National Certified Nurses Day

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On Thursday, March 19, was National Certified Nurses Day. At work, it was nice to get that acknowledgement (again!). The AACN ambassadors put together little bags for all those who are certified as a CCRN. In the bag, there were a couple of AACN and CCRN pens, pins, and chocolate.

My hope is that once you’ve been in practice long enough to get certified, go for it. It just gives you that additional “oomph” and confidence.

 

World Sleep Day: 5 Ways to Sleep Better Tonight

When Sleep is Sound, Health and Happiness Abound

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I don’t drink coffee to stay awake. I know that caffeine is America’s legal drug to stay awake, and coffee shops are abound to fill that need. But for some reason, a 11th grade chemistry poster presentation on caffeine swayed me away from coffee. It’s an artificial way to keep you awake.

Instead, I sleep. Yes, it’s true — I didn’t drink coffee during school. And I don’t drink coffee for work. How is it possible that I just sleep to refuel?

My mom may have influenced me a little. Whenever I physically felt bad or crummy as a kid, she told me to take a shower then go to sleep. So being the good kid, I slept.

I think this country is sleep deprived and we simply don’t get enough sleep every night. Some people say that sleep is a waste of time and you’ll get plenty of it once you’re dead. However, I think otherwise.

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Sleeping allows your brain and body to recharge, and clear your mind for the night. And dreaming at night is your mind’s unconscious way of solving potential and current problems.

I am pretty lucky when it comes to sleeping. When I was a baby and I cried, my parents drove me around the block in the car and I fell asleep. I can still fall asleep almost anywhere anytime. I even miss the snacks on flights. I worked the night shift and sleeping during the day really wasn’t too bad (except for when construction was going on or the neighbors’ dogs were barking).

But some people can’t sleep. Which totally sucks because they are cranky. Irritable. It’s much more difficult to concentrate and remember things. And drowsy driving is dangerous driving.

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During the rare times that I can’t sleep, I found that I did somethings that I shouldn’t do. Here are some things that I do to help me sleep.

  1. Don’t eat a large meal at least 1 hour before sleeping. When you eat a large meal, your body is spiked with glucose and your body is working on digesting food, not getting ready to sleep.
  2. Sleep in a dark room with as little distractions as possible. This is especially important for people who work during the night and sleep during the day. Getting dark shades is helpful. You shouldn’t feel too hot or cold, and the mattress and pillows should feel comfortable to you. If you find yourself tossing and turning often, it may be time to consider a new mattress or pillow!
  3. Clear your mind with deep breathing. This one sounds cheesy but it really works. At work, I noticed that patients who have the most difficult time sleeping are those who have too much on their mind. They think about everything and anything except for deep breathing. They will try to mask the problem by asking for a sleeping pill but that is not always the solution. The mind needs to be clear before falling into a nice, deep sleep otherwise the mind will be too focused on other thoughts.
  4. Write down your day /topics or talk to someone about your day. I find that if you write down your thoughts and issues, then you can set aside the problem for the next day. By writing a journal, you can more clearly see the problems and how you may want to solve them. You won’t have to keep thinking about the problems because you’ve already written it down.
  5. Exercise. Many times, being overweight contributes to a large fat neck. This kind of anatomy can cause obstructive sleep apnea (OSA). You may hear snoring and really the worst part is that your body isn’t getting enough oxygen while you sleep. This often causes daytime sleepiness because your body isn’t resting throughout the night since your brain keeps waking you up to make sure you get enough oxygen!

I hope you learned something new and enjoy sleeping!

Until next time,

Jessica

Nurse Blog Guidelines

Hi nurse bloggers or future nurse bloggers,

You’re probably coming across this page because you’re interested in blogging, or writing your experiences, as a nurse.

Blogging is a great way to:

  • Reflect on the day you had and how you can do better
  • Share your experiences with other nurses

Personally, I feel compelled to write about my experience because I get really drawn into other people’s blogs when they describe their story and figured others feel the same way. However, many times people remain anonymous about themselves, the school they’ve gone to, and their workplace. They often do things for a few reasons:

  • Fear of attention
  • Fear of consequences
  • Horror stories of nurses getting fired for breach in privacy and confidentiality

Of course, I don’t want repercussions for displaying the wrong information. Before I started writing, I did some searches on social media guidelines, but a lot of them are not specific. To shorten the mumble jumble, I’ve consolidated the pages of guidelines to 3 things.

  1. Comply with HIPPA. Don’t use any identifiable information such as a name, specific age, race, specific health condition, specific surgery, address, room number, family members, specific doctors, etc. One way to overcome this barrier is to switch names or if you’ve had similar patients, merge experiences you’ve had together.
  2. No pictures with patients or the hospital without written consent. Don’t take any pictures and don’t post them anywhere unless you have received permission. Even if you have received permission, it is best to show something in the positive light.
  3. Be positive. Writing negative things about specific people such as patients and coworkers is really easy to do (it’s hard not to complain). However, whatever you write will stay on the internet forever, even if you delete the information later on. It is better to deal with negative things with people one on one. While it is true that things don’t change unless you bring up what is ‘bad’ or ‘wrong’, it does not mean complaining about it on the net is any better.

So what are topics that you can discuss?

  1. One way to discuss something negative though is to discuss an issue or a problem, and suggest ways to abolish the problem or improve a system. There are many issues that need solutions. That is how we improve healthcare!
  2. Your conversations with patients and family, and the healthcare team.
  3. What you learned from a situation.
  4. Connecting what you see in the field, what you read in textbooks and journals, and what theories apply.

If you would like more details, I recommend reading the Online Journal of Nursing and the National Council of State Board of Nursing for Social Media Guidelines.

I like wearing scrubs but not when…

I like wearing scrubs but not when it’s freezing outside! I have to wear sweatpants from my apartment to the garage just to make sure my legs don’t turn fire ice and break off. So icy cold.

New Domain!

Hi!

So I’ve been thinking about having my own domain for awhile now and I finally took the plunge (mostly because I make enough now compared to being a poor student). Since I have some time now, I decided to go for it. It seems that a lot of people know my blog as lifewithjess.wordpress.com and type into Google “Life of Jess” or “Jess nurse” or “NYU jess nurse” or something similar to that. To make it easier to remember, I changed the name to NurseJess.com.

I don’t usually post my blog posts on my Facebook but I accidentally did. One of my coworkers saw it and told me that he liked it! Anyways, I always appreciate good comments.

I hope to continue to write posts about nursing that will interest you. Thanks for reading and coming back again and again.

Jess

Update: ever since I switched over, I noticed that some links don’t work so I can currently working on that so you don’t keep getting broken links. Each day I’m off I’ll comb through the posts to connect them to the correct post. Thanks for your support!

Blizzard of 2015: Sleeping overnight at the hospital

Fortunately so far I was usually home when a storm hits. But not this time. On Sunday, the news started to spread that there was going to be 20-30 inches of snow across NYC and Long Island from Monday until Tuesday midnight. And I was scheduled for both Monday and Tuesday.

So I got myself ready… Just in case I was going to stay over. Another pair of scrubs, toothbrush, toothpaste, other toiletries, and pajamas.

I went to work Monday. Watching the news, I saw the weather get worse. I probably would make it home but my small car probably wouldn’t be able to make it back to work. My nurse manager asked if I was going to stay. I said yes– I just need a sleeping area. She said she would arrange one, don’t worry.

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After work, I went to the cafeteria. They were nice enough to give out sandwiches, cookies and water for those staying over. Many of my coworkers came in early the night before. Dedication!

I went back to my car to drop off my lunch supplies and pick up my bags. I was considering sleeping in the car but by the time I got to my car, I thought it was way too cold. I headed back inside.

When I was working the night shift, we put sleeping mats in the shower because we didn’t have anywhere else to store them. I thought that the shower was pretty useless and nobody was ever going to use it. Funny how I ended up using it that night. I just wish I brought my sandals!

I slept on a mat in the conference room. It wasn’t too bad, except that the ground was hard so I had to reposition myself every few minutes haha. I put my phone on airplane mode to conserve battery.

It was actually kinda nice not to have to travel to and from work. Extra sleep time. It was nice to wake up and find out that four other nurses also stayed overnight. One patient care assistant (PCA) worked the 3-11, slept, then 7am-3pm. Another PCA did 11pm and ended at noon. Another one did 3pm-7am. Thank goodness for them!!

They offered a $2.50 credit for breakfast. So that was nice.

But we started with 7 nurses when we usually work with 10 so it was a rough start to the morning. Most of us started with a triple! As the morning came, two more nurses came in so it felt a lot better.

Anyways I am glad that there was a mandate for no cars on the roads overnight so the trucks could plow most of the snow away. And I am glad that I didn’t have to drive through bad weather by staying inside.

We don’t have mandatory overnight stays so we don’t get paid to sleepover. I believe that at some other hospitals that in a state of emergency that they do this to keep enough staff on duty. Do you think that nurses should get paid to sleep overnight or during the day or that it’s a waste of money to do so? Or does short staffing cause unsafe patient situations? What is more important?

I submitted my grad school application– yes!

I finally finished my essay after several drafts so I submitted my grad school application online. It really makes you think about why you want to go into a career and forces you to be certain about what you’re going to do in the next few years.

I did share my blog in the personal statement essay. In this 21st century, I hoped that was ok. After looking at Twitter, I found that the school also had a WordPress blog. Perhaps they will see what blogging can do for someone… And help many people!

It’s been somewhat of a relief to finally be done with applying for grad school. I went to two information sessions, studied and took the GRE, took the PALS classes, studied and passed the CCRN, made sure recommendation letters are completed and in (and thanked those who’ve helped me), got my Michigan license… It’s been quite a few things to coordinate. Having a timeline helped but it’s mostly been studying, studying, studying. While I welcome the break, I know that I’m going to be itching to do something again.

What It’s Really Like to Care for a Dying Parent

It’s really tough to decide the best course of action for someone who is dying, especially in our society where life, any sign of life, is prized, and not necessarily the quality of life. It’s truly difficult to make a decision for someone’s life especially if you love them.

But the better question is, would you want to live in that fashion?

Talk about death decisions with your loved ones so they know what to do in case something happens. This will save time and grief among the family and friends. The health care proxy doesn’t have to be guilted into making that hard decision that no one is willing to make.

As for organ donation, if someone willingly signed up to be an organ donor, I would assume any organ is ok as long as it’s usable and that I don’t look completely mutilated after the process. I mean, in the end an organ is an organ. If it can help save another life and I’m already dead, why not help out someone else?

CCRN: How to Pass The First Time

I passed the CCRN last week! Yay!!! The CCRN is a certification exam for critical care nurses. It basically verifies your knowledge about critical care concepts after working 1750 hours in the last two years. The benefit of getting the CCRN means getting a pay raise or a bonus. Or intellectually, it solidifies your basics. But if you’re reading this, you probably already know that. You have the more important question — how do I pass the CCRN?

Before I studied, I also searched the internet for the best way to study for this difficult exam. There were two things that stood out to me.

  1. Listen to Laura Gasparis’ videos.
  2. Do all of the questions from PASS CCRN®.

I got all of the material from a friend, from another friend.

I listened to all of the videos and wrote down notes the first time around so I wouldn’t have to listen to it again. It meant I had to pause the video sometimes to write notes. There were 6 videos about 2 hours long. So roughly 12 hours. I did 2 videos each week while working full time. It took 3 weeks to complete.

Then I did all of the questions from Pass CCRN. Don’t read the book. Doing the questions will inadvertently make you go through the important concepts and details. I gave myself the goal to complete either a complete section (for shorter, easier sections) or a certain number of questions each day. Cardiac (20%), pulmonary (18%), and ethical (20%) are the most heavily weighted sections. For the cardiac and pulmonary sections, it initially took me about 2-3 hours to complete 30 questions because I would read the rationale and write a flashcard for the material. There are over 300 questions on cardiac alone, and there’s a good reason for it.

I felt the most important things about cardiac are:

  • The different medications (pressors, vasodilators, diuretics, beta blockers, calcium channel blockers, ACE inhibitors, ARBs), how it works, side effects, and how it affects afterload, preload, and contractility (which comprises of stroke volume (SV)).
  • How does SV and heart rate (HR) affect cardiac output (CO)?
  • In different disease states, what is lacking, and what do you need to fix the problem?
  • How does the intra-aortic balloon pump (IABP) help? Complications?
  • What does the pulmonary artery measure, what do those values mean, and what do you do when you see a value out of wack? What are physical assessments would you find?
  • What are the different types of murmurs, where do you listen, what typically causes stenosis vs regurgitation?
  • Different types of chest pain, MI.
  • 12 lead EKG — this took some time for me since at work it’s only required to know how to read a lead II EKG. But since I started studying, I’d look at 12 lead EKGs at work and it’s kinda fun.

For pulmonary:

  • ABG interpretation (compensated vs uncompensated; what would breathing too fast or too slow cause? How would you treat different values?)
  • Ventilator settings – which ones affect respiratory rate? What does PEEP do? How does that relate to the V/Q ratio?

As I did the questions, I used a flashcard program called Anki. It’s a fantastic memorization tool using the concept of spaced repetition. And the best part is that it’s free to download on the computer or laptop and to use over the internet. It’s $25 to download on your iPhone or Android but it’s worth it.

Basically, I did the questions on one side of the screen, and had Anki opened on the other side. Anything I didn’t know or wanted to review, I either copy and pasted questions or answers, or paraphrased the concepts. It’s easy to put too many things to memorize on one card and that’s the last thing you want to do. When you’re reviewing the card, you don’t want to think, “oh I got half of the card correct… so do I choose that I got it right or wrong?” You want to be decisive and pick whether or not you got it correct.

I have the flashcards that I created for the CCRN that is easy for you to download, although you should probably create your own or edit mine to make it easier for you. Updated December 16, 2016: these flashcards can only be used with Anki on a computer or phone. If you are thinking about downloading the flashcards, please download Anki first and make an account. Also, please do not download these flashcards unless you will use them right away.

Updated August 3, 2015: I’ve given the CCRN Flashcards to many people who have used them and passed the CCRN. Since it is time consuming for me to email everyone who asks and I’ll have no income for the next two years while I’m in school, I’ve decided to sell them to help me pay for food during school. People have said that it’s worth $50 but I won’t charge that much for it, especially since I really want you, as my reader, to pass!

And good luck in your endeavor.

Just 89 out of 150 questions to pass. So you can do it! 25 are for research. Only 125 actually count. You have up to 3 hours to take the exam.

The exam is $225 if you’re a member of AACN. You’ll go to goamp.com to see the test sites and register for the exam. You’ll get 3 months to take the exam. Once you pick, you can change the test date once for free. Majority of the test sites are in the HR Block. How nice of them!

I took mine in Astoria, NY. I was the only one and it was quiet. Good experience.

Anyways, go for it.