurse must establish that high blood pressure is the cause of the symptoms. Administering Tylenol for high blood pressure is not recommended.

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Question Of The Day: Preschooler

Q. After discussing asthma as a chronic condition, which of the following statements by the father of a child with asthma best reflects the family's positive adjustment to this aspect of the child's disease?

A. "We try to keep him happy at all costs; otherwise, he has an asthma attack."
B. "We keep our child away from other children to help cut down on infections."
C. "Although our child's disease is serious, we try not to let it be the focus of our family."
D. "I'm afraid that when my child gets older, he won't be able to care for himself like I do."

Correct Answer: C
Explanation: Positive adjustment to a chronic condition requires placing the child's illness in its proper perspective. Children with asthma need to be treated as normally as possible within the scope of the limitations imposed by the illness. They also need to learn how to manage exacerbations and then resume as normal a life as possible. Trying to keep the child happy at all costs is inappropriate and can lead to the child's never learning how to accept responsibility for behavior and get along with others. Although minimizing the child's risk for exposure to infections is important, the child needs to be with his or her peers to ensure appropriate growth and development. Children with a chronic illness need to be involved in their care so that they can learn to manage it. Some parents tend to overprotect their child with a chronic illness. This overprotectiveness may cause a child to have an exaggerated feeling of importance or later, as an adolescent, to rebel against the overprotectiveness and the parents.

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Types of Advanced Practice Nursing

Are you a registered nurse looking to move forward in your career? Are you ready to take the next step in advancing your education. Enrolling in a graduate nursing program allows you many opportunities to advance your nursing practice. Before deciding to pursue advanced practice nursing, it’s important to research what type of work and patient population interests you. Here are a few options to consider:

Is advanced practice nursing right for you? Make sure you have all the facts.

Nurse Practitioner

During the late 1950s and early 1960s, specialization in medicine expanded, and this resulted in a shortage of primary care physicians. Primary care physicians recruited and collaborated with Registered Nurses to identify and treat the primary care needs of children and families.

With the Social Security amendments of 1965 and the creation of medicare and medicaid low income children, women, the elderly, and people with disabilities gained new access to healthcare. Again, this put a strain on the practice of primary care and nurses stepped in to educate families about health promotion and disease prevention.

In 1965, Loretta Ford, a pioneer in nursing education, partnered with physician Henry Silver, to create the very first training program for Nurse Practitioners to fill the primary care void.

In general, the role of the nurse practitioner involves assessment, diagnosis, and treatment of individuals in their particular specialty. There are also subspecialty options with post graduate work. Nurse practitioner specialties include Family, Adult/Geriatrics, Pediatrics, Oncology, Acute Care, and Mental Health. Nurse Practitioners can also work in a variety of settings, including primary care, specialty care, acute hospital care, longterm care, and community health.

Certified Registered Nurse Anesthetist

Throughout the history of nursing, one of its main foundations has been superior pain management. The earliest existing records documenting the anesthetic care of patients by nurses were those of Sister Mary Bernard, who assumed her duties at St. Vincent’s Hospital in Erie, Pennsylvania, in 1887. Since World War I, nurse anesthetists have been the principal anesthesia providers in combat areas of every war in which the United States has been engaged, including the current conflicts in Afghanistan and Iraq.

Over the last decade, with the recent expansion in surgical and pain management fields beyond the hospital to outpatient centers, the demand for CRNAs have increased dramatically. CRNAs begin their relationship with patients pre-operatively with a pre-anesthesia meeting, continuing through the surgical procedure to the post anesthesia care unit.

Certified Nurse Midwife

There are records of midwifery throughout history from the time of ancient Mesopotamia and Egypt through the dark ages and renaissance into the colonization of the United States. With the explosion of medical education in the late 19th century, midwifery in America almost disappeared. In the 1920’s, nurse-midwifery was created through the foresight of Mary Breckinridge, whose own personal childbearing losses promoted a passion for the promotion of maternal and child health.

Nurse Midwives first practiced with rural and underserved populations. Today, Nurse-Midwives can practice in many different settings in their own private practice, or collaboratively with a physician in a hospital, clinic, birth centers or in the military. These nurses are certified according to the requirements of the American College of Nurse Midwives (ACNM) and specialize in providing prenatal and postpartum care, as well as tending to the needs of a woman during childbirth.

Clinical Nurse Specialists

Clinical Nurse Specialists trace the beginning of their practice to Florence Nightingale, the founder of modern nursing. Nurses began to specialize in the late 1800’s and grew in the 1930’s and 1940’s. By the 1960’s, CNSs were firmly established in the nursing profession.

Clinical Nurse Specialists exist in multiple nursing areas of nursing, including diabetes management, oncology, mental health, critical care and community health. Their role is to provide health promotion and disease prevention education to patients and disease and treatment specific education to nurses. CNSs also aid in expanding nursing research.

As you can see, each specialty dictates the specific roles throughout advanced practice nursing. Make sure you research all aspects of a specialty before choosing an educational program. Each state grants licensure for advance practice nurses and outlines the scope of practice for that particular state. Thus, you should also look into the laws outlined by the state you will be practicing.

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Question Of The Day: Toddler

Q. A child with a poor nutritional status and weight loss is at risk for a negative nitrogen balance. To help diagnose this problem, the nurse anticipates that the physician will order which laboratory test?

A. Total iron-binding capacity
B. Hemoglobin (Hb)
C. Total protein
D. Sweat test

Correct Answer: C
Explanation: The nurse anticipates the physician will order a total protein test because negative nitrogen balance may result from inadequate protein intake. Measuring total iron-binding capacity and Hb levels would help detect iron deficiency anemia, not a negative nitrogen balance. The sweat test helps diagnose cystic fibrosis, not a negative nitrogen balance.

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We Celebrate You: Top 5 Reasons to Hug a Nurse this Nurses Week

Human touch - everyone needs it, but not everyone gets enough of it. Being a nurse may be emotionally and physically demanding, but it is also an extremely rewarding career. Nurses are often considered the underdog in the medical field, and sometimes don’t receive the recognition they deserve. So, in the name of nurse’s week, here are the top five reasons you should give the nurses in your life a hug to show your appreciation and help them celebrate!

A good way patients can show their appreciation during Nurses Week is by giving their nurse a hug.

Nurses do the dirty work  

When it comes to administering shots, cleaning bed pans, walking patients to the bathroom, cleaning blood and vomit off of patients, nurses are typically the ones making sure all the patient’s needs are taken care of.  Nurses also do things that most people in the medical field wouldn’t do. Nurses week is the perfect time to show you acknowledge their unique efforts.

Nurses work long shifts

A typical nurse works a twelve hour shift three to four days in a row, and is frequently asked to work double shifts on not much notice. Nurses have to endure long hours, many times with very few breaks.  On top of working lengthy shifts, nurses often work holidays, and every other weekend. Sacrifice is a huge part of a nursing career. So if you see a nurse working a double during nurses week, go on—give them a hug, and buy them a cup of coffee.

Nurses are filled with compassion

They are the first ones to hold your hand and make you feel better. There isn’t a shift that goes by where a nurse isn’t making a difference in a patient’s life. Make a difference in their lives this nurses week—a smile and an appreciative work can go a long way.

Nurses have a high level of patience

Nurses have to deal with family members, patients, doctors, paperwork, charting, and anything else that is thrown at them during their shift. They are trained to always be ready for any medical situation that occurs.

Nurses are like guardian angels

They take care of you and your loved ones, sacrificing their time to help improve yours, providing round the clock care. Nurses work incredibly hard to get to where they are, where they’re expected to work even harder on the floor. So, next time you see a nurse—nurses week or any time of the year—take a second and give them a hug, a high-five, a fist bump, a kind word, or all of the above. They’ve earned your appreciation.

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Question Of The Day: Infant

Q. Which of the following should the nurse use to determine achievement of the expected outcome for an infant with severe diarrhea and a nursing diagnosis of Deficient fluid volume related to passage of profuse amounts of watery diarrhea?

A. Moist mucous membranes.
B. Passage of a soft, formed stool.
C. Absence of diarrhea for a 4-hour period.
D. Ability to tolerate intravenous fluids well.

Correct Answer: A
Explanation: The outcome of moist mucous membranes indicates adequate hydration and fluid balance, showing that the problem of fluid volume deficit has been corrected. Although a normal bowel movement, ability to tolerate intravenous fluids, and an increasing time interval between bowel movements are all positive signs, they do not specifically address the problem of deficient fluid volume.

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How I Learned to Love Nursing School

Let’s be honest, nursing school is no joke. It’s not only extremely challenging, but also extremely time-consuming. If you’re a nursing student, you know what I’m talking about.

From an outsider’s perspective, it seems crazy. You are voluntarily giving up your social life for four years. While your friends are making their weekend plans, you’re making study plans. While their smiles come from last night’s party, your’s comes from passing last night’s test.

So why do we do it? Better yet, how do we stay so disciplined?

Confessions of a registered nurse

The answer is really quite simple - we love what we do. We know the rewards of obtaining a BSN far outway the sacrifices.

There’s no question it takes a special person to become a registered nurse. (Coffee may or may not factor into the equation as well.) I can tell you this without sounding arrogant, because every nursing student is one of those special people.

It takes far more than good memorization skills and intellect to obtain your BSN, which you’ll learn very quickly in your first clinical. A registered nurse must have special skills and unique relational abilities that can’t be taught in the classroom.

Why I chose to pursue a BSN

I first truly fell in love with nursing school during my clinical year. It was through hands-on learning and interaction with patients that I developed a true appreciation and understanding of nursing.

I can remember my senior year of college caring for a patient who was in the hospital for weeks with numerous symptoms. A team of doctors was on the case, and every test you could possibly fathom was being ordered in the hopes of coming to a diagnosis.

Through comforting this patient, as well as the family, during such a trying time in their lives, I understood the impact of what I was choosing to do with my life.

What makes a registered nurse a good nurse

As a registered nurse, you’re not only present to complete morning assessments, administer medicine, and documents in charts. Often times, you’re a pillar of support for patients. There are good days and bad days. Some days your work is truly appreciated and fulfilling, and other days you are a punching bag for patients who have no one else to express or project their anger onto.

Being able to take a step back and put the situation into perspective is a true and necessary skill. You must learn to be personable while not taking things too personally. It’s in those moments where people needed me most, that I realized this is why I love nursing and I’m here. I want to be able to provide that support for them in return.

Nursing school in a nutshell

So I suppose my message is, nursing and nursing school are hard - no doubt that about it. But my ability to step back and separate myself from difficult situations and be empathic is what has allowed me to love nursing school, from classroom to clinical, persist towards obtaining a BSN, and now to love my professional career as a registered nurse.

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Question Of The Day: Basic Physical Assessment

Q. When assessing an elderly client, the nurse expects to find various aging-related physiologic changes. These changes include:

A. increased coronary artery blood flow.
B. decreased posterior thoracic curve.
C. decreased peripheral resistance.
D. delayed gastric emptying.


Correct Answer: D
Explanation: Aging-related physiologic changes include delayed gastric emptying, decreased coronary artery blood flow, an increased posterior thoracic curve, and increased peripheral resistance.

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How to Manage Your Clinical Rotation in Psych Nursing

Any clinical rotation site can be intimidating-from meeting new staff members, working with different nurses, and getting to know your patients. However, when it comes to your clinical rotation in psych nursing, it is a whole different ballgame.

Learn what’s different about clinical rotations in psych nursing. 

Psych nursing is a wonderful sector, but not everyone is cut out for it. For those of you who have never worked in a psychiatric unit in a medical setting, this can be quite overwhelming, exciting, uncomfortable, and intimidating.

Here are some things you can expect during your clinical rotation in psych nursing to make the experience more enjoyable:

No scrubs

One thing that differs from other clinical rotations is your attire. You won’t be wearing your normal scrubs; you will be wearing street clothes—usually business casual (but could vary depending on your program). This is because some patients can become distressed at the sight of traditional hospital uniforms (scrubs).

Many programs will not even permit dark color nail polish, dangling jewelry, wearing your hair down, or the use of pens/pencils during clinical rotations in psych nursing. Patients can become agitated at the sight of color (especially if they have a history of trauma or abuse), or others may try and grab your hair or use your pen as a weapon.

The bottom line here is that all these restrictions are for the safety of both you and the patient. It’s important that you look professional without being distracting.

Timeout

As you go through your clinical rotation in psych nursing and start learning about your patient’s history, it’s very easy to empathize with what they have been through. This can take a toll on you, especially if you yourself have been through a traumatic experience, or have friends or family members who have mental health issues as well.

Know that it’s okay to opt out. Nursing instructors are usually understanding if you need to take a short break off the unit to get some air. It can get intense, especially when patients are agitated, and it’s normal for nursing students to get uncomfortable if a patient is screaming, yelling, or attacking another patient or staff member.

It’s also important to understand that for some of these patients, this unit is their home. It’s a safe place for them. When their routine is switched up, and nursing students are on the unit, it can cause some tension with the patients. The good thing is that some psychiatric units continuously have nursing students throughout the year, so these patients are used to the it—and for the most part, they seem to like it.

Listen and learn

Psych nursing is a great experience, but depending on your program, you can spend anywhere from 4 – 12 weeks on the unit. It’s important to experience as much as you can and interact with the patients simply by talking to them and participating in their activities.

It’s important to heed your nurse supervisor’s advice when it comes to avoiding talking about certain topics. Depending on the patient’s diagnosis, certain things may act as triggers. Reading the patient’s chart will provide you with great background history on the patient, but the real learning will come from your interactions with the patients and nursing staff.

Though challenging, psych nursing may prove to be one of your most rewarding clinical rotations, whether or not you end up pursuing it as your career. 

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Building Mental Strength for NCLEX Prep

Have you ever wondered how a human being could run for 26.2 miles straight? They break down this large feat into small daily increments in order to build the physical and mental strength needed to cross the finish line.

It’s smart to approach NCLEX prep in the same way. With the potential for up to 265 questions and a full six hours, you’ll need all the mental stamina you can muster.

Here are five tips for successful NCLEX prep:

1. Consistency is key. Progress towards any goal is only achieved through consistent effort—an hour a day spread out over a few months will get you much further than day-long cram sessions the week before. Kaplan will help you develop an individualized study plan for success. If you follow this comprehensive model consistently, you’ll gain the confidence you need to conquer the NCLEX. Don’t sell yourself short by thinking a few cramming sessions will be enough NCLEX prep to get you prepared.

2. Train by priority, not fear. While it is tempting to only focus on learning more content—what you really need is to train your mind to answer NCLEX-level questions in a Computer Adaptive Testing environment. Passing-level NCLEX questions are written at the highest levels of application and analysis. They are more intense than the average nursing school exam. Refocusing your priority towards learning “how to” break down these questions and eliminate answers will have the most significant impact on increasing your score.

3. Watch your own “game films”. The time you spend reviewing completed practice questions is a critical training strategy. Kaplan teaches you how to review your questions and identify the three key areas of student errors in Computer Adaptive Testing. That way you can identify your weaker areas and learn specific strategies to overcome them. Reviewing the rationales for each of the correct and incorrect answers and thinking through how you selected your answer will provide invaluable information about your personal testing strategies.

4. Make your own playbook. Another powerful NCLEX prep strategy is to keep a notebook. As you are reviewing questions and target studying content, keep the same notebook with you and write all your notes. For example, as you’re reviewing your practice question rationales, write a brief note for any content that was new or unfamiliar to you. Then make it a habit that you review this notebook daily. This is called “rehearsing” and is one of the most effective ways to transfer that content from your short-term memory (which “evaporates) to your long term memory (where you can retrieve it on the NCLEX).

5. Practice in a test-like environment. While all the above tips are certainly useful, nothing will help you quite like rehearsing the test itself—start to finish. Can you imagine an actor doing a whole show for the first time in front of an audience? Sit down at a computer, use a mouse, and time yourself. You don’t want any of these extraneous factors getting in your way on Test Day.

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Question Of The Day: Medication and I.V. Administration

Q. A client is scheduled for an excretory urography at 10 a.m. An order directs the nurse to insert a saline lock I.V. device at 9:30 a.m.. The client requests a local anesthetic for the I.V. procedure and the physician orders lidocaine-prilocaine cream (EMLA cream). The nurse should apply the cream at:

A. 7:30 a.m.
B. 8:30 a.m.
C. 9 a.m.
D. 9:30 a.m.

Correct Answer: A
Explanation: It takes up to 2 hours for lidocaine-prilocaine cream (EMLA cream) to anesthetize an insertion site. Therefore, if the insertion is scheduled for 9:30 a.m., EMLA cream should be applied at 7:30 a.m. The local anesthetic wouldn't be effective if the nurse administered it at the later times.

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5 Tips for First-Year Nurses

1. Save time with multitasking

The habits you develop as a first-year nurse will serve you throughout your nursing career.

Not only is it important to perform your nursing duties correctly, but with so many patients under your care, it is just as important to do things efficiently. I found I saved a lot of time by grouping tasks together instead of doing them separately. For example, if Patient A is requesting pain medication and Patients B and C also need medications from the Pyxis, why not get all three at once? (Just remember your “rights” of medication administration, of course!)

2. Take pride in your work

This is something one of my preceptors told me in my first week on the floor. If you do something, put your name on it—be proud of your work, and document it. Moreover, if you forget to sign off on a task and that task comes into question, then it is considered incomplete. If you didn’t document it, you didn’t do it. So take credit for your efforts. Be proud of your work.

3. There’s no “I” in team

You’ve probably heard this a million times, but it’s especially true in nursing. Your patients not only rely on you to care for them, but also the health aides, the resident doctors, and attendees. You are also one of several RNs on the floor at any given time. Thus, know that you have plenty of help if you start to feel overwhelmed during your shift. You can delegate certain things to your health aides and ask for help from your fellow RNs. You can also always page your residents if you need their help. Bottom line—you’re not alone.

4. Ask, and you shall receive

Never be afraid to ask questions to any of your nursing coworkers. As a first-year registered nurse, you’ll find that your RNs and health aides alike will have years of experience that can greatly benefit you. Post-op patients, personality types, etc, though new to you, may be things they’ve seen many times. Also, it’s good to ask early. Don’t wait until you’re a couple years into your nursing career to ask basic questions that could have helped you all along. Knowing as much as possible will benefit you as well as your patients.

5. Love your work

Being a registered nurse is a unique, amazing experience. No one else has the skillset you have that allows you to take care of your patients from a clinical standpoint. Nor do they have the compassion you have for your patients from a personal standpoint. The feeling you get when your patients smile and thank you for making their day better is incomparable. Be proud that you are a registered nurse, and love what you do—your patients will love you for it!

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Question Of The Day: Basic Psychosocial Needs

Q. A worried mother confides in the nurse that she wants to change physicians because her infant is not getting better. The best response by the nurse is which of the following?

A. "This doctor has been on our staff for 20 years."
B. "I know you are worried, but the doctor has an excellent reputation."
C. "You always have an option to change. Tell me about your concerns."
D. "I take my own children to this doctor."

Correct Answer: C
Explanation: Asking the mother to talk about her concerns acknowledges the mother's rights and encourages open discussion. The other responses negate the parent's concerns.

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Question Of The Day: Basic Physical Care

Q. A nurse takes informed consent from a client scheduled for abdominal surgery. Which of the following is the most appropriate principle behind informed consent?

A. Protects the client's right to self-determination in health care decision making.
B. Helps the client refuse treatment that he or she does not wish to undergo.
C. Helps the client to make a living will regarding future health care required.
D. Provides the client with in-depth knowledge about the treatment options available.

Correct Answer: A
Explanation: Informed consent protects the client's right to self-determination in health care decision making. Informed consent helps the client to refuse a treatment that the client does not wish to undergo and helps the client to gain in-depth knowledge about the treatment options available, but the most important function is to encourage shared decision making. Informed consent does not help the client to make a living will.

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2 Secrets to a Successful Nursing Career

A nursing career requires much more than just an aptitude for science. You could be the most intellectually astute person in the world, but it’s your passion for nursing and people that will make you great and sustain you through the obstacles.

While it takes many qualities to have a successful nursing career, we’ve narrowed it down to two virtues, which are often overlooked: resilience and humility.

Nursing Career Secret 1: Resilience     

Those who decide to pursue a nursing career are a rare breed indeed. You must possess both an intellectual and emotional resilience—both of which are underestimated by those outside the profession.

First, people often underestimate the rigorous training a nurse in training must undergo. If they are able to pass their nursing entrance exam, they then take on the rigorous nursing school curriculum—giving up a social life to study, differentiating between subtleties on exams, and missing holidays to work 12-hour shifts, to name a few.

But even if you have the best time management skills and study habits on a practical level, you must also develop an emotional fervor. Especially in clinical, you test your ability to practice resilience in the most trying of circumstances—witnessing traumatic events, stomaching graphic injuries, withstanding horrible odors, and losing clients you become close to—all the while keeping a smile on your face and staying strong for those in need. Among all the exams you are required to pass, this will be the most challenging and important.

Nursing Career Secret 2: Humility      

C.S. Lewis once said, “True humility is not thinking less of yourself; it’s thinking of yourself less.” In a profession that still battles a stigma of inferiority, we must remember the first part of this sentence.

You’ve probably had a client say, “Oh, you’re just a nurse. Where’s my doctor?” A comment like this can sting quite a bit. In a moment, they dismiss all the years of sacrifice you’ve put in to pursue a nursing career. Whether a client realizes it or not, you actually contribute to their quality of care and emotional health more than any physician can. Chances are, it is the registered nurse who knows all the clients by names, whereas doctors may know them by the room number.

While sick clients may not always be in the emotional space to acknowledge all that we do, we should take it upon ourselves to show each other the appreciation we deserve and empower each other to keep going. Don’t allow yourself to become discouraged or embarrassed by your profession—a nursing career is truly one of the most noble and rewarding careers out there.

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10 Fascinating Nursing Specialties

Whether you’re interested in the fast-paced and unpredictable environment of the emergency room or the joys and challenges of pediatric care, there are so many different fascinating nursing specialties to choose from.

Of all the many nursing specialties, find the one that best fits you.

Even if you already have a good idea what you would like to pursue, it’s wise to first explore all your options before making a decision. Here is an overview of 10 nursing specialties to help you get started:

1. Critical Care Nurse

A critical care nurse works with clients who typically stay in the intensive care unit (ICU) of a hospital. Communication is a big part of your job—from taking careful notes to talking with physicians about symptoms and changes in the client’s condition. As a critical care nurse, you help make difficult experiences easier for clients and their family members.

2. Emergency Room Nurse

Being an emergency room (ER) nurse can be one of the most hectic and unpredictable nursing specialties. Clients arrive with everything from broken bones to life-threatening injuries, and it’s up to you to respond quickly to assess their condition, provide necessary medications, and decide which clients need immediate attention. Ultimately, your job is to offer comfort to clients in the midst of what can wind up being the most stressful and shocking times of their lives.

3. Forensic Nurse

The role of a forensic nurse goes far beyond medical care for clients—though that’s a big part of it. As a forensic nurse, you’ll need specific knowledge of the legal system and the ability to identify, evaluate, and document injuries. Once you address a client’s immediate medical needs, you’ll often collect evidence, give medical testimony in court, and consult with others within the legal system.

4. Medical-Surgical Nurse  

Medical-surgical nurses are responsible for answering patient questions and serving as a reassuring presence in the operating room. Because of the accountability you have to your team of medical professionals as a medical-surgical nurse, you’ll need to carefully record all information that you gather from each client. You’ll play a vital role in making sure quality care is provided throughout the client’s surgical procedure.

5. Nurse Anesthetist

A certified registered nurse anesthetist (CRNA) is a highly educated healthcare professional who provides the full range of general, regional, and local anesthesia, along with pain management services. As a CRNA, you’re associated with the impressive legacy of anesthesia practice in the U.S. for more than 150 years. The nurse anesthetist position is one of the most lucrative nursing specialties, with projected employment growth of 30 percent by 2022.

6. Occupational Health Nurse

As an occupational health nurse, your job is to diagnose and treat people who get sick or injured in the workplace. This multifaceted position involves not just health care for clients, but also administrative duties. You may work in a small office or a large corporation evaluating workplaces for possible dangers, giving workplace safety talks, holding classes on health education, and training in first aid.

7. Oncology Nurse

At a very critical time in a cancer patient’s life, you can be the oncology nurse who provides a listening ear and a caring touch. A key role you play is to help clients throughout their chemotherapy or radiation treatments. Whether you’re assisting clients in a hospital, cancer research center, specialized care center, or at home, your kindness and compassion can make a big difference physically and emotionally.

8. Palliative Nurse

As a palliative nurse, you’ll have the important job of focusing on quality of life for clients who are seriously ill. You will offer pain and symptom management, psychosocial and spiritual support, and care for the patient as a whole person. Another major part of palliative care includes patient advocacy—explaining a condition and its progression to clients and their families to help them make the best decisions about their care.

9. Pediatric Nurse

As a pediatric nurse, you will need a thorough knowledge of human development and genetic disorders so you can help detect and diagnose illnesses. Being a strong communicator is another must, so you can ask kids questions that don’t confuse them. Pediatric nurses also talk to clients and their families about their illnesses or injuries, the treatments they’ll receive, and how they can care for conditions at home.

10. Travel Nurse

If you enjoy the challenges of new people and places, becoming a travel nurse may be the right path for you. A travel nurse is a licensed vocational nurse or a registered nurse who works at understaffed hospitals, offices, and clinics as part of short-term assignments that might last anywhere from eight weeks to a year. Not only can you travel the world and help people as a travel nurse, but you may get the added benefits of free housing and complimentary airfare along the way.

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Question Of The Day: The Nursing Process

Q. The nurse is caring for a client with asthma. The nurse should conduct a focused assessment to detect which of the following?

A. Increased forced expiratory volume.
B. Normal breath sounds.
C. Inspiratory and expiratory wheezing.
D. Morning headaches.



Correct Answer: C

Explanation: The hallmark signs of asthma are chest tightness, audible wheezing, and coughing. Inspiratory and expiratory wheezing is the result of bronchoconstriction. Even between exacerbations, there may be some soft wheezing, so a finding of normal breath sounds would be expected in the absence of asthma. The expected finding is decreased forced expiratory volume [forced expiratory flow (FEF) is the flow (or speed) of air coming out of the lung during the middle portion of a forced expiration] due to bronchial constriction. Morning headaches are found with more advanced cases of COPD and signal nocturnal hypercapnia or hypoxemia.

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5 Ways Nurses Can Create a Positive Work Environment

Due to the nature of health care, nursing workplaces can be stressful, feel overwhelming, and even take on a negative energy if you don’t guard against it. This creates tension not only among nurses, but also patients. Thus, it is important for nurses to remember that we have the power—and the responsibility—to create a more positive work environment.

Here are five ways you can help promote positive change within the workplace:

1. Demonstrate gratitude

You may have heard it said, “A person who feels appreciated will always do more than what is expected.” Be sure to recognize others for contributing to your success and accomplishments. By showing them you appreciate their hard work and contributions, you establish respect and provide a sense of worth for your co-workers. Well-placed, simple “thank yous” can really go a long way in creating a more positive work environment.

2. Utilize individual strengths

Rather than expecting everyone to do it all, maximize your team’s efforts by identifying and utilizing each co-worker’s strengths. For example, if you excel at calming disoriented patients and your co-worker is a master at explaining things to upset family members, you should plan to work together to quickly and effectively manage the situation. Be sure to share your strengths with your team, and give validation to other nurses for theirs.

3. Don’t take workplace conflicts personally

Conflicts or disagreements will occur from time to time, and it is important that you do not make a bigger deal of them than necessary. Be the cooler head, the bigger person—whatever you want to call it. There are higher priorities right under all of your noses.

At the same time, remain open to constructive criticism from other nurses—you can turn these into valuable learning experiences that can improve your practice. Being a nurse is not about individual egos, but working together to achieve the best solutions and quality care for your patients.

4. Offer solutions to recurring issues

Instead of simply venting with other nurses about issues that arise on the job, try to find solutions to rectify ongoing problems. By suggesting ways to resolve issues in daily meetings, or by submitting a formal request to management, you will help create a more positive work environment rather than adding to the tension.

5. Be a positive role model

Nothing sends a stronger message to your fellow nurses and supervisors than your actions. If you consistently demonstrate professionalism, effective communication, prudent nursing practice, teamwork, and accountability, you will set the tone for how others should follow. No matter what level of experience you may have, it is never too soon to be a positive role model for your colleagues.

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Question Of The Day: Gastrointestinal Disorders

Q. A home health nurse who sees a client with diverticulitis is evaluating teaching about dietary modifications necessary to prevent future episodes. Which statement by the client indicates effective teaching?

A. "I'll increase my intake of protein during exacerbations."
B. "I should increase my intake of fresh fruits and vegetables during remissions."
C. "I'll snack on nuts, olives, and popcorn during flare-ups."
D. "I'll incorporate foods rich in omega-3 fatty acids into my diet."

Correct Answer: B
Explanation: A client with diverticulitis needs to modify fiber intake to effectively manage the disease. During episodes of diverticulitis, he should follow a low-fiber diet to help minimize bulk in the stools. A client with diverticulosis should follow a high-fiber diet. Clients with diverticular disease don't need to modify their intake of protein and omega-3 fatty acids.

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Question Of The Day: The Nursing Process

Q. The nurse is serving on the hospital ethics committee which is considering the ethics of a proposal for the nursing staff to search the room of a client diagnosed with substance abuse while he is off the unit and without his knowledge. Which of the following should be considered concerning the relationship of ethical and legal standards of behavior?

A. Ethical standards are generally higher than those required by law.
B. Ethical standards are equal to those required by law.
C. Ethical standards bear no relationship to legal standards for behavior.
D. Ethical standards are irrelevant when the health of a client is at risk.

Correct Answer: A
Explanation: Some behavior that is legally allowed might not be considered ethically appropriate. Legal and ethical standards are often linked, such as in the commandment "Thou shalt not kill." Ethical standards are never irrelevant, though a client's safety or the safety of others may pose an ethical dilemma for health care personnel. Searching a client's room when they are not there is a violation of their privacy. Room searches can be done with a primary health care provider's order and generally are done with the client present.

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Mastering the Nurse-Patient Relationship

I don’t know about you, but I’m irritable when I’m sick (just ask my husband). And that’s in the comfort of my own home with people I’m know taking care of me. Now imagine having a life threatening illness, in a sterile environment, completely depending on strangers who don’t know your preferences for medications, food, and even bathing. Then getting bad news on top of that.

It’s no wonder there can be tension in the nurse-patient relationship. Fortunately, those who pursue a career in nursing have the rare ability to provide compassionate care for patients at their worst. Here are some key skills to help you nurture the nurse-patient relationship and make everyone’s lives a lot easier:

Listen

As nurses, we often feel obligated to have all the answers, when in fact, the most important skill we can master is listening. When someone is in pain, sometimes they don’t want solutions, they just want to be heard. So before responding to a distraught patient or family, take the time to listen. You may actually find that listening—without interruption or response—is all it takes to resolve an issue.

Reflect

After taking the time to listen, let the patient know what you understood. Repeating back what they said in your own words shows them how they feel is acknowledged and valid. At the same time, it gives patients a chance to hear what they’ve said and expand on it if necessary. This reflection period is an important step in building a trusting, therapeutic nurse-patient relationship

Respect

Once you’re both on the same page, thank the patient for sharing their concerns with you. It can feel very risky to share emotions—especially if they’re already feeling vulnerable. Make sure patients understand that expressing their concerns is welcome and appreciated.

Plan

Once you’ve established an emotional connection you can move onto more practical ways of implementing a solution. Work together to develop a plan that meets the patient’s individual needs, and adjust it accordingly based on his or her input. Verbalize what will happen step by step. Now it’s time to have your patient repeat back the plan of action to you. Research shows patients retain less than half of what is said to them. You want to make sure they leave with a solid grasp on all the information they’ve received and can assimilate proper treatment into their life.

Review and resolve

Summarize the main objective to the patient as well as the exact next step they are to take once they leave the hospital. Answer any remaining questions the patient might have, and let them know they can call any time if more should arise. Also, offer to follow-up with them later.

Mastering the nurse-patient relationship is a crucial and ongoing part of your journey towards becoming a registered nurse. Along with its challenges come several more rewards.  

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