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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?

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Is it true that nurses are just doctor wannabes? Find out the statistic about nursing education that handily debunks this myth, plus four more fun facts that will prove to be food for thought the next time you set foot in a classroom.

1. First, let’s debunk a myth. Ever heard the phrase “Nurses are just doctor wannabes”? If this is true, why are nurses almost 100 times more likely to go on to graduate from nursing school than medical school?

2. Just a century ago, nurses weren’t allowed to be married…and certainly not pregnant. It was almost 100 years ago (in 1919) that Great Britain established the first oversight nursing training and standards. Conditions have certainly changed since then—nurses are now allowed to be married and even work while pregnant.

3. Meet the first U.S. nurse. In 1873, Linda Richards became the first nurse to earn a nursing diploma in the United States. The first hospital nursing school on record was established in Germany in 1864.

4. And the first nursing masters degree? Columbia University School of Nursing was the first university to offer a master’s degree in a clinical nursing specialty, in 1956. It’s estimated that 13 percent of the nursing population, or 377,046, have a master’s or doctoral degree.

5. Nursing is a popular choice of study. Nursing students make up more than half of all students in all health programs. This shouldn’t be surprising. Nurses comprise the largest group of healthcare professionals in primary and long-term care.

How many of those nursing students do you think actually end up working as nurses? Leave us your best guess in our comments section.

Sources:
www.nursingadvocacy.org
www.aacn.nche.edu
www.nmc-uk.org
www.northnet.org
www.nursing.hs.columbia.edu

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You can spot me from a mile a way. All in white. Standing tall and proud with my stethoscope strategically draped behind my neck.

Oh yeah, I’m a professional…can’t you tell? Just feast your eyes on my fancy clipboard. I know, you wish you had one, too. Nope, gotta be part of my club. Only the very elite get to be part of this club. Watch out, future nurse coming through!

I stop sometimes and think how ridiculous I may look to people. I remember rolling my eyes when my younger sister was in nursing school….I thought she was nuts.

Well, here I am some few years later. I am doing the same exact things that I thought were hilarious back then. Sometimes I feel like I have learned so much, other days I know I haven’t even learned a fraction of what it takes to become a nurse.

Top Ten Reasons Why I Know I Am A Nursing Student:

1) I am constantly diagnosing people.

2) I think I have certain diseases we are learning about in school.

3) I get excited over putting in Foleys!

4) I am constantly using medical jargon whether it is necessary or not.

5) I am using proper aseptic technique just to apply a band-aid to a cut on my finger.

6) I feel the need to whip out my stethoscope when my kids have a cough.

7) I have more books than I do shoes.

I think it is so fun to flush a saline lock!!

9) I don’t have a social life anymore.

10) I am guilty of practicing writing my name Megan Gilbert, RN

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Here at Scrubs you are NEVER alone!

Occasionally we get a request for advice from a nurse who is having some difficulty in his/her job situation or home life. We will ALWAYS keep the identity confidential and will respond as best we can by drawing on our highly diverse family of writers.

This is one that we received recently:

I have been an RN for two years, and lost my previous job back in July 2011. I have been unable to get a job since then. I feel like my former employer has been dragging my name through the mud. Either that, or nobody wants me after finding out I lost two jobs. The first job was right out of nursing school and turned out to not be a good fit. I had trouble learning cardiac rhythms and they fired me because of that, even though I asked for help. The job I lost in July was basically because my boss treated me like an outsider and treated everything I did and said as wrong. I never ever harmed a patient or put a patient in danger in either job. This is wreaking havoc on me not only career-wise, but emotionally as well. What can I do? All I know is how to be nurse and I don’t want to give that up. I just don’t know what to do anymore.

Sound familiar? It did to ME! Once upon a time, an RN could leave one job, walk across the street and land another right away with no delays. Unfortunately, in today’s job market we no longer have that kind of clout. Facility administrators are under orders to cut costs by any and all means possible and that usually means staff reduction.

Even older, experienced RNs who have done it ALL find themselves having a harder than usual time getting an interview after sending out dozens of resumes and filling out countless applications. Employers do not seem to value the quality of care as much as they do the bottom line. This is a real slap in the face for those who have dedicated their lives to being the best that they can be and going above and beyond so many times.

The more time that passes takes its toll on your psyche, self-esteem and physical well being. Any nurse in this kind of situation should see a doctor or therapist to deal with the depression and feelings of helplessness and hopelessness that begin to emerge. No one should have to suffer with these drains on your life!

If you have the flexibility to relocate or to work in a different community, it is worth considering, especially if you feel your name and reputation have been “blacklisted“ where you are.

Also, it never hurts to look into other avenues of nursing such as home health, school nursing, hospice care, outpatient surgery or even medical coding and billing specialties. There are a lot of continuing education and technical training courses online which can open up new doors without you having to take on the burden of yet another college degree. Take advantage of the free continuing education offerings in order to stay current on issues and changes in practice.

Managers and employers who treat nurses as you have described usually have their own bad reputations around the area. Most likely there are other nurses who have suffered the same type of abuse and they are usually easy to talk to.

My advice is this: Know that you are a person who is worthy of respect and that you must first love and respect YOURSELF. Get the professional help you need for the depression.

Be still and listen to your inner self. You may be nudged into something you have not even considered. I happen to believe there is a higher power that uses all of us, sometimes in ways which we could not have imagined. Be open to other possibilities even as “temporary” measures.

Most importantly: Do not give up on yourself! You are a worthy person who has made it through a difficult course and you have a license to practice. You are on a rough road that WILL get smoother eventually. Nurses are nothing if not resilient!

iStockphoto + Scrubs

Now that I’ve been a nurse for mrmphyears, there are a few things that, looking back, I wish somebody had told me all of these tips right off the bat.

Not that I didn’t get good training, you understand, but there are some things that experienced nurses take for granted and don’t even think to pass on.

Lesson the First: Know where every bathroom in your building is.
This is actually both easier and more necessary than it sounds. Most modern hospitals have plumbing that’s centralized around a few points. Learn where those points are and you’ll never be without a biffy, even if you have to go down to the locked psych ward and beg to use one of theirs. I learned this early when, six weeks into my very first job, all of the bathrooms on my floor were being remodeled. Simultaneously. Nurses have big bladders, yes, but not that big.

Lesson the Second: Good pens are rarely cheap, and cheap pens are rarely good.
Does anybody even use pens anymore, what with all the computer charting? Let me tell you something, children: Back when I was first getting started, we had to walk 16 miles uphill to the office supply store to….oh, wait. Sorry. The lesson here is that the cheapo permanent markers and highlighters and stick pens that the hospital provides are rarely worth messing with. Buy your own. For a small outlay, you, too, can have one of those nifty Sharpies that hangs off of your ID tag along with all the other stuff you carry with you. And, speaking of carrying stuff…

Lesson the Third: You don’t really need all that impedimentia.
Calipers are nice to have if you’re working on a telemetry floor. A reflex hammer is nice, and a penlight is essential, if you’re doing neuro. I’ll bet you dollars to doghair, though, that somebody’s stashed at least one of whatever you need in a drawer somewhere. The only really critical things you need to have on your person at all times are coffee money and a stethoscope. The index cards, measuring tapes, quick-reference guides and so on can stay on your carefully staked-out turf where nobody will mess with it.

Lesson the Fourth: Learn where everybody’s “spots” are and stake out your own.
Each unit has its weirdo—the guy who gets really upset if you sit in “his” chair. Likewise, each unit has its own system of territory-staking. For my current unit, home is wherever your coffee cup is. In my previous unit, because we had only one nurses’ station, we all just sort of figured out where to dump our stuff and left everybody else’s alone. If you’re new on the job, your spot might be in the back, where the med students are, but eventually you’ll move up to the front of the station.

Lesson the Fifth: Not only are respiratory therapists great at getting nurses’ butts out of slings, but they also have the best coffee.
If you’re starting on night shift, this is vital to know.

Lesson the Sixth: Anything that’s good in the cafeteria or in the vending machines will be discontinued.
Once, many years ago, I saw some White Castle sliders in the big vending machine in the basement. I bought all of them and stashed them in a paper sack in the fridge. At the time, White Castles weren’t even available in the freezer section of your local grocery store and thus were like gold. Our vending machines haven’t had anything close to that good ever since, but I used those tiny, delicious burgers as currency with residents and attending physicians for a good month. Likewise, our cafeteria used to offer a tasty, healthy, low-fat grilled veggie buffet on Fridays. They don’t anymore. The takeaway? If you see something good, grab it, and don’t be surprised when they replace it with vaguely plasticky hot dogs and stale Ho Hos.

The Final Lesson: Nothing is as bad as it seems the first month (or six months) on the job.
I always tell the students I precept that it’s waaaay easier to be a nurse than it is to be a student. While this is true, it’s also true that for the first three months or so, being a nurse really sucks. You’re constantly overwhelmed and terrified, worried about what you’ll have to do next, and you never actually have time to do something thoroughly enough. This will change, I promise. Most of what you do as a nurse becomes routine after a while, so you can spend more time on actually nursing. Fear not, Chickadees. As your hip measurement increases with your time on the job, so do your confidence and efficiency.

Even without those oh-so-tasty little sliders.

Images By: Peter Dazeley

Every nurse has been told this during a conversation about job opportunities: “You need to get some regular floor experience before you specialize.”

You can paint it any color you want, but most nurses who hear this are either new graduate nurses or are seasoned nurses who are trying to dive back into the clinical world.

I’m here to tell you it’s a MYTH. It’s an urban legend. There is NO theoretical evidence that a nurse needs prior experience in order to perform well at a chosen job. Okay, maybe there is, but in my travels as a nurse I’ve never seen this myth supported in any way.

I was one of the lucky ones. When I started as a nurse, all specialty nursing units (ICU) were frothing at the mouth for nurses. They didn’t care how much experience you had–as long as you were willing to go the extra mile, they hired ya. And I’m not talking some small four- or eight-bed suped-up telemetry unit, I’m talking urban teaching hospitals with level 1 trauma status.

As my career progressed, the needs and wants of nursing units changed, and then the economy dropped the infamous ball. Now we’re back to square one, with many specialty nursing units shunning away from new grads with no experience. I’m not sure if it was the strain on the economy or some weird paradigm shift?

What I can tell you is this: In my short tenure as a nurse, I’ve seen both sides of the coin. I’ve seen a seasoned critical care nurse from another hospital with umpteen years of experience fail miserably at a new job in critical care. And I’ve also seen a green-behind-the-ears new grad with no experience shine and become a hard-charging, take-the-lead nurse who scoffs in the face of danger.

I personally don’t think it has anything to do with want or need or ability or personality. I think it has everything to do with desire, willingness and cojones.

I can say with 100% certainty that you are either built for this job or you aren’t. There is no grey area in critical care. You either survive or your drown. I like to make the parallel comparison to our profession in general–you are either built to be a nurse, or you aren’t.

The next time someone feeds you this line of bull, be sure and explain to them why you would be a perfect fit for the job. Convince them they could use a nurse like you. Or don’t you have the cojones?

Image By: Roderick Chen

Nurses and intravenous catheters (IVs) seem to go hand in hand. Yes, yes, I know nurses are not the only health care professionals that place and start IVs, but we do the majority of it. My sincere apologies to all the out-of-hospital EMS personnel.

Oh, and as a side note to all the TV fanatics out there: Physicians RARELY start peripheral IVs. In fact, in my short tenure doing this job, I’ve seen ONE physician start one.

Anyway…

Even though my IV skills had a pretty rough start, I thought I’d share some tried and true tips to help increase your chances of success.

Know your anatomy

• This is a simple yet vitally important rule. Don’t go routing around blindly for that “magic” vein. Know where to look and what you are looking for. Most cephalic forearm veins are overlooked, while the median anticubital vein is usually abused. Remember, the ventral side of the forearm is sometimes a gold mine!

Trust your gut

• After your initial survey, if you know in your gut that you’re going into it blindly, stop what you are doing and ask for help. Ask for assistance or simply hand the task off to someone who is more experienced. There is no shame in knowing your limits, but don’t be afraid to fail, either.

Stick to your own routine

• For some reason, every nurse thinks his or her way of prepping the vein, applying the tourniquet and exposing the vein is the best way. Ehhhh. Wrong answer! Once you develop your skill, be sure to follow your own routine. Your routine will ensure you do it the right way, each time, every time.

Hone your skills of palpation and touch

• This seems to be a dying art these days. Just because you can’t see the vein doesn’t mean it’s not there. Be sure to practice your palpation skills. Practice and sharpen this skill by closing your eyes and palpating a known large exposed vein on a well-hydrated patient. When you see “that” patient with the good veins, be sure to palpate the veins with your eyes closed. Do it over and over again until you can recognize what the vein should feel like. Don’t ever rely on just your sight.

Don’t forget there’s a patient attached to that vein!

• Once again, we nurses get so focused on the task that we forget there is a human being on the other side of that vein. Just because the dorsal hand veins are prominent does not mean you ignore the forearm! You are inevitably causing pain to your patient–be sure to empathize and make every attempt to increase their comfort level. I haven’t met a patient yet who actually likes being stuck with a needle!

Starting an IV is a skill like all others–practice makes perfect. It also follow our mantra, “If you don’t use it, you lose it.” Don’t handicap your practice as a nurse by letting your IV skills lapse. It’s better to try and fail than to never try at all!

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Graduation is approaching–you have the finish line in sight and are SO ready to be done! Of course, most new grads still have the NCLEX to look forward to and to prepare for, but school is almost over!

Now, having made it through and done things you once thought were absolutely impossible, you know you are not the same person who entered nursing school so long ago. You are about to enter the workforce as a professional. No longer a student with an instructor watching over your shoulder, you’ll have your own license and will be responsible for what you do in your own right.

Responsibility is what having a license is all about. No one has the right to practice certain trades, drive a car or fly a plane without providing proof they can do it safely. Successful completion of a course of study from an accredited school is the first of the necessary steps to becoming a nurse (passing the NCLEX is the other).

Why then, should nursing school be so difficult? Hard to get in, even harder to make passing grades and to keep up with your clinical hours! You’re constantly evaluated, not only on tests but also on a personal level by those who observe the way you dress, speak, interact with others and carry yourself as a potential professional nurse. And a social life? Forget about it!

Nursing is a different discipline from any other degree program at a college or university. You are being prepared to literally hold another person’s life in your hands one day. You learn how to resuscitate a person, give drugs that can be very dangerous, perform a physical exam and develop critical thinking skills so you understand what you are doing and why. You learn to be an educator and advocate for patients, their families and other health care providers. Even doctors will learn things from you!

Nursing is not a good career choice for the faint at heart, nor is it a route to snagging a doctor to marry (aka getting an MRS degree). The soap opera depictions of romantic merry-go-rounds do not happen in real life. Nursing is extremely hard work that can be so profoundly exciting and unique, people actually get a high from it!

Is it fair for schools to weed out students who do not have the right stuff to do this kind of work? I happen to believe that it IS–because when all is said and done, it is not about US but about patients’ needs being met. We are not doing anyone a kindness by encouraging people who do not have what it takes to stand and deliver good patient care to stay in the profession.

In most schools, students who figure out that nursing is not for them after all usually drop out of the program. And many who stay in because of a false sense of job security from a recession-proof career and other such notions find themselves miserable and going from job to job, seeking the satisfaction and happiness which never was guaranteed in the first place.

So yes, nursing school is about teaching you critical thinking, meeting patient needs, and being an advocate. But it’s about making sure you’re ready for the truly difficult task ahead: Recognizing that you’ve entered more than a career…you’ve entered a calling. Even at times when things were truly bad and I desperately wanted to get OUT of the profession and prayed for guidance toward something else, the answer was a firm NO and I was steered back into nursing, whether I liked it or not at the time.

So, as you prepare to receive your diploma and school pin, be happy and proud that you are embarking on a journey into one of the toughest jobs you will ever love!

What lies behind us and what lies before us are tiny matters compared to what lies within us (Ralph Waldo Emerson).

Myth: “Real” nurses work in hospitals.

Fact: More than half of all nurses work in hospitals, but that doesn’t make them more “real” than the rest of us. I used to work in an emergency room, and I can tell you for certain that I have been as much a nurse since I left as I was in the hospital (I’ve done everything from conducting medical exams for insurance companies to preparing nurses to take their boards for an education company).

Yet, from the day I stepped out of the hospital into the world of nontraditional nursing, the questioning (“Why did you leave nursing?”) started. And it has never stopped. I always give the same answer, very calmly and very proudly: “I never left nursing. I’m still a healer, teacher and nurturer.” I have a very broad view of who a nurse is and what a nurse does.

While many of us wear scrubs, there are still nurses who wear uniforms, business clothes, even overalls. Being a nurse is about who you are, not about what your wear or where you work.

Myth: Patients like to be called by their first names. It’s just friendlier.

Fact: With all the available techno-communication—from email and IM to MySpace and YouTube—we’ve become an increasingly informal society, and sometimes we automatically address people by their first names. Many patients are more comfortable with formality in the health care setting, and the use of surnames and titles helps maintain the professional relationship. Plus, there are many people, especially older individuals, who consider it disrespectful to be addressed by their first names.

The bottom line: Be sensitive to your patients’ preferences. It’s probably safest to start out with formal forms of address and progress from there.

Myth: You can always tell a good nurse by how much she or he knows.

Fact: An excellent store of information and experience is essential in a nurse, no question about it. But a deep sense of empathy and compassion are equally important. A nursing instructor at a community college told me that she always explains to new grads, “Patients don’t care how much you know until they know how much you care.”

Myth: Apart from the language issue, most foreign-trained nurses find that working in an American hospital is not much different from working in their home country.

Fact: Foreign-trained nurses now account for about five percent of the total United States nursing workforce, and are an intrinsic part of our health care system. Thank goodness, because there are some parts of our country that are suffering from a nursing shortage. Most foreign-trained nurses, despite their high skill level and excellent training, still have to sort out a host of cultural issues and professional expectations that they often hadn’t expected.

Nurses from the Philippines, for example, who make up nearly half the foreign-trained nurses, usually find they have much more responsibility here. They also have to be more independent and use more critical thinking skills. Why? Because in the Philippines, most hospitals are teaching hospitals, and the residents and medical students do most of the procedures. When they get to the United States, nurses find, for example, that they’re required not only to start IVs, but are also supposed to interact with doctors and patients’ families, even if they’re not the charge nurse; additionally, they’re responsible for discharge planning and case management. Add to all this a brand new language, and you can really see what foreign-trained nurses are up against.

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1. Carry around strong mints to overpower those smells that may turn your stomach. One drawback: You may start to associate mints with illness.

2. Vapor rub applied to the upper lip can block out those nasty smells.

3. Don’t look directly at the things that may flip your stomach. If a patient is vomiting, divert your eyes from the vomit. Learn to look indirectly at it by focusing on a point above the vomit, bedpan, etc.

4. Sympathy works wonders. Being able to sympathize with a patient who is expectorating can help keep your mind occupied on something other than “the gross.”

Eventually, you’ll grow accustomed to the sights and smells of your workplace. The more you learn, the more experience you gain and the more sympathy you feel, the less these things will affect you.