cnmbfa 3,614 Views
Joined Jan 14, '06.
Posts: 156 (58% Liked)
As a faculty member who teaches this topic, I have found a mostly successful strategy for mastering this. We work in small groups to write a backwards case study. I give them an abnormal lab value, and have them create a story for how it developed (diuretics without eating any K+ rich foods, ran a marathon drank plain water no sodium replacement; borderline renal function using magnesium laxatives, etc) Next they describe the presenting signs/symptoms and the nursing interventions. They end by saying not just what the normal lab values will be, but the other symptoms will resolve. They know they will be handed a lab value and have to create a case on the next quiz. Works well.
OP here, I'm NOT the person she was referring to. The person she was referring to took "it's just a job" and turned around to the person who stated that and launched into "I hope you're never my nurse" and other things of the sort.
Couple of ideas:
Debrief with a nurse you respect. Ask him or her what you could (if anything) do better next time. You may find out that you actually did all you could. That might help you realize that randomly bad things happen to patients that are out of our control. Just do the best you can.
Make a list of all the small early warning signs you caught and acted on in the last 2 weeks. Then make a list of all the kindnesses you showed, and/or how how ability to listen or provide comfort helped someone.
Ask to talk to the chaplain before or after work, even if you are not religious. This person will listen to you, support you, and help you cope.
While I somewhat agree, as a faculty member, I see GPA as a stand in for a lot more than just smarts. It is a reflection of self-discipline and willingness to work hard. It is also under student control to a large extent. Some persons learn from mistakes and never make excuses for themselves. They also read their textbooks, ask questions, come to lecture and clinical prepared, stay off Facebook in class, know their priorities, and are willing to make sacrifices (like working fewer hours and not buying new clothes or going out as often). None of these things are impossible. I for one am SICK of the people who don't do these things, yet expect the same A. They say to me "but I worked so hard." My responses: the criteria for getting an A were spelled out to everyone. If you want an A the next time, what will you do differently?
This is from a document I post for my students at the start of clinical. Doing any of these things will probably result in failing clinically. Remember, we faculty have wide leeway in making a call on this. It often boils down to not letting you move on if you are unprepared, unprofessional, unsafe, unskilled, are unable to critically think, or communicate poorly with others or fail to take responsibility for your actions.
The following infractions may result in a clinical failure:
One of the nurses who was watching told me that the mid-level felt like she could treat me like that because I appear too apologetic. But I don't know how to avoid this. I feel as though I have lost all the confidence that I had before I came off orientation, and now I am setting myself up to have people ream me even when I haven't made mistakes.
Figure out how to manage your time well. Develop skills in reading and analyzing research studies, since a lot of what your learn will come from journal articles in addition to texts. If you are not already skilled at it, have a college librarian teach you how to efficiently teach the literature.
As for clinical, be open-minded and flexible, ask questions. Treat everyone (clerks, etc.) with respect. If you do not know fetal monitoring well, buy the $50 DVD from the Wisconsin Assoc for Perinatal Care or take the AWHONN course.
Agree, it depends. I worked in one practice with enough CNMs that I did two 12-hour shifts per week in L&D, did rounds, saw ER and triage patients. In another, had two partners and we split up the month, with every third weekend on. I came in for some (not all births) even when not on if a patient who was really attached to me requested it--maybe once a month.
I was on my own for 20 months when I started that practice, and actually found being on call 24 x 7 not too bad. Here's why: I was able to put a limit on how many patients we took in, so that I never had to do more than 10-12 births per month. I could also get a long weekend off by asking my consulting OB to cover for me. I usually did that when I had few, if any, patients due to give birth. I took vacations, and even had a choleycystectomy without any disruption to my life or the practice.
Once we started to add CNMs, the lid was off, and we ended up doing more birth (average 16-18). It eventually became clear to me that the owners of the practice were in no hurry to hire a 4th CNM because they made a lot of $$ by keeping it to three, even if it exhausted us.
When joining a practice, ask not just how much call, but how many births they do per month. If you have young kids, look for a practice with less call, and hope for one that does not require you to work in the clinic after being up at night.
Yes, it's challenging, but not as bad as it sounds. And the job is VERY fulfilling and well worth it.
Do you remember that one guy not forever ago who came on here after a hospitalization asking how we are able to do our jobs with such sexual arousal being exposed to so many genitals?
I still have nightmares about that one. I felt like telling him that our name badges are secretly outfitted with a microcamera that takes pictures of how well endowed our male patients are...or are not. The problem is, he would have likely believed me.
Go low tech. Get an alphabetized pocket sized notebook. Every evening, no matter what, go to Up-to-date and write brief notes on various conditions, beginning with the ones you encounter most often. Eventually you will have an impressive pocket brain, and the act of writing the notes will probably help you remember the information, or be able to find it quickly.
Skip electronic versions--make your own.
Every night in bed, reread some critical content from school. Hopefully, you now realize that NP school gave you the bare essentials you need to practice, and that there is far more that you need to learn, fast. Go to Medscape and subscribe to get emails on your specialty areas or any areas you are week on. My other favorites that I skim through are Health Day and Consult 360. There is no reason not to be able to keep up, and often its easier than you might think. Ask your colleagues if they have any favorite sites.
Don't be hard on yourself, but don't EVER make excuses for yourself, and work diligently to master the learning curve. The mark of an excellent practitioner is that they always wonder what it is that they don't know that they don't know! That drives them to continually learn, even years after graduation, so that they can stay on top of their field.
Don't quit. You will always wonder about what might have been if you do.
Be sure to meet with the faculty and ask them what you should do differently to pass. Do not be defensive, do not make excuses, listen and then do whatever they say. Schedule a meeting with this person for every two weeks, so you don't fall behind. Ask if there is a tutor.
Think about how you learn best. For example, if you are visual, look on You Tube, where there are dozens of pharm videos ranging from simple to high level. Become a time management expert. Use every spare moment to study pharm. For example, write key points on index cards immediately after lecture. Carry them with you and review them when in line at the bank, etc. Or go over the Power Points out loud while taping your voice, then listen to them while driving to school.
I worked full-time and went to school full time with kids in first and third grade (would not do it again--it was too hard on my kids). I used to go to bed with then at 8:30, then got up at 4AM to study on the day of tests. Hard, but possible.
Ask your family to agree to do laundry for you and clean your house in place of Christmas and birthday gifts.
Calculate out for your husband how much money you will make over 40 years as an RN (It will come out to about $2 million bucks) and talk about what that would mean for your lives. Then ask him to make a list of tangible things he will do to help you have time to study and to get there.
This is doable, but the more organized you are and the more help you line up, the better.
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