Tag Archives: nursing

Life After Orientation

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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.

Nursing: Medical Vs Lay Language Barrier

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“He is going to draw your blood.”

“I don’t understand.”

2 minutes later… After my PCA already drew the patient’s blood, I thought about a different way to word it.

“He took your blood.”

“Oh!!”

When someone doesn’t understand something, it doesn’t mean he is confused. And it doesn’t mean you repeat the same thing over and over. Or try to pass it off as something that she won’t understand. It means that you have to use different wording to get your message across. And the wording should be in a way an average person would know.

Sometimes it’s difficult to switch from “speaking medical” to “speaking with patients”. But I feel that a fine balance between the two is essential to being a great nurse.

NYC Blizzard Nemo – and I’m working through it

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It’s snowing a lot outside.
The nursing home called to ask if I can work
tomorrow morning from 7a to 3p.
I said yes mostly because
If I said no, they would be short.
And those working conditions
Are not safe.

Although I can hear people plowing the streets now,
I hoped that the sidewalks are still clear
Or at least mostly clear
By morning.

I should be used to the snow
I am from the Mitt
But it’s been 6 years out
I even slid when I drove,
And shiver every time
I’m back home.

I gotta go get ready.

My move to the hospital

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To update you from what has happened from Christmas to now (one month later), I got interviews at a hospital and received the clinical nurse position on a medical-surgical telemetry floor with a focus on orthopedics. I am super pumped.

Yesterday, I received my schedule for the first two weeks. It looks bad — and good. The first 3 days that I’m working nights is IN A ROW and I heard that was a killer. Early exposure to the worst will make me relieved when I don’t have 3 in a row, right? Or maybe I’ll realize that 3 in a row isn’t as bad as people say. At least I’ll have 6 days off after that. I’ll have to figure out what to do with that time!!

The hospital also provides good preceptor selection and training so I really hope that will help felicitate my learning.

I’ve already finished the first two weeks of orientation and I have one more week left. I can really tell that they have developed great nurse educators, clinical nurse specialists, CWOCN (Certified Wound and Ostomy Care Nurse), and overall people here. I think that it’ll be a really supportive environment but I’ll find out soon enough!

Since this hospital focuses on the heart, we spent a great deal of time learning about different cardiovascular diseases, pre & post procedures, EKG readings, stroke, arrhythmias, emergency situations. We also went through different systems (GI, GU, neuro and Skin!!!! wound/ostomy care, and pressure ulcer prevention ~for 2012 0.81% developed PU throughout the whole hospital compared to 2011 when it was at 1.11%).

Intentional Hourly Rounding is also something that I haven’t heard of, but it makes a lot of sense. Ask about personal needs, pain, positioning, education, etc. Ultimately, this is to help prevent falls.

Epic went live at this hospital in December. Based on what people have said, they really like the program and it has helped a lot with documentation. I completed day 2 of Epic training yesterday, and I feel that it’ll be a great tool and hopefully help accelerate the documentation process. In the ‘doc flowsheets’ it asks a lot of questions that you would normally write down in a note. My question is, do I still have to write a progress note based on some abnormals? I think the answer is, probably, but from there, I can copy and paste, and right click to create a note.

Next week, there are 3 exams. Core exam, EKG exam, and Philips monitor. And there’s technically an Epic exam. I have to pass with a 90% or higher (yup, it was the same for the NLN medication exam that I had to take prior to officially having this position). I think that it adds a little more pressure on the employees to do well, but it also puts higher standards for the hospital. And that in the end, the patients receive better care.

This weekend, I’ll definitely be practicing EKG strips. And studying.

Why I Went Into Nursing

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* Registered Nurse License in New York State
* Basic Life Support Certification through the American Heart Association
* BSN
* Fluent in Mandarin

I am a registered nurse who graduated in May 2012 from the NYU Accelerated Program. I went into nursing because I enjoy collaborating with people about their health and I feel passionate about improving people’s health. For me, it is unacceptable that 2/3 of Americans are overweight or obese, and that extra weight is causing a wide range of health problems, including heart diseases, diabetes, and mental health issues. My goal is for each person to be as independent as possible and to make educated decisions. My LinkedIn Profile has a more detailed list of my experience.

I’ve shown my commitment to nursing through the extracircular activities I did outside of my part time job as a swim instructor and schoolwork. In nursing school, I co-founded the Asian Pacific Islander Nursing Student Association because I saw a need for peer support among Asian nursing students. In addition, I became a mentor to a younger nursing student to guide him through school.

Since I am currently located in New York City where there is a large population of Chinese people, I know that the need for nurses who speak Mandarin is great. That also meant that health problems specific to Chinese people must also be high. I found that the NYU Langone Medical Center has a Center for the Study of Asian American Health. One of the programs was targeted Chinese people and hepatitis B (B Free CEED). I had to get involved because I felt that I will eventually serve this community. I became an intern in October 2011 through May 2012 and learned more about public health and the roots of health inequity.

Due to the tight constraints of an accelerated program, becoming a nurse extern over the summer is not possible. However, over the winter break, I was able to partake in an opportunity at a Taipei City Hospital to observe in the Operating Room (80 hours) and ICU (80 hours) as a nurse extern. It has opened my eyes to the nursing practice differences between the US and Taiwan and helped me gain insight into the role of the nurse.

My long term goal is to become a nurse practitioner. I also would want to become a nursing instructor. Since I have taught swimming to over 700 people from toddlers, children, teenagers, young adults, adults, and older adults for over 4 years, I learned that there is a stepwise progression to learning, and individual attention and goals are essential for students to grasp and utilize material (this idea is similar to the philosophy used at khanacademy.org).

Please feel free to contact me via email with any questions or comments – I’ll get back to you shortly! ~ jesschang07@gmail.com.

What are the Universal Laws of Health Care Systems?

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In the book, Healing of America, by TR Reid, I found that the American economist Tsung-Mei Cheng formulated the Laws, denoting that people tend to be bitter about their healthcare.

1. “No matter how good the health care in a particular country, people will complain about it.”
2. “No matter how much money is spent on health care, the doctors and hospitals will argue that it is not enough.”
3. “The last reform always failed.”

COW is now WOW to not offend people

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Last night, I ate with one of my classmates and she was excited that the hospital she’s working in finally has COWs. Or Computers On Wheels.

In Michigan when I was touring several hospitals, I saw that there were WOWs. I finally had to ask the nurse educator, “What is a WOW?”

“Oh, that’s a Workstation On Wheels.”

“Oh, that’s kind of like COW. That’s what I learned in school.”

“Yes, it used to be called a COW but we changed the name to WOW to not offend people.”

“How would you offend someone by calling a computer a COW?” I paused for a moment to think about it. “Oh, unless someone is self-conscious about his weight and you say, ‘Hey, can you bring that COW in here?’ And he thinks that you’re talking about him instead of the computer. I get it now.”

Interesting choice of words~ I guess we have to be careful with our choice of words.

Kaplan Nursing for the NCLEX with NYU

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Yes, this course is included in the tuition. In fact, Kaplan Nursing is used throughout the entire 15 month accelerated program and I definitely felt that it was helpful to practice NCLEX questions throughout my studies.

Most people finished their finals on the last Thursday in April. Those in the dual degree program finished the masters level class on the second Tuesday in May. Those taking other non-nursing electives finished their classes sometime in the second week of May.

Graduation was during the third week (Grad Alley – Tuesday evening, Yankee Stadium – Wednesday morning, Nursing breakfast & Commencement – Friday morning). My sister also surprised me getting sending me an iPad for graduation (and yes, I’m using it right now to type!). :)

The following week we did the 180 question diagnostic. And 3 question trainers. And we reviewed every single question.

The last week of May, we attended 4 days of 10am to 5pm classes where we focused on answering 60 questions per class to master the “decision tree”.

Since then, I’ve been doing 50 questions a day, reviewing medications (2 pages a day since there are about 70 pages in the RN Course book to remember!). Tomorrow, I’ll take another exam.

So far, NYU sent out the information to New York State at the end of May so hopefully by mid June, I will receive my ATT, or ‘permission to test’ and I will be able to register for the NCLEX for mid July.

As for job searching (since a few readers have reached out to me for me to write about this topic)- I haven’t sent out applications yet. As for my classmates, some who have done externships in NYC have a job and will begin orientation in July. Others in Michigan, Texas, and upstate New York already have a job for them as well. However, the vast majority do not have jobs yet. But I am confident that we will soon!

A few classmates have also decided that going into the Masters program for their NP was a priority. One will attend PACE University for the Family NP program and another will attend Columbia for the acute care NP program.

I hope that by writing this, it will help you gain some insight into the NYU accelerated nursing program. If you have any questions, feel free to email me at jesschang07 @gmail.com.

Community health profile: Evidence-based practice for smoking cessation among Chinese American smokers in NYC

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For my community nursing class, it requires a group of 8 students to write a community health profile. We divided up the work, and I’m responsible for writing about the evidence-based practice section. Considering that the NY Times has recently highlighted the fact that all of NYC residents has decreased smoking rates EXCEPT among Asians, I decided to write about that. http://www.nytimes.com/2012/03/02/nyregion/asian-new-yorkers-resist-anti-smoking-efforts.html

Using Google Scholar, I was able to search a couple of articles and settled on one through PubMed. I went through the NYU Library website to download the PDF file. In case you’re interested, here’s the citation (APA format):

Wu D, Ma GX, Zhou K, Zhou D, Liu A, Poon AN. (2009). The effect of a culturally tailored smoking cessation for Chinese American smokers. Nicotine Tob Res, 11(12):1448-57. Epub 2009 Nov 13.
http://www.ncbi.nlm.nih.gov/pubmed/19915080
Considering that the study takes place in NYC, it should be relatively easy to implement in Chinatown. Now, we just have to get more organizations involved and train CHWs.

NYU Nursing Accelerated 15-Month Program FAQs

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I recently had a former classmate ask me about NYU College of Nursing – Accelerated 15 Month Program. I felt that she had some good questions and thought that others may benefit from this information. Feel free to contact me directly at jesschang07@gmail.com for any other questions or comments. At the time of writing this information, I have completed my 3rd out of 4th semester through the program.

Where did you take your prerequisites?

I took my prerequisites at my first college. However, you can take nutrition and lifespan development online and other courses at any accredited community college or university.

Is the program really intense or is doable?

The program is intense, but it is also very doable. You will learn how to balance your school-home-social life.

How much of the 15 month program is actual lecture and how much is clinical? What is the schedule for classes?

It is about half and half. Two days are clinical days and two days are lecture days. For example, Monday and Wednesday are lecture days. Each class is about 3 hours long, except for Integrative Seminar, which is a class developed for students and the professor to give feedback to each other and gain a greater understanding of nursing as a whole. Then Tuesdays and Thursdays are clinical/simulation days. Each class has a slightly different clinical schedule.

How much is the program? How much is tuition? Are there scholarships?

As of December 2011, tuition is about $19,000 per semester. The program is 4 semesters. Scholarships are available, especially through HSRA. However, I know that most students take out a student loan.

Where do you do clinicals?

I have done my clinical at New York Presbyterian – Cornell (GI), Bellevue (oncology), NYU Langone Medical Center (telemetry), Hebrew Home (rehab and dementia), a local housing site (psych), Mount Sinai (Maternity), and Maimonides (pediatrics). In the spring, I will be at Lenox Hill Hospital and a community health center in Chinatown. You will be able to pick where you want to do your clinical. It is also recommended to go to different hospitals (private and public) to get a feel for the differences in the hospitals.

What is the schedule like for simulation days?

During the 1st semester, the simulation day is from 7:30am – 2:30pm including a 1 hour lunch break. It is crucial to review the skills by reading the book and watching the videos so that you are prepared to perform those skills during class.

During the rest of the time at NYU, the simulations are 3 hours long. There is a scenario posted on Blackboard and pre-simulation questions that must be completed and submitted 48 hours prior to simulation.

Is 15 months = 4 semesters?

Yes.

Do they expect you to remember a lot from the prerequisites?

It is strongly recommended that you understand anatomy and physiology for a first semester class called pathophysiology. If you do not remember, then you will have to play catch up during the semester.

Nutrition will be helpful as well. As long as you understand the basics of microbiology and lifespan development, you will be set. Chemistry – you should understand osmosis. Statistics will play a bigger role in Introduction to Research (taken 2nd semester), but you will be provided a quick refresher at the beginning of the semester.

How are the professors? The exams? The grading? The amount of homework/studying?

I believe all professors are doctorate prepared. Majority of them are great – they care deeply about their subject. The exams and grading are fair. During non-exam weeks, I study and do homework for about 10-15 hours per week. I begin to prepare for exams one week in advance and study for 30-40 hours that week. Most classes also have podcasts available. Some podcasts are directly from the lecture and other podcasts, the professor expects you to listen to them before the exam (they aren’t discussed in class).

Do you recommend the school and program?

Yes. Make sure your finances are okay first though because it is a big investment.

How does specialization work with nurses anyway?

Once you graduate, you will become a BSN, RN. You are allowed to choose any field that interests you. If at any point you want to change, you have the ability to change fields without consequences. Dr. Ea wrote a book called 201 Careers in Nursing, which goes to show you the width and depth of nursing. Johnson & Johnson has also created a fantastic website on exploring nursing specialties, detailing the setting, education you’d need, the typical salary, job characteristics, and some nurses’ stories about the field. To specialize as a RN, you will do certificates. To further specialize, you can return to school for Masters, DNP, and PhD.

What is the dual degree program? When do you apply for it?

NYU College of Nursing allows students to apply for the dual degree program in their 2nd and 3rd semester. It allows students to work for a year after graduation, and return to NYU for their Masters of their choice.

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For current new graduates and NYU Nursing students, I wrote a brief outline of what you can do for you to get a job shortly after graduation.

Update 5/27/2015:

Read NYU’s Accelerated Nursing Program FAQ’s Part II, which is an email of questions from a prospective nursing student, 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.