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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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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

I’m currently in nursing school. It’s a challenge for everyone, but luckily for me, my mother, now retired, has been with me every step of the way, giving me direction, advice, hints, encouragement and smiles. If I make it out of nursing school, it will be because of her constantly exhibiting a “being with and doing for” attitude.

When I started, she warned me that my program wouldn’t be easy, but I would learn more than I dreamed possible. She was so right. The best part is that I never regretted the decision I made.

My first day of clinicals, I was excited and scared. Her hilarious stories of her nursing school days helped to dispel some of my fears. The first day on Labor and Delivery, I was nervous about witnessing the great event of a birth—her horror stories of her own days thrilled and delighted me.

The day I told her I was finally able to read the doctors’ notes excited her as much as it did me. When I started on the ICU, I told her how nervous I was. She smiled and told me, “Sometimes that’s best. It keeps you on your toes and more alert.” She was never more right.

I never would have made it this far without my mother. She is my support, encouraging me with every decision I make. I know she will be behind me no matter what I decide to do in my nursing career.

When I was little, I wanted to be a doctor. But as I matured more and saw my mother’s caring attitude toward others, I knew I had to be a nurse. If I can be half the nurse that my mother is, I will consider my nursing career a success.

Happy birthday, Mama, and thank you.

Catherine Perry is a nursing IV student at the Good Samaritan College of Nursing and Health Science in Cincinnati, Ohio. She is the secretary of the student organization and volunteers in the OR of her local hospital. Perry hopes to work in surgery after graduation.

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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).

Anton Prado | Veer + Scrubs

A little over a year ago, I wrote a brief FYI blog post about the future goals of advanced practice nursing and the role of the DNP according to the consensus model by the AACN. Questions have come up that I’d like to address.

Will there be a set of uniform guidelines that each state follows in transitioning the requirements from an MSN to a DNP for a current practitioner?

As most nurses have discovered, state requirements are very different from national requirements. While all states share the same minimum requirement of following national certification guidelines, each state’s specific requirements for licensure and employment is at its own discretion.

In my opinion, this means each state will choose how you may transition. If the current state protocols are a reflection of things to come, be sure to do your homework and contact your local state agencies to get the details. I would not assume the guidelines for one state will mirror another, no matter how close their geographic locations are.

I’m in the last year of my ACNP program and we quickly are learning that there are many hoops to jump through and red tape to follow when applying for licensure.

What incentives does acquiring a DNP have other than just being a requirement?

Many nurses are questioning the motives behind the impending changes and what incentives exist to motivate a current nurse to pursue the DNP. More specifically, are there pay rate changes to the DNP as opposed to the MSN? I mean, we’re technically being required to get another 12-24 months of advanced education–are we being compensated? More education should equal more pay, right?

It’s not a simple answer.

The NP profession sort of shot themselves in the foot with this one. For years, NPs fought for independence. Independence in the practice, and then independence as a practitioner. Granted, this fight was more for the general practitioners (Family Nurse Practitioners), but since the NP profession has become more specialized, it affects all specializations.

Now in some states, an FNP can open a clinic or office with the assistance of an MD. And in some states, the FNP can practice without the actual physical presence of the MD (just a phone call away).

Not to minimize the concept, but Uncle Ben from the Spiderman comics said it best: “With great power comes great responsibility.” If we as a profession want to have the power to work independently and function with that kind of “power,” it is our responsibility to be prepared. More responsibility equals more education, period.

Oh, and let’s not minimize the ever-expanding complexity of health care, our patients and their health challenges. The truth of the matter is, our patients are living longer and have more health challenges that did not exist a decade ago thanks to advancements in treatment. We as the practitioners need to “up our game” to meet these challenges. Upping our game means attaining a higher level of education.

So the “motivation” for attaining your DNP is simple. Do it to improve the care of our patients.

If you’re worried about not being compensated for your additional education, we might want to take a step back and look at our economy as a whole. Our profession is one of the few that is not being affected by the current economic strain. There are MANY health care professionals out there who have no job opportunities at all.

I, for one, predict that depending on the area you choose to work, the pay rate will change, but not because you simply got your DNP–rather, because your role as a practitioner has expanded and will continue to expand in the years to come. Yes, an MSN prepared NP functions just as a DNP prepared NP does currently, but I foresee that changing very soon.

In the end, if the impending educational requirement from an MSN to the DNP is affecting your decision to advanced your degree or swaying you towards not advancing your degree all together, then maybe it’s just not for you.

Links of interest:

• http://www.iom.edu/Reports/2010/The-Future-of-Nursing-Leading-Change-Advancing-Health.aspx
• http://msntodnp.com/average-salary-msn-vs-dnp/
• http://community.advanceweb.com/blogs/np_7/archive/2010/05/04/will-employers-pay-for-a-dnp.aspx

Some additional articles:

• http://scrubsmag.com/5-perks-of-an-np-degree/
• http://scrubsmag.com/a-doctor-in-nursing-uniform/
• http://scrubsmag.com/doctoring-the-doctor-title/

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In a widely quoted statistic by the U.S. Bureau of Labor Statistics, over 700,000 Registered Nurse jobs are expected to be added by 2020, making the occupation one of the fastest growing in the country. This, of course, is great news for the nursing industry, but doesn’t help explain why it remains difficult for many new nurses to find the jobs they desire.

Back in 2003, Ardis Bush, RN was named one of the first grand prize winners of the Cherokee Inspired Comfort Awards, and she recently spoke of how her profession has changed since she received the award.

What concerns Ardis about new nurses is that many are postponing their nursing careers after graduation, or being forced to accept jobs outside of their preferred fields. Internships are a great bridge between nursing school and the workplace, but Ardis points out the lack of resources currently available for many of these programs.

“Internships are an excellent opportunity to address the ‘reality shock’ and enhance the critical thinking necessary for transitioning safely from the classroom to the bedside. But the challenge is: How do we attract the resources in all hospitals to accommodate more new graduates?” Bush said. “Is the answer to ask the federal government to provide an incentive for health care organizations that address the nursing shortage by promoting internships and incorporating them into the employment practices for their entry level nurses? The present competition for internships is great, but the need to increase the number of nurses in the workforce to address the future shortage is even greater.”

What’s your take? Do you feel internships are a key to solving the nursing shortage problem? How do we expand internship programs? Let us know in the comments below.

Ardis J. Bush, MSN, MS, RN, CMSRN, NE-BC, works at Ben Taub General Hospital in Houston, Texas.

Do you know a nurse who is a thought leader? Tell us about them at hello@scrubsmag.com. Also, be sure to nominate a nurse who has inspired you for a Cherokee Inspired Comfort Award by clicking here. Nominations for the 2012 season are accepted through June 30, 2012.

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In celebration of spring and what is, for many students, the LAST clinical rotation before graduation, here are a few tips for excelling in that experience!

• Arrive 10 minutes before the official report time–appropriately dressed, well-fed and ENTHUSIASTIC!
• Leave the extra jewelry (diamond rings, bracelets, necklaces and dangling earrings) at home. These items are not safe and are a source of infection. Most are against school and hospital policy in patient care areas.
• Short nails (NO artificial!) with no chipped polish are expected. This is a CDC standard. Lots of “nasties” have been cultured from nurses’ nails!
• You will have, of course, already been to the bathroom and done a “mirror check” to be sure that no underwear or tattoos are showing and that your hair is out of the way. We prefer “above the collar.”
• Introduce yourself to your assigned preceptor and present to him/her your list of learning objectives–this person is your instructor and will evaluate you during your time together.
• Remember that you are there to watch, listen and learn! It is YOUR responsibility to let your preceptor know what you are or are not allowed to DO.
• Your preceptor will look for learning opportunities, which may involve: observing surgery, going with a patient to CT scan or MRI, or even assisting another nurse with a procedure.
• As you get comfortable working together, your preceptor will welcome your input. You will find a lot of things which do not fit the mold you were taught in school.
• One day you will be given the chance to fly solo–with supervision, of course. On that day you will get report, quickly assess your patient(s) and gather up all lab and X-ray results so they’re there when the MD arrives. You know exactly how much intake and output/bowel movements the patient has had as well as any other information. The Goal is to make the doctor’s rounds go as smoothly as possible and to let them learn to trust YOU.
• NEVER tell a doctor “I don’t know.” Say instead: “Let me double-check that for you.”(Because of course you know ALL things, but you need to be sure.) This keeps the doctor from becoming anxious about your abilities as a nurse. Remember The Goal.
• Doctors LOVE to “teach” (i.e. show off what they know); your preceptor often will ask the doctors to describe/show/explain what they are doing in a procedure.
• Remember that the only stupid question is the one that you do not ASK!

I never teach my pupils; I only attempt to provide the conditions in which they can learn (Albert Einstein).

See one. Do one. Teach one.

This mantra is well-known in the nursing world. It’s how we as nurses have learned and will learn most of the skills (and knowledge) we possess.

The application of knowledge into practice is an amazing challenge. None of these skills would be part of our repertoire without the expert tutelage of a sage preceptor. That nurse who has experience in the trenches, who has walked the walk. Every nurse can tell you a story or two about their preceptors.

Unfortunately, there are some who should not be given the responsibility to teach and guide those who require it. Precepting an inexperienced nurse takes a unique set of traits. The following are five traits that, if you possess, means you might want to rethink being a preceptor:

Hearing but not listening

• This is when you nod appropriately when the student is explaining or presenting, yet you simply let them talk for the sake of talking. Learn to pay attention to what the student is saying.

No feedback

• After a skill is performed, you don’t rate performance. You give the students no inclination of whether they are doing well, or if they lacking the skills needed to succeed. Negative feedback is still feedback, but be sure to be constructive and not demeaning.

No inquisition

• During a new learning experience, you fail to challenge their thought processes. Having them cognitively process the skill first prompts them to think about what they are doing, not just perform it.

Impatience

• Everyone has a different learning curve. Some are fast learners, others need a little extra care. You should have the time to explain a concept before and after the experience. As a preceptor, expect to have longer days.

Instructing instead of teaching

• There’s an amazing difference between instructing from personal experience and perspective and guiding students through their own thought processes. It’s your job to help them navigate through the obstacle when they veer off the path. It’s not your job to steer the wheel.

Anyone else care to add to this list?