Content That Joe V Likes

Content That Joe V Likes

Joe V (49,381 Views) Admin

If you made it this far--thanks for visiting. My name is Joe. I'm's Information Architect. I'm the tech behind the scene. I'm in charge of everything that makes tick. Isn't she a beauty! I consider myself to be extremely fortunate, because I love what I do.

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  • Feb 8

    Congenital heart defects are America's #1 birth defect. Some of the conditions include atrial septal defects, Tetralogy of Fallot, hypoplastic left heart syndrome, transposition of the great vessels, and ventricular septal defects.

    Christy Sillman was born in 1980 with Tetralogy of Fallot with pulmonary atresia. Doctors told her parents she would likely only live a few days. Luckily a trial drug and a shunt helped her to survive.

    Childhood was filled with many more treatments and surgeries. She admits to being a “terrible patient!” Around age 18, her pediatric cardiologist told her she was “cured” and wouldn’t need to see a cardiologist again.

    For the next ten years she moved on with her life. She went on to become a health educator, graduated from nursing school and got married. When she got pregnant, additional problems resurfaced. She developed arrhythmias during her second trimester. She delivered a healthy baby boy, but soon after it was found that she had developed postpartum cardiomyopathy. Fortunately, treatment was successful.

    Christy has worked as a nurse in both inpatient and outpatient settings, with children and adults. She applies her experiences to the nursing care she provides and is an advocate for patients with congenital heart defects. Christy’s frustration with being told that she was “cured” moved her to become an advocate for patients with CHD. She blogs for the Adult Congenital Heart Association on a wide range of topics including nutrition, working with insurance companies, medications, finding balance, life as a heart Mom and her trip to Washington, D.C. to be part of Congenital Heart Advocacy Day.

    In her blog post entitled “Heart Shaped awareness”, she wrote about what she wants others to know.

    I want them to be aware of how common CHD is. One in 110 babies are born with some form of CHD; that’s a high rate of occurrence. This isn’t a rare disease.I want them to understand that it can be a “silent” disease. That even though I look “normal” I face challenges every day that others don’t. It’s a condition I always carry with me, even if I don’t always garner attention about it.
    She continues with...
    I want them to understand that it’s not a cookie cutter disease. Every person with CHD has a unique set of issues and has faced many different types of procedures. I want them to know that even though I’ve had “corrective surgery” my heart will never be repaired or “normal.” Once you cut into a heart it is forever changed. I want them to understand that CHD is still considered a pediatric disease by many in the medical community, but since the development of successful treatments, there are now more adults with CHD than children, and our needs are unique within the context of aging and adult life events. Despite this shift in the CHD population, most research continues to focus on the pediatric patient with CHD.
    Today, Christy is the nurse coordinator for the Adult Congenital Heart Program at Stanford. The medical director of the program had this to say about her.

    My patients tell me that they love talking to Christy because not only is she an exceptional nurse, but she gets it,” said George Lui, MD, medical director of the program and clinical assistant professor of cardiovascular medicine and pediatric cardiology at the Stanford University School of Medicine. “They’re excited to speak with someone who has been through it firsthand. Not many programs have this kind of asset.
    Christy’s advocacy efforts also involve being involved in a group called the “zipper sisters”. They have a page on Facebook and for CHD awareness week, the group is featured in a touching video on youtube.

    Can you help Christy spread awareness?

    Patients born with congenital heart disease need lifelong specialized care. As Christy says, “Once you cut through the heart it’s never the same. It always needs to be cared for.”


    Adult Congenital Heart Program

    How a Terrible Patient became a Dedicated Nurse

  • Feb 8

    Our directors are very fond of saying "evidenced based practice" when telling us what to hourly rounding, bedside report, safety huddles, etc. etc. I usually have no problem with any of this. I'm a "go with the flow" type of person.

    Next up is a mandatory report sheet we have to use to give bedside report, in the SBAR format. Again, I'll go with the flow and I helped create one for our floor and sent it for approval (but they lost it and it's not saved..doh). A director was talking to our unit about it, siting "we're modeling ourselves after the airline industry that greatly improved safety over the years. Hospitals have the worst safety record of all industries. Evidences shows lack of communication is one of the things that cause mistakes and evidence shows this SBAR report will help with that."

    Me: "I have one word to say: ratios. Evidence based practice over and over shows this improves safety and outcomes".

    They want it, great customer service scores, high profit, but don't address the one elephant in the room.

  • Feb 5

    My ten tips for dealing with pre-nursing classes (as I have experienced it.)

    1. Shoot high Early. My first semester back I took all math, and science. it was an experiment for me to see if I was even capable of the work. I shot for a 4.0 at midterm I had it, and ended up with two bs instead of my 4.0. I came down with a lung abscess, and could have died. If I hadn't worked so hard early on I would not have passed, much less done well enough to justify the money I spent.

    2. Results not excuses. Excuses won't get you through pre-nursing I have plenty. Clinical depression, Chron's disease, and I had an 11cm lung abscess. Then I heard a story about a man with cancer, who would go to chemo, and still go to nursing school. That man earned his right for a seat in nursing school, and it was his right to attend. I lamented my fate, but I learned some people walked harder roads than me, so it was a wake up call for me.

    3. Wake up calls. I bombed my first quiz in statistics 36% I spent the entire week studying, and got a 96% on the exam. Take your wake up calls early, and let it give you a sense of urgency. We all make mistakes, work to rectify them early before they snowball.

    4. If you are in a hole start climbing. I started back with a 2.55 cumulative. Its at 3.235 its still not very competitive. I could blame my crohn's disease, but it won't get me into nursing school. You know what might graduating with my associate studies science with a 3.5 which is what I have the opportunity to do.

    5. 4 Brings me to my next point, Look at each semester as an opportunity. Every semester brings the opportunity to improve yourself. My GPA is steadily climbing each semester, and I love the ride.

    6. Remember why you are taking these classes I am a tutor, so I see this all the time when I tutor, and I imagine its the same with nursing school. They are trying to groom you for the rigors of the next class, and in turn your education is trying to groom you for whatever you are going for. So remember why you are learning what you are learning, its not busy work, its so you have a chance at achieving a level of educational, and professional success that takes years of work.

    7. Get ahead early. Its so much easier on you if you get ahead early, you can relax, and get 8 hours of sleep instead of cramming. So if you have the opportunity to do something a week in advance do it.

    8. Take a CNA course. I know a lot of people turn their noses up at this one, and its not really necessary. However My CNA course taught me a basis for many classes to come, and critical thinking skills that I would need to succeed in classes like anatomy. Also before you drop 60 grand on your education a CNA course will give you a taste of what its like to care for a person who cannot care for themselves, and its a great way to make excellent contacts with professors who can teach you amazing things about the medical field, and students who also have similar goals and stories.

    9. Enjoy the ride. Remember you have a goal, but try to enjoy each semester of material it makes it so much easier when you don't fear going to class to learn each day. Try to develop a mindset "todays going to be a good one." You might be surprised how good your day is.

    10. Gauge yourself early, and adjust. If you are struggling with something that is going to be on a test, be aware of it, and prepare accordingly. I was very diligent in learning nomenclature in chemistry because it was something I struggled with. So I paid extra attention in class when it came up, and I am seeing tutors to review the material. Identify your strengths don't neglect them, but focus extra time on your weaknesses. I hope this helps I apply to nursing programs this fall wish me luck! I have been at pre-nursing about a year. P.S. Apply to multiple schools!!! Nursing is competitive so apply to as many schools as you are eligible within your area. I will be applying to over half a dozen in the fall.

  • Feb 5

    Hey guys, I was in the same boat as a lot of you with this test. It's very hard and sometimes seems unfair. It's crazy to think how a "minimum competency" test can make you feel like you learned nothing from nursing school. However don't give up. As the title stated, I failed 4 times, before passing the 5th time. This is how my tests went, and what I did to finally pass.

    My first attempt, I scoffed and thought it was over-hyped. On attempt number 2, I was way more prepared, but not quite there. Then on attempts 3-5, I racked my brain, going for all 265 questions on all 3. However, after 4 failed attempts, I got news that I passed on January 28th, 2016.

    Now, on to how I actually passed this thing. The study materials I used included, The Hurst Online content review, The PDA book by LaCharity, and oddly enough the NCLEX mastery app on my iPhone. Now, all of these items themselves will cost you about $400 give or take, but they WILL help.

    How I used them was a little bit of my own study plan. First, I completely read the PDA book and did all the questions in it. Then I would do questions any time I had a free minute on my phone with the NCLEX mastery app. Then I did the videos with the content course for Hurst, then I read through it twice the 2 weeks leading up to my test. And while reading, I would do some questions after I read a chapter or two.

    Now, as I said I found out I passed and this is how I tested. I took everything that I learned from other resources like Kaplan's decision and threw it out the window. It was too much to remember. I have a 2 year old and am used to noise, so I studied with noise. During the test I put on my noise cancelling head phones and found myself lost in my own head, so I removed them and personally feel like I could concentrate better that way. Don't dwell on the last question, answer it and move on.

    Lastly, please don't get discouraged or give up. You made it thru school and you can make it thru this test. Keep pushing and working hard, it will pay off. Don't let people saying that your chances of passing after the first attempt fall drastically bother you. That's a load of crap. You didn't learn how blood flow throughout the body and heart worked the first time you read it, but after 2 or 3 times you had the idea. This test is just a stepping stone to your career as a nurse. Keep studying and working hard. If your religious my motto may help you, "study hard, pray harder." It will help. IF you have questions please ask in this post or feel free to send me a message. If I passed the NCLEX, you can too. Good luck and all the best guys!!!

  • Feb 5

    I have read a couple of posts lately where people are complaining about people farting breaking wind, passing gas etc...

    What exactly is the big deal? The average person farts 14 to 20 times a day and if you say you don't fart you're either lying or you are an alien species.

    Yes it can be gross and smell bad but it's like poop it just happens sometimes.


  • Feb 5

    Hi all,

    I have worked in a Level II NICU for about 2.5 years. I absolutely love my job. Luckily, our babies are mostly stable so deaths are few and far between, but I knew I wouldn't be spared forever.

    A few nights ago we had a baby born with a very low chance of survival. This little boy only lived for a very peaceful couple of hours as his parents didn't want any extreme measures taken. Because we were so incredibly busy, as NICU charge I was the only person available to perform bereavement care. After he passed I completed his photographs and his foot prints and plates, as well as all the paperwork and getting things settled with his parents.

    I have to say, I handled it so much better than I thought I would. Of course, there were tears, but I feel like I was composed when it was most important. There is something so intimate about providing this care. I feel honored to have been such a big part in helping this family grieve and being able to provide them with tokens of their son's memory. It was devastating, yet in a way, it was beautiful.

    I just wanted to share my feelings on the experience for any new or prospective NICU nurses worried about this aspect of working with sick newborns. It is so different than I anticipated. I do realize this was much different than a code situation, however, I will no longer be fearful of the actual postmortem and bereavement care. I imagine this is similar to the feeling that draws people to work in hospice. I understand the beauty in it now, which is something I never thought I would say.

  • Feb 5

    When people at allnurses get upset with others, and they can't think of anything else to say, they say "I would never want you as my nurse! ".

    Can't we just all get along?

  • Feb 5

    Over the course of my nursing career I have heard endless spiels about "customer service" and "patient satisfaction" and the importance of these two things. What no one really explained was how I fit into that equation or what the ramifications of those scores meant to the organization or me personally. With that in mind, I am going to address those things now for all of you.

    First, let's define customer service. In healthcare it seems to be this vague, arbitrary term that is interpreted to mean whatever makes the patient happy. Let's be clear on what we're talking about and not taking about here. The phrase "customer service" is an umbrella term that refers to how a person or entity (healthcare facility, professional association, business, individual practitioner) treats the people they serve. By "serve" I mean tending to those who come to us for help, advice, medical care. The phrase "customer service" is not "waiting on people" like a waitress in a restaurant. Nor does it imply that those we serve must be called "customers" rather than "patients." It's the concept not the terminology that matters. The phrase is universal.

    I frequently hear things like, "I just want to come to work and do my job" or "I am a nurse not a waitress" or my personal favorite, "Employee satisfaction is going to decrease if I am expected to worry about patient satisfaction." Let's be honest ... nursing is an educational degree that equipped all of us with a certain set of clinical skills and knowledge however, in today's healthcare world, having the degree and skills isn't enough. Healthcare is a customer service industry. Granted, we are a highly educated customer service provider but we still provide a service. Today, being a good nurse also includes being able to provide good customer service. Treating patients and families with courtesy and respect, empowering patients to participate in their decision making, making them feel safe and cared for, providing them with information…all of those skills are part of what used to be called "bedside manner." That was a basic nursing skill because most people went into nursing with the desire to help people.

    I've heard nurses say that we do these things "only" for patient satisfaction scores. Of course the scores are tool to measure how well patients perceive their overall care and hospital experience. A patient's perception does play a role in his/her care because we all know that the happier, safer, and more cared for patients feel, the better their recovery; the fewer times they hit the call button; the less inclined they are to initiate a law suit; and the more inclined they are to have good feelings about the facility and it's staff overall. These things are all important to any nurse because it impacts our livelihood. It impacts our livelihood!! I will explain how that happens...

    Healthcare reimbursement is decreasing and costs are going up. We can save money on supplies and try to find other cost savings measures, but that will not close the gap. Payroll is around 65% of a healthcare organization's operating budget. With healthcare reimbursement being tied to performance on patient satisfaction scores, of course it will have an impact on payroll and your paycheck. Many organizations have had to freeze wages, decrease educational support, or reduce benefits. Raises cannot be given if there is a decreasing amount of money coming in to the organization.

    Every employee is responsible for their piece of "patient satisfaction." Nursing is the single largest work force in the organization and the closest to the patient. We can have a large impact on our patient's perceptions of their care here. That is how you personally fit into this equation and how the organization's reimbursement ultimately affects you personally. Like it or not, the care you give, the attitudes you display, the interactions you have with patients and families have an impact on the scores…the financial health of the organization, and ultimately on your own paycheck.

    It's a give/take relationship. It may be one you are not fully invested in or believe you should have to participate in. Perhaps you are feeling like you shouldn't be held accountable for those patient satisfaction scores. I challenge you to find a nursing job anywhere where you are not held accountable. Coming to work to "just do your job" now includes doing a great job with customer service. It does not mean you are a highly educated waitress. It does not mean that you are going to make every encounter positive at the detriment of clinical outcomes. We are never going to make every person happy. It does mean that you need to come to work prepared to spend time with patients and their families communicating clearly and helping those patients and families feel empowered to participate in their care.

  • Feb 5

    Most people in the nursing community are at least somewhat knowledgeable about the stories behind the more popular historical figures of the profession. After all, instant name recognition occurs in the vast majority of nurses when the names Florence Nightingale, Dorothea Dix, Mary Eliza Mahoney, Linda Richards, Clara Barton, and Margaret Sanger are mentioned. We have all learned about these remarkable individuals and their achievements during the course of our nursing educations. These aforementioned women are arguably the pioneers of the nursing profession because, without their contributions, nursing might not have ever evolved into a profession in its own right.

    Nonetheless, many other wondrous nurses from yesteryear have faded into languid obscurity along with their stories and accomplishments. Susie King Taylor, the first African-American army nurse, is one notable historical figure whose story is rarely brought to light by modern day nursing textbooks. In the spirit of Black History Month, her story will be revived and she will be remembered for all the feats that she accomplished during her 64 years on earth.

    Susie King Taylor was born Susan Baker on August 6, 1848. She had been born into slavery in Liberty County, Georgia to parents Hagar and Raymond Baker, and was the oldest of nine children. In an era where formally educating slaves was vehemently against the law, her personal road to informal educational attainment began at age seven. It was during this time period that she started learning to read and write by way of attending a 'secret school' that was operated by a freed African-American female named Mrs. Woodhouse and her daughter, Mary Jane. She also received secret informal reading lessons from a white playmate named Katie O'Connor.

    At the age of 14, Baker and a number of other African-American people obtained their freedom by escaping to St. Simons Island, one of the Georgia Sea Islands. The year was 1862 and the U.S. was in the midst of the full-blown Civil War conflict. At that time, St. Simons Island was occupied by Union Army forces, and her advanced literacy skills had attracted the attention of several officers. After all, it was exceedingly uncommon for former slaves to be educated or even know how to read and write at a marginal level, but Baker was a resounding exception.

    She agreed to organize a rudimentary school upon the request of Commodore Louis M. Goldsborough, and thus, became the first African-American teacher at a freedmen's school in the state of Georgia. Baker taught basic literacy skills to 40 freed children and a handful of free adults. She taught at the school for approximately six months until the end of 1862, the time when St. Simons Island was evacuated. During her six months at the freedmen's school, she met and married Sgt. Edward King, a non-commissioned officer in the Port Royal encampment of the 1st South Carolina volunteers, which later changed its name to the 33rd U.S. Colored Troops subdivision.

    She followed her husband's regiment for three years, providing an assortment of services along the way. She taught Union soldiers how to read and write during their off-hours. She also served as a nurse, rendering care to wounded and dying soldiers and attending to injuries alongside camp doctors. Susie King made frequent visits to the first regimental hospital for black soldiers, located in Beaumont, South Carolina. It was at this hospital that she became acquainted with and worked alongside Clara Barton, the renowned founder of the Red Cross. King served as an army nurse until the Civil War ended in 1865.

    Her husband, Edward, died in 1866. After teaching freedmen in Georgia for several more years, she relocated to Boston with her two young children and eventually got remarried. She married a man named Russell L. Taylor in 1879 and, from this point forward, became known as Susie King Taylor. She spent her later years working as a domestic worker for a white Bostonian family before dying in relative obscurity in 1912.

    Susie King Taylor is one of the few African-American figures from the Civil War who captured her recollections in the written word. Her memoir, Reminiscences of My Life in Camp with the 33rd United States Colored Troops Late 1st S.C. Volunteers, tells the story of what is known about her life and experiences during wartime. Taylor's compassion for the sick, injured and wounded shine through her words. She writes, "It seems strange how our aversion to seeing suffering is overcome in war, --how we are able to see the most sickening sights, such as men with their limbs blown off and mangled by the deadly shells, without a shudder, and instead of turning away, how we hurry to assist in alleviating their pain . . . with feelings only of sympathy and pity" (Taylor, 1902).

    Taylor's accomplishments deserve to be highlighted since she lived a full life that involved unselfish service to others in the form of teaching and nursing. Inc. wishes to keep the spirit and memory of Susie King Taylor alive.


    Butchart, R.E. (2013). Susie King Taylor (1848-1912). New Georgia Encyclopedia. Retrieved from Susie King Taylor (1848-1912) | New Georgia Encyclopedia

    Malburne, M. (2004). Summary of Reminiscences of My Life in Camp with the 33rd United States Colored troops Late S.C. Volunteers. Retrieved from Summary of Reminiscences of My Life in Camp with the 33d United States Colored Troops Late 1st S. C. Volunteers

    Taylor, S.K. (1902). Reminiscences of My Life in Camp with the 33rd United States Colored troops Late S.C. Volunteers. Boston, MA: Susie King Taylor.

  • Feb 4

    I took the following sections:

    * Math
    * Reading comprehension
    * Vocabulary & general knowledge
    * Grammar
    * Anatomy & Physiology
    * Learning styles
    * Personality test

    Best test prep for the MATH section:

    The Elsevier HESI Admission Assesment Exam Review books--either the second or third edition. The two editions are nearly identical except that the third edition contains an algebra section and color drawings! Everything else is exactly the same.

    This is the best math prep because the problems in the books mirror the problems on the test. Practice, practice, practice! Complete all the practice problems after each section as well as the larger battery of math questions at the end of the book. Even if you think you know the basics, PRACTICE the problems because it's really easy to make a tiny mistake and submit the wrong answer. I scored 100% on the math section, and I believe that happened because I started studying about a month before my test date. I spent a little time (almost) every day with a couple of longer (1.5-2 hour) sessions thrown in on non-work days.

    Best test prep for the A&P section:

    Again, the Elsevier HESI books--either second or third edition--along with Cliffs Notes A&P and flash card/test sets on Quizlet. It's been four years since I took A&P I and II, so I knew I'd have to brush up. I scored a 90% on this section because I took time to review A&P terminology/vocabulary. Again, I gave myself about a month to prepare, increasing my study time in the week before the test. The "just the basics" format of the Cliffs guide and the repetition of the Quizlet sets helped a lot.

    I have seen several posts that complain about the Elsevier HESI books' A&P review. I actually found the books helpful because they gave me an idea of the types of questions asked on the actual test. I've noticed some posters are surprised when the review questions don't show up verbatim on the test. That shouldn't be the expectation, but you should expect the review to acquaint you with relevant question types. It's hard to describe this without giving specific examples from my test, but hopefully you know what I mean.

    Best review for reading comprehension / vocabulary / grammar:

    Once again, the Elsevier HESI review books. I recommend completing all practice questions--those at the end of each section as well as the ones at the end of the book(s). Also, make mental note of the "HESI Hint" boxes in each section--for some reason I found a lot of this information really helpful on the actual test. Ultimately, I knew these sections would be the easiest ones for me, so I spent far less time studying for them and kind of consolidated my preparation.

    Best review for personality test/learning styles:

    Knowing best how you learn, and whether you're introverted or extroverted--no studying required! There are no right or wrong answers on these sections, so just respond honestly and don't stress.

    General testing tips:

    1) Thoroughly read the directions before answering a question. Each section contains several different question types with different instructions that you should understand before selecting an answer.

    2) Use scratch paper for math problems to write out each step. Even though you don't get credit for showing your work, writing out each step prevents small errors and wrong answers! This method is also better than relying on "mental math" if you don't have to.

    3) Complete your "challenging" section first, when you're most alert. I felt better about tackling the remainder of the test once my hardest section was out of the way.

    I apologize for the epic length of this post, but I wanted to share my experience and emphasize that a little work beforehand pays off in the end. I don't recommend taking the HESI A2 cold because tiny mistakes can add up and cost you valuable points.

    Good luck to everyone who's taking the HESI A2.


  • Feb 3

    Dear Going to Nights,

    Congratulations on landing your first nursing job! So exciting and I hope you love it.

    Night Shift is Different... and it Takes Time

    Everyone is different as to how they respond to working nights and to an alternative sleep schedule. Sometimes it’s hard to know if you’re sleepy, dehydrated, or hungry, you just know you’re out of sorts. Give yourself time to adjust.

    I think it’s safe to say you will either love it or hate it. Or you may have a love-hate relationship. But either way, and while it’s a major adjustment, there are some distinct advantages to working night shift. One is higher pay, which is great, and adds up! Another is not having to get up at 0500, and some night shifters throw out their alarm clocks altogether.

    My hat is off to the night shifters- major props. They are a special group of nurses, and without them hospitals would be sunk.

    Night Shift

    Night shift is a completely different environment than day shift. There’s generally a closer sense of camaraderie among night shifters, which means support for you. It’s a great time to build strong connections and bond with co-workers. Some people believe night shifters are a more laid-back, fun group of folks.

    It’s not as chaotic. There are fewer interruptions, which makes it easier for you to concentrate. Fewer visitors, administrative-types, doctors. Diagnostic tests often wait until morning, so fewer “road trips”. No meals to serve.

    You have more time to spend with patients, and you have time to read the chart. You will learn so much by reading History and Physicals, progress notes, test results, labs. It really helps when you are learning to see the big picture.

    Early in your shift, check to see if you need anything from other departments that close for the night. Do you have a question for MRI about what time the procedure the next day will be, or the prep needed? Do you have all the meds you need for the whole shift, before most or all of the pharmacists go home? Do you need more tube feeding or flush bags from Nutrition or Materials Management? Call your doctors for any routine requests early, before they go to sleep, and check with your coworkers to see if they need that doctor as well at the same time.

    Two am to four am can be the witching hours when your body slows down the most. You may experience drowsiness, you may be cold (bring a sweater). You may even have trouble talking properly. Plan your tasks before this time or after this time. Walk around the unit, do some squats or lunges if able, walk a flight of stairs, go outside to get a bracing breath of fresh air to get the blood circulating.

    Many night shifters grab a quick nap during their thirty minute off the clock break, which can help tremendously. Set your phone alarm to wake you up and find out where there is an acceptable spot for you to do this. Night shift nurses have a risk of decreased vigilance on the job, which means you can make errors (Leman, 2012). Napping can help with alertness.


    Sleep disturbances and fatigue can affect mood, especially for those who have a pre-existing mood disorder. You may experience anxiety or depression. See your doctor if symptoms persist.


    It’s easy to overeat on nights because you are out of routine, eating/snacking keeps you awake, and there’s usually a lot of food available. You can also easily eat 4 meals (or more) a day- dinner with your family or at dinner time; meal break at work; morning breakfast; and lunch when you wake up.

    Stress hormones can make it easier to gain weight. Try bringing your food from home. The key is to make healthy choices before you hardwire the bad habits. Some people do well grazing, or eating frequent, light meals with fresh vegetables, fruits, dried fruit and nuts. What you eat has a major effect on your energy levels and performance. Stay hydrated.

    Sleeping Tips

    The quality of sleep is just as important as the quantity. A solid four hours of sleep may be better for you than a fragmented eight hours of sleep. You will need to find the sleeping pattern that works for you. Some nurses fall asleep immediately when they get home (that was me). No preamble, just strip scrubs off while walking from front door towards the bedroom and fall in bed. (Unfortunately only to wake up in a couple of hours because my bladder was on day schedule). Other nurses need to transition, wind down, read, or practice a relaxing bedtime ritual.

    Blackout curtains can be an excellent way to help trick you into staying asleep during the day. Sometimes the problem is falling asleep, and sometimes the problem is staying asleep. Uninterrupted sleep is better than trying to catch up on sleep, which rarely works.

    White noise (get an old fashioned box fan, not a silent fan) can be hypnotic, soothing and help drown out the neighbor’s mower. Earplugs and a sleep mask can help as well.
    Some people use Melatonin, an OTC sleeping aid, or Benadryl. Others use aromatherapy, such as lavender in a diffuser.

    Avoid alcohol and caffeinated beverages close to bedtime. Keep your room temperature even and comfortable- on the cool side, with air conditioning if needed in the summer.

    Family and Friends

    I can’t count the number of times I was sympathetically told by a well meaning person “Yes, I know just what it’s like to work nights. Once I had a job where I didn’t get off until eleven pm!!”

    Educate them, and tell friends and family you will be sleeping during the day and to not disturb you. Oddly, some people think nothing of calling you at 1400 (translate 0200). Turn your phone off if able. Post a sign on your front door saying “Day Sleeper” for UPS.

    You can feel isolated or out of step from friends and family and social events in general when you work nights. You have to plan a bit more to get together, and purpose to stay connected.

    Your Days Off

    Some night shift nurses sleep the same every day whether they work or not, to keep their body on a consistent schedule. That means staying awake all night at home on your night off, or shopping at Walmart at 0300. That never worked for me, but I have a hunch it’s healthier for your body. You will have to decide.

    Take a nap before you go back to work if you’ve been off. Sometimes the first night on, you operate on adrenaline and actually feel Ok. Then go home in the morning and sleep for as long as you can. Try taking a short nap again if you can before you go back into work.

    Your Safety

    Pull over immediately when driving home if you are sleepy. Tragic accidents have happened when fatigued healthcare workers drive home after a night shift. If you commute from out of town, consider getting a motel room for your stretch of nights on if feasible. If you drive, try talking (hands free) to someone on the way home, and try chewing gum.

    The National Sleep Foundation (NSF) says that if you find yourself turning the volume of the radio way up and opening the car window in an effort to combat sleepiness….you should immediately pull over. These tactics do not work effectively, and are a serious warning signal that you are too fatigued to drive.

    The NSF further says:
    “Cognitive impairment after approximately 18 hours awake is similar to that of someone with a blood alcohol content (BAC) of 0.05 percent. Cognitive impairment after 24 hours awake is equivalent to a blood alcohol content (BAC) of 0.10 percent, which is, higher than the legal limit in the U.S.”

    Please be safe, and I hope you enjoy your new job! What tips do you online night shifters have for a newbie?


    Nurse Beth


    Gaba, D. M., & Howard, S. K. (2002). Fatigue among clinicians and the safety of patients. New England Journal of Medicine, 347(16), 1249-1255.

    Lerman, S. E., Eskin, E., Flower, D. J., George, E. C., Gerson, B., Hartenbaum, N., ... & Moore-Ede, M. (2012). Fatigue risk management in the workplace. Journal of Occupational and Environmental Medicine, 54(2), 231-258.

    National Sleep Foundation accessed January, 2016

  • Feb 2

    I just started the 2 year ADN program at my community college about a week ago. I am actually the youngest in my program at 18, and I have no nursing experience. Before I started, I obsessed over blogs and spent a lot of nights wondering if I could even make it through nursing school. I graduated high school in the top 5% of my class with a good ACT score, and I'm generally a hard worker. I am just wondering, was nursing school as hard as you thought it would be and if so, why?

  • Feb 2

    I finally finished my RN-BSN program at WGU and I'm so happy! What a relief, I am such a procrastinator and I really put forth a lot of effort in this program. I love learning though, and I truly took a lot away from this school. Can't wait for graduation at Disney World next week!!

  • Feb 2

    I am aware of this being a touchy topic on AN, but my school has a nursing information session and within the session they state that nursing is more than just a steady income, it is a passion. You need to be passionate and able to set aside your problems to help somebody in "what could be the worst day of their life." Thoughts?

  • Jan 30

    Years ago when I worked in the micu of a midwestern university teaching hospital, I took care of a patient named dan. Dan's original problem is lost in the recesses of my memory. I honestly don't remember why he came to the hospital in the first place. He was a farmer; he may have had some sort of farming accident that got later led to an infection. For whatever reason, he'd been in the MICU for a couple of weeks. He was agitated and combative, always a joy, and he had an arterial line and a central line. Conversing with dan was always an unpleasant experience. He was an angry young man, upset about being in the hospital, about being in the ICU, about not getting enough drugs to "make it fun" and about life in general.

    Even his mother and his girlfriend seemed anxious to get out of his presence and were un[phased by the restrictive visiting hours we used to have in the icu. They seemed to visit more out of a sense of duty than from any genuine desire to be in his presence, and his girlfriend's visits seemed to taper off as his "incarceration" progressed. Then one night dan announced that he was going home.

    Like good little nurses, my friend karen and I (one of us was in charge and one of us was taking care of dan that night, but for the life of me I can't remember who did what) explained to him why he needed to be in the hospital, why he needed to be in the icu and the consequences of leaving. He didn't care. He wanted to go home. As he became increasingly adamant about going home, he became increasingly agitated and then combative. About the time he picked up the knife off his dinner tray and threatened to "cut off your tits", we called the "code grey" for security and restrained him. Restraints accompanied by a hefty dose of "the fun drugs" seemed to calm dan down considerably, and he drifted off to sleep. Satisfied that we had things under control, karen and I both breathed a heavy sigh of relief. It was late in the shift, neither of us had eaten. So we got out our lunches (this was a night shift and over a quarter century ago, so things were slightly different then) and sat down at the charting table next to the monitors to eat.

    Things were quiet, even in dan's room. He had a nice, steady ecg and art line waveforms, not a lot of artifact and from what we could see through the window into his room, he looked comfortable. We were all the way to the dessert course (fresh fruit) when dan's monitor started to alarm. I looked up to see an enormous amount of artifact on his monitor, and when we looked into his room we didn't see Dan.

    I met him in the doorway to his room. The central line was on the floor and there was blood oozing fairly briskly from the hole in his neck. But the interesting thing was his art line. He'd somehow disconnected it . . . Un-oh. He'd chewed the tubing apart and when he let go of it, blood spurted out the ragged end of the pressure tubing.

    This was in the early 1980s -- right about the time HIV and AIDS were coming to the forefront and everyone was worried about them. Including dan, it seems.

    "Stay back," he ordered, "or I'll spray you." to emphasize his point, he allowed the blood to spurt in our direction. No amount of reasoning seemed to reach him. And the blood continued to leak from his art line at an alarming rate. We called his doctor, who complained that he didn't know what we wanted him to do, and couldn't we just take care of it ourselves? "we are taking care of it ourselves, but the hospital requires a doctor's signature on our plan," Karen told him sweetly. "Right now the verbal orders says "do you know what time it is? This better be good! Why are you bothering me with this nonsense? Just take care of it yourselves." he rousted himself and was at the scene in very short order.

    Having recently read "house of god," I was familiar with "all bleeding stops eventually," and when Karen proposed calling security to rush him and tie him down, I wasn't enthusiastic about getting sprayed with possibly aids infected blood. Neither were the three security guards milling around our unit trying to remain inconspicuous. "let's just wait," the md said finally. "He'll stop bleeding sooner or later." so while Dan stood in his doorway yelling and threatening, we waited. When he started to get a little pale and shaky, we had already called the blood bank to make sure they had a current sample and to order several units of blood. And when dan passed out, we were ready!

    He woke up, once again restrained to the bed. We'd put in a new art line and central line and were transfusing blood. Strangely, his desire to leave to hospital had evaporated -- at least until he was fully transfused again and the md allowed us to start to taper "the fun drugs".