Nursing Profession

The foundation of the professional practice of nursing exists with the aim to provide quality care for all individuals. In order to fulfill this purpose, practicing nurses should:

◉ Maintain adequate credentials

◉ Follow the code of ethics, standards, and competencies

◉ Continue professional development and education

In most countries throughout the world, the practice of nursing is regulated by national or state law to keep the practice standards high. As such, an individual wishing to enter and continue in the profession is required to pass certain education and training requirement set by the government.

Ethics, Standards, and Competencies

Nurses are responsible for the care of all individuals from every ethnicity and religious background, including both healthy and ill individuals. This is usually a holistic care approach comprising of the patients’ physical, emotional, psychological, intellectual, social, and spiritual requirements. In order to provide this care, nurses use scientific theory with technological aids for the best patient outcomes.

Although the exact code of ethics differs for each country, there are four main principles that form the foundation of nursing practice, as follows:

◉ Prioritize the care of individuals with respect to their dignity

◉ Cooperate with other health professionals to promote the health and wellbeing of patients

◉ Provide exemplary care at all times

◉ Act with integrity and honesty to uphold the reputation of the profession

These principles hold the base of good professional practice and should be followed by all nurses to ensure that the care provided to patients is the most beneficial for each individual.

Professional Development and Education

In order to be recognized and practice as a nurse, an individual needs to hold adequate credentials in terms of education, training, and experience, as determined by the regulatory body in the respective country of the world.

A nurse may practice as a licensed practical nurse (LPN) or a registered nurse (RN). The entry requirements and scope of practice of these roles differ slightly for each country. In general, a university degree is required for an RN, whereas qualifications for an LPN can be obtained via a shorter diploma. Registered nurses provide the scientific and technical knowledge needed to make decisions in practice and also have the option to do further study to gain specialized knowledge.

It is important that a nurse continues to learn and improve their standard of practice throughout their career as a nurse. This involves continued professional development through education and experience. In many countries, it is a requirement of LPNs and RNs to complete a number of development activities each year to continue practicing as a nurse.

Female Predominance in Nursing Profession

Although there is equal opportunity for individuals of any gender to become a nurse, the profession has traditionally been, and continues to be, dominated by females. To illustrate this, the male:female ratio in the United States and Canada is approximately 1:19 and this remains relatively consistent in other regions of the world, with a few exceptions.

Source: news-medical.net

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Nursing Healthcare Profession

Nursing is a healthcare profession that focuses on the care of individuals and their families to help them recover from illness and maintain optimal health and quality of life.

Nurses are distinct from other healthcare providers as they have a wide scope of practice and approach to medical care. They play an integral role in promoting health, preventing illness, and caring for all individuals, including those who are disabled or are physically or mentally ill.

Nurse pushing an injured patient on a wheelchair - Image Copyright: Minerva Studio / Shutterstock

Role

They are responsible for the ongoing care of sick individuals and need to assess their health status and help them throughout the process to recovery. The role of a nurse may include to:

◉ Promote health and prevent illness

◉ Care for the disabled and physically / mentally ill people

◉ Engage in healthcare teaching

◉ Participate in the provision of healthcare alongside other team members

◉ Supervise training and education of nurses

◉ Assist in healthcare research

Nurses advocate for the best interests of the patients at all times and focus on holistic health, which encompasses the physical, social, emotional, and spiritual needs of the patient. They are also involved in the treatment decision-making process to represent the patient’s situation and make recommendations, if required.

Types

There are various types of nurses, according to the level of education and role in the healthcare team. These include

◉ Nursing Assistant (CNA)

◉ Licensed Practical Nurse (LPN)

◉ Registered Nurse (RN)

◉ Nurse Practitioner (NP)

◉ Nurse Midwife (CNM)

◉ Nurse Anesthetist (CRNA)

◉ Nursing Instructor

Additionally, a registered nurse may practice in a particular field with a specialization. There are many different types of specializations, including addiction, cardiovascular, mental health, and oncology nursing. In order to become specialized in a certain field, additional study and a certification exam is usually required.

Workplace

The majority of nurses work in a hospital environment and provide medical care to patients with illnesses in this environment. However, there are various other possible workplaces of a nurse, including residential care homes, in-home care services, governmental services, military, schools, and research facilities.

The physical demands of the workplace are significant, and nurses are prone to back injuries due to the need to lift and move objects or patients around the workplace. Additionally, nurses are at risk of infection or illness due to exposure to bacteria, viruses, and hazardous drugs or substances in the work environment. To minimize this risk, appropriate sanitization and safety guidelines should be followed.

Given that continuous care is required for patients in hospital, nurses usually work in shifts to provide round-the-clock care. Although the work schedule differs according to individual workplace, nurses are usually required to work night shifts and on holidays or weekends. This can also disrupt sleeping patterns and, in some cases, lead to shift-worker sleeping disorder.

Profession

As a profession, nursing has several ethical principles that guide their philosophy of practice throughout all tasks in the workplace. These are to

◉ Provide exemplary care at all times

◉ Prioritize the care of patients with respect to individual dignity

◉ Cooperate with other health professionals to improve patient outcomes

◉ Act with integrity and honesty to maintain the profession reputation

In accordance with these principles, nurses are able to care for patients in the best way possible to promote positive health outcomes.

Source: news-medical.net

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Researchers encourage longer dosing intervals for Pfizer-BioNTech’s COVID-19 vaccine

Researchers in Canada, Italy, and the United States have encouraged extending the interval time between two doses of Pfizer-BioNTech’s coronavirus disease 2019 (COVID-19) vaccine among individuals who have not previously been infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

The team found that while administration of a second dose at 16 weeks did not significantly improve humoral (antibody) responses among individuals who were infected prior to the first dose, it significantly enhanced these responses among infection-naïve individuals.

Andres Finzi from the CHUM Research Centre in Montreal, Quebec, and colleagues say the findings should help to alleviate concerns that an extended interval between doses might affect the efficacy of vaccination.

A pre-print version of the research paper is available on the medRxiv* server, while the article undergoes peer view.

Strong humoral immune responses against SARS-CoV-2 Spike after BNT162b2 mRNA vaccination with a sixteen-week interval between doses. Image Credit: NIAID

More about extending the vaccination interval time

Since the COVID-19 outbreak began in late December 2019, several effective vaccines against the causative agent SARS-CoV-2 have been approved for use in many countries, including Pfizer-BioNTech’s BNT162b2 vaccine.

This vaccine targets the viral spike protein that mediates the infection process when it binds to host cells. Therefore, this spike is a primary target of antibodies following vaccination or natural infection.

The approved standard regimen for BNT162b2 vaccination involves two doses administered 3 to 4 weeks apart.

However, during the initial phase of vaccination rollout in the winter and spring of 2021, vaccine supply shortages prompted some public health authorities to extend this interval to maximize the number of individuals who could be immunized.

This strategy was supported by studies indicating that a single dose confers around 90% protection just two weeks following vaccination.

Elicitation of RBD- and Spike-specific antibodies in SARS-CoV-2 naïve and previously-infected individuals. (A) SARS-CoV-2 vaccine cohort design. (B-E) Indirect ELISA was performed by incubating plasma samples from naïve and PI donors collected at V0, V1, V2 and V3 with recombinant SARS-CoV-2 RBD protein. Anti-RBD Ab binding was detected using HRP-conjugated (B) anti human IgM+IgG+IgA (C) anti-human IgM, (D) anti-human IgG, or (E) anti-human IgA. Relative light unit (RLU) values obtained with BSA (negative control) were subtracted and further normalized to the signal obtained with the anti-RBD CR3022 mAb present in each plate. (F-I) Cell based ELISA was performed by incubating plasma samples from naïve and PI donors collected at V0, V1, V2 and V3 with HOS cells expressing full-length SARS-CoV-2 S. Anti-S Ab binding was detected using HRP-conjugated (F) anti-human IgM+IgG+IgA (G) anti-human IgM, (H) anti human IgG, or (I) anti-human IgA. RLU values obtained with parental HOS (negative control) were subtracted and further normalized to the signal obtained with the CR3022 mAb present in each plate. Naïve and PI donors with a long interval between the two doses are represented by red and black points respectively and PI donors who received just one dose by blue points. (Left panels) Each curve represents the normalized RLUs obtained with the plasma of one donor at every time point. Mean of each group is represented by a bold line. The time of vaccine dose injections is indicated by black triangles. (Right panels) Plasma samples were grouped in different time points (V0, V1, V2 and V3). Undetectable measures are represented as white symbols, and limits of detection are plotted. Error bars indicate means ± SEM. (* P < 0.05; ** P < 0.01; *** P < 0.001; **** P < 0.0001; ns, non-significant).

Concerns about the impact on vaccine efficacy

However, this decision led to concerns about the impact on vaccine efficacy, particularly in the context of the SARS-CoV-2 variants of concern (VOCs) and interest (VOIs) that have rapidly emerged and spread worldwide.

These variants are more transmissible than previously circulating strains and, in some cases, more resistant to the neutralizing antibodies generated following vaccination.

For example, the spike mutation D614G that arose early on in the pandemic is now present in almost all circulating strains, and the B.1.1.7 (alpha) variant that emerged in late 2020 soon became the predominant strain globally.

More recently, the highly transmissible B.1.617.2 (delta) lineage that emerged in India in the spring of 2021 has now become the dominant strain in several countries.

Although several vaccines have demonstrated high efficacy in protecting against severe disease caused by these variants, some have also been shown to generate less effective neutralizing antibody responses.

However, the majority of these studies analyzed plasma samples collected from individuals vaccinated on the short (3 to 4 weeks) dosing interval regimen.

“Little is known about vaccine-elicited immune responses with longer dose intervals,” says Finzi and colleagues.

What did the researchers do?

The team assessed vaccine-elicited humoral responses among 22 SARS-CoV-2-naïve individuals and 11 previously infected individuals who received two doses of Pfizer-BioNTech’s BNT162b2 vaccine separated by an interval of 16 weeks. The previously infected participants had tested positive for SARS-CoV-2 around nine months before they received the first dose.

Blood samples were analyzed longitudinally for antibody binding, Fc-mediated effector functions and neutralizing activity against the D614G strain, several VOCs and VOIs, and SARS-CoV-1.

What did they find?

In the SARS-CoV-2-naïve group, immunization elicited antibodies with weak neutralizing activity but strong Fc-mediated functions three weeks following the first dose.

These responses declined over the following weeks. However, administration of a second dose 16 weeks later significantly enhanced these responses.

Notably, neutralizing activity against some VOCs, VOIs and even the divergent SARS- CoV-1 was significantly increased.

What about the previously infected individuals?

Several studies have shown that vaccinating previously infected individuals elicits strong humoral responses.

In agreement with these studies, the researchers found that the first vaccine dose induced strong humoral responses among the previously infected participants that remained relatively stable over time.

However, a second dose administered 16 weeks later did not significantly enhance any of these responses.

The team says this finding indicates that previously infected individuals reach peak immunity following the first dose of BNT162b2, suggesting that a second dose could possibly be delayed beyond sixteen weeks in this population group.

Modifying the interval dose should be considered

The researchers advise that bringing the COVID-19 pandemic to an end will require rapid vaccination of the global population, including in countries where vaccines are scarce.

“Modifying the interval at which the two doses are administered might be an important factor to take into account,” they suggest.

*Important Notice

medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.

Source: news-medical.net

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This Is The Reason Why Nurses Are Not “OK” Right Now

My friends are all leaving me, and I don’t blame them. Throughout the past six months, it seems as though every week I walk onto the unit, I hear that another one of my coworkers has put in their two weeks’ notice. The horribly sad part is that it feels like management just sees it as another job posting to start advertising for, but to the staff that has worked alongside them for years, it feels like a moral injury to see their position so easily replaceable. These nurses provide skills and bring character to the unit that no one else can replace, and although new nurses can bring their own gifts and talents, it is devastating seeing your department’s heartbeat start to change. 

Not only are nurses working in a global pandemic pouring everything we have into helping patients, a new pandemic has hit healthcare workers specifically; it’s called burnout. Unfortunately many of the issues that contribute to this burnout have existed for decades, but COVID has multiplied their effects and are pushing nurses to their extreme limits. 

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Nurses constantly mention that the pay rate in relation to the risk remains one of the main reasons that drives them away from the bedside. 

◉ Nurses haven’t received any hazard pay throughout this entire pandemic, and most have not received any raise larger than the expected cost of living increase. 

◉ It feels insulting when hospital management will not offer any retention incentives, but will pay travelers 3 times the hourly wage to do the same job. It’s no wonder so many nurses are leaving their current place of employment and traveling for a short time, but until hospitals can start offering more incentive for nurses to stay, the problem will only continue to escalate. 

Unsurprisingly, however, the most common reason nurses are leaving the bedside is the increased physical, emotional, and mental demands that have occurred within the past year. Regardless of the department, the pandemic has caused a decrease in staff, supplies, and support which has resulted in nurses picking up extra patients, shifts, and responsibilities. Our breaks have been replaced with extra patients, and our empathy has been replaced with exhausted hearts. Just in the past few weeks, I have heard nurses tell me these reasons they find nursing harder than ever.

◉ “The more I’m in the hospital, the more I hate the hospital”

◉ “It is hard to care for patients anymore”

◉ “I just can’t find it in me to care anymore. I try, but I just don’t care.”

◉ “It is just depressing watching people die all the time.”

◉ “I’m now doing three people’s jobs. Shouldn’t I get paid three people’s salaries?”

◉ “My body can’t handle it any more. I need a way out to save my physical body.”

◉ “I am starting to hate human kind.”

Anonymously share your experience working as a nurse right now - take “The State of Nursing” survey. 

Gone are the days of the idyllic images of Florence and nurses walking around with neatly done hair and large smiles while ambulating their patient down the hallway. Now we have images of nurses in space suits with cracked lips due to dehydration, hair in dreads from the three masks that keep rubbing their heads raw, and bags we don’t even get discounts for recycling under our eyes from doing the work of three other people. 

America is about to see a nursing shortage unlike anything else. Unless we see systemic change beyond what we could even imagine, this profession will endure an inevitable change. I do not place any blame on my coworkers who have chosen to pursue a different career, but for those of us that continue to work at the bedside, it often feels like so much effort to remain upbeat and positive about the nature of our profession. 

Read more about the systemic issues causing nurses to leave the profession, click here. 

Source: nurse.org

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Norwegian study on the benefits of COVID vaccination for residents and employees in nursing homes

The elderly have been determined to be among those most vulnerable to coronavirus disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). The mortality rate and severity of the disease in this group are reported to be extremely high. In most countries, COVID-19 vaccination has been prioritized for residents and staff of long-term care facilities (LTCFs) and frontline workers. In Norway, residents of LTCFs primarily receive health care at the facility. They are generally not admitted to hospitals except in emergencies.

Background

It is important to understand the vaccine effectiveness (VE) to determine how much protection it offers to the general population. Unfortunately, only a few studies are available that have determined the effect of the COVID-19 vaccine among the residents of LTCFs.

The unique setting in Norway allowed the scientists to study VE among both staff and residents in LTCFs.

Taking this opportunity, researchers focused on estimating the effectiveness of COVID-19 vaccines in preventing SARS-CoV-2 infections among residents and staff of LTCFs. They also analyzed the effect of the vaccine on the rate of hospitalization among staff and deaths among residents.

It must be highlighted that both these factors, i.e., mortality rate and hospitalization represent disease severity. This research, which can act as a guide for COVID-19 vaccination programs, is available on the medRxiv preprint server.

Study: High vaccine effectiveness against COVID-19 infection and severe disease among residents and staff of long-term care facilities in Norway, November – June 2021.

Effectiveness of COVID-19 vaccines among residents and health care workers in LTCFs

In this study, researchers obtained data from BeredtC19, a preparedness registry containing individual-level data from various Norwegian registries.

They included all health care workers (HCW) who worked at LTCFs in the third week of January 2021 and residents who registered for a long-term stay at an LTCF in 2020.

This study excluded individuals who did not adhere to national recommendations about the interval between the first and second dose of the COVID-19 vaccine.

To avoid biases, individuals who had prior SARS-CoV-2 infection were not considered in this study. Researchers defined the vaccination status as unvaccinated (less than 14 days after the first dose of vaccine), partially vaccinated (14 days or more after the 1st dose and less than six days after the second dose), and fully vaccinated (seven days or more after the second dose).

In the sample considered for this study, 85.4% of LTCF residents and 71.1% of the HCWs received at least one vaccine dose during the follow-up period. The median ages of the residents and HCWs were estimated to be 87 years 39 years, respectively.

Researchers used Cox proportional hazard models to calculate VE in this study cohort, considering the vaccination status and adjusting for the age, sex, and associated underlying health conditions. They estimated the VE against positive SARS-CoV-2 infection to be 81.5% among the fully vaccinated and 40.8% for partly vaccinated residents and HCWs.

Scientists explained that in this study, personal attributes of LTCF residents, such as sex, age, and underlying conditions, had a minimal effect on the estimation result due to the relatively uniform population characteristics.

The Cox proportional hazard models could not estimate the degree of protection that prevailed among partly vaccinated residents, which may be due to rapid vaccination rollout and relatively short intervals between doses, i.e., residents received their second COVID-19 vaccine dose three weeks after the first.

The mortality rate of the resident population owing to COVID-19 disease was high. As a result, researchers estimated the VE in preventing death from COVID-19. They reported that in the fully vaccinated group, the mortality rate was reduced by 93.1%.

After adjusting for the age, sex, and underlying conditions of the HCWs, the VE against positive SARS-CoV-2 infection was estimated to be 45.0% among the partly vaccinated members and 81.4% among fully vaccinated candidates. Previous studies had reported a low mortality rate associated with COVID-19 in the general population of Norway.

Unlike the previous group, hospital admissions were considered to be an indicator of disease severity among HCWs. The current study reported that around 56 HCWs were hospitalized with COVID-19, among which two candidates were partly vaccinated.

None of the fully vaccinated HCW candidates required hospitalization. This study reported VE against COVID-19 hospitalization to be 81.7% for partly vaccinated HCWs in LTCFs.

Interestingly, this study observed that the total protection of unvaccinated residents significantly increased through staff vaccination. Thus, scientists believe that the outcomes of this study could be essential for the management of COVID-19 in LTCFs.

Source: news-medical.net

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Could monitoring headaches after COVID-19 vaccination help identify rare cases of cerebral venous thrombosis?

Shortly after the mass vaccination program against coronavirus disease 2019 (COVID-19) began in the UK, news outlets began to report severe side effects in a minority of those vaccinated. One of the more serious conditions that occurred is known as cerebral venous thrombosis (CVT) – a blood clot in the brain's venous sinuses that can lead to swelling, hemorrhage and death.

Even more worrying, CVT in those who had recently been vaccinated showed a much higher mortality rate than CVT that had been triggered by alternate sources. Headache is the most common symptom following vaccination, and is also one of the most frequent symptoms of CVT.

Researchers from the Akershus University Hospital in Norway investigated 77 cases of CVT in vaccinated subjects to identify risks and warning signs to better predict these severe side effects. The group's findings can be found in the Journal of Headache and Pain.

Study: Delayed headache after COVID-19 vaccination: a red flag for vaccine induced cerebral venous thrombosis.

It is worth noting that these symptoms only occurred in a very small minority of individuals, and authorities recommend that everyone eligible to become vaccinated does so.

The researchers searched through PubMed for all case studies and reported cases of CVT, as well as examining reports from the United States Centers for Disease Control and Prevention and the European Medicines Data. They evaluated these gathered cases based on certain variables, including age, sex, use of contraceptives, use of hormone replacement therapy, presence of a headache, presence of additional symptoms, the interval between headache and first symptom, intracranial hemorrhage and death.

For a control group, they used reports of headaches following the vaccines from the United States Vaccine Adverse Event Reporting System. A search of 'headache' against coronavirus vaccines returns over 100,000 results.

To analyze the cases, univariate logistic regression was used, with a standard 0.05% confidence limit. In total, 4.2% of patients suffering CVT were between 60 and 69, 95.8% of patients were below sixty, and 46.5% were below 40. This is supported by previous studies from CVT in non-vaccinated patients, showing that individuals ~30 years old are at most risk. Women were more affected than men, and made up 89.7% of cases. Five patients used contraceptives, and one was receiving estrogen therapy.

It normally took over a week following the vaccination for the first symptom to present – in 50% of cases, this was a headache, with various systemic or neurological symptoms in the other 50%. In ~25% of cases, multiple location thrombosis was recorded. In 24.7% of cases, the patient died. The statistical analysis clearly showed that In patients with CVT, the presence of headache was associated with increased risk of hemorrhage — but not with increased risk of death.

While headache is a very common side effect, in the vast majority of cases, it is resolved harmlessly and quickly. In almost all of the cases of CVT in which the headache was described, the onset was delayed for a week or longer – a rarity in patients that did not suffer CVT. The headaches were also severe, became progressively more so, and did not respond well to treatment.

The authors highlight the value this early warning sign could provide, especially as most cases of CVT are not immediately diagnosed, and delayed treatment reduces patient prognosis significantly. They urge that physicians be informed of this warning sign. Informing recently vaccinated individuals could also increase survival rates – although it may easily increase vaccine hesitancy as well. CVT can be detected with computed tomography, which will could show warning signs such as hyperdense veins or sinus, venous infarcts, edema or intracranial hemorrhage. World Health Organization recommended treatment includes immunoglobulins and non-heparin-based anticoagulants.

Source: news-medical.net

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I’m a Nurse and I Miss The Joy I Used To Feel

As an ER nurse, I am more nervous than ever for the future of our hospitals. When I say this, I am not referring to the catastrophic outcomes that have devastated so many patients and their family’s lives. I am talking about the abuse this pandemic has beaten down our staff with by hurling unrelenting punches in successive order; and I am worried about how hospitals will respond to this crisis. 

For the first time in my career, I am seeing nurses, doctors, techs, and a myriad of other ancillary staff express an anger towards some of the patient’s we are caring for. There are staff members that are verbalizing frustration and disdain directed at patients as a result of exhaustion. 

Under normal circumstances, many healthcare workers use dark humor and sarcastic banter directed at patients as a coping mechanism. But right now there is no comedic goal woven into the words I am hearing at work. There is anger, frustration, exhaustion, and apathy. My friends around the country are so burnt out; they have lost their desire to pour their hearts into this job because it keeps sucking the life out of them. 

Walking around the hospital hallways, I miss the joy. I miss the spark. I miss seeing my friends come alive after a meaningful patient interaction. I miss feeling supported. I miss the days when we talked about the headlines in one another’s lives instead of the headlines on the news. I miss seeing each other’s smiles. 

Compassion Fatigue

Compassion fatigue, defined as “the physical and mental exhaustion and emotional withdrawal experienced by those that care for sick or traumatized people over an extended period of time,” is slowly killing the future of nursing. Although this has always had disastrous ramifications for any nurse throughout their career, we are seeing unprecedented amounts of nurses fleeing the bedside because they can no longer deal with the secondary trauma related to our work. Understaffed and overworked has just become the new normal. Nurses have been refused vacation time, mandated overtime, forced to care for double the patient load, and required to work on new units. The disruptions in supply chains have made our jobs increasingly more challenging as we have to adapt to new materials and add extra steps to already complicated processes. 

Regardless of an individual’s personal opinion on the vaccine, both sides have felt the shift from being “essential” to being “expendable.” Some nurses feel personally disrespected as unvaccinated patient’s charge into our hospitals demanding that we save their lives. Other nurses fear losing their jobs after loyally serving a given institution for their entire career. The compounded amount of tension on top of an already stressful job has already pushed many nurses away from the bedside and in some hospitals has caused a division among their own staff. 

The REAL Nursing Shortage

The spring and early summer weeks gave us time to imagine what life might be like when this is all over. But, I worry that entering into another round of continually living in “fight or flight” mode in the hospitals will eventually use up all the reserve that some nurses have to give. Hospitals are currently treading water. They are unable to fill their hundreds of open clinical positions, older nurses that remained in the fight to get us through the initial wave are now retiring, new nurses coming into the profession have not been able to receive the same level of experience that they should, and the health of their current staff is declining at the rates COVID is increasing. 

As the months and years ahead begin to unfold, I am confident that the term “nursing shortage” will be thrown around like a football on a beach day. 

Let me be very clear. It is not that there is a shortage of nurses in this country. It is that there is a shortage of facilities that have been able to provide adequate working conditions throughout this pandemic to retain their staff. I fear for the endless ramifications this will have on my future in this profession. 

Read the report on the REAL reasons behind the nursing shortage

But perhaps my greatest fear is this. 

That in a few years when one of your family members is hospitalized, they will be missing out on some of the kindest, most compassionate, gracious, and attentive nurses because this pandemic pushed them away from the bedside. So America, please help do your part to end this. And please, be kind to my friends across the country who continue to show up despite having a tank that is well below empty.

Source: nurse.org

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NICU Nurses, Here’s How You Can Win MamaRoo Swings for Your Unit

In honor of NICU Awareness Month, which started in September, the popular baby gear brand  4moms is helping out NICUs across the country by donating nearly $18,000 worth of MamaRoo baby swings to 15 different hospitals. 

The giveaway campaign from 4moms is being done in partnership with Project Sweet Peas, a non-profit that supports NICU families as well as families who have experienced infant loss and The Superhero Project, which raises money for NICUs, donates needed items like gift baskets for parents, and works to place Angel Eyes cameras so families who need to be away from their hospitalized infants can always keep a close eye on their little ones. 

All of the organizations involved are incredible and like any family who has experienced a NICU stay knows, every thoughtful gesture makes an entire world of difference. 

How to Win a MamaRoo for Your NICU Unit

The way the giveaway campaign works is simple: parents, families, or nurses can all nominate any NICU that they think is deserving to win the MamaRoo infant seat donation. In total, 15 hospitals will receive donations of the MamaRoo infant seats. 

4moms has sponsored this giveaway in the past, but this year has expanded its program to donate swings to 5 more hospitals, giving almost $10,000 more in product. Last year’s recipients were:

◉ Ascension Saint Vincent’s Hospital (Birmingham, AL)

◉ Elliot Hospital (Manchester, NH)

◉ Grandview Medical Center (Birmingham, AL)

◉ John Muir Medical Center (Walnut Creek, CA)

◉ Prisma Health Richland (Columbia, SC)

◉ Saint Joseph Hospital (Denver, CO)

◉ University of Maryland Medical Center (College Park, MD)

◉ Valleywise Health (Phoenix, AZ)

◉ Willis Knighton South (Shreveport, LA)

◉ Woman's Hospital (Baton Rouge, LA)

Because 4moms hopes to reach as many hospitals as possible, the 10 recipients from last year aren’t eligible for the gifting this year but can be nominated again in 2022. 

How MamaRoos Benefit NICUs

According to 4moms, the mamaRoo infant seat is instrumental in the NICU, especially because it can be an effective non-pharmacological intervention for babies experiencing symptoms of Neonatal Abstinence Syndrome (NAS). 

A 4moms representative tells Nurse.org that both doctors and nurses have found the natural bouncing and swaying motion of the MamaRoo Infant Seat to be a valuable tool for helping to calm and soothe these fragile patients when their families can't be there.  

If you’re not familiar with the magic that is the mamaRoo, allow us to explain it: unlike traditional baby swings, which only swing back and forth or sometimes, side to side, the mamaRoo is completely different. It doesn’t swing like a traditional baby swing but instead, bounces both up and down and from side-to-side, mimicking the motion of a baby being in a parent or caregiver’s arms.  

If you’ve never noticed how a baby will cry when you’re sitting down, but magically be happy again when you stand up and bounce them, you’ll understand exactly why the mamaRoo infant swing can be so helpful, especially in a NICU setting when babies need a lot of cuddling to thrive. The swing and seat combo provides much-needed movement as an extra “set of hands” for the hardworking and always-busy NICU nurses on the unit. 

Nominate a NICU

If you know of a NICU that you’d like to nominate (including your own, if you’re a NICU nurse!) you can fill out a form on the 4moms website to share about the NICU you’ve nominated and enter them to win. All you need to do to nominate a NICU is share a little bit of information about yourself, the NICU you’re nominating (you’ll need name, city, and zip code) and a 500-word submission about why you’d like 4moms to donate infant swings to that NICU unit. 

The 4moms website explains that the NICUs are chosen based on many different factors, including the submission story itself, how many times the NICU is nominated and if Project Sweet Peas or The Superhero Project are able to deliver in a market. The nomination submission period ends on September 30, 2021, so get out there and start nominating! 

Oh, and one last thing: 4moms also has another way to support NICUs if you’re already a mamaRoo infant swing owner--you can donate your gently used mamaRoo through 4moms partner program, Good Buy Gear, and in return, mamaRoo will donate one new infant seat to a NICU. Pretty cool, right?

Source: nurse.org 

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The Surge of Sensationalist COVID-19 AI Research

There seems to be a tendency to hastily use imperfect and questionable data to train an AI solution for COVID-19, a dangerous trend that not only does not help any patient or physician but also damages the reputation of the AI community. Dealing with a pandemic – as significant as it is – does not suspend basic scientific principles. Data has to be curated by medical experts, and full and rigorous validations have to be performed, and results have to be reviewed by peers before we deploy any solution or even proposal into the world, particularly when the society is dealing with many uncertainties.

It is safe to say that we are all deeply concerned about the COVID-19 pandemic. This coronavirus has drastically changed our reality: stress, restrictions, quarantines, heroic sacrifices of caregivers including staff, nurses and physicians, losing loved ones, economic hardships, and massive uncertainties about what is in store in the coming months. Under such circumstances, it is only natural that many of us are thinking of ways to help - in the fastest ways possible. The AI community is not an exception.

Machine learning methods live from data. They learn from labeled data to classify, predict and estimate. The quality and reliability of any AI method directly depend on the quality and reliability of the labeled data. In computer science, we talk about “garbage in, garbage out” (GIGO) which summarizes the experience that low-quality input data generates unreliable output or “garbage”. This becomes even more critical when we are dealing with highly complex data modalities, such as medical images - data that generally require highly specialized knowledge for correct interpretations.

Within the AI community, we are fully dependent on data. As long as the domain is not sensitive (finance, healthcare, surveillance, etc.), we usually assemble our datasets by using different methods; From the manual gathering of samples up to highly sophisticated crawlers to parse through the Internet and other publicly available repositories. In medical imaging, we deal with a highly sensitive domain in which a long process is generally required to curate and access a set of labeled images. Needless to say, the curation has to happen within the walls of a hospital not just because the experts are there, but also due to the required de-identification of images to comply with privacy regulations.

But, sometimes we get impatient; we create our toy datasets by the manual collection of publicly accessible sources (e.g., online journals) - and there is generally no concern about this approach. Most of the time we – as AI researchers with no clinical or medical competency – create our toy datasets to run initial investigations and get a feeling for the challenges to come. This usually happens in anticipation of receiving a professionally curated dataset, a process that is often slowed down by ethic reviews and intellectual property negotiations.  

To be clear, a “toy dataset” in the medical imaging domain is not a toy just because it is commonly very small, but more importantly because it has been created by engineers and computer scientists, and not by physicians and medical/clinical experts. And, nobody would complain if we play with our toys inside our AI labs to get prepared to deal with the actual data from the hospital.

Radiologists around the world are understandably very busy, to put it mildly; it is not the best time to forge collaborations with radiologists if you are an overambitious AI researcher who wants to help. So, some of us have started to assemble our own dataset to get prepared for future tasks.

Collections of x-ray and partly CT images – scraped from the Internet – seem to emerge here and there and appear to be evolving as the creators continue to add images. Because of the availability of such datasets on one side and the ubiquity of basic AI knowledge and tools on the other side, many AI enthusiasts and start-ups have impulsively begun to develop solutions for COVID-19 in x-ray images. One finds websites and blogs that advise how to detect COVID-19 from x-ray scans with high accuracy. Others provide a sort of tutorial on detecting COVID-19 in X-ray images. We are even starting to see non-peer-reviewed papers that go a step further and baptize their solution with aggrandizing names like “COVID-Net”. This type of works commonly lacks many experimental details to explain how one has dealt with a few images from a very small number of patients to feed the deep network. Such papers report no validation, and no radiologist has guided the experiments. Many of these works were hurriedly made public before the creators of datasets could even provide sufficient explanation about their collection process. In an attempt to overcome the small data size, AI enthusiasts and start-ups mix the few COVID-19 images with other public datasets, i.e., pneumonia datasets. This is generally quite clever but I looked more closely at one case and the trouble is that the pneumonia cases were pediatric images; so the COVID-Nets are comparing pediatric pneumonia (children one to five years old) with adult COVID-19 patients. Well, this happens when we exclude radiologists from research that needs expert oversight.

Why are we rushing to publish faulty AI results on tiny datasets mixed with wrong anatomies, with no radiological backing, and with no validation? Do we want to help COVID-19 patients?

Perhaps the abundance of funding opportunity announcements in recent days, and the possibility of getting exposure for our research is misleading us into faulty research conduct; we cannot abandon fundamental scientific principles due to lockdowns and quarantines. AI is neither a ventilator nor a vaccine nor a pill; it is extremely unlikely that the exhausted radiologists in Wuhan, Qom or Bergamo download the Python code of our poorly trained network (using insufficient and improper data and described in quickly written papers and blogs) to just obtain a flawed second opinion.

Yes, we all want to help. Let us wait for real data from hospitals, let us do the ethics clearance and de-identification, and let us work with radiologists to develop solutions for chest issues of the future. Otherwise, we may create the impression that we are doing sensational research and are more concerned with self-promotion than with the well-being of patients. Radiologists are working day and night to understand the manifestation of this virus in medical images. Let us work with them and learn from them to unleash the true potential of AI for combating viral infections in the future.

Source: news-medical.net

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Effect of Sleep on Your Emotions

Sleep plays a key role in human function and cognition, affecting learning, memory, physical recovery, metabolism, and immunity. The functional role of sleep is well documented across species, and more recently, research has revealed the function of sleep in regulating emotion. The relationship between the two is reciprocal; sleep is crucial for mental and physical health while regulating emotion plays a vital role in decreasing the detrimental effects of emotional stress on sleep physiology.

How does sleep affect the processing positive and negative stimuli?

It is widely accepted that sleep is strongly implicated in the processing of daily stresses and emotions. Scientific literature has shown how sleep appears essential to our ability to cope with emotional stress in everyday life. Sleep loss and insomnia have been found to affect emotional reactivity and socialization. The effect of sleep has been well documented at various levels of function, such as on the psychomotor, sensory-motor, and cognitive levels; however, the emotional effects are less descriptive.

However, in general, the reaction to negative emotion has been documented to be significantly enhanced, while reactions to positive events are often subdued. A sleep deprivation study found that the response to positive stimuli was faster relative to the response elicited from negative and neutral stimuli. Other studies have corroborated this, showing that sleep loss increases subjective reports of stress, anxiety, and anger in response to low-stress situations and increases impulsivity towards negative stimuli. Notably, impulsivity is correlated with aggressive behavior – a tendency associated with sleep deprivation.

In another sleep deprivation study, 33 participants were subject to repeated functional magnetic resonance imaging (fMRI) sessions to determine the effect of 42 hours of sleep deprivation and after sleep recovery on brain responses and circadian rhythm in 33 healthy participants. The results showed participants' feelings of emotional distress (negative affect) remained comparatively stable during the first day, later significantly worsening after the first and second melatonin onsets in their circadian rhythm, which signals sleep.

The disruption or deprivation of sleep is both a symptom and a risk factor for several psychiatric disorders. In studies with children and young adults, insufficient sleep has increased incidents of confusion, anger, and depression alongside feelings of irritability, aggression, and frustration. This occurred in even as little as one night of sleep deprivation; subjects saw an increase in psychopathology schools for anxiety, depression, and paranoia. In this same research group, sleep deprivation was associated with a decreased ability to accept blame.

The long term effects of sleep deprivation on mental health

Sleep disturbances impede a sense of well-being and may affect the development and prognostic outcomes of affective disorders like depression. Since both rapid eye movement (REM) and non-REM (NREM) sleep help modulate emotional and motivational drives, these two sleep phases allow greater emotional capacity and adaptiveness during wakefulness. Healthy sleep repairs functional brain activity and adaptive processing. The integrity of the medial prefrontal cortex-amygdala connections is important in emotion regulation processes. Indeed, one night of sleep deprivation triggers a 60% amplification in the amygdala's reactivity to emotionally negative pictures relative to a normal night of sleep.

Another main aspect of regulation is the regulatory action of the hormone cortisol, which is involved in the control of stress and reactivity against emotions. Melatonin, which can regulate the reaction of cortisol, is a source of circadian disturbance and explains the change in emotional reactivity and alteration of the circadian cycle as a result of sleep deprivation – which is a source of emotional dysregulation.

As well as the exacerbation of emotional reactivity and responses to fear, sleep can create a negative outlook and increased levels of anxiety. Collectively, research demonstrates that sleep deprivation increases worry about future events, particularly if subjects are predisposed to anxiety in general. In one such study, sleep deprivation was found to increase anticipatory anxiety. Brain scans of 18 healthy young adults observing images containing emotionally disturbing or emotionally neutral content were used to trigger anticipatory anxiety. Ahead of viewing these images, subjects, when well-rested and subsequently sleep-deprived, were given visual cues before each series of images to convey the emotion to be elicited (neutral, negative, or either). Brain activity in response to the anticipatory signal was greater when the participants were sleep-deprived relative to the well-rested state, and this was pronounced in response to participants waiting in suspenseful anticipation. These responses were found to be particularly pronounced in the amygdala and the insular cortex. This was particularly amplified in subjects who were reported to be innately anxious. Explanations for this difference are attributed to changes in the amygdala, the emotional control center. Here, sleep-deprived participants show a 60% higher level of activity in this area relative to the well-rested state. Moreover, sleep deprivation has been found to disrupt the connection between the amygdala and the medial prefrontal cortex – this area regulates the amygdala function. Sleep deprivation causes the amygdala to overreact to negative stimuli as it becomes disconnected from brain areas that normally moderate its responses.

Sleep loss is also associated with reduced empathy and emotional recognition; therefore, poor sleep may reduce understanding between partners in a relationship, increasing the potential for conflict. Reduced empathy and empathic accuracy are also associated with increased levels of miscommunication and increased propensity to retaliate during conflict. These effects are linked to another finding; just one night of sleep loss impairs problem-solving, exacerbating an inability to resolve conflict.

Sleep loss compromises optimal effective functioning, affecting emotion generation the ability to regulate emotions and express them. The consensus is that getting an adequate amount of sleep each night promotes improved mood and health.

Source: news-medical.net

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Roles of a Nurse

The primary role of a nurse is to advocate and care for individuals and support them through health and illness. However, there are various other responsibilities of a nurse that form a part of the role of a nurse, including to:

◉ Record medical history and symptoms

◉ Collaborate with teams to plan for patient care

◉ Advocate for the health and wellbeing of patients

◉ Monitor patient health and record signs

◉ Administer medications and treatments

◉ Operate medical equipment

◉ Perform diagnostic tests

◉ Educate patients about management of illnesses

◉ Provide support and advice to patients

Patient care

A nurse is a caregiver for patients and helps to manage physical needs, prevent illness, and treat health conditions. To do this, they need to observe and monitor the patient, recording any relevant information to aid in treatment decision-making.

Throughout the treatment process, the nurse follows the progress of the patient and acts accordingly with the patient’s best interests in mind. The care provided by a nurse extends beyond the administration of medications and other therapies. They are responsible for the holistic care of patients, which encompasses the psychosocial, developmental, cultural, and spiritual needs of the individual.

Patient advocacy

The patient is the first priority of the nurse. The role of the nurse is to advocate for the best interests of the patient and to maintain the patient’s dignity throughout treatment and care. This may include making suggestions in the treatment plan of patients, in collaboration with other health professionals.

This is particularly important because patients who are unwell are often unable to comprehend medical situations and act as they usually would. It is the role of the nurse to support the patient and represent the patient's best interests at all times, especially when treatment decisions are being made.

Planning of care

A nurse is directly involved in the decision-making process for the treatment of patients. It is important that they are able to think critically when assessing patient signs and identifying potential problems so that they can make the appropriate recommendations and actions.

As other health professionals, such as doctors or specialists, are usually in charge of making the final treatment decisions, nurses should be able to communicate information regarding patient health effectively. Nurses are the most familiar with the individual patient situation as they monitor their signs and symptoms on an ongoing basis and should collaborate with other members of the medical team to promote the best patient health outcomes.

Patient Education and Support

Nurses are also responsible for ensuring that patients are able to understand their health, illnesses, medications, and treatments to the best of their ability. This is of the essence when patients are discharged from hospital and need to take control of their own treatments.

A nurse should take the time to explain to the patient and their family or caregiver what to do and what to expect when they leave the hospital or medical clinic. They should also make sure that the patient feels supported and knows where to seek additional information.

Source: news-medical.net

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What Does the NCLEX-RN Exam Consist Of?

If you're preparing to take the NCLEX-RN, you're probably wondering what to expect? What will the test consist of? How long does it take to get your results? How should you prepare? Keep reading for everything you need to know about the NCLEX and how to get ready for it.

What to Expect on the NCLEX-RN

According to the National Council of State Boards of Nursing (NCSBN), here's what you can expect on the NCLEX:

1. The first thing you'll need to do to take the NCLEX (after completing an accredited nursing program) is apply for licensure/registration with your nursing regulatory body (NRB)

2. Next, you'll need to register and pay the exam fee to Pearson VUE via the Internet or telephone.

3. Then, you'll receive Acknowledgement of Receipt of Registration from Pearson VUE by email. BON/RB makes you eligible in the Pearson VUE system.

4. After that, you'll receive Authorization to Test (ATT) through an email from Pearson VUE. You must test within the validity dates (an average of 90 days) on the ATT. There are no extensions.

5. Now you can go ahead and schedule your exam appointment online or by phone.

6. When your exam date arrives, you'll show up for the exam appointment and present your acceptable identification.

7. After the test is over, you'll receive your official results from your BON/RB up to six weeks after your exam (this time period varies amongst BONs/RBs).

What Does the NCLEX RN Consist of?

The NCBSN recommends prospective NCLEX test-takers download the NCLEX Candidate Bulletin to get the full picture of what to expect before, during, and after the NCLEX RN. We reviewed it for you and outlined the main takeaways:

1. How Much Does the NCLEX Cost?

For U.S. candidates, the NCLEX-RN will cost $200 in 2021. 

2. How Long is the NCLEX RN?

The minimum number of questions on the NCLEX is 75 and the maximum number of questions is 145. The max amount of time you can take on the exam is 5 hours, including all breaks.

3. What Subjects are on the NCLEX RN?

The NCLEX RN covers the following subjects:

Safe and Effective Care Environment

◉ Management of Care - 17-23%

◉ Safety and Infection Control - 9-15%

Health Promotion and Maintenance - 6-12%

Psychosocial Integrity - 6-12%

Physiological Integrity

◉ Basic Care and Comfort - 6-12%

◉ Pharmacological and Parenteral Therapies - 12-18%

◉ Reduction of Risk Potential - 9-15%

◉ Physiological Adaptation - 11-17%

4. What Format is the NCLEX Test In?

The NCLE is taken in a computerized adaptive testing (CAT) format. Essentially, the test will recalibrate itself based on your answers to questions. According to the NCBSN, "The computer’s goal during the NCLEX is to determine the ability of the candidate in relation to the passing standard. Every time the candidate answers an item, the computer re-estimates the candidate’s ability. With each additional answered item, the ability estimate becomes more precise." 

5. How Will You know if You Passed or Failed the NCLEX?

As we mentioned above, you'll receive your official results up to 6 weeks after you take the test. There are 3 different scenarios the CAT testing format uses to determine whether or not a candidate has passed the test according to the NCBSN:

1. 95% Confidence Interval Rule

This is the most common rule. Essentially, when the computer has determined with 95% confidence that you've either passed or not passed the test, it will stop giving you questions. 

2. Maximum-length Exam Rule

This is when the computer keeps giving you questions until you've reached the full number of possible questions. It will do this when you're really close to the passing standard. Then it will look at your final ability estimate to determine if you've passed.

3. Run-Out-Of-Time-Rule (R.O.O.T.)

If you run out of time before reaching the maximum number of items, one of two things can happen. If you answered the minimum number of questions, then the computer will score you based on your final ability estimate. If you didn't answer the minimum number of questions, you'll fail the exam.

Source: nurse.org

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What is Nursing?

21st Century nursing is the glue that holds a patient’s health care journey together. Across the entire patient experience, and wherever there is someone in need of care, nurses work tirelessly to identify and protect the needs of the individual.

Beyond the time-honored reputation for compassion and dedication lies a highly specialized profession, which is constantly evolving to address the needs of society. From ensuring the most accurate diagnoses to the ongoing education of the public about critical health issues; nurses are indispensable in safeguarding public health.

Nursing can be described as both an art and a science; a heart and a mind. At its heart, lies a fundamental respect for human dignity and an intuition for a patient’s needs. This is supported by the mind, in the form of rigorous core learning. Due to the vast range of specialisms and complex skills in the nursing profession, each nurse will have specific strengths, passions, and expertise.

However, nursing has a unifying ethos:  In assessing a patient, nurses do not just consider test results. Through the critical thinking exemplified in the nursing process (see below), nurses use their judgment to integrate objective data with subjective experience of a patient’s biological, physical and behavioral needs. This ensures that every patient, from city hospital to community health center; state prison to summer camp, receives the best possible care regardless of who they are, or where they may be.

What exactly do nurses do?

In a field as varied as nursing, there is no typical answer. Responsibilities can range from making acute treatment decisions to providing inoculations in schools. The key unifying characteristic in every role is the skill and drive that it takes to be a nurse. Through long-term monitoring of patients’ behavior and knowledge-based expertise, nurses are best placed to take an all-encompassing view of a patient’s wellbeing.

What types of nurses are there?

All nurses complete a rigorous program of extensive education and study, and work directly with patients, families, and communities using the core values of the nursing process. In the United States today, nursing roles can be divided into three categories by the specific responsibilities they undertake.

Registered Nurses

Registered nurses (RN) form the backbone of health care provision in the United States. RNs provide critical health care to the public wherever it is needed.

Key Responsibilities

◉ Perform physical exams and health histories before making critical decisions

◉ Provide health promotion, counseling and education

◉ Administer medications and other personalized interventions

◉ Coordinate care, in collaboration with a wide array of health care professionals

Advanced Practice Registered Nurses

Advance Practice Registered Nurses (APRN) hold at least a Master’s degree, in addition to the initial nursing education and licensing required for all RNs. The responsibilities of an APRN include, but are not limited to, providing invaluable primary and preventative health care to the public. APRNs treat and diagnose illnesses, advise the public on health issues, manage chronic disease and engage in continuous education to remain at the very forefront of any technological, methodological, or other developments in the field.

APRNs Practice Specialist Roles

◉ Nurse Practitioners prescribe medication, diagnose and treat minor illnesses and injuries

◉ Certified Nurse-Midwives provide gynecological and low-risk obstetrical care

◉ Clinical Nurse Specialists handle a wide range of physical and mental health problems

◉ Certified Registered Nurse Anesthetists administer more than 65 percent of all anesthetics

Licensed Practical Nurses

Licensed Practical Nurses (LPN), also known as Licensed Vocational Nurses (LVNs), support the core health care team and work under the supervision of an RN, APRN or MD. By providing basic and routine care, they ensure the wellbeing of patients throughout the whole of the health care journey

Key Responsibilities

◉ Check vital signs and look for signs that health is deteriorating or improving

◉ Perform basic nursing functions such as changing bandages and wound dressings

◉ Ensure patients are comfortable, well-fed and hydrated

◉ May administer medications in some settings

What is the nursing process?

No matter what their field or specialty, all nurses utilize the same nursing process; a scientific method designed to deliver the very best in patient care, through five simple steps.

◉ Assessment – Nurses assess patients on an in-depth physiological, economic, social and lifestyle basis.

◉ Diagnosis – Through careful consideration of both physical symptoms and patient behavior, the nurse forms a diagnosis.

◉ Outcomes / Planning – The nurse uses their expertise to set realistic goals for the patient’s recovery. These objectives are then closely monitored.

◉ Implementation – By accurately implementing the care plan, nurses guarantee consistency of care for the patient whilst meticulously documenting their progress.

◉ Evaluation – By closely analyzing the effectiveness of the care plan and studying patient response, the nurse hones the plan to achieve the very best patient outcomes. 

Nurses are Key to the Health of the Nation

◉ There are over 4 million registered nurses in the United States today.

◉ That means that one in every 100 people is a registered nurse.

◉ Nurses are in every community – large and small – providing expert care from birth to the end of life.

◉ According to the January 2012 “United States Registered Nurse Workforce Report Card and Shortage Forecast” in the American Journal of Medical Quality, a shortage of registered nurses is projected to spread across the country between 2009 and 2030. In this state-by-state analysis, the authors forecast the RN shortage to be most intense in the South and the West

◉ Nurses' roles range from direct patient care and case management to establishing nursing practice standards, developing quality assurance procedures, and directing complex nursing care systems.

Source: nursingworld.org

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Signs You Failed the NCLEX (And What to Do If You Did Fail)

The final hurdle to become a fully licensed Registered Nurse is the National Council Licensure Examination (NCLEX).

To some, this is a daunting feat requiring countless hours of preparation and thousands of sample questions. Others take lengthy review courses in conjunction with online study programs. According to the National Council of State Boards of Nursing (NCSBN), 85% of new graduates passed the NCLEX on their first attempt in 2021.

So what does that mean for the other 15%?

Nurses who’ve failed their boards on the first attempt -- as well as nursing experts -- explain that it takes commitment, perseverance, humility, and grace to overcome this hurdle. A shocking number of new graduates fail their boards on the first attempt, but it’s rarely discussed.

Interestingly, a large number of nurses have a coworker who failed the NCLEX. In fact, including internationally educated nurses and repeat test-takers, the pass rate in 2021 was only 66% on the first attempt, per the NCBSN.

Signs You Failed the NCLEX RN

While the only way to know for sure whether or not you passed the NCLEX is to wait for the official results, we all know it can be impossible to wait. Especially when it can take up to 6 weeks to get those results.

So you can have some sense of how you did on the NCLEX exam, let's dig into how it's scored. 

How the NCLEX RN Is Scored

The NCLEX is taken using a Computerized Adaptive Testing (CAT) format. Basically, the computer adjusts the type of questions and number of questions you answer based on how you responded to previous questions.

Because of this, many people try to gauge whether or not they passed the test based on how many questions they were given. 

According to the NCBSN, there are 3 different scenarios their testing software uses to determine whether or not a candidate has passed the NCLEX:

1. 95% Confidence Interval Rule

With this rule (the most common way they judge test-takers), when the computer has determined with 95% confidence that you've either passed or not passed the test, it will stop giving you questions.

Since the minimum number of questions you'll take on the NCLEX is 75 and the maximum is 145, this could happen at any point between those 2 numbers. Theoretically, the computer could know from your first 75 questions that you failed and stop giving you more, or it could know that you passed. It's impossible to know which scenario you fall into based on how many questions you answered alone.

2. Maximum-length Exam Rule

If you end up answering the full 145 questions, that is an indication that you're close to the passing standard and the computer is going to keep giving you questions until you've reached the full number of possible questions.

So, don't think just because you had to answer all the questions, or the test is taking you longer than others, that you failed! The computer is just doing its best to determine where you are at. It will look at your final ability estimate to determine if you've passed, rather than the 95% confidence rule mentioned above. 

3. Run-Out-Of-Time-Rule (R.O.O.T.)

If you run out of time before reaching the maximum number of items, one of two things can happen.

◉ If you answered the minimum number of questions, then the computer will score you based on your final ability estimate.

◉ If you didn't answer the minimum number of questions, you'll fail the exam.

So, one sign that you did fail the NCLEX is if you ran out of time before completing the minimum 75 questions. Other than that one scenario, unfortunately, you're going to have to wait for those official results to really know whether or not you passed. 

What to Do If You Did Fail the NCLEX

If you did fail the NCLEX, don't freak out! You can take it again. And now that you have some experience with the exam, you're even more well-equipped to nail it the second time around. Here's what to do if you failed the NCLEX:

1.) Analyze Why You Failed the NCLEX

It’s important for nurses to recognize why they failed, and for every nurse the reason will be different. Some fail due to personal responsibilities, including family. Others suffer from lack of preparation, difficulty with critical thinking and multiple choice questions, the inability to focus during studying, or being distracted during testing.

Each of these can be overcome but require immediate and focused attention.

A study conducted in 2008 by the NCSBN concluded that for those who fail, it’s important to retake the NCLEX as soon as possible. It found that delaying the exam after graduation doesn’t increase the chance of failure. Rather, delaying after initially failing can increase the chance of failing a second time.

Once it’s been determined why you failed, think about what you need to do differently in order to change the outcome.

Enrolling in NCLEX prep courses can be helpful for those requiring personalized attention and in-person reviews. Many of these courses are instructor-based and offer a money back guarantee. Review courses can increase confidence and help with critical thinking skills.

It’s important to take multiple practice tests and answer hundreds of questions in order to become increasingly familiar with the test format and questions. Some questions have multiple answers that may in fact be correct, but the NCLEX searches for the best possible answer. Sample online tests can be found through various websites or through NCLEX study books.

2.) Take Action to Make Sure You Pass the Next Time Around

After determining why you failed, it’s time to take action with this information. First, write down as many of the topics from the initial test that you can remember. These could include lab results, obstetrics, cardiology, or time management questions.

If there’s one area where you feel especially weak, spend some time reviewing content material related to this subject. Some experts suggest answering 50 questions per day with a specific focus on areas of weakness. 

Study guides containing review questions are a potential nurse’s best friend. Every day, regardless of outside factors, experts recommend at least 150-250 questions should be answered. The questions answered incorrectly should be reviewed and content material reexamined if there is still confusion. 

Lippincott's NCLEX Review Guide contains more than 3,000 sample questions with correct and incorrect answers and rationales, as well as a diskette containing an additional 100 questions. The book is separated into different clinical areas so that you can concentrate on your weak area and not spend too much time on areas where you’re more comfortable. 

3.) Stay Positive!

Despite the hours of preparation, the most important advice any nurse can give is to stay positive and expect to pass. Failing the NCLEX on the first attempt doesn’t adversely affect one’s future nursing career. It’s important to not get stuck in a cycle of depression or self-doubt after failure.

Don’t give up. Remember, you made it through nursing school, so you have the persistence to pass the state boards and earn your license to practice.

Source: nurse.org

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