hissteps4u

"come on...the nclex is not that hard." your not being honest it is one of the most complicated tests in the nation next to medical md certification and lawyers state bar exams if a person gets that torn up just taking the test, how will they react with a patient emergency??" test anxiety and the ability to react with a cool calm and collected head in a medical emergency are vastly different things and you should recognize that. your being unfair. "sure it was stressful...a lot rides on the results. but nursing is as stressful if not more. and lives ride on the results of a nurse's actions/non-actions." yes lives do ride on a nurses abilities in conjunction with physicians abilities to recognize and diagnose problems, yet again this has little if nothing to do with test anxiety... snip: "take breaks if you have to. do the best you can do and relax." i sure don't know what you mean here??? no such things as taking a break during the exam which is timed in sections for two days??? no getting up and taking a break-- what third world test site did you attend? not in the usa... there are nurses in the world who really care for others and then there are nurses in the field who only care about themselves and the money they can make and some even have little mercy for others. as someone who has been in and around the field for along time they are easy to spot and even easier to read as they deal with others be they nurses or patients. yes patients rely upon us for care, yes it is an all important decision making process we go through as we determine what course of action and nursing measures to take based upon a diagnosis. i can write care plans off my head for almost any diagnosis---when i see others have to dig into a book to figure out what to do so what???? most nursing stations now even have care plan books by diagnosis to pull out and copy to make your life easier. i don't use them but again so what??? everyone is different and everyone needs to be seasoned and to gain practical experience. i bet you trembled like a vibrator the first time you ever felt a uterus to gage the effacement and presentation of an impending birth. i as a male nurse felt great anxiety as the dr in my clinical took my hand and guided it to understand the process in the poor woman who was only 2 centimeters at the time. she as a patient was a real trouper for allowing me to gain that experience so early in my training. have some compassion for others in their quest for this awesome field we work in. it is truly complicated. i have worked med surge, psy, long term, or, pulmonary, hospice. each has its challenges and its unique ways of doing certain things yet they are all tied together in a number of ways and the only comparable experience to that is to become a physician. this poor student has some issues to deal with no doubt about it but some positive feed back rather than a slap in the face would be a lot better than pouring salt in the wound and blaming them for the pain caused by it. the truth is there are folks like this poor person who have severe anxiety when it comes to test taking.... i use to be one of them. i would almost fold under the pressure of a test but in real life i was able to recall what i needed to do easily and the more i worked and gained knowledge in the real world the better off and more seasoned i became the easier it became and the more confident i became as well. i know nurses who have been around for years that can not even start an iv or do the math if they have to calculate and titrate a particular medication to exact orders much less figure out what a normal lab looks like and how to treat an abnormal one or when to stand up to a physician and fight for the rights of the patient much less simply keep up with the tons of paperwork we must do on a daily basis. every field has its nitch and particular ways of doing things. in every hospital across the land nurses make medication mistakes all the time usually because they are in to dam a hurry and do not follow protocols correctly. we read about it daily in the national news this poor student has some issues to resolve and to work through.... what is it nurses do by nature???? we nurture those around us, be they other students, patients, family and others as well. what makes a true professional in my mind is one who is level headed, understands the world around them, knows their place in it and one who seeks to be the best that they can be and one who is supportive of others in their quest to do the same. true enough they ought to take a step back for a short time to evaluate things yet the only way to be ready for the test is to study, cram and study some more no if's ands or butts about it. but some great relaxation techniques could help with such things and yes there are those who have to rely upon chemical's to get them through the day and life in general because they are so anxious about things. i hope such is not the case for this poor student and that they are able to see the light at the end of the tunnel and move forward and reach it and then the real story begins. all college is really about anyway is how to look up information, how to remember it and how and what to do with it once you have it. it boils down to a simple formula. it just takes some folks a little longer to get it than others. i remember correcting a student in front of a nursing instructor in class, he became indignant thinking that i embarrassed him on purpose.. it was not true i was trying to help yet he was one of those kind of folks who did not want others to help him in any way. sad but there are lots of premadona's in the world. they are a dime a dozen and i would trade 5 regular joe's or janes for any premadona any day of the week because i know that most of the regular folks are working and doing their dead level best to do a good job and do not mind peer review to help them to become better. the premadona thinks they already know it all and wont listen to another's advice... in all my years of school and college and education and life i have learned this... i don't know squat about a lot of things but i am willing to learn and know how to listen and know how to find out information and what to do with it once i have it. that's a pretty neat trick if i do say so myself for an old country boy from the south who failed in high school and was 30 before i ventured back to college and found my calling in nursing.

I feel for you. I took mine back in the days of the Dinosaurs but passed. I puked the whoe day before the event and all the next day knowing i had failed! I never saw so many medication questions in my life! LOL In all honesty it is a good thing to have high standards back in 1989 when I took mine it was no different. Drove several hundred miles to take it did not know a soul dared not look around for fear of a Monitor thinking I was cheating somehow and was a nervous wreck the whole time. My wife Hid the results of the test on me for mOnths and finally at Christmas she gave me a present in this huge box with another Box inside and so forth.... 4 boxs later I found this letter from the state Boards telling me I had passed the Exam. I was over whelmed thinking that I had just wasted all my time in school and was expecting a Failure notice form the state any time. Cliff Notes, buckly down for Months what ever it takes to gain the information, go back to previous instructors and fellow class mates who you may have a good relationship with, if it was me I would get all the books possiable, cram Cram Cram. Face facts if this is what you want to do you have to do something to give yourself an edge and the only real way to do that is to Pour over every Note taken, read every book possiable. move in with your folks if necessary to cram and Make it your JOB to Learn the information.. You must have an ideas of where your definicies are and focus on those areas diligently, have people test you with Mock exam questions of every concievable angle you can think of you really have no other choice... There is no Majic Bullit or pill you can take to help you to better recall the information.. Some people have performance Anxiety when it comes to tests and lets face it this is the test to end all tests... nothing harder than nursing except Legal and Med school... Buy self help tapes, work on your anxiety and above all dig for information talk about it make up test cards, buy test cards, learn the Meds backwards and forwards and cover everything possiable and every senerio possiable it is the only way to do it. Your fortunate you have the Option to take it again count your blessings.. Best of Luck :typing

lovely sentiment. what do you think of assisted living facilities having hospice patients and do not provide direct care services? who advertise hospice services but do not have staff to provide direct care or pain medications because they "are not trained to assess pain" or how to care for a bedridden patient. i live and work in the pacific northwest wont say where it makes no difference the concept and ideals are the same. i know a number of excellent al facilities who are not only capable but do an excellent job at helping their patients get the full range of services required depending upon their particular diagnosis. conversely i know many facilities who's only drive and ambition is numbers because numbers=$$$$$ this is particularly true in private pay facilities. while they are generally in a very beautiful location and have beautiful homes and amenities that is the facade and lurking beneath is the almighty dollar to pay off these homes. generally run by immigrant families as a business venture in this area anyway and it is a cash cow! it's just that simple in the industry. way to many folks are in it for the money and not for the care of patients. while it is a regulated industry the regulations are so lax and levels of competence between one facility and another can be daunting for families when they are out there seeking help for their family members and legally we are not allowed to steer a family in one direction or the other in hospice "comfort" is the focus, and how does one provide comfort when the care givers are not qualified to care for the patient and when family is not told this care will not be provided? it is true that some care givers are not really qualified to a degree or even trained adequately to handle the myriad of problems which can develop in hospice patients along the way. there are some very minimum qualifications in place for care givers. certification as cna/cma is in my view important yet even with that many who enter the field lack the compassion required for service in such a nitch industry. families are led to believe hospice is present 24/7 we know what constitutes eligibility in hospice for 24 hour or continuous care. if education is needed the hospice nurse provides it but it goes unheeded. 24/7 hospice facilities are few and far between. the real issue is education of the patients, their families and facilities as well. hospice organizations are everywhere with licensed nurses working all over with varying degrees of experience and expertise sad to say but as in my original post there are many nurses who are in hospice for the money and not the patients and do not have the personal communications skill set to be an effective hospice nurse. lets face it. i have stood toe to toe with a dr and argued that he could not force a patient to do tests if the patient stated they did not wish to do them. most nurses i know do not have the gumption to make such a stand for fear of their jobs yet as a hospice nurse who is first in the equation the physician or the patient? it is the patient always! conversely there are some dr's in the field who are ill suited for such work and they usually do not last long as hospice directors. i have seen them come and go as i have seen nurses come and go. it is hard work yet worthwhile work. hospice generally speaking is not a 24/7 constant contact yet they are available 24/7 for consults and problems as they arise. most patients get seen 2 times a week by a hospice nurse this is the norm and the frequency increases as the patient deteriorates and becomes worse and all this is natural.. what i fine more than not are going back over a nurses patients and what i fine disheartening are nurses who go for a visit sit for two hours looking through a chart and then spending no time at all with the patient in evaluation of their current condition or if they do not addressing with a sense of urgency the problems they may discover with that visit. sending a fax for instance for an urgent situation and letting it go at that is simply unacceptable. where is the sense of urgency, where is the call placed to the dr demanding they answer the problem at hand? yes dr's have a life yet as the primary caregivers they have a duty and responsibility to address the patients needs in a timely fashion and we as nurses have a responsibility to make sure that the answers and issues get addressed promptly which effect care and the well being of the patient the nurse is told by these assisted living facilities that they do not want the "patients" to be out of their rooms for fear of the "wrong image" for their facility. how wonderful caring and compassion would be but in reality the bottom line is the dollar. the al facility charges $8,000 a month for a room...when the person becomes debilitated or terminal rather than lose this income ( perhaps 6 months worth) the assisted living preys on these families to squeeze out another profit...and promises what they do not in reality provide. there are unscrupulous alf's around that's for sure. thats where a great ombudsman or case manager ought to be involved and giving the family some great advice. it is a money game unfortunately. when hospice becomes involved we assume control of meds and dme and bills related to the admitting diagnosis only>>>>> many folks think we pay for everything no matetr what and that is just not the case at all. if the patient for instance wants aggressive treatment for a cure then they are usually discharged from hospice that's not what hospice is nor what we do. hospice does not pay for aggressive treatment or for long term rehabilitative measure which are not palliative in nature or designed for relief of pain in adding comfort or control of the patient. some nurses fail at communicating properly to the patients families and patients what hospice is and how it functions. some do excellent jobs at it while others may simply gloss over the important points rather than go in-depth. a great hospice nurse will spend as much time as necessary to teach the patient and family and help them in the process and instruct them why we are there and what the ultimate outcome is and how we can help them in the process. if we as hospice nurses walk in the outcome is usually not in doubt. hospice has a ways to go and need to be careful when hireing staff for these jobs. times have changed and the industry is growing so fast it is hard to keep up and staff. companies need to be cautious when staffing and seeking qualified applicants. we can train most folks to do most any kind of job but you can not train out an attitude or behavior from someone and there are many who want to enter the field who may have great skills yet do not have the drive or energy required to follow through for their patients. 20 or more patients is not uncommon to have and staffing is always a problem it seems and more disturbing then that is watching nurses go from hospice organization to hospice organization and still as ineffective as they were in the first one yet because of the constant openings they are hired yet again to fill vacant positions and perpetuate the problems in the kinds of service which the patients deserve. one bad nurse can cause a company to stumble and fail and lack of action on the companies part to correct the problem can bring down a company and cause problems across the board.

Care for terminal patients is becoming a booming business as the Boomers come of age. Being one myself, I can tell you that Nursing care for these patients will only become more critical as shortages continue in the nursing field, even as new nursing schools ramp forward for the next big boom in our industry! I have a Pet Peeve though which really irks me. It's nurses who do not truly care for their patients. It's Nurses who perform their jobs with reckless abandonment. It is nurses who entered the field for the money and not for providing true Nursing care to patients. When we look back at Florence Nightingale and the inspiration which sprang forth from her and the drive to help others the Modern nursing method began to take hold and develop as she created and started the first school of Nursing. What is it hospice Nurses do? A Primary function is support! Familial support, patient support, physician support, facility support, logistics and planning, record keeping and followup and follow through with orders and basic nursing functions as we go about our Jobs taking care of patients. If there is one revolving theme among hospice organizations it is turnover! Not only patient turn over which is expected, but care giver turnover. There are of course many reasons for such turnover. Burnout is a key factor in this specific and very frustrating segment of the health care field. Lets face it our patients are going to die and there is nothing we can do to stop it! That is a hard thing to get use to for a Nurse I think. We spend a few years to a number of years in school to learn to care for people and to help facilitate the healing process and the real blunt truth is Non of our Patience will heal or get better save a miracle from God and they likely will die. I think some nurses enter this field because it is one of the fastest growing fields in health care along with the Money which is often the best in the industry for such a specific field as far as nurses go. One should be a well rounded nurse. Having cut their teeth in Med surge to gain basic skills and often many other specific fields within Nursing. Experience is a key factor in ones ability. I see such dynamic changes nowadays. I see nurses coming straight out of school with basic skill set entering this field because of the money and not because of the ability to effect change for the patience. Call me old fashion but patient care is an all encompassing field and requires a skill set with many different areas and is a dynamic field. Dealing with Terminal patience takes a certain type of person, male or female it takes what I like to call a caring soul. One who with empathy for the patient and with a self propelling drive to make their situation as comfortable and as easy as possible. Dying is not an easy process and some deal with it very differently. I believe in my heart the Nurse has to be an Jack of all trades. An advocate for the patient, the ability to stand up to the physician when they wish to do things which the patient does not want to have done. The ability to hold a hand, share a hug, hand out a kiss or two and to be a support to the patient, family and friends and also help them to gain knowledge of their rights and to help them do the things they can do and to be at ease as one can be with their impending death. In reality everyone wants to be cared for and to feel that they are in control of their situation as much as possible and our job is to facilitate that in every way possible. To make sure that they are as informed as they wish to be about their condition and to help them navigate the health care system and to receive the best possible care and to provide the best options possible giving their conditions and situations which may dictate. Nurses need to be careful that they do not simply walk and perform basic skills with out including their patients into the mix which a number do not. I have seen nurses walk in a room never say hello, never acknowledge the patient, simply sit read the chart begin to do things to the patient and never tell them what they are doing and forget that they are dealing with a Live person and not some Log. Nurses need to stop take a deep breath and to bring the patient into the conversation where possible and include them in everything they do. They need to seek the patients assistance and to help the patient to navigate the dying process if possible and to help them in every way possible. nursing is a well respected field going through many changes and growing so dramatically and as nurses, health care professionals we have got to get back to the basics of Florence Nightingale and to help our New nurses to gain critical knowledge of patient dynamics and teach them skills in communication which seem to be seriously lacking. To be fair there are a great Many nurses who care deeply about their patients and do everything in their power to help their patients in every way possible and are very deliberate in their actions on the patients behalf and to those nurses I give them a pat on the back. Hospice is a difficult field as are many such specific nitch nursing fields and require a well rounded and capable nurse able to navigate the entire process for their patients. I intend to create a course for Hospice nurses and to get it approved for CEU's on dealing with Hospice patients and I pray that the next wave of nurses out of school before they jump straight into hospice go and gain some well needed knowledge and practicle work experience in a hospital so that their skills are well rounded it is so critical to have some basic knowledge and Nursing school only gives us a very small snap shot of skills. Lets face it if you get to do more than one procedure twice while in nursing school it is a Minor miricle given the time constraints in the hospital settings in which we train while doing clinical settings. I love this field so much and worry that without the kinds of skills and basic understandings and knowledge its the patients who ultimately suffer...

Permanent Cath's for Paracentisis are more common now adays paticularly with OV Cancer patients and other disease processes which are terminal and where the use of a permenent cath would be in their best interest. Certainly it is better to place one for those who's acities is a continual problem every few days. It is not uncommon at all to have patients only get Marginal releif for a few days and require another procedure. This way Families can be taught how to care for their Family member in their home where they are most comfortable and for those who are Terminal this is likely the most Humane thing to do to assist them with Palative care in the best way possiable. As a Hospice Nurse we often see these.. Care is relatively simple and easy to do.