Making yourself better

JNcCole15~

Certifications: CEN and CPEN ... they make you study!

Classes: ENPC, TNCC, and numerous continuing education courses from documentation to active shooter, trauma etc... Free webinars are available if you are an ENA member. You can earn contact hours and up your knowledge.

Conferences: Attending an ENA conference opens your eyes to best practices, new ideas etc. ENA offers some partial scholarships to attend. An application process occurs usually in the first part of the year. Check out ENA Homepage

Teaching/Precepting: Whether teaching formally or informally, at a staff meeting or skills day, students teach me what I know, what I don't know, and how I can be better. To know content is one thing but to explain it is another.

Chart Review: Whether it's real-time review or retrospective, chart review is a valuable tool for learning.

Conversation: Sharing cases and learning/teaching points with colleagues. Discussions with EMS providers (some can teach you a ton) are invaluable too! Asking a physician to take a pause for a "teaching moment".

Reading: Reading emergency nursing journals, case studies, reviewing diagnoses that I saw that day at work etc.

Cross-training: Time in ICU made me a much more confident ER nurse and significantly improved my critical care skills.

Ask questions, ask questions, ask questions. There is a start at least....

This is great! We have to keep up with so much! Reading is a great way to stay current with medicine. My hospital started doing IV Lidocaine for kidney stone pain relief. They are trying their best to provide alternatives to narcotics. This is the first time I, as well as seasoned nurses, have heard of this. I've did some research, it is interesting.

I love working in a teaching hospital. Doctors (residents and attendings) go out of their way to teach. No question goes unanswered!

Great info, thank you!

I've been able to do a lot of self improvement through reading academic journals found on databases like EBSCO, pubmed, etc.

I have a special set of notes where I jot down everyday things that I see, and then research it extensively when I get home. For example, the other day I was researching the sodium bicarbonate that I had pushed earlier that day in a code. Through the online databases, I was able to not only learn about sodium bicarbonate, but lactic acid buildup in trauma/sepsis patients, the correlation between lactate levels and mortality (all pts with a lactate over >2.5 mM should be closely monitored for signs of deterioration as their chances of mortality is much higher), the transformation of the lactic acid/bicarb combination to carbonic acid, then CO2 which is expelled from the lungs (which is why great ventilation is critical in CPR, otherwise the CO2 from the lactic acid and bicarb you just gave cannot exit the lungs adequately and the acidosis can get worse) metabolic acidosis, why acidosis is so harmful (acidosis inhibits the response of the CV system to catecholamines), associated hyperkalemia, rebound alkalosis, cerebral hemorrhage and paradoxical CNS acidosis. These are all concepts that I was able to learn from deciding to research the bicarb I had pushed earlier that day.

I take those concepts I just learned, and go on more tangents. Why does acidosis happen in trauma/sepsis/cardiac insufficiency/cardiac arrest patients? (anaerobic glycolysis) And then it was down that rabbit hole. I found a sentence in one of the abstracts about how as the patient gets more acidotic, they become more hyperkalemic. Then it was off on that tangent. Why does that happen? What are the effects of it? How do we treat it in an emergency? etc etc

My favorite preceptor was the one who taught me to study like this. He suggested that I start studying like this right off the bat, and to constantly be asking "why." The more I do it, the more I find that so much of what we are exposed to in the ER can be traced back to a complicated, but clear, interwoven web. You just have to know your pathologies, and dig in deep. Learning this way was personally more helpful than when I was studying the material for the CEN exam. When I was studying the material, I found that I was approaching it on a superficial level. The deeper I try to understand things, the more sense it makes. And then it almost becomes intuitive so that when presented with a case in the ER, I'm able to navigate it a little easier than before. It's not foolproof, as some of the tangents aren't particularly helpful, and I still have a lot to learn, but it's made me so much more comfortable.

This is great! You learn so much more when you start to ask "why" and "how"

Awesome tip!