Latest Comments by cnmbfa

Latest Comments by cnmbfa

cnmbfa 3,975 Views

Joined Jan 14, '06. Posts: 156 (58% Liked) Likes: 388

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  • 2
    AliNajaCat and KindaBack like this.

    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.

  • 2
    JrRnNycole and mamagui like this.

    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.

  • 1
    loriangel14 likes this.

    Quote from pmabraham
    Since almost all nursing programs require you to have mastered and remember your prerequisites (nursing is not like other degrees where you take a course and can forget it), looking for the fastest, easiest can lead you down the path of failure when your RN instructor expects you to remember what you learned in microbiology, sociology, etc. at the mastery level (i.e. no faking it or partial answers).
    This is 100% correct. You may not want to hear this, but here goes: There is no easy, fast, simple way to gain the knowledge you need to be a nurse. Nursing requires a high level of knowledge and skill, and a lot of hard work and dedication. If that doesn't appeal to you, go into something less critical.

    Think of it this way: Would you want your child to be cared for by nurse with a superficial level of knowledge of A&P? And don't you WANT to have a high level of knowledge? If so, then why are you looking for "the easiest and shortest program"?

    And have you considered these two things: If the program is easy, might that handicap you when you get to NCLEX? And, local hospitals DO know and take into consideration the reputation of various schools when they hire nurses. Same is true for any reputable grad school. Don't you want to graduate from a well-respected program?

  • 2

    Quote from pmabraham
    Since almost all nursing programs require you to have mastered and remember your prerequisites (nursing is not like other degrees where you take a course and can forget it), looking for the fastest, easiest can lead you down the path of failure when your RN instructor expects you to remember what you learned in microbiology, sociology, etc. at the mastery level (i.e. no faking it or partial answers).

    Thank you.
    This is 100% correct. You may not want to hear this, but here goes: There is no easy, fast, simple way to gain the knowledge you need to be a nurse. Nursing requires a high level of knowledge and skill, and a lot of hard work and dedication. If that doesn't appeal to you, go into something less critical.

    Think of it this way: Would you want your child to be cared for by nurse with a superficial level of knowledge of A&P? And don't you WANT to have a high level of knowledge? If so, then why are you looking for "the easiest and shortest program"?

    And have you considered these two things: If the program is easy, might that handicap you when you get to NCLEX? And, local hospitals DO know and take into consideration the reputation of various schools when they hire nurses. Same is true for any reputable grad school. Don't you want to graduate from a well-respected program?

  • 1
    PatMac10,RN likes this.

    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.

  • 1
    In CNM
    AspiringNurseMW likes this.

    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.

  • 3

    When I was in undergrad, I HATED them because others used it to get a free ride off my good work. I had much better experiences in grad school probably because everyone there was a serious student, contributed ideas, and did their share--so there is hope.

    Fast forward to now--I am the faculty, and for a variety of reasons, sometimes need to put people in groups. I know full well that the problem of freeloaders still exists, along with the type A control freaks. I have an idea I may try out this fall: I plan to ask who hates group projects and why and then put them all in the same group!

    My thoughts are that this would mean that I could create a group with no freeloaders, or one made up entirely of persons who like to get things done early (or made up of procrastinators). That way, the good students will not feel put upon, and the free loaders might not be able to get by on other's work.

    Do you think this might work?

  • 1
    cafeaulait likes this.

    Quote from futurepsychrn
    Did it not annoy you that you were being treated like a child? I need a break from the instructors, classmates, and hospital to clear my mind.
    Bring your lunch, eat quick and go browse in the gift shop for 10 minutes. They often have cute stuff, so leave your credit cards at home.

  • 4
    smileyanh, LockportRN, kidsmom002, and 1 other like this.

    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.

  • 1
    canoehead likes this.

    Quote from nursingjudgment
    Hey everyone,
    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.
    Along with cutting way back on the apologies, maybe try this: Just say "OK." so they know you heard them. Then just don't say anything more. If they push you, say "I need a minute to take this in and think about it." Refuse to let that person get your goat. Then go back later and say "I admire you and would one day like to be as good as you. When you have time can you share with me how you would handle ______."

    I did this once with someone who was trying to grind me down--it worked like a charm, and he went out of his way to start mentoring me.Reply

  • 1
    CHRISTOPHERSDAD likes this.

    Quote from nursingaround1
    Strange, but of the hundreds of girls I've referred to the gynaecologist (I work in schools now) they all, every single one of them, only agree to go if it's a female gynaecologist
    Also - the male nurse needs a chaperone anyway, so why not let the woman do it.
    nursingaround1

    This is an excellent example of confirmation bias. You see this as inappropriate and as a sexually tinged issue, so you look all around you and latch onto every little bit of anecdotal evidence that confirms your idea. As a previous poster noted, when you are caring for patients, you are a nurse first and a male second.

    By the way, use of a chaperone during exams is not universal, and if there is a chaperone, she may be a clerk, CNA, etc. and not be able to do it for you. And, it's simply not fair to your nurse colleague shift work to them.

  • 2
    bagladyrn and Here.I.Stand like this.

    Aspiring NMW

    Nurse and midwife bleed into one another. I know this as someone who has been both an L&D nurse, a Mom-baby nurse, and a CNM in practice for 10 years. Nursing skills are foundational to midwifery, which builds on the knowledge, skills, values, ethics, ability to communicate, assess, problem-solve, evaluate, and more learned through nursing education and practice at the bedside. Please do not undervalue or discount this, or view nursing education as just something you have to endure to get to the good stuff, being a midwife.

    Maybe you did not mean to come across as you did, but I sure hope you do not and will not look down on the RNs you will need to work with and rely on. Maybe the persons who stay RNs don't want to responsibility or crazy hours, are sick of going to school, etc. Maybe they like relating to patients one-to-one in L&D or helping to launch new families on Mom-Baby. It is that often RN who is at the bedside helping that woman through her labor for hours before you come in. Many of them know as much or more than some CNMs, and may some day pull YOUR feet out of a fire. They have a deep understanding of labor, of FHts, and more, so show listen to the, value them, and show them some respect.

  • 1
    Kitiger likes this.

    Quote from beccalynn175
    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.
    My bad--I mixed things up. Both of the two of them handled themselves poorly in their exchange. I am, however, concerned about cynicism being too quick to see idealism and new grad enthusiasm as bad.

    Sorry for getting lost and messing up.

  • 0

    Quote from chiromed0
    Geez, if failure is what it took to stop me I would have never left the womb. I have proven that true so many times in my life I just don't accept failure as anything more than just another step to getting something done. That's the goal; just get it done even if it ain't pretty.
    I love your attitude. And just think--you never once blamed anyone else, or said "The instructor is picking on me."

  • 10

    I am bothered by the "the school doesn't adequately prepare students" comment. It may be true, but don't you think that maybe you can work around that by doing everything you can to prepare? I for one would never go into a new situation without first doing everything I could to prepare myself. You may have to just take in on yourself to prepare.

    And, if they are not meeting your needs, why don't you transfer to another program?

    Lots of students have graduated after failing clinical. However, that will only happen IF you do a thorough, honest, full appraisal of why you failed. Start by non-defensively asking for specifics about why you failed. Then address every single thing. do not expect to be taught or spoon fed. Watch videos and then go to the lab and practice assessments and skills until you have then down, then ask the the lab staff to watch you and give you feedback. Practice doing a health history on a family member. Videotape it, then watch yourself and figure out how to communicate better.

    Yes, I have failed people. Some were for not doing things I directed them to do. If I tell you once that you need to walk your postop patient or reassess pain, I know you learned about it and should know why it matters, don't even think of skipping it again.

    I will warn you and then fail you if you give a med without knowing what it is or what you need to assess for before and monitor after giving it; this is a two strikes and you're out issue.

    I will warn you if you fail to follow the five rights; for this one, it is a 3 strikes and your out issue.

    I will consider failing you if you lie to me even once.

    I will definitely fail you if you make up vital signs or other data.

    I will fail you for being a no call, no show, or for being late 3 times in one quarter.

    I will warn you and then fail you if you repeatedly are rude to anyone (including peers) or endanger patients.

    The hospital will kick you out if you violate HIPAA or if you use a cell phone in clinical areas.

    I will fail you if you obtain inaccurate vital signs or have poor assessment skills or other skills and ignore me when I tell you to go and remediate in the lab.

    If you have poor communications skills or ignore patient needs, I will roleplay with you, but if you don't improve over the next two clinicals, you may fail.

    I will ask questions to assure you prepped. If you cannot answer common questions about your patient's meds, patho, labs, plan of care, I will warn you and then fail you if it happens a third time.

    I would consider failing you if you hide from me or leave the unit without anyone knowing where you are.

    I will look poorly on anyone who is highly defensive, makes excuses for everything, and has little to no insight into their own contribution to not doing well. If I see no effort to improve, you will fail.

    I have failed someone for repeatedly not turning multiple things in on time, especailly after we renegotiated deadlines and she still did not keep them. Made faculty who had grading deadlines to meet crazy.

    This one is hardest to spell out: I will fail you if you don't seem to "get it" as evidenced by showing higher levels of being able to function and think over the course of the clinical. The bottom line is that if you cannot handle these patients, can you handle the next ones, who are often sicker and require higher level skills? If I see that you are struggling early on, I will take you aside and share my thoughts, we will develop an improvement plan jointly. If you don't carry it out, you get to live with the consequences.

    Reading this, I sound like a real meanie. I am not--my students see me as deeply caring and as very much interested in their success. However, I simply will not unleash dishonest, uncaring, unreliable corner cutters who lack a conscious or any insight onto the public.

    You do have another chance. Instead of thinking ahead to the preceptorship, focus on being awesome in the next clinical. Ask the instructor every single week for feedback. Ask specifically "What are my weaknesses? What can I do to get better?" That will go a long way toward ensuring your success.


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