Are Nursing Students Prepared for Their First Patient Loss?

Death is a part of living and we will all have to face it in our lifetimes at some point or another. I have dealt with very tragic losses in my personal life and seeing other families go through that process is heart-wrenching and brings back many deep wounds. In nursing school we will all take some form of "Death and Dying" class, but will it really prepare us for our first patient loss? My school incorporated the teaching within its Psychology in Nursing class and it only briefly skimmed the surface of our role as nurses.

My first contact with a dying patient was in a long-term health facility. In a setting like that you expect death and even prepare for it, so the loss was easy to accept. My second encounter came on the pediatric floor and I watched for hours as the code team tried in vain to rescue a young girl. That was my first real experience with a sudden and tragic loss of a patient that deeply affected the family and staff. Watching the mother go into shock is an image that will forever be ingrained in my memory.

The next day the hospital held a meeting to discuss the loss of this patient. The primary physician, nurse, hospital coordinator, chaplain, counselors and I were all present. It was a great opportunity to talk about what happened and to really process the loss of this patient. The primary nurse asked the physician if there was anything more she could have done, while the physician responded with information that there was nothing that could have saved this patient. It was a wonderful way to get closure and to elevate any feelings of guilt that the staff may have encountered in a very positive and non-judgmental way.

Recently, I experienced another loss of a patient who was very young. From my previous experience, I was able to identify what resources were available to me and I found a very positive way to express my feelings and concerns about this patient loss.

In nursing school you may or may not come across the loss of one of your patients. If you do, be sure to contact your resources to help get you through that experience. Your clinical instructor will most likely be a helpful tool in finding other resources to utilize, as well as possibly coordinating a meeting with all of the staff involved in that loss. As nurses we need to prepare ourselves for death and dying in our careers, as well as ensure we are being healthy and taking care of our own mental, spiritual, and physical bodies.

Avoiding New Graduate Nurse Burnout

As the end of nursing school draws near, the fear of being all on my own with a patient load becomes more and more scary. Will I really be able to handle it without having a mental breakdown every day? It seems that hospitals are also considering this concern, as the reality of new graduate nurse "burnout" is becoming a problem for staffing and resources. More and more hospitals are turning to nurse residency programs to stall the increasing burnout rate. Some hospitals automatically enroll new graduate hires into the residency program, while others make it an optional position that is highly competitive and sought after.

The American Association of Colleges of Nursing has a great site (http://www.aacn.nche.edu/education/nurseresidency.htm) for finding out more information on what hospitals offer a residency program as well as some of the benefits. One interesting statistic is that the retention rate is "94.4% - which can be contrasted with published reports indicating turnover rates of 30% in the first year of employment." Residency programs have also been found to reduce practice errors. If you want to make it in nursing, why not start out with better tools and resources?

Some of the benefits including in a nurse residency program include:

* Competitive salaries

* Transition from "novice" to "expert" nurse

* Extended preceptorship on unit* Specialty courses to increase knowledge and confidence

* Graduate nurse support meetings and resources* Great way to "get your foot in the door" at a magnet hospital (http://www.aacn.nche.edu/education/pdf/ParticipatingResidencyPrograms.pdf is a current list of participating hospitals)

So if you feel that you are not quite ready to be all on your own as a new graduate nurse, consider the many nurse residency programs located throughout the country. After all, how can you go wrong with more support and more education?

Test Taking Tips and Strategy for Nursing Students

Alternate item formats are generally the most dreaded questions on exams. Usually instructors will throw in one to two of them into the majority of multiple choice questions on exams. They are usually the questions that students get wrong.

So what are alternate item formats? Alternate item formats are pretty much any question that is not multiple choice. They include multiple response questions, fill-in-the-blank, hot spot questions, and prioritizing questions.

Multiple response questions are generally the questions that state, "select all that apply." A simple strategy to answer these questions is to ask yourself, "what is the question asking?" Then go through each of the possible answers and determine if it is true or false. If it is true, select it. If it is false, don’t. Afterwards simply move on and don’t spend time thinking of "maybes" because there are none.

Fill-in-the-blank questions will usually be calculation problems. The best practice for these is to work out the problem and put the answer in the blank. Then, before submitting it, work the problem all over again to determine whether you get the same answer. If it is, submit it. If it is not, rework it. Usually the answer is just the number. Read the directions carefully to determine if the unit is desired.

Hot spot questions are either an illustration or a figure. This can mean a medication label, heart strip, etc. These questions can be asked in multiple choice, multiple response, fill-in-the-blank, etc. Remember to read the question and focus on the illustration. Then use the specific strategy for the type of question.

The next type of question is the prioritizing question. First visualize the situation and then use your nursing knowledge to answer the question. Remember to use the ABCs (airway, breathing, circulation) to prioritize your steps. Don’t forget to use Maslow’s Hierarchy, the nursing process, and teaching and learning principles to organize your interventions.

Focus on doing well on alternate format items while you can. Usually when taking the NCLEX exam they are the questions that are the hardest. If you can improve your skills now, while in school, it will only improve your chances of succeeding later on the NCLEX.

Transformation into a Nurse

Today we had our senior/sophomore experience. A senior/sophomore experience (for those of you who do not have this clinical at your nursing school) is a day where seniors get to develop their delegation and leadership skills, while assisting sophomore nursing students on their first clinical in the hospital.

I was in one of the first classes at my nursing school to start in the fall semester, so my class did not have seniors on our first day of clinical. I remember how absolutely terrified I was on that day.Having had no hospital experience prior to nursing school, the first clinical I had was an eye-opener, to say the least. I remember dreading going into my patient’s room for the first time. What would I say? How do I introduce myself? What do I even do? Those feelings I first had still give me the butterflies.

After my first day I remember going home and being completely shocked. That’s what nurses do? I had an image in my head of Florence Nightingale sitting next to her patient’s and being with them. These days nursing encompasses so many skills that I feel my original image only imagined a role more along the side of nurse’s aide than anything else.

Now I know what they mean when they say that nurses are a part of a "profession." The nurse’s role is so bountiful and endless with technology, medical expertise, documentation, and of course being with their patients, to name a few.Being with the sophomore students reminded me of all of this. As I watched them step into their patient’s rooms for the first time with all of the nervousness that I had, I finally realized how far I have come.

I know that I could walk into any patient’s room anywhere in the hospital and be their nurse. My nursing school has prepared me for this. I am an expert. Granted, I do not have the wisdom and experience that many of the older nurses have, but I know that I am capable of gaining it. I am still full of lists of questions, but I hope that I always am. Today made me realize that I am perfectly able to step out on my own and make it as a nurse.

To those of you that are sophomore nursing students, you too will see this transformation in yourself and probably never see it coming. It’s a long road - but somehow they turn us into nurses.

Practical NCLEX Tips

Preparing to take the NCLEX-RN exam is a very scary and stressful place to be. It is a time to transition from being a nursing student to a nurse. How is that accomplished? How do you make that leap?

Here are some very practical and simple tips to use while you prepare to take the NCLEX:

1. Start soon! When is it too early to start studying for the NCLEX? Never. Most nursing school books have NCLEX questions at the end of each chapter – even beginning semesters. Do them! It is a great tool to help measure if you know the material in the first place and it helps to prepare you for the style of NCLEX questions.

2. Start believing that you are a Registered Nurse. The first day of my NCLEX preparation class, my teacher made us all write our names with “RN” following them. “Cassie Applegate, RN” - It has such a nice ring to it! If you do it enough times you may actually start to believe it.

3. Find your weaknesses. There are many great tools to take NCLEX pretests. Some even analyze them for you and determine which areas you are strong in and which areas you are weak in. It is also a good idea to study the categories that you are not interested in. Generally, we tend to study the areas we like – therefore we know those areas the best. If you know you hate pharmacology, for instance, maybe that’s a good place to start.

4. Take the tutorial. The National Council of State Boards of Nursing has some great information on their website about the NCLEX. They have basic information as well as a tutorial on how to take the exam here: https://www.ncsbn.org/1213.htm This tutorial walks you through the computer-based NCLEX format, and even gives you time to practice using the calculator and manipulating the screen. The more comfortable you become with this the easier it will be when you sit down to take the test. It is also a great idea to take the tutorial again while you are taking your NCLEX exam because you will waste those first few minutes of anxiety on the tutorial instead of on the actual NCLEX questions.

5. Practice in a similar environment. This means do not study in a room where the TV or music is on, or while you’re lying in bed or sitting on a couch. Go somewhere quiet and sit on a hard chair. Try to schedule your study time into your week so that you know you will have no interruptions or distractions. It is also very useful to study for at least a couple of hours. If you’re not used to it by the time you go in to take your NCLEX, you might get too fidgety and stop concentrating completely on the questions. Try to use the calculator on your computer and use a whiteboard to write out your calculations. These tools will eventually become familiar to you and you will feel more comfortable while taking the exam.

These are just a few simple tools that you can begin to integrate into your study times. Remember that by the time you take the test you will have learned all of the material needed to make you a minimally safe and competent nurse – which is what the NCLEX is testing you for. You can do this and these tips will help you feel more comfortable and confident during the process.

TB Infection from a Patient? The Community?

Every semester in nursing school we are required to get a PPD skin test to determine whether we have tuberculosis or not. Every semester my PPD skin test has come back negative - until this summer.

This summer in order to work at the hospital I had to go through all of their procedures before acquiring the job. I had to be cleared by the occupational therapist, show my current CPR certification, and take a TB Gold test. This test is different than the PPD skin test because it works by taking whole blood to determine whether there is Mycobacterium tuberculosis present. There was. This meant that I then had to go back to the hospital to have chest x-rays done to see if I have an active case of tuberculosis. Fortunately for me I did not show an active TB infection, which means that I have a latent case of tuberculosis. This means that I cannot give TB to anyone through the usual route (air droplets) but rather that the bacteria lives dormant in my lungs until it may or may not become active at a later date.

The question that has been plaguing me since this information arose has been - how did I get it? Who did I come into contact with that had an active case of TB? I do not believe that I got it in the hospital, because I did not take care of any patients that had a TB infection. The only thing that I can think of is if I got it from the community. This last semester we spent a lot of time with underprivileged persons and outreach programs in my area. This could have very easily been transferred through the air by someone who sneezed or cough in an area around me. This was a huge wake-up call for me. As much as I have learned about disease and the risk of transmission to healthcare workers, I don’t think I fully understood how real and dangerous this profession can be at times. If there is ever an outbreak of a disease, it will be nurses who are at the frontline taking care of those patients. This is something that nursing school tries to teach us, but that I could only really understand when it happened to me.

This truly is a dangerous profession. We must be ever vigilant to ensure that we are educating the population about disease prevention and following our own advice to ensure the safety of our patients, our lives, and our family’s lives.

Has something like this ever happened to you? Have you ever experienced an infection from a patient, or a close-call? I would love to hear your stories.

NCLEX Study Material Piling Up – Where to Start?

As my summer ends and my last semester of nursing school looms near, I have become more and more overwhelmed by the pile of NCLEX study material that has accumulated in my house. I have put this pile near my bed in an effort to remind me to study when I wake up, but instead I see it right before I sleep.

This has led to numerous stress-related nightmares where I can never remember the right answer even though I know it.

I know that the best way to get over this stress is to just dive right in and study the material. But how do you even start? And where do you start?

Being a nursing student we cover such a wide variety of health information that crosses the whole lifespan of a person – it seems daunting to think that we can remember all of it. But, the truth is, we can’t. When I was doing my clinical in the ICU the primary nurse I was following made a wise comment. He said, “I never want to work with a nurse who thinks they know it all. They’re dangerous.” This man was probably the most intelligent nurse that I have come across, but he was wise enough to realize that it’s better to go find the right answer, then to just assume you know it. This is a very valuable tool to use with patients, also. I find that patients are much more comfortable and confident in my skills when I tell them honestly that “I don’t know the answer to that… but I will find it for you.” We have endless resources as nurses, and it is our duty to ourselves, the nurses around us, and most importantly our patients, that we use them.

In the context of taking the NCLEX I had a teacher tell me not to worry about the information at all. She said, “If you have sat through four years of lectures on this material – you know it. It’s just a matter of learning how to take the test.” This is one of the most valuable pieces of advice that I have heard on the NCLEX. Now when I finally stop procrastinating and start reading my NCLEX review books, I will look more to the style of the questions and learn how to objectively assess what the question is asking. This, after all, is one of the most important parts of nursing. Not just simply knowing everything, but knowing how to weigh a situation and assess for the best solution.

In the meantime, I think I will start off by learning how to read NCLEX questions. Tips and tricks are welcome!