When you graduate from nursing school, do you ever wonder where you should put your new credentials? And what order it should be in? I know that I wanted to know!
First things first. As a nurse, you will have to get licensed first (this is your RN). After you work a year or two, you can then pass an exam to get your specialty certification (medical surgical nursing, etc – thus becoming a RN-BC). You can find the different certifications at the American Nurses Credentialing Center (ANCC). There are also Nurse Practitioner and Clinical Nurse Specialist Certification for who go back to school for their masters. Another national certification is the CCRN – Critical Care Registered Nurse.
Yesterday marked the last day of my critical care probation. So what did I do to pass? Instead of being at the hospital, I went to the simulation lab with Mr. Sim Man.
While I did sign a confidentiality agreement not to discuss the specifics of the lab, I can briefly state that it was similar to being at work in the hospital. When you receive a patient, you do a Head to Toe assessment, and determine the next step in care. Is he stable or unstable? If the patient doesn’t respond to your care, what is the next step?
It’s exciting to be off probation now, considering that I’ve been on the unit since December 2013! Now I will have to float to the SICU or CTICU, stepdown, PACU and ER. I’m a little scared to not know everything is (again), but it should be ok!
In Off the Charts, the official blog of the American Journal of Nursing, it states that 71% of bedside nurses use Google to search for Evidence Based Practice to better their practice (and here’s how to do it better). However, how do you know about the quality of a journal? There are 100s of nursing journals. One of the best ways to evaluate a nursing journal is through the Impact Factor (IF).
Go to your college’s library website. Part of your tuition goes into purchasing these journals for students to use (because they can get very expensive if you bought them on your own!). If you are attending NYU, go to library.nyu.edu, go under find resources, then click on journals. Or go to getit.library.nyu.edu. Be sure to log in to read the journals!
I hope that by understanding what the Impact Factor is, you can make better decisions on which Nursing Journals you should read or even buy. Maybe you’ll even join a nursing organization! Keep updated on the latest and greatest in this constantly evolving field. And share what you learn with other nurses. Maybe it’ll even make a difference.
He so in control, even when he’s ill Demanding that the TV’s on as he rolls into the new room “Sir I need to make sure you’re breathing” “No, the TV will keep my sanity” Even when he can hardly breathe
Nothing’s my way only his way “But dad when you do it their way you get better and you do it your way and you’re back in the hospital So just listen to them”
No I don’t want that then what do you want I want what’s best for me what is best for you? I don’t know you tell me let’s keep this on Okay
He wants control, his decisions because slowly but surely he’ll lose one thing at a time So he’s demanding and mean
I get it but what do I do? How do I deal? Just wait for 12 hours to be over?
For 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 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.
Step 5 If after 8 weeks, you can call them (I waited 25 minutes!) or email firstname.lastname@example.org 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.
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.
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.
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.