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.
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.
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.
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.
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!
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.
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.
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’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:
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.
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.
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.
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.