It’s time to be a Strong Nurse

I was about to ‘boost’ a patient up in the bed with a colleague and I noticed how strong she was. I hardly did anything! Later that night, a patient coded and she started CPR. I noticed that she could do it for such a long time with so much force. She’d take a break just for a few minutes before she took over again.

When I took over, I realized how little endurance I had. I was wiped out after a minute.

After the code, another colleague mentioned how she heard pumping noises right before the code was called. She knew that it was that strong nurse doing CPR.

After I went home for the day, I felt my abs hurting.

This made me think about all the strong nurses there are. Especially in the ICU. Especially her. So she’s my strong nurse idol. I want to be a strong nurse.

I bought new running shoes and workout clothes yesterday from Adidas. I haven’t had a sports bra since high school (I’ve been swimming instead). I have to build my endurance. Do free weights. Etc.

It’s time to be a strong nurse.

And I’m bringing my boyfriend along for the ride.

Strong nurse!

Talking to intubated patients make a difference

I’ve taken care of my fair share of intubated patients. But over the last 2 nights, I encountered something different. They went from calm to wild in just a few minutes. If the sedation was down, then I increased that. Normally it works pretty fast.

But it wasn’t so in this case. Both patients were ‘bucking the vent.’ One didn’t have a PRN order ready so for one I had my coworker help me get an order and prepare ativan. But in the meantime, I remember reading critical care nursing journals about the experiences of previously intubated patients. They said to always assume that the patient can hear you. They said that when the nurse talked to them about where they were, what’s going on, and what to do, in a strong confident voice, that the patients felt comforted by that. So that’s exactly what I did.

This patient kept biting down on the tube (which is a big no no because we don’t want a punctured tube!!). “You’re in the hospital and you’re very sick. I’m Jessica, your nurse. Right now you’re having trouble breathing so you have a breathing tube. I know it’s uncomfortable but you need this. Try to calm down and take slow breaths. Open your mouth. Your face is very red but calming down will allow you to breathe better.”

Once I said this, the patient did calm down and opened her mouth.

“Good, your face is looking better and you’re oxygenating better. We are going to turn you to the side to clean you because you had a little accident, ok?”

She was able to cooperate much more at this point. And this happened before giving the ativan. My coworker then came in, administered it (“we’re going to give you something to help you relax now”), and she was at peace again.

Even though she couldn’t focus her eyes and couldn’t follow simple commands, it seems as though what I said did make a difference.

 

Where’s my ID?!

So they say that a vacation is most enjoyed prior to the actual trip — mostly because you get to fantasize about all the fun you’re going to have. But once you’re there, some things don’t go according to plan — but you’ll still remember that feeling before the trip.

Currently, I’m stuck at the JFK airport waiting for my flight. I’ll back up.

Last week was my boyfriend’s brother’s high school graduation in San Diego so I went for a few days. On the way back, his mom let me use one of her bags to carry back stuff. I first put my ID in a orange backpack. After going through security, I put my ID in that green duffel bag. And left it there.

I worked 4 days. I packed this morning, thinking my ID was in my wallet. I checked my wallet on the way to the airport… a little too late. And no ID.

I thought I left it in the orange bag. My boyfriend, Dan, goes back to see if he can find it. I waited in line for 1/2 hour only to be told that they don’t need a ID to check in but it’d take 1/2 hour to go through the process. Except my flight by then was in 1/2 hour. I rebooked my flight for $50.

Dan gets home. He doesn’t find the ID. I had to go outside to call him. So then I finally recall that the ID was in the duffel bag. And I was carrying that duffel bag in my carryon. I opened up my carry on and there it was — in the front pocket.

I changed up my routine and didn’t put the ID in my usual spot.

Never again… at least I’ll arrive in Vegas at midnight for our biannual vacation with the family.

So moral of the story —

  1. Always return your ID in that special spot ASAP.
  2. Check the ID before leaving for the airport.

At The New Grad Nurse Interview: Be a storyteller

how to get a new grad nurse job - be a storyteller Your interviewer loves stories. In fact, you love stories. Everyone loves stories. So it only makes sense to become a great storyteller. To secure your first job as a nurse, you have to perfect the art of storytelling. About yourself.

I royally screwed up telling the story about myself. Twice! My first interview, I wasn’t prepared at all and just said whatever came to my head. My second interview, I didn’t focus my story about being a clinical nurse and drifted off into ‘health policy’ –that was a no-no.

I got better after learning the hard way. For my third interview, I started to focus my answers and got the job at a nursing home. By the time my current employment interviewed me — my fourth and fifth interview — I had some real nursing experience and relied on that to come up with some great stories.

So what’s the difference between a tale and a story?

A tale is simply stating something that happened. People don’t usually care about what happened. However, a story has a moral, a meaning, a takeaway point to it. We care about the 3 major things – the ‘bad situation’, the ‘thing you did to make it better’, and the ‘aftermath.’

Here’s an example for a question: Tell me how you dealt with a difficult situation.

A tale: a women wouldn’t take her medications. Later she did after I convinced her.

A story: a women wouldn’t take her medications. After thinking about why she wouldn’t, I realized that she wanted more control over what was happening to her. Instead, I gave her a choice and asked her, “would you like to take your medications in 10 minutes or 20 minutes?” She replied, “in 10 minutes. Thank you.” 10 minutes later, I went back to her to give her medications and she took them like a champ. Giving her the options allowed her to gain some control but not complete free-reign. This compromise allowed me to accomplish my goal (to give her meds) and made the patient happy.

Here’s another example: Tell me about your greatest strength.

A tale: I ask a ton of questions because I always want to learn.

A story: As a new nurse, I know that I have a lot to learn. I understand that sometimes I will be asked to do something that I’ve never done before but I am not afraid to ask questions to make sure that I’m competent the next time it comes up. I wasn’t sure how to put someone on a bedpan so I asked the ancillary staff. The next time I did it with someone. Another time I wasn’t sure if I heard the breath sounds correctly so I asked another nurse to confirm what they heard. Asking questions is my strength and understand that this is key to learning fast.

Here are some common questions. Think of your clinical experiences and come up with a story for each question.

  • What is your greatest weakness?
  • “Tell me about yourself.”
  • What made you interested in nursing?
  • What do you like about nursing?
  • What was your favorite clinical rotation? Why? (please relate this directly with the position you applied for)
  • Tell me about a time when you had to prioritize.
  • Tell me about a time when you had to delegate.
  • Tell me about a time when you had to problem solve.
  • Where do you see yourself in 5 years?
  • Do you have plans on going back to school?
  • Tell me about ‘x’ experience that you wrote about on your resume.

Work on becoming a great storyteller and you’ll find that you’ll use this skill over and over again during every handoff report. And hopefully you’ll get a job offer! Good luck! Let me know if you have something crafted but would like a little help looking it over.

—-

I wrote this article as a part of the “Most Marketable Skills” Campaign on Webucator. I have to thank Bob Cleary for letting me be a part of the campaign! While I personally haven’t utilized their resources, they look helpful! Currently they are offering a free Microsoft Word 2013 class that involves learning about advanced formatting, using Word 2013 drawing tools, creating and managing tables, and working with column layouts. Each month they offer a new free course, so check it out even after this post is long done.

In case you missed the campaign, here are some of the other blogger’s input:

Achieving Success in the workplace – What is your most marketable skill? by @cjperadilla

What makes you marketable by @amandastrav

Self Brand Marketing : Social Proof To Boost Your Career by @CustomerRivet

Preparing for the workforce: Why learning to write well is worth your while by @moses_says

The Success of Mimicking by @Lbee27

What they don’t teach you in nursing school [INFOGRAPHIC]

Thanks to Madeline from Accelerated-nursing.net, this great infographic displays the multiple things that nurses have to be and do to be successful!

What They Don't Teach You In Nursing School
Source: Accelerated-Nursing.net

Here are my 2 cents on the infographic.

Prioritizing and multitasking: Just remember ABC, vital signs (+ pain) are the most important. Try to clump tasks together so you don’t waste time running around.

Charting: It is a necessity but patient care is always comes first. Chart immediately after seeing a patient unless circumstances do not allow you to do so (e.g. when all your patients demand your immediate attention!).

Collaborate: You’ll talk, talk, talk about what’s going on with your patients with the healthcare team and put your 2 cents in!

Tough love giver: You’re the pillar of strength and kindness for your patients!

Comforter and Advice giver: I feel this part is not so easy but I try to be honest when I can, joke when things are lighthearted, serious when appropriate, and provide empathy. Some patients and family members are anxious so answering their questions and reassuring them is important.

School doesn’t teach how to deal with

  • death – this one is tough but knowing that the patient is at peace and no longer suffering helps me. Or if the death is sudden, then I’ll think of the alternative: if they had survived, their life would never be the same and their quality of life would suffer.
  • stress – I always take a break. I ask for help & delegate and don’t stop until I’m happy with the result.
  • good & quick reports – follow a format every time and you’ll soon became a great storyteller; also always look at the latest orders!
  • prioritizing – the NCLEX drills this into your brain (at least the guidelines). Now it’s just time to put it into action. If there really isn’t anything exciting happening, then just finish everything on time!
  • and ill-tempered doctors – this one I feel the younger generation are trying to change this because collaboration is really key to good healthcare. And it’s not just docs but also PAs and NPs. Personally I try to be nice, be competent, question things, and hope they come to their senses.

Free BLS / ACLS giveaway

I’ve done annual CPR/AED classes for the American Red Cross consecutively for 5 years throughout college because I was a ARC swim instructor for the City of New York (yup, that was my part time job!). However, for hospitals, they require BLS certification from the American Heart Association. Since I knew the sequence and the ARC and AHA requirements are nearly identical, and I didn’t want to shell out more money, I tried out an online BLS certification.

There were videos for review and I passed the x item test. I got the certificate in the mail. I gave it to my hospital and they accepted it. Woot!

Anyway, the reason I’m writing about my online CPR/AED BLS certification course is because through ACLS Medical Training, I am able to offer a giveaway!! ONE free BLS, ACLS, or PALS course == you pick (worth up to $275). This is an honor of National Nurses Week (and yes, I realize that I’m a week late but hey, free stuff is still free stuff!!).

Personally, I did my first ACLS class during my orientation for critical care in class. I liked the hands on aspect of it and I’m not sure if I would be comfortable doing it online. Prior to the first class, we had to complete a pretest getting 80% or higher  using the code ‘compression‘. It’s helpful to have the algorithms in front of you.

I think an online course is good for people who have had a lot of experience with CPR/AED. Anyway, I’ve never used this before so here it goes. Enter into the raffle. The giveaway ends May 22.

a Rafflecopter giveaway

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!