Go help Jason reach his BSN dream. Thank you!

So several people are emailing me recently regarding loans and costs, especially after they have been accepted and are deciding whether or not go through with it.

I don’t know that much about private loans. I do know that a lot of debt sucks and it takes a long time to pay it back. Being consistent is important (maybe $1-2k/month is that is possible!).

Anyway, one student named Jason asked for my help to spread the word that he’s maxed out on his loans and needs help finishing the last 2 semesters!! Here was his email to me:

I am currently about to start 3rd sequence of the NYU accelerated program. Glad your blog is out here. Very well written and insightful.

Got a question for ya….

Any words of wisdom for a student who is facing a brick wall with federal and private student loans. I am a second degree student, so I came into the program with quite a hefty chunk of student loans. First two sequences ate up the remaining available borrowing according to the new federal max aggregate student lifetime educational borrowing.

Right now I’ve applied for several scholarships and have created a GoFundMe crowd funding page (http://www.gofundme.com/HelpJasonPay4NYU-Nursing). If you have any other suggestions or if you were interested in forwarding my story and plea for help with NYU tuition, it would be greatly appreciated.

Thanks so much
Jason Kennedy
NYUCN ABSN Fall 2013 Cohort

So there you go. Wish come true. I really do hope that people reading this blog will help him out. I know I will. Caring is giving and what goes around, comes around.

“I like your ring”

I had 3 patients last night.
One was bleeding from her ash splint cath.
One was in pain.
One said, “I like your ring!” As I told her to keep her arm straight so I could do a dressing change.

Haha, love my patients.

Get Started on Your Retirement now!

A Path to Retirement, For Those Far From It

Hello!

I’m in my 20s and I’ve been really into saving for retirement since I was 18 when I opened up my own individual retirement account (IRA). This morning I read a New York Times article on saving 15% of your gross income just for retirement, then splitting it 33/33/33 percent into these accounts:

  • A US total stock market index fund
  • A international total stock market index fund
  • A US total bond market index fund

In If You Can: How Millennials Can Get Rich Slowly, it recommends doing it on your own. After using MarketRiders (try it and get $25!), I have a gist of what I should do (and what I’ve been doing for the last year) and I wholeheartedly think this is the best idea.

Since I use Fidelity, I use the FREE ETFs (exchange trade funds) that costs nothing to buy or sell (most costs $7.95 per trade at Fidelity). ETFs basically act as mutual funds but costs 0.10-0.30% vs 1-3% (so you keep more money! Woot). It’s a collection of companies in one ‘fund’ which is a great way to diversify. Often you don’t want to own just one company stock just in case it tanks.

Ok, so let’s say you really want to make this happen. Hypothetically, let’s say you have $3000 to invest. That means we will put $1000 into each major category. Here’s how I would break it down using the ETFs I recommend below.

  • A US total stock market index fund

US Stock ETF

I like the S&P 500 ETFs growth (IVW), blend (IVV), and value (IVE) because it follows the S&P 500, which on average over long term, it pulls in 10%. That means if you invested $5000, by the end of the year you’ll get back $500. That’s pretty good to me!

I also like the S&P small cap 600 growth (IJT) because it’s nice to invest in smaller companies. While there’s more ‘risk’ to it, it has a higher potential to bring more back to you.

Using a total of $1000 (as of 5/5/2014*; round up or down as you see fit):
IVW: $250. 1 stock = 100.15* so buy 2 stocks. ($250/$100.15 = 2.5)
IVV: $250. 1 stock = 189.21* so buy 1 stock. ($250/$189.21 = 1.3)
IVE: $250. 1 stock = 87.51* so buy 3 stocks. ($250/$87.51 = 2.9)
IJT: $250. 1 stock = 114.54* so buy 2 stocks ($250/$114.54 = 2.2)

 

  • A international total stock market index fund

International Stock ETF

I bought ACWI, but it’s hard to go wrong with one of the * ones which is a Core ETFs such as emerging markets (IEMG) or total international stock (IXUS).

Using a total of $1000 (as of 5/5/2014):
ACWI: $1000. 1 stock = 58.65 so buy 17 stocks. ($1000/$58.65 = 17)

  • A US total bond market index fund

US Bond ETF

I recommend the Core Total US Bond Market (AGG) and High Yield Corporate Bond (HYG).

Using a total of $1000 (as of 5/5/2014*):
AGG: $500. 1 stock = 108.58* so buy 5 stocks. ($500/$108.58 =4.6)
HYG: $500. 1 stock = 94.00* so buy 5 stock. ($500/$94 = 5.3)

Just keep in mind that as stocks go up, bonds go down and vice versa. Don’t worry about the daily emotions of a stock — think long term. It’s a good idea to look at the profiles of the ETFs or any stock you’re interested in. What is the return? What are the rankings? What companies are they invested in? Do you agree with those selections (ethical investing can come later)?

By the end of the day, your hypothetical $3000 portfolio looks like this:
IVW: $250. 1 stock = 100.15* so buy 2 stocks. ($250/$100.15 = 2.5)
IVV: $250. 1 stock = 189.21* so buy 1 stock. ($250/$189.21 = 1.3)
IVE: $250. 1 stock = 87.51* so buy 3 stocks. ($250/$87.51 = 2.9)
IJT: $250. 1 stock = 114.54* so buy 2 stocks ($250/$114.54 = 2.2)
ACWI: $1000. 1 stock = 58.65 so buy 17 stocks. ($1000/$58.65 = 17)
AGG: $500. 1 stock = 108.58* so buy 5 stocks. ($500/$108.58 =4.6)
HYG: $500. 1 stock = 94.00* so buy 5 stock. ($500/$94 = 5.3)

I hoped that helped.

If doing it on your own is a little scary, the New York Times published an article called Financial Advice for People Who Aren’t Rich comparing other Inexpensive Advice for Index-Fund Investments such as Betterment, WealthFront and more.

assetbuilder, betterment, folio investing, future advisor, hedge able, jemstep portfolio manager, market riders

assetbuilder, betterment, folio investing, future advisor, hedge able, jemstep portfolio manager, market riders

rebalance IRA, SigFig, Target-Date Mutual Funds, Vanguard, Wealthfront, WiseBanyan

rebalance IRA, SigFig, Target-Date Mutual Funds, Vanguard, Wealthfront, WiseBanyan

 

Let me know how it goes!

Confidence between Women and Men

The Confidence Gap

The less competent men are, the more they overestimate their abilities—which makes a strange kind of sense. Since women are less confident in their abilities, they don’t pursue future opportunities.

Men overestimate their abilities and performance, and women underestimate both. Their performances do not differ in quality.

Underqualified and underprepared men don’t think twice about leaning in. Overqualified and overprepared, too many women still hold back. Women feel confident only when they are perfect. Or practically perfect.

Perfectionism is a confidence killer. The irony is that striving to be perfect actually keeps us from getting much of anything done.

What Honest Overconfidence Does

Men have honest overconfidence. People like this. However, people can also snuff out a fake in a second. People hate this.

Some individuals tend to be more admired and more listened to than others. They are not necessarily the most knowledgeable or capable people in the room, but they are the most self-assured.

“When people are confident, when they think they are good at something, regardless of how good they actually are, they display a lot of confident nonverbal and verbal behavior,” Anderson said. He mentioned expansive body language, a lower vocal tone, and a tendency to speak early and often in a calm, relaxed manner. “They do a lot of things that make them look very confident in the eyes of others,” he added. “Whether they are good or not is kind of irrelevant.” Kind of irrelevant.

External vs Internal Attribution

“Wow, that was a tough class.” Recognizing a tough situation is a external attribution.

“You see, I knew I wasn’t good enough.” Internal attribution, which can be debilitating.

When bad things happen, women blame themselves (internal). Men blame the situation (external).

When good things happen, women say they are lucky (external). Men say they are awesome (internal).

confidence women vs men
Our Brain, Testosterone and Estrogen Roles

The amygdala is the brain’s primitive fear centers, involved in processing emotional memory and responding to stressful situations. Women activated their amygdala more easily in response to negative emotional stimuli than men do—suggesting that women are more likely than men to form strong emotional memories of negative events. Women are more apt to ruminate over what’s gone wrong in the past.

The anterior cingulate cortex helps us recognize errors and weigh options — the worrywart center. It’s larger in women.

By supporting the part of the brain involved in social skills and observations, estrogen seems to encourage bonding and connection, while discouraging conflict and risk taking— tendencies that hinder confidence.

Testosterone is thought of as the hormone that encourages a focus on winning and demonstrating power. Higher levels of the hormone fuel risk taking, and winning yields still more testosterone. This dynamic, sometimes known as the “winner effect,” can be dangerous: animals can become so aggressive and overconfident after winning fights that they take fatal risks.

However, testosterone levels in men decline when they spend more time with their children.

How School and Sports Shape a Person

School is where many girls are first rewarded for being good, instead of energetic, rambunctious, or even pushy. But while being a “good girl” may pay off in the classroom, it doesn’t prepare us very well for the real world.

They have longer attention spans, more-advanced verbal and fine-motor skills, and greater social adeptness. They are most valuable, and most in favor, when they do things the right way: neatly and quietly.

And yet the result is that many girls learn to avoid taking risks and making mistakes. This is to their detriment: many psychologists now believe that risk taking, failure, and perseverance are essential to confidence-building.

Girls who play team sports are more likely to graduate from college, find a job, and be employed in male-dominated industries. There’s even a direct link between playing sports in high school and earning a bigger salary as an adult. Learning to own victory and survive defeat in sports is apparently good training for owning triumphs and surviving setbacks at work.

Catch-22 – Women’s character

The more a woman succeeds, the worse the vitriol seems to get. It’s not just her competence that’s called into question; it’s her very character. The more she talked, the less confident she appeared.

Confidence Equals Action

Confidence is the factor that turns thoughts into judgments about what we are capable of, and that then transforms those judgments into action. In turn, taking action bolsters one’s belief in one’s ability to succeed. So confidence accumulates—through hard work, through success, and even through failure.

When women don’t act, when we hesitate because we aren’t sure, we hold ourselves back. But when we do act, even if it’s because we’re forced to, we perform just as well as men do.

confidence gap

The above is my summary and heavily paraphrased article. The original article is quite long so I picked out the parts that is the essence of the article.

—This article reminds me of grade school when the idiotic boys would raise their hands and blurt out a ridiculous answer. And they always think that they are 100% correct.

—It reminds me of a guy who said, “Jessica, I’ve seen you drive and you suck. You’re an Asian girl so you just naturally suck at driving.”

I replied, “How many driving tickets have you gotten? Because I’ve gotten zero.” Exactly, I’ve got the proof to backup my claim.

—It reminds me of my girl friend who gave up her dream because she couldn’t get a perfect score on the admission test.

—It reminds me of the times when I try to reassume my patients and they ask for a doctor. When someone did see them, the patient was fine.  What do I need to do to show my confidence in my assessment?

—It makes sense that our second born siblings tend to do better in business. They aren’t that ‘perfect’ image and they have dealt with criticism and be more resilient than the first born.

—It reminds me of the stereotypes of Asians, Hispanics and Blacks. People have confidence in Asians and think ‘Asians are smart and hardworking’ and maybe THAT’S why they perform better. People think that Hispanics and Blacks are not as smart. The women of both races internalize that and lose confidence in their ability to do well in harder classes. So they don’t even try.

5 Triggers for Palliative Care in the ICU

Right now, I notice that some patients get palliative care too late in their stay at the hospital and sometimes pass away a day later after the consult was put in. We can do better than that to ensure patients are living the way they want to!!

I came across an article in a critical care newsletter called Estimates of the Need for Palliative Care Consultation across United States Intensive Care Units Using a Trigger-based Model. It said 1 in 7 patients need palliative care and that there are 5 triggers that indicate the patient has a poor prognosis and the healthcare team should put in a consult. It will give the patient and the family members more support and help guide them through difficult decisions. Here are the 5 triggers:

  1. ICU admission after hospital length of stay of at least 10 days
  2. failure of three or more organ systems
  3. stage IV malignancy
  4. status after cardiac arrest
  5. intracerebral hemorrhage requiring mechanical ventilation

 

Is NYU Nursing worth it? How I paid off my student loan

Hi my lovely readers,

I’ve thought a lot about my impact on you, directly or indirectly. For me, one of my everyday joys is to view my blog stats and watch it grow every week. It’s the thing that cheers me up when I feel down, knowing that I’ve helped another soul gain insight into something that they didn’t know before. So thank you for reading my blog.

One of the most common questions I get through email is the following:

Is NYU Nursing worth it?

I think that by the time that you ask this question, you’ve already decided that a nursing career is for you. Now you’re deciding on which school to attend. Of course, with NYU as a top ranking school, you want to know if the tuition is worth it. Right now for the school year 2013-14, here is the tuition cost:

NYU Nursing Tuition

It’s about $21k for tuition. Plus fees and health insurance, it’ll cost about $24k per semester. As for a scholarship, I’ve heard they typically give students about $3-4k in “College of Nursing Scholarship” (that’s what I got). Let’s just say you have to pay about $20k for 4 semesters.

That’s about $80k, or approximately your first year’s salary as a nurse.

What?! Really? Yes, it’s really that great. According to Forbes, NYU Nursing graduates ranked #3 for the College Diplomas with the highest salaries in 2013.

NYU Nursing BSN Salary

It’s quite possible that this is because many students stay in NYC area and the average starting salary as a brand new nurse is about $75k. Or graduates go back home to California and hot spots command an even higher salary (with a mandated lower patient-to-nurse ratio. That means less patients per nurse = more time with patients and less time running around making sure everyone’s safe. Because safety is always #1. That’s AMAZING!!).

This is even more than any business school. Only one engineering school and one computer science school beats NYU Nursing.

Just remember, sometimes it’s more about the LOCATION of the school rather than just the name. In NYC, private top hospitals command a higher salary compared to other locations.

Also remember that nurses run the hospitals. And yes, doctors go in and out, deciding on treatment plans, performing surgeries, etc. But a lot of time, nursing input is CRUCIAL and nurses are there 24/7 with the patients. So yes, while nurses do some ‘dirty work’, they are the ones performing much of the care. I remember during a code, a PA said that he knows WHAT to DO, but he needs to the nurse to DO it because he doesn’t know HOW. So I’m proud of that. And a lot of times nurses know what to do too… it’s just not ‘official’ until you have an order (that you may have suggested).

And as a nurse, from any school, you will be a vital part of the health care team.

But it still comes down to this. After you graduate from ANY nursing school, you will still have to pass the NCLEX and you will be a registered nurse.

A RN. And a RN is a RN.

On your badge, it’ll say that you are a RN. It doesn’t say which school. The only way for someone to know which school you went to is if you tell them. And yes, as a new nurse, a lot of people will ask you. Over and over again. And yes, patients will notice that you, as a new nurse, are just not as fast, or do things with grace, or seemed to be always crunched for time. But don’t worry. They will still appreciate what you do and you just keep going.

As for a pay differential, hospitals don’t look at which school you went to (or maybe they do unknowingly as do many companies, since they typically have feeder schools too). Hospitals nowadays do not hire new associate degree nurses. This happened because of many study that compared associate and bachelor of nursing graduates (ASN vs BSN) perform. It showed that patients were safer and had a lower mortality rate when taken care by BSN graduates. Anyway, there’s usually a BSN pay differential at hospitals because they want to ‘encourage’ those who were already hired as a ASN to get their BSN.

If you’re questioning if you should get a ASN or BSN, always go for the BSN, especially as a second degree student. You’d be in school for the same amount of time anyway and a BSN is standard now. Don’t waste your money and time on a ASN. I heard that most ASN are hired mostly by nursing homes now. And maybe that is the route you want to go but I say if you want to keep your nursing career options wide open, go for the BSN. Don’t limit yourself.

So let’s get back to the question:

Is NYU Nursing worth it?

There are two typical paths people take while going down the road of nursing.

If you wish to be a bedside nurse forever (and trust me, a lot of my colleagues have been. And they love what they do and they are amazing people!!!), then I think getting a BSN anywhere is ok.

BUT

If you wish to keep your options open, and you have that flaming desire to do more than bedside nursing such as management, informatics, research, global work, etc, then I think NYU Nursing is worth it.

Maybe it’s the characteristics of the students who go there have similar taste as you. Because they want the same things too. The same drive and ambition. The chances you take to learn something new and to overcome challenges. To not give up when it gets tough and to push forward. To help other coworkers and patients who aren’t assigned to you. To still have a smile on your face and still want more.

Maybe it’s the extra-edge of a ‘brand name’ school that gives you –or your future employer– the confidence. You’ll know you received a top level education and it doesn’t get much better than this (although as a student you’ll still think of ways to improve it because you can’t help it). You’ll know that whatever you don’t know, you’ll pick it up fast anyway and be able to perform at a top level.

Your future employer will know this school and not question its validity. Maybe not initially but down the road it becomes more significant. As you may or may not know, many of the top hospitals in NYC have Chief Nursing Officers (CNO) who are NYU Nursing graduates. Know that with pride.

Honestly though, you can still have all these desires to go on a winding nursing career and not go to NYU Nursing. It’s still an individual who decides her own path.

Here’s the second question:

How did I pay for my student loan?

Personally, I hate owing money. Especially at an interest rate of 6.8%. As soon as I started making money, I put everything I could into paying off my loan. Yes, you could pay the minimum payments for 10 years but I can’t do that.

For me, I had parents who were able to help me financially and I thank them for that.

I owed about $20k in student loans. After taxes, I received about $4k/month. Less than half went toward rent, transportation, and food. The other ‘more than half’ went to paying off the student loan as quickly as possible. In 6 months from December 2012 to May 2013, I paid out $15k, or about $2.5k per month.

In May 2013, I received a credit card offer for a balance transfer. Normally I ignored these but this one was offered at 1% fee. That meant instead of paying 6.8%, I could pay only 1% to borrow the money as long as I paid it off by the deadline of March 2014 (and also not use that credit card for regular purchases so credit card companies can’t confuse you with the different APR for balance transfer vs purchases).

I wrote the check to myself and cashed it at an ATM. I saw $5000 in my checking account. On the credit card, they deducted $5000 plus the 1% fee of $50. I paid off the rest of the student loan with that $5000 and that account was closed in May 2013. Then I spent the next 8 months from June 2013-February 2014 slowly paying it off about $650/month.

The good thing about this balance transfer is that I only had to pay $50 to borrow $5000. If I had left that amount in the student loan, then I would’ve had to pay $5000 * 6.8% = $340 to borrow that same amount.

—-

Anyway, I hope this helped you. Please let me know if it did and if you have any additional questions, comment below or send me an email. Thanks.

And go team! 🙂

In bed by 8:07am

Wow, I’ve never driven home from work, shower and be in bed by 8:07am. Yay!!! And I’m getting report from the same nurse tonight. I love that– back to back report to and from the same nurse.

How to Pick a Good Nursing School

How to Pick a Good Nursing School

Once you complete nursing school, you must pass the NCLEX exam. Hopefully you’ll pass the first time you take it. I recommend picking a nursing school that has a high first time NCLEX pass rate. Every 4 years the NCLEX changes its content and questions so the new cycle may have lower pass rates. You can find the 2013-2017 NCLEX pass rates here. You’ll also see how many students attended each school.

For NYU, these are the 2008-2012 NCLEX first time pass rates. Compare other New York State nursing schools there.

2012 2011 2010 2009 2008
New York University 89.6%
396/442
91.6%
327/357
 89.4%
244/273
88.5%
216/244
86.1%
217/252

 

My First ICU patient who passed away

He officially passed away this morning
while I was on break. DNR status.

Yesterday his son asked for my thoughts.
“I think he’ll make it tonight.”
Even though he was slowly deteriorating,
Maxed out on oxygen and 3 drips to keep up his blood pressure.
On fentanyl to make him comfortable.
He made it.

I returned last night.
It was a different story.

“Jessica, how’s he doing?” His son asked.
The generic “he’s fine” is off limits. It was time for the truth.

“Last night his respiratory rate was 9 or 10. Now it’s 15-18.
Often when people are nearing the end of life,
it goes from slow to faster and back to slow again.”

“But his heart rate looks ok. It’s 85.”

“Yes that’s true.
But his blood pressure is slowing decreasing.
His heart is still trying to compensate.”
He cocked his head. I tried again.
“His heart is trying to get enough blood to his body
but it’s not working. It will eventually give up.”

Optimism in his voice,
“But wouldn’t the heart rate slowly taper off?
I thought he would live a couple more days.”

“No, his heart can suddenly stop because it’s giving up.
I’m not sure if he will make it through the morning.
His drips cause his blood vessels to constrict.
That explains why his hands are cold
and the oxygen probe to not read well.”

After midnight, his HR was suddenly dropped to 42. RR was 9. SpO2 77%.
“Can you give us an update, doc?”

“Well I’m not a doctor.”

“It’s ok. We’ve promoted you. Just give it to us straight.”

I started to tear up a little bit.
It wasn’t easy for me to tell them what I thought:
He’s on his way out.

They told me that they’ve shed their tears already
and were waiting this.
“Thank you for taking great care of him.
You should be proud of you and your coworkers.
Tremendous sense of purpose and goal and comradery.”

His blood pressures stop reading.
Apnea alarm sounds.
That probably should’ve been my cue.
I still felt a carotid pulse.
I checked my drips.
Gave report and went on break.

I came back from break and looked at the monitor.
His was black.
“Your patient expired.”
Icy cold hospital terminology.

I debriefed with the experienced nurse covering for me.
What could I do better next time?
1. Listen for his heartbeat, not only feel for pulse.
2. Consider the BiPAP machine delivering breaths for him.
What’s the rate set at and what is his RR now?

In the final progress note
Include: heart rhythm- PEA,
who pronounced time of death,
which doctors notified of death.
Family at bedside or contacted.

In the end,
This family was ready to accept their father’s fate.
The son shared his friend’s voicemail message:
“How did they prepare the chicken?
They told him he was going to die.”
We chuckled.
Humor can start the healing process.

After I gave report,
I said bye to the family
And they all gave me a hug
And thanked me again.

I drove home
Half crying
Trying to drown the feeling
By turning up the radio.

I showered, ate, and wrote this down
So that I don’t forget.

How to use Google Scholar and get NYU Library articles

How to use Google Scholar and get NYU Library articles

For the last couple years, I used Google Scholar to get a general idea on various research articles. I clicked on the links that led me to PubMed and more. But I can only get free articles at home.

I did things the hard way — I found the articles that I wanted the full PDF on. Logged into library.nyu.edu and searched for the journal, year, etc. It took forever!!!

Now, I can still use Google Scholar to find articles. I just followed the directions in the link. It has made my life so much easier. So thank you Google Scholar and NYU Library.