StudentNurse2011 3,741 Views
Joined: Apr 2, '10;
Posts: 89 (62% Liked)
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I depend on my brain sheet too, but it helps to only concentrate on the abnormals. If a pt has a CBC and CMP, I don't waste brain cells worrying about a WNL CBC when I have a K+ of 2.9. The exception to this is lab values or VS that I need to know before medicating a pt. If I'm giving a pt dig or cardiac drugs, I make a mental note of their pulse and/or BP. If the pt gets warfarin, I make a mental note of their INR. I don't consciously remember or ignore any facts; my brain just seems to automatically weed out the information I don't need.
It comes with practice. Don't sweat it; at first, just write down everything you think you'll need to remember. In time, you'll find that you remembered without looking at your brain. When I first started as an RN, I was amazed at how much information everybody could remember. My head spun even when writing everything down. Now it's just second nature. You'll get there too.
Thank you for this article; the story, writing, and emotions were beautiful. Yes, it brought tears to my eyes as well.
I've had a patient for the past two days that is going downhill very quickly. I was with her yesterday when the MD told her there was nothing more we could do for her. She's a precious lady - very gracious and ready to rest. I spent as much time as I could with her yesterday. I held her hand while the doctor broke the news to her, and we hugged frequently throughout the day. We celebrated her life together, and yes, we cried together.
Typically, I consider tears to be the highest expression of weakness, but I've learned that sometimes it takes strength to cry. Suppressing emotions is a way to protect ourselves from having to feel them. It takes strength to allow our vulnerabilities to show - and yes, sometimes our humanity. As difficult as yesterday was for me, I wouldn't change a thing. The patient was still alive when I left last night, but I've wondered about her all day today. She declined so quickly - right in front of my eyes. Being a nurse means being a professional, but sometimes it also means being human. Most of the time a patient's needs are physical, but sometimes they're emotional or spiritual. I believe it's our duty to be there emotionally and spiritually as well as physically, and I believe that's what nursing is all about.
Godspeed, sweet lady. I hope I touched your life just a fraction as much as you've touched mine.
When your child, as a preschooler, gets into an argument with another preschooler about how babies are born. My daughter was convinced they're all born by C-section. Yeah, that was a pleasant conversation with another mother's child. LOL
When the same child, now entering kindergarten, gets into an argument with her teacher. The teacher pointed to the child's knee and asked what that's called. Daughter promptly answered, "That's my patella." Teacher marked her wrong. Daughter got mad and tearfully asked me to tell the teacher that it really IS a patella. The teacher sweetly explained that she meant the knee....daughter angrily told her that if that's what she wanted, she shouldn't have pointed at the BONE. LOL
Same kid....about 9 years old. Spouted the 12 cranial nerves and whether they're motor, sensory, or both to a doctor - then didn't even bother smirking when the doctor's jaw dropped open. She also told him some of the different types of tissues that I can't even remember now. I believe one was non-keratinized stratified....something....lol and the other was pseudostratified columnar something. We had mnemonics for them - one was No KiSSeS and the other was PCCE.
Same kid in middle school - she and her friend were at a drama club performance when the other girl slammed a door on her toe. Daughter calmly helped her to the dressing room, elevated her foot and gently removed her shoe and sock, and delegated other kids to make an impromptu ice pack. She sent another kid to get her friend's parents out of the audience. Turned out the friend's toe was broken, and daughter gave pretty good first aide - for a 10 year old. LOL
My husband isn't a nurse, but he still knows better than to pull a stunt like that. LOL He gets front row center seats to my frequent rants about what I'd love to do to the inventor of the call light if I ever got the opportunity.
I have to brag on my husband; he's a restaurant cook who works 2nd shift. He cooks all afternoon and evening, but on the days that I work, he still comes home and cooks dinner or brings dinner home from the restaurant. He knows that I'll be wiped out after my shift, so he doesn't expect me to do anything after work. Bless his sweet heart, I'm sure the last thing he wants to do is to come home and cook more, but he takes care of me.
Call bells are even worse at my hospital because we recently installed a phone system that's tied to the call bells. When a pt hits their call light, it calls the RN. Even worse, just answering the call doesn't turn off the call bell; we have to physically go to the room and shut it off there. Of course, 99% of the calls could be handled by the aide. I entertain myself with thoughts of all the ways I could heap torture on the inventor (and buyers lol) of this system if I ever came face to face with them - and could get away with it.
I'd probably get their phone number from my caller ID and call them in the middle of the night the next time I worked night shift. LOL But I'm just mean like that.
I have always HATED that 1100am call...."We thought we would let you sleep.....but could you?????" Just burns me up.
If I called you 3 hours after you went to bed "WOULD I WAKE YOU??????" (that felt good)
NOBODY at work has my cell phone number, and I never answer the landline phone if it's from the hospital. I listen to the voice mail after they hang up. I am not on call for this hospital, and I refuse to be treated as such.
If you only have a cell phone, you could always assign a special ring tone for your supervisor. My choice would be "Dirty Deeds Done Dirt Cheap." LOL When you hear that ring tone, you know to ignore the call - without even having to look at the caller ID.
Lab coat - never. Warm-up jacket, maybe but doubtful. I'm too hot-natured anyway. I burn up just wearing regular scrubs and doing my job. If I wore anything extra, I'd positively melt. LOL
I wear cargo style scrub pants - the more pockets, the better, and scrub tops with at least 2 pockets at the hem. More pockets are good, but I can deal with just 2. I *like* a breast pocket for my pen, but it's not a must. I've been known to clip my pen to the neckline of my scrub top so I don't lose it in the multitude of "junk" I have in my pockets.
Honestly, at this point, if I were you, I'd put all the books, study guides, websites, and anything else NCLEX related away. Take some time to relax, and don't even allow yourself to THINK about anything NCLEX related. Do something fun with the kids, your family or friends......SOMEthing - ANYTHING to forget about the test.
Somebody else already gave you great NCLEX test tips, but I have a couple more to offer. Remember that everything on the NCLEX happens in this fictional NCLEX hospital where it's never short-staffed, every supply imaginable is always at your fingertips, and everything is just perfect. (In other words, you aren't in Kansas anymore, Dorothy! LOL)
Ignore the clock and just concentrate on the one question in front of you at that very moment. Read the questions and all answers before you answer. Make sure you know exactly what they're really asking, and don't add to the scenario.
One of the best tips my professors gave us was never second guess yourself. If you put an answer, do not go back and change it. Trust your first instincts - unless you know for an absolute FACT that the first answer is wrong.
Oh, and there's a really easy way to get a pretty close estimate of heart rate from EKG readings. 300-150-100-75-60. Find an R wave on the line of a big box, and count the "big lines" until the next R wave. If there's only one big box between the R waves, the rate is 300. If there are 2 big boxes between the R waves, the rate is 150, and so on. If you can find 2 successive R waves that are both on a "big line," the count will be more accurate. Even if you can't find 2 successive R waves on a big line, it'll still give you a rough estimate of the rate.
Relax, and good luck!
Ugh, RC, I feel for you. This is one of the (many) reasons I can't wait to finish my year of med-surg and get back to the procedure room.
Here's what our hospital does: We have rounding sheets that go in every patient room. During day shift, there's a place to time, initial, and note the reason for pt. contact on an hourly basis. It looks something like this: SN 0745 VS. Either the RN or the PCT can sign it, depending on who was in the room. Frequently, there are blocks signed both by the PCT and myself. It's a total PITA because it does take a little time every time you walk in the room, but you can prove that the patient was indeed cared for every hour. It might be toileting, pain control, assessment, meds, repositioning, pt. sleeping, to cath lab, or whatever, but somebody was in that room every hour. At night, instead of every hour, it's every two hours.
Maybe it would be a good idea for you to suggest something like that to your nurse manager. It's a proactive solution that you can offer her. Of course, as somebody else also mentioned, your charting already covers your....you know....but it never hurts to be able to show the family a piece of paper that everybody has signed - every hour - proving that we were in the room. Our NM knows that we're in and out of the rooms all the time, but it's nice to have proof in writing. The fact that the paper hangs in the room a full 24 hours for the family to see doesn't hurt either.
One more thing - please allow me to offer my sincere appreciation for all of you who spend your careers in bedside nursing. I couldn't do it. I simply don't have the personality or patience for it. I am in AWE of all of you who work every day in a basically thankless environment in which the patients and families consider you little more than waitresses who pass meds - and always with a smile on your faces. I saw a quote today from a nursing-based Facebook page that said, "Save one life and you're a hero. Save a hundred lives, and you're a nurse."
I think we've worked for the same NM.
I remember interviewing with a previous boss. Thought she would be AMAZING to work for. Now I'm pretty sure that she's the spawn of Satan. With amazing skills at making a giant turd look like a sparkly diamond.
I go to work for the sheer joy of helping people. OK, now that I can breathe again after that laughing spell, honestly, I go to work to pay the bills. Once in a great while, I have an exceptional patient who realizes that I really went above and beyond the call of duty to help them (like yesterday), and they tell me how much they appreciate the extra effort. THAT's what really makes the job worthwhile.
LOL Yup! That's why I said "safe." ;-) Only nurses can appreciate the humor (and truth) in "Asystole is a stable rhythm."
Another thing I learned as a nurse is that everyone has a different definition of the word "emergency." I used to tell my family not to call me at work unless it's an emergency, then I went on to remind them that an emergency means something is on fire or somebody isn't breathing. lol My favorite quote: "Lack of planning on your part does not constitute an emergency on my part." My daughter used to have a bad habit of making impromptu plans with her friends, then expecting me to drop everything to accommodate those plans.
To be honest, pretty much everything we learn in nursing can be applied to life. Assess, diagnose, plan, implement, reevaluate. Always prioritize and be willing to delegate when necessary. Those steps have kept me out of hot water more times than I can count. And the ability to detect a lie; never tell a nurse a lie and expect to get away with it. We can smell lies from a mile away. We should be able to; we've heard them all at least a few hundred times.
Reminds me of a nursing bumper sticker, "Asystole is a stable rhythm."
Chaos in nursing? Nah. LOL In six short months, I have learned to ignore almost anything that can be safely ignored. The single most important lesson that I've learned is that I'm one person. I can only do so much at any given time. As long as everybody's breathing and has a relatively safe rhythm on the tele monitor, it's all good. I learned to stop focusing on the infinite number of minute details that threaten to derail my day. As long as everybody's still breathing when I leave my shift and the boss isn't up my rear end, I call it a good day.
Now, I'm still a new grad/new nurse. Some days overwhelm the h*** out of me. (Today was one of those days. lol) I think the most important lesson that I've learned is to laugh about it after it's over. Yep, today kicked a$$, but we won out in the end. The day is over, we're all home in our nice, comfy jammies, and most of us are probably already well on our ways to being 3 sheets to the wind (or already passed out in bed lol). It was a tough day, but in the end, WE WON! Sometimes survival through sheer stubbornness is all we can do. Thank goodness sheer stubbornness was one of the traits that I brought with me when I started this crazy career! It does come in handy sometimes.
When I've had an ungodly crazy shift - 12+ hours of being called away from the task at hand every few minutes, I come home, let the dogs out and feed them, then sit on the couch...in total darkness and silence....with a cat in my lap purring his fool head off and one dog on either side of me. Works every time. It's impossible to be stressed with a purring cat on your lap.
I also like to go to the beach to unwind - alone - and get out in the water where there's nobody else around. It's just awesome to be totally alone where nobody knows your name and even more importantly, nobody knows you're a nurse. LOL Anonymity is the best!
Something else to think about - what is your plan of focus for your Master's Degree? If the discounted school only offers an educational or management focus but you want to be a clinical NP, that will also affect your decision. One school that a local hospital pays 100% of the fees only offers a few options. Yes, their program is an accredited NP/MSN program, but it only offers education, leadership, and informatics.
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