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.