NYU Accelerated Nursing Program FAQ’s Part II

I recently received an email from a prospective nursing student and thought that it was worth posting my answers.

Hi Jessica,
I came across to your blog while searching for NYU’s accelerated nursing program.  Reading your blog has been very helpful. Congrats on becoming a nurse. Currently I have my undergrad in a business discipline and I am really considering a nursing career instead. I just have some questions regarding nursing, it would be great to get your feedback. Thanks so much if you have the time to answer any of these questions!

1.       Does it matter whether you take your pre-reqs at a community college or 4-yr college when applying to NYU? Do pre-req grades matter? Will there be a higher chance if acceptance if pre-reqs are taken in NYU?

You can take your pre-reqs at a community college or a 4 year college. Pre-req grades matter a lot. Definitely do well on these. I don’t believe there’s a higher chance of acceptance of the pre-reqs are taken at NYU. Majority of students take pre-reqs at a community college or a 4 year college.


2.        What were your credentials when you applied to NYU (eg. GPA, experience)? And did you find NYU to be worth it after working in the field? Is there any other nursing programs you would recommend in NY?

My GPA was 3.84. As for experience, I volunteered at a hospital when I was applying. It’s important to highlight your feelings towards nursing especially after speaking to them and seeing what they do.
NYU is a great school and I’m glad I attended the school. The professors are top-notch and the students are helpful. There’s an interdisciplinary program so med students and nursing students learn about working together and each other’s roles. It is one of the top research institutions as well especially in elder care (NICHE Program http://www.nicheprogram.org). However, it is a really expensive program so I don’t recommend it to everyone.
The other nursing schools in New York / Long Island that I hear good things from include Hunter, Columbia, Stony Brook, Adelphi, Molloy and Pace.

3.       Difficulty finding a job? Did you work part-time while studying in the program?

After I passed the NCLEX, it took about 6 months to find a nursing position. A couple of problems I ran into included not knowing how to interview (because this is a skill you need to practice). I didn’t start my search until after I passed. Some students connected with nurse managers during clinical and were able to secure a position shortly after graduation.

I did work once a week as a swim instructor during school to help supplement the costs. Some students didn’t work at all while others worked 36 hours a week (a full-time job!!). The first and second semester are the toughest so give more time devoted to school before deciding to work.

4.       Do grades matter a lot to employers? Do I need to get straight A’s or can I afford to have a few B’s or even a C?

Some employers require a minimum GPA (3.4, 3.5) before they even look at your application. Some don’t. It’s how you present yourself and your mannerism that matter and whether you retained information from school and can apply it.


5.       What is the starting salary like and is it worth being a nurse practitioner? What kind of nurse do you think is best to become/specialize in if any?

Starting salary differs from location to location, ranging from $40-80k. In NYC, it starts around $70-80k if you’re working at a private hospital.

Becoming a NP is dependent on the person. While I’ve heard that becoming an NP is the greatest thing in the world (I hear a lot of positive feedback), there are still a few who are discontent with the position, as there is more responsibility that comes with the position. Some people don’t want to deal with the higher stress and responsibility but wanted to go back to school and ended up hating being an NP. This requires a lot of self-reflection. What do you think would suit you and are you ready for it?
Personally, I’ve explored many advanced nursing professions. Not only should you look at your duties but also the lifestyle. Where would you want to work, what would you do, when would you want to work, what income would you make, what mobility is there? The best advanced nursing profession depends on the individual and what they want out of life. I picked Certified Registered Nurse Anesthetist. I like the one-on-one direct patient care aspect requiring a high level of critical thinking and autonomy and teamwork.

6.       What’s life as a nurse? What are the difficulties and good parts of being a nurse? Expectations in the work force?

Life as a nurse differs between the environment that you work in. I work at the hospital where there’s 12 hour shifts (7-7:30am and pm), 3 days a week (for full time) and you can choose your schedule (with some limitations such as having to choose at least 3 weekend days, 2 Fridays, etc). Some people choose to do 3 in a row each week and have 4 days off. Other hospitals have it so you work 3 12-hour shifts plus 1 additional day every 4 weeks. Some units, especially in CTICU, PACU and ER, have other shifts from 11am to 11pm or 2pm to 2am.

It’s great having 4 days off because you definitely need it to recuperate and you’ll have time to do something else if you’d like.
Some places have day (7a -3p), evening (3p-11p), and night shift (11p-7a), especially in rehab and nursing homes, and require you work 5 days a week.
At work, you often need to have handoff communication about the patients. Then you assess the patient and pass out medications. You make nursing diagnoses about each patient and use critical thinking. You think to yourself: What’s the goal for the patient today? And then make it happen. You’ll speak to various disciplines to coordinate the care.
There’s a couple of tough parts about being a nurse.
1) Families – Some follow the unit policies and others do whatever they want. Communication is sometimes hard but trying to understand where they are coming from helps.
2) Physicians, MLP – your input is often crucial to the patient’s outcome but sometimes the provider will disagree with you.
3) Patients – some are nice and others are crazy, confused and not so nice.
4) Self- being able to let go everyday of the outcome is tough. At the end of the time, you have to set 1 small goal for the patient and as long as they meet that, you have to be satisfied with the care you provided. Nurses tend to be overachievers and want to always give more but with the number of things that must be done, it’s impossible to do everything you had in mind. You have to remember that nursing is a 24/7 job.
The good parts about being a nurse is knowing that you’ve made a difference is someone’s life. You get to think about an active problem and you get to take yourself and solve that problem. You get to hold someone’s hand and reassure them. It’s an amazing privilege to have to save a life, to have a better life, or to let someone die with dignity.
As for expectations in the workforce, there are several different angles you can discuss but I’ll discuss about your own expectations. There’s a nursing theorist named Patricia Benner who stated that the nursing career is based on the nursing model-
You really do start not knowing a lot, just the basics. You focus a lot on technical skills because it’s something you have to work on. Then as you progress, you build more confidence. Soon you’ll start to see areas in nursing where care can be streamlined or have protocols to standardize care. You’ll be in charge, take on harder assignments, be a preceptor, etc.

7.       Any general suggestions on what I should focus on or do to become a nurse/get into NYU program?

Do well on your pre-reqs, volunteer or work in healthcare, and get to know a few professors who will write a letter of recommendation for you. And write a killer personal statement answering every question asked.

I hoped that helped! Read my first post for more information on NYU’s Accelerated Nursing Program, find out if NYU Nursing is worth it, how to pick a good nursing school, and find out if you can afford an accelerated program. Or if you have any further questions, email me.

Jessica

Why Not Volunteer as a nurse?

USNS Comfort Navy Hospital Ship

USNS Comfort Navy Hospital Ship

Has it been difficult for you to find your first nursing job after finishing nursing school? Recruiters often say, “You need to get a year’s experience.” How are you supposed to get the year’s experience if no one is willing to take a chance on you?

Courtney Lenberg, RN, from www.fromnewtoicu.com, guest posts about her volunteer nursing experience prior to getting a paying job.

The most impressive thing that I did to beef up my resume was volunteer! I had always wanted to go abroad and help those less fortunate. Luckily for me I was able to get nursing experience that helped me professionally as well!

I tried to use my license in any way possible, even if I wasn’t getting paid for it. During my future job interviews, this showed that I was motivated to get my first nursing job even though it was difficult.

Volunteering on a Navy Hospital Ship

I volunteered for five months as a nurse through LDS Charities on the USNS Comfort, a Navy hospital ship that travels to Central and South America giving free services to the local people. The main activities I helped with were surgeries onboard the USNS Comfort; medical clinics with general practitioners, pediatricians, optometrists, and dentists; and education. Education topics included neonatal resuscitation, public health, water purification, amongst other health issues.

One of my most rewarding experiences was shared by LDS Charities: “In Colombia, Lenberg helped 12-year-old David with massive burns on his hands, face, arms, legs, and back; he also had a massive infection on one hand and contractures (shortenings of muscle, tendon or scar tissue that cause deformity) in his fingers on the other hand. Lenberg said she tried “so, so, so hard” to get the boy in for surgery the next day, but was unable to do so because the surgical area was overbooked.

To Lenberg’s surprise, David was the first patient admitted the next morning for surgery.

‘My eyes instantly welled up with tears because I was so thankful that this little boy was able to get his much needed surgery done,” Lenberg said. “I don’t know that I have ever felt so much intense gratitude in my entire life as I felt in that moment. David’s dad said that I was David’s angel because I had tried so hard to get him the surgery that he needed. It was such an amazing experience to feel such intense love for someone that I had only know for such a short time.’ ”

Volunteer Opportunities

Operation Smile

Operation Smile

What an amazing and rewarding experience this was for me! One of the other most prominent charities to provide volunteer nurses on the USNS Comfort was Project Hope. Project Hope provides many opportunities to educate those less fortunate in foreign countries; the next trips are scheduled for Haiti, the Dominican Republic, India, and more.

Another organization called Operation Smile is one of my favorite charities! They provide free surgeries for children in need of cleft palate or cleft lip repairs. Their mission trips are less than a month in length; they travel internationally to countries including China, Morocco, and Russia.

If you want to help with disaster relief in the United States, the American Red Cross is a good option for you. Other local opportunities can be found if you look search around your community. Talk with your public health department or local nursing homes.

If looking for volunteer opportunities lasting for longer amounts of time, the US Peace Corps provides “life defining experience in more than 60 countries.” These assignments last for approximately two years. Nurses volunteer in a variety of ways, but most missions revolve around educating and empowering people in poor communities. The Peace Corps Response is another alternative for nurses who cannot volunteer for quite as long. These assignments are approximately 3-12 months and are for nurses who have 10 or more years experience.

There are so many neat opportunities for medical professionals! These experiences will not only help you to grow individually, but it will help your resume to grow as well. If you are feeling stuck in your nursing situation whether it be as a new graduate RN or as a charge nurse of the same unit you’ve been at for a while, then try volunteering for a change of pace! Nurses change the world one person at a time!

—–

Courtney, RN from www.fromnewtoicu.com, guest posts to talk about her struggle getting her first nursing job and how she overcame it – she volunteered! Now, she works in the medical ICU. I personally thought that this was a great idea and wanted more people to know about it.

Her website is great too — its goal is to make finding nursing school information as easy as possible. This will make it faster for both high school students and high school counselors looking for nursing school requirements, such as the GPA requirements, tuition information, prerequisite classes and more. Go check it out!

How to get a Michigan RN License from Out of State

Fonature pathr a number of reasons, we travel to a new state, such as Michigan, after we’ve already obtain our first nursing license. Since I plan on working in Michigan, I have to get my Michigan Nursing License first. Here’s how I’m doing it and the related costs.

Ease – Easy
Time to Invest – 2 days
Time to Completion – from 1 to 3 months
Total Cost Minimum / Maximum – $146.50 / $181.75
This does not include the cost of an envelope and stamp to mail. If possible, use credit or check to pay. Otherwise getting a money order may cost more.

Step 1 Go to the Michigan Nursing License website and download the RN by Endorsement Application. Fill it out, attach a check for the State of Michigan ($54 or for $10 more, you can get a temporary license first for those who currently have 2 licenses), and snail mail the form.

Step 2 Decide if you will get your fingerprints done in Michigan or Out of State. If done in Michigan, go to www.identogo.com. Pick a location, book an appointment (date and time — it’s suggested to schedule your fingerprints 7-10 days AFTER you’ve submitted the RN by Endorsement Application), fill out your information, and submit $62.50 with credit or pay at the site with a check. After your fingerprinting appointment, keep the Livescan Fingerprint Request Form and receipt as it will contain the TCN Number.

If done Out of State, go to your local police state, get a hard stock fingerprint card (in New York State, it’s $25), and mail in the fingerprint card WITH the Livescan Fingerprint Request Form (page 11) and check of $62.75.

Step 3 Have your nursing license verified through www.nursys.com. They will send the verification for you for $30.

Step 4 Wait for the State of Michigan to process your application. After about 3 weeks, you should receive a Application Confirmation containing your customer number, which you can use to check your status online at www.michigan.gov/appstatus. According to others on allnurses.com, if it’s been over 8 weeks, contact your local rep or senate with your complaint. Typically, they find that the application is completed shortly after that.

Edit (12/31/14):

Step 5 If after 8 weeks, you can call them (I waited 25 minutes!) or email bhcshelp@michigan.gov with your TCN number that is found on it Livescan Fingerprint Request Form, and your customer ID number. They emailed me 2 days after stating that they found my fingerprint and they will forward it to the processor. 2 days after that, I got my license. I hope your experience is smooth.

Jess

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

SBAR: How to Give a Good Handoff Report

SBAR

Probably one of the most nerve wrecking things that you have to do as a new nurse is to give a good report to the next oncoming nurse, the charge nurse, the nurse who covers you on break, the doctors, and the ancillary staff. You want to give the right amount of information that is pertinent to each person.

While I was in school, I thought it was a little silly to repeat the information that the instructor just gave me and I thought that I was doing it all wrong. But honestly, it’s good to just repeat the information out loud so you know what’s going on.

SBAR is really comprehensive and is great for the oncoming nurse. Here are the elements.

S : Situation – State Name, Unit, Patient, Problem

B : Background – Admission Diagnosis, Pertinent history, Current treatments

A : Assessment – Current VS, Physical assessment, Test results

R : Request – Needs MD/MLP evaluation, Further testing, Transfer to higher level of care

For example…

S: This is Jane Doe, 78 year old female under Dr. So-And-So. A/O x 3 but forgetful. No allergies, No isolation, full code.

B: She came in with pneumonia. Her past medical history includes COPD and diabetes. She came in yesterday (blah blah blah)…

A: (Vital signs) Her vital signs are stable. Afebrile. No pain.
(Activity) She can get out of bed to chair with 1 assist.
(IVs) She has 2 peripheral IVs in the right AC from two days ago. No drips but gets IV antibiotics.
(Skin) Her skin is intact. Palpable pulses.
(Lungs) She’s on 2 L nasal cannula sating 95%. Lungs diminished bilaterally.
(GI) Active bowel sounds. Regular diet. Last bowel movement was today.
(GU) Voids. Good urine output.
(Glucometer) No fingerstick.
(Labs) She needs a CBC and BMP in the morning.

Current labs Her WBC is elevated.

R: I recommend ID (infectious disease) consult on her.

—-

For a doctor or PA/NP who already knows the patient, you can do a shortened SBAR by stating name, the situation, the pertinent assessment (change in vital signs, mental status, respiratory, GI, GU, lab work), vital signs and your recommendation. For more information, the IHI (Institute for Healthcare Improvement) has the following documents that may be helpful.
SBAR Guidelines Kaiser Permanente
SBAR Worksheet Kaiser Permanente

For a doctor or PA/NP who is new to the patient, do the above but with pertinent past medical history and trending labs if possible.

For the charge nurse, you give report twice. Once in the beginning of the shift and one closer to the end. In the beginning, say the situation, any drips, and the plan for the patient. And if you anticipate that you’ll need help from her, this is a good time to speak up. For the second report, state what has changed since you started your shift (any new labs, tests performed, drips, assessment) and the plan for the patient.

For the nurse covering your break, state the situation, code status (Full code vs DNR etc), mental status, activity, diet, drips, and any abnormal vital signs that has stabilized or anything else to look out for.

For the ancillary staff,  state the situation, code status (Full code vs DNR etc), mental status, activity, diet, and any other additional things that they can do (fingerstick, lab work, turn patients, last wash, incontinence).

I hoped that helps!

First Code – CPR or hospice care for terminal illness?

20130717-231231.jpg

This 90 something year old man was repeating, “I want to die” a couple days before. With stage 4 cancer (meaning, it spread from the source location), he should’ve been DNR (Do Not Resuscitate). But since he started to lose his mind (he couldn’t answer the 3 questions: name, location, and time), his family members began to make decisions for him (as a Heath Care Proxy). His family was in such denial that it was time for him to pass away. They believed he didn’t need morphine to ease his pain and should remain in full code in case his heart rhythm converted to v fib or v tach (at this point, you do CPR).

Throughout the night, he kept moaning. But his family would only allow him to take Tylenol. Which honestly isn’t enough if you have overgrown cells invading essential organs. And these organs allow you to breathe and circulate blood throughout your body.

After I had given out my morning meds and taken out a foley, I saw a nurse run. The next thing I heard was “999 on 1 West”. I saw 2 nurses with the crash cart wheel past me heading to a room in the next district over. When I saw them wheel the cart into that room, I knew it was him. The nurse there was already doing CPR compressions and someone else got the ambu bag ready. Though it felt like 5 minutes, about 30 seconds later, 2 critical care PAs, 3 critical care nurses, 2 MDs, respiratory therapist, nurse educator, patient care assistants, and all the nurses on the unit were there. The PAs took over the compressions. The pads were slapped on.

The EKG monitor was still on, so I watched it go in and out of v fib and v tach. Nurses made the call out to the attending and the family to tell them to come in immediately. My nurse manager told me to go the next unit over to get the Line Cart. I learned fast that’s the cart with the equipment to do a central line. Inserting a central line would allow them to bolus (or “quickly give”) fluid directly to his heart to increase blood pressure. Without a properly beating heart, the body won’t have circulating blood.

When I came back, I saw that he was also bleeding out from his rectum and abdomen. Cracked ribs and his tap sites from before may be the cause. Regardless, I primed the normal saline line to attach it to blood that we would give to him.

More epinephrine was needed. More flushes. The nurse educator asked if I knew any of the nurses in the room so she can document everything that’s happening in the room. I gave some names and then let the nurse who was taking care of him take over.

After the defibrillator delivered the shock, I heard that sound. That sound was an asystole sound. A solid beeeeeeeeeep. I looked at the EKG monitor and saw a solid line. He was gone. He got his wish.

This happened in 17 minutes.

20130717-231534.jpg

If only he had been DNR and was comforted, he would’ve died more peacefully. He wouldn’t have bled, have cracked ribs, have something tied to keep his tongue down in case of intubation. He died suffering from pain and misery. It could’ve been in peace in his sleep.

Family members may feel guilty if they decide to make their loved ones a DNR. They may feel that they aren’t doing the right thing and that they should do everything possible to save them. But in terminal cases, the focus should switch from treatment to comfort. This increases the quality of someone’s end-of-life care.

In my mind, when I die, I would want to die in my sleep. Peacefully. No pain. Just as living is a part of life, death is too. And we should pass with dignity.

Education Day 2: Communication and Delegation

Today was our second “Education” Day. The first Education Day that happened one month ago covered medication errors and IV insertion. Today, we talked about communication, delegation and the electronic health record.

Communication among the nurses, patients, doctors, and ancillary staff are crucial for good patient outcomes. We communicate to convey  messages to other people. What do you think is the most important part about communication? Take a guess first!

  • Words
  • Body Language (facial expressions, hand gestures)
  • Paralinguistic (the tone; the way that the words are said)

*

*

*

It’s body language, which accounts of 55%. Words account for 7% and paralinguistic accounts for 38%. Body language shows your attitude and shows how you feel.

There are different ways to give and receive information. Even though we spend 7-12 years of our education on learning how to write and read, we spend less than 1-2 years of formal education on how to speak and listen. This is almost counterintuitive, considering that over half of our communication depends on LISTENING to each other.

We broke out into 4 groups and discussed about traits of good listeners vs bad listeners.

Good Listeners:

  • Eye contact
  • Gives feedback
  • Not rushed

Bad Listeners:

  • Interrupts
  • Has a reply or rebuttal before letting the other person finish speaking

Etc, etc, it can go on and on. To show that we care,

  1. Look at the patient in the eye (not at the WOW all the time; let the patient know you’ll ask a series of questions on the WOW so they know you’re not purposely trying to not give eye contact)
  2. Sit down next to the patient to show that you’re not rushed
  3. When they are concerned about something, ask them for more details (especially regarding pain!)

*************

As for delegation, it is something that new nurses struggle with. The most important takeaway messages I got was:

  • Be specific
    • Example: Take that patient for a walk vs
    • Take that patient for a walk for 80 feet. 1 assist with a walker and oxygen is needed at all times. It’s the first time the patient is getting up so take a pulse ox before and after he goes for the walk. When that’s completed, please tell me what happened.
  • Vital signs and I/O
    • “Please tell me any abnormal vital signs that you see. And for these specific patients (congestive heart failure, post-open heart patients, renal), please document intake and output.”
  • Change priorities as needed
    • Some ancillary staff may think that cleaning equipment or doing the bedtime bundle or whatever it is that they are doing is more important than a patient’s change in condition. Sometimes when you say, “please go do a fingerstick stat” or a “EKG stat” or something else that’s more urgent (such as compromised patient safety aka a patient getting out of bed without supervision especially if they want to use the bathroom or go for a walk but forget or don’t want to call you!), the PCA takes their time to do what you asked them to do.
    • It may help to say: “That isn’t important right now. Right now, it’s more important for you to take a set of vitals on this patient.”
  • If there is an isolated problem (they don’t know or just forgot), it is important to address it right away in private (never in front of the patient!!). Sandwich a compliment, criticism, and compliment. If it is a continuous problem (due to attitude or laziness), then still address it but also bring it up to management.
  • Give feedback. Everyone is valued and needed on the unit. Using their name and saying thanks goes a long way.

 

I’m almost off probation at the hospital!

It’s been 5 months since I started on the med-surg telemetry unit and it’s almost time to come off of probation! One of the nurse educators watched two of my head-to-toe assessments and me giving out medications (satisfying the 5 rights for a PO med, SQ injection, intravenous med, and narcotic).

I remember one of my first nursing school classes– doing the entire head-to-toe assessment in 10 to 15 minutes and stating each finding. That was probably one of the most important classes because it’s now kinda easy to recognize something abnormal.

Especially for a cardiac patient, pedal pulses, edema, lung sounds, heart sounds, and neuro checks are important.

Bowel sounds and asking for the last BM is important for surgical patients or for constipated people.

Skin checks at pressure ulcer points (sacrum, heels, back of head) are of upmost important, especially for bed bound and incontinent patients. Is it red? If it’s red, is it blanchable (turn white when you push it)? Could it be a stage 1-4 or a deep tissue injury?

Surgical sites should be monitored for bleeding, leakage, etc.

Urine output of a minimum of 30 ml/hr is also important, especially for those who have a foley! But even knowing how often patients urinate is important. If they haven’t gone all day, then it’s a problem!!

Anyway, I could go on and on. But for right now, here’s an example where the assessment made a different (and trust me, there are many, many examples).

A patient was having a productive cough and felt like he was having a hard time breathing. His O2 sat was 94% on 2L nasal cannula but his lungs had crackles (it sounded wet!) bilaterally (on both sides of his lungs). His feet were puffy (or +2 edema) although pedal pulses were palpable. After calling the PA, I got an order for IV Lasix — which basically works your kidneys to draw in the fluid and excrete it through your urine. Throughout the rest of the night, the patient continued to cough, but his lungs began to sound better. However, due to his surgical site, he experienced a lot of pain too. While I gave him pain medications according to the orders, I noticed that the patient started to get a little more confused by the end of shift. This is when I had to start questioning the type of pain medication given. When giving report to the day shift nurse, I made her aware of my findings. Because of that, she was able to talk to the PAs, NPs and MDs on the floor who are more readily available during the day and make an appropriate decision to treat his pain without him getting confused.


Anyway, I passed the head to toe assessments and giving out medications portion. Now, there are two sections left.

1) Code master, setting the IV pump, and doing the appropriate medication calculations

2) 50 question EKG test with a > or = 90% since I’m on a telemetry unit. It wouldn’t make sense to work there if I can’t read the rhythms. Even though each month I have to pass a 30 question exam too, they still want us to pass the 50 question exam. It’s ok– I’m ready anytime. 🙂

Skills Day at the Hospital

Yesterday, we had our first Skills Day! It’s been 5 months since I started working at the hospital. Basically, we got paid to learn more. Sweet!

In the morning, we had discussions about medication errors.
After lunch, we learned how to put IV’s in.

Medication Errors
We watched a video about Josie King, who was a young child who died due to medication errors at Johns Hopkins. Her mother was angered, and instead of retaliation, she was determined to decrease the number of deaths caused by medication errors. She created the Josie King Foundation.

Medication errors do not occur due to one person. Rather, it is caused by a system error. It’s caused by miscommunication among the healthcare providers (prescribers, dispensers, and administers), not listening to the patient’s or family’s concern especially relating to change in mental status, and more.

It’s important to report potential and actual medication errors so that a ‘root cause analysis’ can be conducted to understand and fix the problem.

IV Insertion
When new graduates are just starting off, they are not to do IV’s at my hospital. This is to allow them to focus on nursing assessments, giving medications, and coordinating care. When an IV has to change (every 72 hours), they often ask the assistant nurse manager, charge, or another experienced nurse.

It is a very technical skill with specific steps.
1. Assess: Ask the patient what other providers have said about their veins and where they have previously put it in. Look at the arm. It’s always better to start from the hand and move up the arm. Those needing short term therapy can start higher on the arm.
2. Preparation: Prep the saline flush and IIA. Tie the tourniquet on (left on for 90 seconds or less!). Find a vein that is soft and palpable. Clean the site with chlorhexidine. Prep the needle. Use left hand to pull down on vein so that it doesn’t roll.
3. Insertion and Dressing: Use right hand to hold needle. Insert until flashback is seen. Use right index finger to advance hub. Place gauze underneath hub. Get IIA ready. Retract needle and connect IIA. Pull back on syringe to make sure it’s in the vein. If blood is seen, then flush the line. Disconnect the saline flush. Dress the IV site.

Ok, I think I’m ready!!

Life After Orientation

I just attended my first Life After Orientation. It’s an hour of talking to the nurse educator and the VP of Nursing. It’s probably better to go with a list of things to talk about next time but here were a few topics.

  • Delegation to the ancillary staff, especially regarding fingersticks, stat EKGs, answering call bells
  • Handout off to the next nurse – IV rounds with both nurses and bedside handoff; making sure there’s enough fluids in the bag for the next few hours and the patient is medicated for pain prior to report (if necessary)
  • Breaks – before going on break, do a quick round to make sure everyone is ok. Then tell the 2 nurses next to you on the unit, the charge nurse and ancillary staff you’re on break. It’s a good way to recharge and eat!!

Hospitals talk about patient satisfaction scores all the time now because it’s one of the major factors for reimbursement. I have to say that I’m proud of the unit I’m on because it just went from the lowest to the highest scores in the hospital. We aim to have nearly every score above 90%.

Ok that’s it for now.