The Beginning and the End as a Nursing Student

Guest blog post by Jae Kook Lim

HELLO! My name is Jae Kook Lim and am currently attending the University of Central Florida College of Nursing. I began my college career in the summer of 2012 and I'm now in my third year of college. I am also the Student Senator, representing the College of Nursing to the Student Government Association and other Colleges. Since I started school, I have been remained active in the school life. In the past, I was an Orientation Team Leader 2013, Volunteer Teacher Assistant for Human Anatomy, dancers for Rukus Entertainment and Fresh off the Beat, student secretary for School of Social Work undergraduate and graduate, and peer adviser! The list goes on and on but from this, you can say that I am very active and enjoy being involve.

Nursing: A Sea of Options with an Ocean of Danger

Sarah was so excited that she secured her first job as a nurse before she graduated, even though jobs were scarce in her community.  Sarah was hired in the OR at one of her community’s largest hospitals. She was a bit apprehensive at first, because Sarah was shy, easily intimidated, and struggled with confrontation. Although she heard about how stressful working in the OR was, she was way more excited about getting offered a job!

On her first day, one of the cardiothoracic surgeons screamed at her for getting close to his sterile field. At the end of the day, the lead OR nurse told her she needed to “grow a thick skin” if she wanted to be successful. Sarah left her first day in tears. Within 6 weeks, Sarah felt she had no choice but to quit.

What went wrong?

Congratulations Nursing Graduates! Your public is waiting for you

Congratulations! You’ve just completed the 1^st leg of your journey to becoming a competent and compassionate nurse. Getting through nursing school is a HUGE accomplishment!!! Congrats...you've earned the right to call yourself NURSE. However, with this title comes expectations with regards to competence and compassion. 

Guest Post: Top 10 Skills Employers Seek in New Nurses

Thanks to Katy for a great post!

One of the toughest challenges recent nursing school graduates often face is competing for jobs with the experienced labor market. The good news is that there are employers looking for not-so-seasoned nurses. In fact, we found 284,576* job postings over the past 12 months seeking registered nurses with two years or less experience.

One way you can be sure to set yourself apart from other green nurses is to come armed with inside information on what employers are looking for. If you know the keywords they are using in their job descriptions, you can get one step ahead of your competition by using those same words in your resume and job application.

Message for Graduating Nurses: Remember these words

Several years ago I was asked to give the graduating commencement speech for a local school of nursing in Pittsburgh. I can remember talking with many, many new nurses and parents after who were very inspired by my speech. Knowing that this is the time of year again for new graduates, I wanted to share that speech with you to hopefully inspire you too as you begin your journey into the wonderful world of nursing.

Nursing Practice Tip: Documentation “Never” Events!!

I think we’d all like our roles as nurses a whole lot better if we didn’t have to document. I hear nurses say all the time that they spend more time DOCUMENTING than taking care of patients. And sometimes, I agree.

But documentation is an important part of what we do. Why? Well, documentation helps providers identify problems and make appropriate treatment decisions; allows you to take credit for the work you do; ensures that you’re practicing according to standards of care; and helps your organization get the maximum reimbursement for your hard work!!

However, documentation can also be used against a nurse – especially when patients have bad outcomes.

New Nurse Tip: Your patient passes out. Now what?

Before I became a nurse, I worked as a Medical Assistant at a local women’s clinic in Pittsburgh, PA. I worked in the lab and drew blood on about 50-60 people a day. It was inevitable that out of the 50-60 people, at least one of them would start to drop their pressure and pass out.

When I became a nurse, the same sort of thing happened but sometimes it wasn’t because I was drawing their blood – sometimes it was because they had a massive GI bleed, were septic, or severely dehydrated.

What would be your initial independent nursing intervention if your patient passed out? Pick one.

You’ve already learned how to become a successful nurse

If you are in nursing school or newly graduated, you may feel overwhelmed with everything you have to learn to be a successful nurse. You may also be confused by the contradictory advice and behaviors of others. “Be professional” yet you see how nurses sometimes treat each other.

I know how you feel.

Even as a seasoned nurse and business owner, I sometimes question my decisions and advice others give me. One person says, “do this” yet another person says, “no. Don’t do that…do this!” Ugh. It’s a struggle sometimes to make good decisions and always do the right thing…especially when others don’t.

Good news! If you get overwhelmed about what to do or get confused by how to behave, just remember the words of Robert Fulgham.

New Nurse Success Tip: Standing at the Crossroads of your Career

When nurses graduate from nursing school, unbeknownst to them, they are standing at a crosswalk. Some nurses will go left and some will go right. This decision will determine how successful, happy and satisfied they are with their decision to become a nurse. This decision will determine if they will become successful and thrive or unsuccessful and burn out.

Which way will you go?

I study human behavior – in particular, successful people. I just love to read about how someone who was locked in a closet for the first 4 years of his life and fed dog food, grew up to be a world humanitarian while someone else who was provided all of the luxuries known to man become a drug dealer or psycho killer! Human behavior fascinates me.

Out of the 2,000 + books and articles I’ve read about successful humans, one common characteristic exists. It’s this characteristic that faces you at the crossroad…it’s this characteristic that determines how successful you become.

NEW NURSE SUCCESS TIPS: MASTER THE 100% PRINCIPLE

I spend a lot of time helping students and new nurses “get” things – get through nursing school, get their first job, successfully get through orientation, and beyond. Getting these things helps them secure a foundation for future success.

However, quite often while chatting with students/new nurses, they tell me they've either had a horrible academic, job hunting or orientation experience. And then they provide me a litany of examples and reasons.

My first question back to them is this:

STANDING OUT AMONG THE SEA OF NURSES: #1 RESUME MUST!

When you’re swimming with a sea of other nurses in the quest to find a job/promotion, who all “look” alike, you need to give yourself the added edge. One way of doing this is by making sure your resume includes one critical element.

CLINICAL TIP FOR NURSES: WHO WINS? GLUCOSE OR INSULIN?

Is it the glucose or the insulin??

When I teach clinical seminars, I always, always talk about fluid and electrolytes. One of my favorite things to talk about is potassium. In particular, how we treat hypo and hyperkalemia. In the next few blog posts, I'm going to map out some of the most common treatments for hyperkalemia - starting with glucose and insulin.

One thing you need to understand about potassium is that you have WAY MORE potassium INSIDE (145 mEq/L) the cell than you do OUTSIDE (3.5-5 mEq/L) the cell. So, any time you damage the cell wall or change the pH of the blood (will discuss that in a future blog post), the potassium INSIDE the cell will leak out into the extracellular space (blood vessel). 

Knowing that hyperkalemia can wreak havoc on the heart and other muscles, it's important to get the potassium back into the cell where it belongs!!!

PRADAXA VS. COUMADIN: JUST THE FACTS MA’AM!

The media sometimes snookers even nurses when it comes to new drugs. The fancy ads, testimonials by “doctors” on commercials and even patients can influence our opinions. However, be warned…as a new nurse, it’s so important that you first do a bit of fact finding before you buy into the latest new miracle drug.

Dabigatran (Pradaxa) seems like a wonder drug, right? It has the same effect as Warfarin (Coumadin) but without the need for weekly blood work. However, don’t throw Warfarin out the window yet! 

There are important differences between these two anti-coagulants that nurses need to understand to help patients make good decisions.

CLINICAL PRACTICE TIP FOR NEW NURSES: BIG BELLY RISK

Anytime I care for a patient with cirrhosis of the liver who is in crisis, my internal alarms go off. These patients often arrive with high ammonia levels causing confusion, extreme malnutrition, coagulation issues, and huge abdomens from ascites. Although we check their ammonia, coags and mental status, they are not the most important aspects of our assessment.

When caring for a patient with the above issues, what is the most important aspect of your nursing assessment?

NEW NURSE SUCCESS TIP: THE POWER OF FOCUSED ASSESSMENTS

The quintessential gift nurses bring to the delivery of healthcare is our assessments. Our assessments provide clues; telling us if patients are getting better or worse. In addition, assessments help us and others make decisions regarding care.

In the ideal world, nurses would have ample time to do a comprehensive assessment on every patient as often as needed. In the real world, nurses are lucky if they get 5 minutes to do a “drive-by” making sure their patients are breathing!

If assessments are our gift, how do we continue to “give” with the added demands placed on us?

We do this by mastering the skill of focused assessments.

MEDICATION ADMINISTRATION: DO NO HARM?

It’s been said that hospitals are one of the most dangerous places for patients. Although we provide great care, we can also do great harm – especially when administering medications. We all know the 5 rights, but even if we comply, mistakes are made.  Potassium is given to a patient with a level of 5.5mEq or Dilantin is given to a patient with an existing level of 30mcg/ml (normal is 10-20). By not doing our due diligence prior to administration, we put our patients at risk.

Making sure you give the right drug to the right patient isn’t enough. We have to truly understand how every drug we give will affect the individual patient. Mastering that is quintessential way we can provide “great care” to patients.

TIPS FOR NEW NURSES: BE THE MASTER OF DELEGATION

Many new nurses struggle to delegate patient care activities to nursing assistants. Sometimes it’s because they were working as a nursing assistant before they graduated and have trouble with role transition. Other times it’s because they may be working with older NAs who have been there for a long period of time. These more seasoned nursing assistants may be intimidating causing new nurses to avoid delegating anything to them.

However, independent of the reason, the only way you will succeed as a clinical nurse in today’s complex healthcare environment is to master the skill of delegation.

NEW NURSES UNDERSTANDING FLUID BALANCE. WHO’S AT RISK?

When the temperature heats up or during flu season, some patients are more at risk for dehydration.  Who’s at risk?  To answer this correctly, you need to understand how the body maintains fluid balance.

Question

Who has more water in their body – men or women; the elderly or babies?

To answer this question, you have to understand this…

NEW NURSE: 3 TIPS TO AVOID GETTING BLINDSIDED

Ashley was blindsided by her boss during her 6-month review. As a new nurse, Ashley thought she was doing a good job. Her boss, however, thought otherwise and told her she wasn’t meeting expectations.

Expectations according to what?

NEW NURSE TIP: THE MAGIC OF TRENDING

Caring for patients is getting more complex. One reason is that only the really sick are actually admitted to a hospital – everyone else is being treated as an outpatient. Years ago on a medsurg unit with a 6:1 assignment, you would have one or two really sick patients; the rest were “walkie talkies.”  Now you have the same number of patients but they’re all really sick!

To effectively care for patients requires you to anticipate problems early and intervene quickly. One of the best ways to do this is by understanding the importance of trending.