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jjjoy LPN

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Content by jjjoy

  1. Your explanations make a lot sense. Thanks! : )
  2. jjjoy

    Good Thinking Workshop

    I'd call it "test-taking strategies" or "prep for nursing exams" as opposed to "good thinking." In my experience, "good thinking" (or real critical thinking) sometimes seemed to make it *more* difficult to choose the "best" answer. Nursing test questions can be worded oddly, so easily misinterpretted, especially if you "over-think" it. And even worse, in my opinion, there are those questions where NONE of the answers is really accurate and you're supposed to choose the "best" from the selection of not-quite-right choices... as if that's totally objective. So having any kind of prep for these test questions before going into the first test will probably be a good thing. : )
  3. jjjoy

    Not Enough Clinical Experience

    i think we do mostly agree! : ) since i am personally much stronger in analysis than in application, i just tend to find the advice "oh, you'll pick that up in no time; don't worry about it!" frustrating. especially when faced so often by the expectations of colleagues and employers that one *should* already know this and have done that. it's not my experience to hear "oh, of course you wouldn't know that/have done that yet!" more like an exasperated huff and "what are they teaching in schools these days" comment. since i'm not a quick study in regard to *feeling* competent in psychomotor skills, i tend to feel threatened by implications that i may not be meeting expectations. here are these experienced nurses who seem to expect that i should have more comfort and familiarity with a whole plethora of skills, and i not only haven't done a couple of them, but i've only done one or two of them, once or twice, ever... am i supposed to stay in that position in good faith when i know that it will take another six months to a year to really have the skills to fill my job role? that during that time, my colleagues will be burdened by my lack of experience and not only be burdened by it, but huff every time until i do finally get up to speed... i know, i need a thicker skin. : ) yes, a working nurse is likely to get this kind of experience within their first six months to a year. but i think it's a shame and a bit backwards for the newbie to have to not get that kind of experience until after they have the license and have been hired into a position that is really for someone who *already* has that kind of experience. the first six months, the newbie isn't only learning the specific job they are doing, they may be getting their first real exposure to . if nursing school only ensures that graduates are *ready to learn* to practice nursing, as opposed to *ready to practice* nursing, then a formal transition step between nursing school graduate and ready-to-hire rn would seem to be necessary - like residency for physicians. i do see the many dilemmas with that model. i just also see many dilemmas with the current system. i don't think there are any easy answers, especially when one must factor in limited resources.
  4. jjjoy

    Not Enough Clinical Experience

    I agree that a unit secretary job, depending on the facility and exact job description, could be *very* useful for someone going into nursing. It's not hands on clinical care, but the exposure to the floor routine, calls to and from physicians and other departments, and familiarity with meds and dosages if doing order entry could really be priceless.
  5. jjjoy

    Not Enough Clinical Experience

    heck, by that logic, why be so impressed with just about any skill or service out there? the majority of services provided in the world can be done by anyone with enough practice, can't they? much of the intense competition to get into nursing school, medical school, law school etc has more to do with not enough teaching resources or strategic limits of entry to the field, not a lack of qualified applicants. a couple of psych and soc courses could bring any lay person up to speed with the psych/soc aspect of rn education. most any life science major will have taken more science courses than that required by most nursing programs. i came to my nursing program with a strong background in psych, soc, life science in general and human biology specifically so i didn't get much more out of the nursing program in those aspects. clinical exposure? that's definitely a benefit of a nursing program, but my bsn program had just 5 measely weeks (2 days/week) in each different clinical setting. it was a great introduction to the spectrum of nursing care but by no means prepared us to actually take on full rn responsibilities in those arenas. yes, nursing is *more* than just psychomotor skills, but let's not diminish the value of such psychomotor skills. anyone can learn to change the motor oil on their car, just like anyone can learn to insert a foley or start an iv. but i'd expect a *professional* mechanic to bring to their work the experience of already having changed oil on many different cars, to have more than just a barely passing exposure to the variations in oil change procedures on the most common cars out there, and to recognize problems that may otherwise have gone unnoticed. and as a licensed nurse myself, i had hoped to bring more of this type of competence in basic psychomotor nursing skills in most common situations - not everything and not in every situation, but more rather than less. but as a student in my program, we had few opportunities as students to do much of anything besides pass oral meds and take unrealistically long and involved health histories and physical assessments.
  6. jjjoy

    Not Enough Clinical Experience

    It's frustrating enough to get minimal quality intensive clinical experience as a student; it irritates me even more when given the assurance "no one expects you to be able to do all that" and "don't worry, they'll teach you" but at least half the time, colleagues and supervisors of new grads toss out "you've never done what?!" "how did you graduate?!" "you're not picking this up fast enough" (within just a few days or weeks). I'm sure it's different everywhere but that doesn't seem an unsual experience - unfortunately! What to do about it? Be persistent, and more persistent, during clinicals to get as much exposure and practice as possible. You may have to be just this side of obnoxious to really maximize your experience. "Round" on each other's patients as students so that you can see as much as possible. Even if you aren't *doing" as much as you'd like, assessment is a big part of nursing and the more you see first hand (eg various symptomatology, wounds, skin conditions, etc) the more you have to draw upon in the future. Presenting on each other's patients is also a good way to help nail down meds, diagnostics, lab values, etc ... stuff that may not be directly tested on in NCLEX-style tests but that will be useful to draw upon in future practice. I'm sure you see a lot as PCT and asst, but I know when I was working as a PCT, I was so busy with my job responsibilities that I had little time to find out anything beyond what I needed to know as a PCT; so student clinical time for me was best used focusing on issues beyond basic care. I'm very grateful for my nsg asst experience as I never would've learned so many 'tricks-of-the-trade' or gotten as comfortable with basic patient care just on student clinical time.
  7. jjjoy

    Why are Nursing Programs so Cruel to Students

    Get the frustration of it off your chest and then get going to do whatever it is you need to do to finish this thing despite the obstacles - which is what you are probably doing anyway. Why do some schools seem so unsupportive? We can speculate and speculate - I still have questions about my program from years ago - but there's not going to be a satisfactory answer to your question and you've still got to jump through the hoops. As far as the weather and driving, maybe there are some creative possibilities? Just because you're an adult with a husband and college-age kids doesn't mean crashing at a friend or classmates place now and again is definitely out of the question (though there may be other reasons it wouldn't work). Getting a motel room closer to the school on bad weather nights might cost $40-50 a night, but that's a lot less than an accident would be. If you could avoid driving home at all some days, you'd be saving the gas money. There may be reasons that wouldn't work and all the creativity in the world may not resolve anything. If you keep plugging along, though and don't have too much bad luck weather-wise, you can get past this and not have to worry about that again. Be safe, of course. If you did end up having to fail due to missing/being late from avoiding dangerous roads, it would really be horribly frustrating but would still be better than ending up in a horrible accident, injuring yourself and/or others. It sounds like you've already shown that you're willing to do what it takes. Keep it up and you'll succeed one way or another!
  8. If you won't be able to pick up extra shifts right away, maybe you can come up with some other potentially-income producing activities for your days off? How about child care for neighbor/friends' children? You get to spend time with your child and make a little money at the same time. Many moms would much rather leave their kids with another mom than a teenager and may be willing to pay a decent amount. Hit some yard sales then sell on E-bay? If you cook regularly, you could multiply the servings and offer pre-made meals for other busy moms/professionals who don't have time.
  9. jjjoy

    Why are Nursing Programs so Cruel to Students

    My school was certainly quick to put a person on warning to fail status for what could seem to be very minor, easily correctable issues or contestable borderline grades (such as the example the OP gave) and make it sound as if the student had committed some inexcusable error that indicated they were horribly inadequate/ irresponsible/etc (even though there were plenty of other possibly fail-worthy mistakes that were never addressed so punatively). But with the dire warning, they did usually offer one more chance to "prove oneself" and if the next hurdle was passed, then the student was back in good standing - though never totally secure that some other small something might land them out of the program without any more "second chances". Looking back, my conspiracy theory tendences wonder if it was almost part of the curriculum for every student, not matter how strong academically or clinically, to experience the threat of being failed from the program at some point in their time as a student. So our program had the threat that anyone might fail at any time but the actual fail rate was relatively low.
  10. It sounds like you've had more exposure to 'real' nursing than many, even those with family in the field. It sounds like you've been right on the front line already and probably have a much better idea of the realities than most at your stage of the game. Your motivation and inspiration goes well beyond the reasons "I always wanted to be a nurse" and even "my mom was a nurse for 40 years." Hopefully, you can feel more reassured about your plans!
  11. Volunteering can definitely be a benefit. I wouldn't discourage it at all. I'd still strongly recommend CNA training and hands on patient care as an aide if that's a reasonable option. That would allow *much* more exposure and experience than volunteering in most situations as volunteers are often *very* limited in patient contact. My experience was predominantly filling water pitchers and restocking gloves in pt rooms. Whereas as a nursing assistant I learned many 'tricks of the trade' in basic patient care - bathing, linen changes, transfer assistance, the art of bedpan placement and removal - which can help ease the transition to professional nursing because you can free up more time and energy if you've got those basics down. As an aide, I also had to learn to work with time and resource limitations - AM care complete for all assigned pts before pts start being whisked away for PT, scans, etc? And work with both great and grumpy nurses. As a volunteer, I could more easily avoid grumpy nurses and take my time to "do things right" - when that can be much more of a challenge when on the clock for 8-12 hours with work that at times seems to require 14-16 hours to complete. Again, best wishes on your journey!!!
  12. It certainly can be disheartening. Can you get some first hand exposure to real-life nursing, such as working as a nursing assistant in a hospital? Even better if you can float as a CNA to see different units as they can be very different depending on type of patient and the personality make up of the staff. Have you asked about shadowing a bedside nurse for a couple of hours? (some places won't allow this, but others will so ask, ask and ask again at different places with different people). Getting this kind of exposure before starting nursing school can only help if you continue on, or may give you insight into another direction. It might help you feel more sure of your choice to be in the midst of the working environment that so many nurses do complain about... see how it looks and feels to you. I'm suggesting bedside/hospital nursing because that's where the bulk of demand for nurses is as well as the type of foundational work experience that makes many nurses so valuable (the license itself is barely a start, several years experience actual experience as a nurse in a an acute care setting is highly valuable even when looking beyond the bedside eventually). Nurses are involved in many different roles. However, non-nurses can also be responsible for many functions that nurses do and have done over the years... such as breastfeeding consultant, community health education, respiratory therapy, some kinds of medical case management, surgical scrubbing, etc. So if there's a particular aspect of health care that appeals to you, there may be other pathways there. So "what do you want to *do*" is an important question, not just "what do you want to *be*". May you find peace in your heart about whatever you do!!
  13. jjjoy

    Time to call a duck a duck?

    Interesting perspective. To me it comes back to what *is* nursing care. As you note nursemike many nurses do something besides bedside care... are those other roles also providing nursing care? Is an "infection control nurse" practicing infection control nursing? Or practicing infection control as it relates to the provision of nursing care? Is an LTC DON practicing nursing in that role? Or are they practicing administration as it relates to the provision of nursing care? Uh-oh! Tangent on an already endlessly long thread!!!
  14. ..... what more can I say than 'duh!' ? .....
  15. jjjoy

    considering nursing, part-time, nontraditional roles?

    Best wishes to you as map out a plan! It sounds like you will work something out! You say you've been in MT, maybe also look into other areas in Health Information Management. Working with information can sometimes better allow for working around bad days than working in a hands-on clinical capacity. Much of the opportunity and flexibility in nursing comes from one's experience working as a nurse, as opposed to just having the license. The skills and knowledge required by those opportunities often come from specific work experience, not just nursing school. New grads are often strongly recommended to work a few years full time in an acute care setting to build the skills and experience for which nurses are valued. Nursing school really only introduces you to nursing and gives you the license to *start* practice. Strong assessment skills, clinical judgement, prioritization, working with physicians - these can only be developed with more time and experience and exposure than nursing school alone provides. There are roles for nurses that do not require acute care experience, but just be aware that not having solid acute care work experience does *limit* the scope of flexibility and opportunity for which nursing is known.
  16. jjjoy

    Major in nursing and minoring in Psychology?

    In many US universities, one doesn't just "major in"nursing, they enter the "nursing program" which is a very structured series of nursing courses and clinical experiences that each cohort of a very limited number of nursing students moves through together. If you fail a class or clinical, you generally are out of the program altogether immediately and you may have to apply for a spot in the next year's cohort and/or hope for someone to drop from the next year's class so that you can fill their spot. Courses and clinicals generally are at pre-set, non-negotiable times (eg Lecture MWF 8-12, clinical Tues Thur 7a-3p, skills lab MW 2-4) which can make taking other coursework rather difficult just logistically, even if you weren't overwhelmed by the workload. There is lots of required reading and projects that take a lot of time *outside* of class and clinical time as well. At my uni, you'd be pre-nursing the first two years (taking gen ed, pre-req sciences) and then apply for the nursing program for junior year. The nursing program was then two years. If a pre-nursing major didn't get into one of the just 50 yearly spots, they'd either just have to wait a year and apply again or switch to a non-nursing major. Many majors, on the other hand, don't have such strict limits on the admission of students in the major or classes. My uni's BSN program did count many psych courses as elective credit towards the nursing degree - courses such as developmental psych & abnormal psych. So you still may be able to get some extra psych under your belt as a straight BSN student. There are lots of different majors that focus on how the body works. You can major in anatomy, physiology, psychobiology, human biology (or some variation therein) and learn about the body. Nursing school level science courses are not as in depth as the courses for other science majors. Nursing school is about gaining the foundation and qualifications to be able to start working as an RN after graduation. Some say the "real learning" starts then. Just food for thought!
  17. Guilty as charged!
  18. ADPIE is a problem solving process that works very well without the D. This particular format of problem solving works well for nursing. It also works for problem-solving in many other areas as well. Assess, Plan, Implement, Evaluate. To assess is to identify the problem that needs addressing. Heck, I'd argue that the diagnostic process is *part* of the *assessment process* If an initial assessment identifies the problem to be addressed, then go straight to planning. If the initial assessment doesn't provide enough to plan an intervention, then one detours through the diagnostic process as part of the assessment step. Assessment? chest pain Plan? it depends on if the cause of the chest pain can be determined Diagnostic detour: consider possible etiologies and run tests = further assessment Assessment? ECG shows ST-elevations = Diagnosis: myocardial infarction Plan? (continue planning based on assessment) Assessment? chest pain, ST-elevations ND? altered tissue perfusion, cardiac r/t impaired transport of oxygen and interruption of blood flow aeb chest pain, ST-elevations Plan? (plan based upon the ND - which includes all relevant assessment information within the 'diagnosis')
  19. I kinda felt this way. It's not that more information wasn't in the official curriculum, but there was That is, somewhere in the thousands of pages of reading surely was lots of useful information. But a good percentage of that reading wasn't useful (ad nauseum repetition of basic nursing interventions - therapeutic listening, turn-cough-deep-breath, etc). And the rest of it, well, who had time to do more than skim the readings when more intensive reading only made test performance worse (d/t 'overthinking') and so much time needed to be spent on care plans (ad nauseam repition of basic nursing interventions) and other projects? So the nursing school could claim to have 'taught' so much info on all variety of conditions (see it was in the curriculum-week 3, chapters 12-20) wheres what was actually learned could be a whole other story.
  20. Thanks for sharing! (and enjoy your 6 weeks!) Thing is, what is the difference between 'diagnosing' diarrhea and nausea and simply having made the observation of diarrhea and nausea? It sounds to me like the nursing care plan book with it's comprehensive list of possible interventions is what helped, not a 'nursing diagnosis'. With or without 'nursing diagnoses', a nurse or physician or dietician or worried mother can identify chronic diarrhea and nausea as a problem and research possible etiologies, diagnostic tools (such as a dietary holiday), interventions, etc. Page 1 of the US Dept of Health and Human Services - National Digestive Diseases Information Clearinghouse notes celiac disease as a possible cause of diarrhea.http://digestive.niddk.nih.gov/ddiseases/pubs/diarrhea/
  21. msn10- question here... can you specifically identify which ND helped in this case and how it helped lead to an answer? I just reviewed a list of NANDA approved ND and I'm not seeing how NDs would help further the search for an answer.
  22. I appeciate the exchange msn10 and hope I'm not coming across as snarky either. My perception is that most people find NDs to actually HINDER communication between health care providers. If one nurse tells another nurse that this patient has impaired mobility r/t loss of limb & weakness, they'd probably have to follow it up with a translation as well as other relevant info - pt has a right BKA due to diabetes, is weak & needs assistance getting OOB. So I don't see ND assisting with communication there. Does it help students? The concept that nurses need to consider mobility issues is important. But I think students can easily learn that concept without the awkward wording of ND. If a student can't figure out that mobility MIGHT be an issue in a pt with a BKA, then ND aren't going help, are they? And I know I'm not the only who found ND MORE confusing than helpful. In general ND as I was taught them seem circular. The student/nurse recognizes mobility might be an issue for the BKA pt. The student/nurse does an assessment. They see that the pt is weak and unsteady. They determine that the pt should have assistance getting OOB. Where exactly does formally hanging the label of "impaired mobility" add any value? I see that the issue of mobility directs the nurse's assessment - a young pt in for a nose job may not get such an intense mobility assessment from the nurse as an elderly BKA pt. If a patient needs assistance OOB because of BKA and weakness, tagging on the ND "impaired mobility" in no way further clarifies things.
  23. Again, what about the fact that the use of the term 'diagnosis' in ND only further muddies the water? A cancer pt undergoing chemo has thrown up after eating several times. ND: Altered nutrition (or pot'l for). How did we 'reach that conclusion'? If someone is having trouble keeping food down then they aren't taking in as much nutrition as they would otherwise. Brilliant! 1+1 = 2 is not the diagnostic process. Pt had a hip replacement yesterday. ND: Impaired mobility. Is there any possible way someone with a hip replacement yesterday would NOT have impaired mobility? Pt is having loose stool. ND: Diarrhea. Assessment = diagnosis. Yes, there are extenuating concerns r/t to the problems, but it still confuses matters to me to use the label 'diagnosis'. A pt with impaired mobility may also be likely to be a fall risk. How does one determine that? By doing an assessment and pulling upon one's knowledge of the particular mobility impairment, not by using the diagnostic process. A pt with diarrhea may be at risk for fluid volume deficit. How does one determine that? *Any* pt with diarrhea may be at risk for fluid volume deficit. Who is more at risk? An assessment would give valuable in addition to knowledge of the pt's known medical conditions. No use of the diagnostic process there.
  24. First off, thanks for the interesting & civil dialogue! Lots of food for thought! Are you suggesting, though, that nurses would have been more likely to figure out the cause of the illness? Are you suggesting that "the nursing process" (and the DO process, presumably?) is more likely to yield an answer than "the medical diagnostic process"? If so, when those few holistic MDs incorporate a more holistic approach into their assessment & diagnostic process, are they then applying the nursing process (or DO process) ? I don't think so. I'd argue that the nursing process (in the broadest defintion) *is* a holistic health care assessment that drives a plan of care (APIE). Teachers also must do holistic assessments of their students, considering home conditions, psychological issues, etc in order to fully address their students' needs. Ideally physicians would do holistic assessments. The medical diagnostic process is simply the diagnostic process applied to health conditions. The diagnostic process is also utilized by mechanics attempting to determine why the engine "is making a funny noise." This is where ND fail. There is no diagnostic process in determining ND. To me, diagnosing is attempting to determine why something is different. Why is the pt experiencing chest pain? Maybe it's cardiac ischemia. Maybe it's indigestion. ND seems more like a translation of the subjective and objective *assessment* data. Assessment: pt can't dress self (dressing self is self care and the patient has a deficit) = self care deficit. How is that a "diagnosis"? Maybe just getting rid of the word "diagnosis" in ND would help matters - a formal *typology* of nursing considerations DOES make sense to me. To ensure nurses are covering all bases, they can make sure that they address all of the typologies relevant to their area of practice - self care, fluid/volume balance, nutrition, etc. Hmm... what to call it? Calling this categorization a nursing diagnosis, just seems to confuse things - at least for me - and apparently my instructors - and many other nurses!