Latest Comments by cnmbfa

cnmbfa 4,362 Views

Joined Jan 14, '06. Posts: 159 (58% Liked) Likes: 390

Sorted By Last Comment (Max 500)
  • 2
    OrganizedChaos and Irish_Mist like this.

    Superb explanation. Thanks for making it clear that nursing is about THINKING and using information, in context, to address patient problems.

    Memorizing will only get you so far. To excel at Pharm, you must understand the drug and then think through the implications of that.

  • 0

    Absolutely NOT. They probably do not have enough time to address all the new content.

    Why didn't you consider that you were going to need to KNOW anatomy and physiology and USE it in your future courses and practice? Are you one of those folks who think that nurses don't need to know things at a deep level because the doctor will rescue them somehow? How realistic are you about what it takes to be a competent, thinking nurse who can make good clinical decisions?

    Get out the books and start relearning everything you should have NOW. If you struggle in the first few weeks, drop the course and use the time to reteach yourself.

    Learn a lesson from this: classes build on one another. Don't ever do a superficial job of learning (just enough to pass a test) in any of them ever again.

  • 0

    Wash your hands a LOT (before and after every patient contact, before and after lunch, eating, etc.) and avoid touching your nose/mouth when at work. Get a sign made for sign-in that tells all patients with cough/sneeze, etc. to cough into their sleeve. Use a paper towel to touch door knobs, etc. Have some cleaning wipes to wipe down keyboards, phones, etc. at start of day. Think about things sick patients or other personnel who don't wash hands touch, and use hand gel after touching them (shared thermometer, scale, clipboard, etc.) Use 1-2 pens that you wipe down and that never leave in your pocket, not ones used by others. Eat a healthy diet.

    May be happening because you are in a smaller space (exam room with closed door, less air flow) compared to larger patient room. In hospital, you had probably 4-5 patients per shift. If exposed to 20-25 people per day. of whom 16 have an infection, odds are against you unless you have a huge awareness of what spreads them, what surfaces, objects, etc. are likeliest sources, how to reduce # of pathogens that make it into your body.

    Here is an example: If you use hand gel, and then open door room, you may as well not have bothered. Instead, open door, leave it open a few inches, stick you head in and say "Mr. ___, I'll be with you in a minute." then clean hands and enter the room.

    Get your employer to put wall mounted gel dispensers outside of very room, or have a bottle in every single room, including your charting areas. Get someone assigned to wipe down on buttons, computer keyboards, door touchpads, shared equipment, etc. every day with disinfectant. Make the case that they will recover the cost if it means that each employee is sick two less days per year. (AND I am sure there is an OSHA rule requiring this that they may be breaking.)

    Good luck with this.

  • 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.


close