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.

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.

Caring from the heart is nursing

Yesterday I wrote about a frustrating moment I had. A reader said that nursing is caring from the heart. I agree with that.

Since going to the ICU,
most of my patients can’t talk to me.
But one was A/O x3, could speak, though didn’t seem normal quite yet.

He was what I called “call-bell happy.”
Too hot, too cold, not comfortable–
it can all happen in a matter of 10 minutes.

1st night- “can I have a sleeping pill?” “Ice, ice, ice” “blankets on, blankets off”

2nd night- slept throughout the night but I’d catch him when he woke up and waved at me to come over. “hurts, hurts, hurts” “your bum?” He nods. I turned him to the other side and boom! He was fast asleep again.

3rd night- he looked like a new man!! Ahh the wonders of a good night rest.

He waved me over to fix him up at change of shift. He proceeded, “thank you. I knew that the moment I looked at you that you’re caring from the heart. You have made a big difference for me.”

I was a little bit shocked that he spoke so normally. We continued to talk and he spoke about another hospital. I asked him about his experience there. His eyes lit up and said, “You should be working there! There’s where you belong. You see that everyone collaborates and works so seamlessly as teams.”

I was taken back a little bit because I felt my unit had members who worked well as teams too. Does that mean he implied that here was worse than there?

He continued, “Leave your information. I’m friends with the head doctor there. I’ll get you a job there. I will. Include your specialty.” And he repeated this several times before he went to sleep.

Unfortunately, he was a step down patient and a critical care patient needed to get transferred into his room. So he left. And a new patient went into his place.

I never did leave my information because I felt that it was a little unprofessional but also, would he really remember? He still has to go to rehab to recover and it would be odd to have my information amongst his personal belongings. I’m not sure if I would’ve gone- I kinda like where I am now. Plus I’m just starting here!!

Another patient- I also had her for 2 nights with a couple days off in between. On the 3rd night she just came back from a procedure. She saw me and reached out for me. The PACU nurse said, “aww she really likes you!” I squeezed the patient’s hand and she squeezed back.

I think that says everything.

When the human condition is in conflict with itself

Wow, I just read grrm.livejournal.com blog and it reminded me of how I used to write. Just as myself and not another “list” or really thought out piece. So here’s my start to get back to journaling.

I came across another article about stories– the only stories worth reading are the ones when the human condition is in conflict with itself. You have a set of ideals and yet you’re torn with how you feel.

For example, last night a patient was complaining of pain and her nurse gave her pain medication. 15 minutes later, she’s asking for help. Her nurse is across the room and she saw me sitting at nurse’s station. I knew that her nurse had already attended to her so I ignored her (wow that sounds bad but I was busy catching up!!). After she called 3 more times I walk over and ask her, “what’s the problem?”

“Why didn’t you come over right away?” She probed.
“Your nurse just spoke to you. What’s going on?”
“I’m in pain!”
“Did you tell your nurse?”
“Yes. He gave me pain medications.”
I overheard him say that he gave the pain meds 15 minutes ago. “Ok, then you have to let it kick in.”
“Yes but it hurts!!!”
“Ok but you still have to wait for it to kick in!” I thought to myself, why made her think that complaining to me would make any difference?

I felt sympathetic for her because face it, who likes to be in pain? But I felt the issue was already addressed and that’s nothing left for me to do. Is that wrong? Did I lose my patience?

She ended up falling asleep.

As a nurse, I feel compassion and empathy but there’s only so much to go around. I pour it all on my patients and any patient that has a 3 alarm star going off… Or I’ll help out another nurse “boost” a patient up in the bed. But that’s about it.