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I was sitting down to finally wade through my unread stack of the American Journal of Nursing when one article caught my attention. A nurse was talking about her memories of nursing in the 1970s. No, she wasn’t reminiscing about the disco scrubs she wore…she was recounting an important lesson she learned during that time.

This nurse discovered that we’re often wrong when we assume what our patients want. So she began each shift by asking the patient and/or their family, “What is one thing that will make today better for you?”  This simple question often resulted in simple answers. “Water.” “Juice.” “Another blanket.” The request may be something so simple for us, but it makes a world of difference for our patients.

She talked about a particular case in which she asked a dying patient this question and he requested rice pudding. Despite his NPO orders, she spoke with the MD and they agreed that it might be worth the chance to provide this patient with his pudding. He passed later that day, with his wife and an empty bowl of rice pudding at his bedside.

While this is sort of the extreme case and situation, and probably wouldn’t “fly” in most of our units, this question is one that I really like, and I am going to try to incorporate it into my daily care, if I can. I think we just go through our day thinking that the one thing that will make our patients’ days better is to “go home,” but I have a feeling that I’m going to be surprised at the answers I get if I start asking this on a daily basis.

Their request may not always be a task I can complete for them, but if I can do it, and make their day a little bit brighter, why not just ask?

Here is the link to the full AJN article referenced in this post.

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I remember back when I was an art student just barely getting the ball rolling on changing my major to nursing. I knew that nursing was what I wanted to do and that switching majors and switching schools was the right thing for me, but the big question was where do I go?

At the time, I didn’t know a lot about nursing schools, other than that the city colleges around my area had good nursing programs. As I looked into it a bit more, I learned that there were LVN programs, RN programs, and that you could get your bachelor’s degree in nursing! Again, it was all new territory. After taking pre-reqs at a city college, I opted to transfer to a university to get my BSN. Since the programs were so impacted, I figured I had a better shot at getting in via the merit system in the BSN program than the lottery program the city college had. Plus, in only one more year I could have my BSN done.

Other than the additional classes, I didn’t really know what the difference was between a BSN and ADN. I figured a BSN degree would be better since I could move up the nursing ladder and get my master’s degree or higher. I just assumed that a BSN degree would provide a better education. I don’t regret choosing the BSN program at all, I love my school, and I think they’re really preparing us well for what’s to come out in the working world. But I have many friends who have gone through ADN programs, or are in them right now, and as I am  comparing my classes with theirs I’m starting to realize that while we do cover the same areas, there are some advantages to ADN programs that the BSN schools are lacking.

In the BSN program, our last three quarters are filled with the “extra” classes, the ones that set us apart from the ADN schools, community health promotion, public health, leadership, case management, all the classes that have to do with a different side of nursing that goes beyond the acute care hospital setting. It’s been very interesting, and more than anything, I am learning about how many different opportunities we have as nurses to reach out an help people in need. But I am noticing that while we’re getting experience in a range of different settings, my friends in ADN programs are getting a much greater and more challenging experience in the hospital setting during their clinical rotations.

Our school only has one-day-a-week hospital rotations, as opposed to two or more, and it seems as though the expectations for my friends in the ADN programs are set higher. They are expected to care for more patients earlier and increase their patient load much more than we are and are tested in NCLEX style in all of their classes, not simply in the classes where teachers prefer that method.

Like I said, I love my school, and I really like how we rotate through everything, but I can’t help feeling like ADN students are getting a much greater clinical experience while in school since that is, above all, their main focus.

ADN and BSN students: what are your thoughts? Do you feel like your school teaches you what you need to know on the same caliber as other schools? Does your school set a high bar of expectations for you?

I’m sort of torn.  Of course, I took the advice we learned from orientation and bought a button down top (in case you get dirty) and extra large pockets (for all the odds and ends we shove into them). The top is a little loose for comfort (and better pocket use), and with my school patch on the left sleeve I look like ::superhero voice::  STUDENT NURSE – soon to be healer of the sick!

Ok, so I don’t really think looking like the Michelin Tire man is all that great, but you know, we’re not in a beauty contest, so I will over look that. I do understand the need for students to be identifiable, to stand out when there’s an emergency, and to be easily differentiated from the rest of the staff.  However – maybe it’s just me, but I feel like when I wear my uniform it’s like having “CAUTION – STUDENT” written all over my face.

I actually didn’t really notice the way I was treated differently in white scrubs until I was allowed to wear colored scrubs during our pediatric rotation.  Obviously, white’s a bit sterile and scary to kids, so we were able to don whatever colors or patterns we wanted (a super exciting moment!). But WOW – what a difference.

On my first day in teal colored scrubs, I walked in, introduced myself as a student nurse, and was treated with more respect than in the previous year of rotations. The parents felt comfortable talking with me, the kids weren’t afraid, but the biggest, most recognizable difference was the attitudes of the staff members. I felt like we were suddenly treated as part of the team, not as “just some student.”

We were asked opinions about care and not just utilized as someone who could do the dirty work (as it’s seemed we were labeled in other hospitals). Granted, a lot might have to do with quality of care at the hospital, but I’m not convinced that the attitudes toward us students would have been the same had I been wearing my crisp white uniform.  I think that as long as we inform our patients and staff that yes, we are students and we’re here to learn, we don’t need to be more identifiable than anyone else.

On the issue of color coding the floors/specialties, etc., I can see the advantage, sure. I get that patients have a ton of people going in and out of the rooms, but I really don’t think it’s something that can’t be fixed by introducing yourself to your patient and having a small conversation with them. Maybe all that’s needed is an in-service on bedside manners? One hospital I was in had an extension on their name tags with a specific color and a very large “RN” printed on both sides so there was really no question who you were talking to and what floor they were on. Seems a lot more simple than mandating a color coded floor.

I don’t think we need to be color-coding everything, but whatever is in the patient’s best interest. I do, however, think that nursing school uniforms should be re-considered, maybe ALL white isn’t the best choice.

Nursing students: What do you think about your school’s uniform? Do you think it impacts the way you’re perceived by patients? By staff?

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Another clinical rotation has finally finished! ICU was a great experience, actually, it really surprised me. All those pre-conceived notions I had in the beginning were just nerves. Now that it’s over, I’m finally realizing that I only have 9 months left of this program…and then I will finally get to sign, “Ani Burr, RN, BSN!” It seems so surreal, and as we finished our last day on the floor, I realized that I wouldn’t be working in a unit again until my last quarter when I get to precept! How incredibly exciting is that!?

I finally feel like I am getting the hang of it, like I really am going to be able to handle being a nurse. My new job has definitely helped boost my confidence too. I think that 9 more months will really get me prepared and ready to go. But as we were leaving the unit the other day, one of my instructors mentioned something to us. She said, “specialties are nice, and you want to do what makes you happy, but you really want to get your adult med-surg experience in because you want to keep your skill sharp, you never know what job you’ll have to take on.”

So… I get her point, obviously. Med-surg nursing is essentially the basis for everything we do, and adult med-surg is where that experience is . But, what if that’s not what I want to do? At all? Yes, I could do adult-med surg, but I would rather do pediatric med-surg. I would rather do ICU than med-surg. In fact, I’d rather do just about any other specialty than adult med-surg (with the exception of Psych, since we all know how I felt about my psych rotation!). It’s not that I don’t like the adults, it just wasn’t for me. I didn’t get that “tingly” feeling I got with peds, or even OB. My feelings are that if you love something – if you truly love that specialty – then go for it! Why not do what makes you happy? After all, when you’re doing what you love, you’re bound to strive to do your best.

On the other hand, I understand where my professor and all other’s who’ve said it before her are coming from. Adult med-surg is where the skills are, it’s where you’re bound to see just about everything. I understand it, but I don’t believe it’s necessary. Student nurses: what have you been hearing about going into a specialty right out of school? Is it med-surg first?  Seasoned nurses: what are your thoughts?

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After seeing our New Nurse blogger’s blog, “You know you’re a pediatric nurse when”, I got to thinking about what makes us student nurses stand out from the crowd.

The good, the bad and everything in between, you know you’re a student nurse when:

1. You’re walking around looking like a marshmallow in your stiff, unstructured, stark-white scrubs.
2. You are more excited about drawing blood than all the vampires in Twilight put together.
3. Prepping an IV piggyback is fun.
4. You’re more excited about giving shots than you are taking shots, and your non-nursing friends don’t get it…
5. People look at you weird when you throw medical terms into your daily conversations.
6. You’re banned from talking about your day at the dinner table because you’re family gets grossed out (see Nursing student table etiquette).
7. Getting to wear colorful scrubs for the first time is the highlight of your year!
8. You check on your patient every 20 minutes with “How are you feeling now?” and “Is there anything else I can get you?” until they’re almost sick of you.
9. You perform physical assessments on your family: listening to lung sounds at every cough, bowel sounds with an upset stomach, and every time someone has an ache you ask them to rate it on a scale from 1-10.
10. Consequently, you’ve become the “resident nurse” at home and you’re now expected to be able to answer questions about mystery diagnoses and know how to treat every ache and pain.
11. You volunteer to clean up and bandage your niece/nephew’s boo-boos and owies.
12. You try to diagnose all kinds of symptomatology based on the chapter you just read – and you think you’re coming down with every disease in the book, including the mental illnesses.
13. Sadly, every time there’s a code-blue, even though you’re really scared and anxious, there’s still a small part of you that is excited to see what happens.
14. You try to convince your friends to go into nursing.
15. The night before clinical you’re so anxious you can’t get a decent night’s sleep, and until you’re 2 hours into your shift your stomach is in knots.
16. You can take a morning break, but you don’t want to because you might miss out on some big experience.
17. You’ve become a professional vital-sign-taker (even if you constantly check to make sure their within normal limits!).
18. And a professional accu-checker.
19. You watch Grey’s Anatomy and Nurse Jackie and comment through the whole thing about how that would NEVER happen in real life.
20. You vent to your family about how overwhelmed you feel with all the papers due and tests to study for, but for some reason, you wouldn’t trade it for any other career out there.

And…of course…you know you’re a student nurse when you’re proud to become a part of such an amazing, compassionate, and fulfilling profession.

Can you think of any more? Add your own to the comments section!

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We’ve all got those teachers we love, the ones that make us look at nursing in a different light.  And then there are those instructors that we just don’t get. When you just don’t understand each other, and the more you have to work together, the worse it gets. What do you do? This instructor is plays an integral part of your nursing career, but you’ve also got to do what’s best for you. So what happens?

For me it was a clinical instructor. I will spare all the little details, but it was my second quarter (of 3) in my med-surg rotation.  Things were going well, but I was still feeling very nervous before each clinical day. I confided in my instructor that I was feeling anxious, and that even though I was very prepared for class each week, I felt like I had forgotten something. She was a very laid-back instructor, and so I thought that in telling her this, she would be able to help me out and that maybe I would start to feel a bit more confident.

Wrong! I guess she thought she was helping me, but she ended up babying me. Not having me take on challenging cases, or perform new skills. I felt lazy because I really wasn’t being challenged any more. As the quarter was coming to an end, my instructor basically told me that if I didn’t hurry up and “get more confident,” I would probably fail the next quarter. WHAT?  Really? No one had ever told me I was going to fail before. And it wasn’t like I was doing poorly, I was performing skills well and taking good care of my patients, but because I told her I was nervous, she’d lost confidence in me.

At first I was devastated, and I started to lose confidence in myself. But after mulling it over for a few days, I really started to get angry, and then I was just out right determined to prove her wrong. We didn’t click. She’s a smart woman, but I couldn’t have faith in an instructor that gave up on students so easily. I worked my but off to prove to her that I was confident enough and skilled enough to survive. And when the next quarter brought on a very challenging instructor, I knew that the only thing that would boost my confidence was not to prove it to my instructor, but to prove it to myself that I could handle it.

We don’t have much say when it comes to our instructors, and when you get stuck with one that you just don’t click with, there isn’t much that you can do.  If they’re telling you you’re not cut out for this, or that you won’t make it, remember why it is you are in nursing school. Don’t prove work to prove it to the instructor that you’re competent, prove it to yourself and in the end, no-one can doubt you.

Nursing Students: What are your thoughts? What has happened or what did you do when you didn’t click with an instructor?

Yuri Arcurs | Veer

I’ve been a working nurse for three and a half months now. It’s not a lot, and I still feel like a beginner in many ways.

But even though it’s been only a short time, my career has launched and I’m on an amazing ride.

As I reach my fourth month of training, this is how I’d describe my life as a nurse so far:

• Stressful. In nursing school, you learn about stress. It’s not always a bad thing–remember, there is eustress (the good kind!) too. It’s like the stress of getting married: It’s intense and there’s anxiety, but it can be both positive and negative. In a bad way, nursing is stressful because there is so much to learn and remember, and there is so much at stake with your every action. But it’s stressful in a good way because with every day that goes by, you know you’re making a difference.
• Emotional. I always knew nursing was an emotional job, and I got a taste of it when I was a nurse’s aide, but there really are some things you can’t prepare for. We see people at their very worst; kids who are sick and parents who are worried sick. Sadness, hopelessness, frustration, anger–nurses get hit with the brunt of it. It’s all about being therapeutic and trying to remember the more positive emotions we get to experience–happiness, hope, love, caring.
• Intense. I’ve had a few patients who have been in some intense situations. I haven’t been in a code yet, and I haven’t called for an RRT, but there have been some close calls. In those moments, I’ve really been surprised at how quickly I was able to think, and how calling the doctor (which is usually pretty intimidating) is not an issue. In fact, it’s in these moments that I really feel the whole team unite.
• Not. Real world nursing is NOT like nursing school. I haven’t yet figured out if this is a good thing or a bad thing. It’s not that what we learn in school is wrong or misguided information, or that we don’t follow policy and EBP on the units. It’s just not the same.
• Fun. Nursing is fun. I think #4 has a lot to do with this. When you’re in school EVERYTHING is so intense, you can’t even enjoy your time with the patient because you’re worried your instructor is going to come by and think you’re not staying on top of your tasks. Nursing isn’t all tasks, and a lot of the time, you can do so much more for a kid just by giving him or her some TLC and having a good time than any med will do.
• Love. I use this word for many reasons–I love my job. I love my nursing team, my unit, my managers. I love leaving work feeling like I made a difference for someone. Despite the challenges, I love that it’s stressful and keeps me on my toes. I love that it’s emotional–it should be; when it’s not, it’s time to leave. I love the intensity and I love that it’s fun.

Nursing is an amazing career. Is it everything I expected? It’s way more! Here’s to another month and a half of training, and a long career ahead!

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Random, right? But she had this amazing-looking water with oranges, ginger, cucumbers, and berries in it. Just looking at it made me thirsty! It got me thinking: I wake up, drink coffee, take coffee with me to work, drink that, get more, and don’t drink anything else for the rest of the shift. How bad is that!?! And what’s worse is that I never even thought about it.

So I went home and dug through the cupboards looking for just the right water cup–one of those plastic, reusable ones with the straws (straws help me drink more of just about anything…not so good when it comes to cocktails, but GREAT when it comes to water!). I even filled it with lemons and ice to keep it flavored and cool.

What a difference! I don’t feel as tired anymore, and I don’t snack as much (when your water tastes good–try flavoring it with Mio drops too!–you don’t feel the need to snack on whatever’s lying around). It’s a lot easier to make it through my shift when I’m well hydrated. Sure, it means more bathroom breaks, but that’s a small price to pay. Even my skin feels better now.

So lesson learned: wanna feel great, hydrate! It’s amazing what you learn when you least expect it. Now excuse me while I go fill up my water bottle!

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Dear Santa.

I’ve been super good this year.

I went to all my classes, and even when I was going to skip that one Family Nursing Lecture to go to my best-friend’s graduation, I stuck it out and stayed (thank you for canceling class that day!).

I’ve studied hard and worked my butt off coming up with some pretty amazing nursing diagnoses and care plans for my patients. And even though I’ve doodled a bit too much on my notes and maybe spent too much time on Facebook in class, I’ve really been trying to stay awake!

So here’s my Christmas wish-list for this year:

1. Some new scrubs – rotating between 3 pairs is great, but a few more sets would add some variety into my daily routine (no white please!)
2. Really awesome bandage scissors – I know the seasoned nurses have said there’s no point because I will lose them anyway – I would still like a pair that cut well… with pink handles
3. Extra supplies are always good – black pens that write really well that look cute (Hello Kitty!) or maybe some colorful dry-erase markers, a spare pen light is always good too.
4. New hospital shoes – mine are feeling the wear of the last two years and are a lot heavier than I remember. Maybe some Reebok Easy-Tones, so I can go to work and workout at the same time?

I’m pretty much set after that. But if you’d like to send some Christmas magic my way as well, here are a few more things I could use:

1. A good night’s sleep – it doesn’t have to be every night (that would be a miracle!), but if you could work it out so I can sleep soundly the nights before clinical and before work, I would greatly appreciate it. Plus, you know, it will help me be more efficient during the day… so you’d be helping me in the long run too.
2. A confidence boost – I’ve come this far and done pretty well, but that doesn’t mean I don’t forget it all when it comes time to turn in a project or write another case study. If you could just send an extra boost of confidence my way and remind me, that’d be great
3. A pillow that functions as a membrane – you know, so I can stick my text book under it and go to bed and learn through osmosis. Would be particularly awesome for studying for the NCLEX…. I could be learning 24/7!

Now Santa, I hope that’s not asking too much (and if it is, I am fine with using the osmolar pillow only on nights before tests!), but I think I’ve been pretty good this year, and well, some Christmas magic would really help bring some cheer in all this rain – and get me through the home-stretch!

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I’m halfway through my training program–11 weeks down and 11 to go. I can’t believe how quickly time flies (It never went this quickly when I was in nursing school!).

But nevertheless, the more time flies, the closer I get to working on my own and truly feeling comfortable in my shiny new skin.

I’m becoming more independent. That’s a huge word with so many meanings. Let me break it down the way I see it–In.De.Pen.Dent.

“In” – It’s about being “in” your zone. It’s that feeling that you can go from relaxing and getting your coffee while talking to co-workers straight to getting report without feeling flustered. When you’re “in” you’re finally able to switch on and off without it messing with your brain and stressing you.

“De” – The “de” stands for dependent. “Doesn’t that throw off the whole meaning of the word ‘independent’?” you might ask … NO! Becoming an independent nurse means knowing that you’re still dependent on others to make it through your day. You’re dependent on someone to double-check a medication for you, or dependent on your charge nurse to help you through a rough situation. It’s partly a dependence on the docs, and a dependence on your aides. Nurses can’t be nurses alone.

“Pen” – This stands for your charting, for covering your bases and remembering that age-old saying that if it wasn’t charted, it wasn’t done. But it also stands for getting organized. Becoming independent is about that moment when you get to work and you know what you need to write down and how to write it so that you can have an efficient, productive and organized day.

“Dent” – “Dent” is the constant reminder that despite becoming more comfortable in my skill level, I’ve still only made but a dent in my career as a nurse. Even though I’ve learned a lot in these 11 weeks, there’s still a ton to come in the next 11 weeks, and then more still in 11 months and years and so on. Being an independent nurse means you’re constantly learning from your experiences and changing your practice to keep up with the times.

I’m becoming more independent, but I am learning that skill and tasks are only part of the job. Eleven more weeks until I’m truly working on my own … I better keep learning!