PositiveEnergy

All good points. So true about life-long learning. When you really begin to practice you realize how much there is to learn, and how little you really know in the big picture. So keep on asking the "whys" and "hows" and not be afraid to say "I don't know, but I'll look it up." Know your resources...so you know right where to go when you need an answer quickly. Always remember to keep in the forefront of your mind - "If that was me (or one of my family), how would I want to be treated." "What would I want that nurse or provider to say to me?" Remember your patients are sick and have their own worries - they don't want to hear the dynamics of the unit, complaints about other staff members, being short-staffed....this can make them fearful about whether or not they are going to receive proper care. Make a room check without focusing on doing a patient care task - instead take a moment to chat with your patient. But most importantly compliment yourself each day on something you did well, or just felt good about. For those things that were challenging, plan how you would improve on them the next time. If you see a colleague do something you think is stellar - compliment them as well. All to often nurses failure to pat each other on the back and say "well done."

The old saying, "a picture is worth a thousands words" came to mind when I read this. Essentially your mental visualization is providing you a wealth of direction/information to guide you through your daily procedural challenges. I cheer you on this practice - definitely an approach that boosts one's confidence before engaging in unsure waters. Sometimes if time allows, this imaging can help one identify their own weak areas and seek direction/answers to these idenified weaknesses before the scenario actually plays out.

Certainly a noninvasive intervention and worth at least trying for those who suffer from cramping.

In general my experience both professionally and with family members who have noctural leg cramping is that finding something that effectively, and most importantly, continuously relieves leg cramping rarely happens. Hence as listed by individuals in these post, there are abundance of suggestions, but how many are truly effective and valid is questionable. But those who experience the excruciating pain are willing to try most anything to obtain relief. Even pickle juice. Unfortunately there does not seem to be that "one fix, that fits all." But, we can't stop investigating potential calming agents because these people's pain and sleep interrupted nights affects their overall well-being. One area I think healthcare providers should check themselves on is how often they immediately assume the person's cramping is from low potassium and/or insufficient Mg. And the next step is to suggest the person either begin to take supplements or increase foods and drinks that will boost their levels of these electrolytes. It seems the appropriate first step would be to have these serum electrolyte levels tested before suggesting the person increase intake of these items. As we know, boosting levels of these electrolytes in individuals can have negative results (even worsening cramps) if the increased intake causes to high serum levels and/or kidney function is an issue.

Well said.

Excellent ideas here. Because students aren't often directed to do some of these needed task they don't even think about them - especially those things patients need upon discharge to assimilate back into their home life. Even some seasoned inpatient nurses have a gap in truly understanding what patients need when going home. If you have ever worked as an RN in both inpatient settings and in home care settings you can appreciate how communication is lacking between the two entities when coordinating home care for patients. Great idea to get those students nurses thinking about these patient discharge concerns. How about having some of those students sit at the bedside with their patients and educate them on their disease process. One would be amazed if they take a pictorial anatomy book in to their patient and show them the part/s of their body involved with the disease process. Often patients have no idea of their internal anatomy and are very appreciate of learning. Students too will gain confidence in patient teaching and reinforce their own A&Ps knowledge.

"The energy is kind of bad on the unit." "My students literally cried about..." I read these statements above and had flashes of all the conferences, papers written, general presentations, and professional dialogue on "Nurses Bullying Nurses" or "Nurses Eating Their Young" and I hear this sentiment here. Honestly, it feels like we talk and talk about this behavior, but it still keeps happening. And here we have novice nursing students learning from the modeling of senior nurses and what are they learning on how nurses treat one another. I only hope they say when I am a "real nurse" one day I am never going to treat students like I was treated. I am going out of my way to show them the ropes.

The first thing that jumps out at me is not to give the staff the task of writing out your student assignments. You might involve the staff by asking them which patients might benefit/appreciate having a student assigned to them and what nurses are most receptive to having students assigned to them. Remember, you know what your clinical objectives for the day or clinical course are, so you would be the best one to make assignments that best addresses the students needs. Many times staff have a totally different perception of what students should be focusing on. An important piece for you is to be sure the staff understand what the students are focusing on that semester in clinical. Take the time to share this with the staff. You would be surprised how many nurses will then seek out students to participate in something that is occurring at the moment which addresses their objectives. To prevent students from standing around you have to get creative: Some things I always found helpful: 1. Discuss not standing around in groups with the students. Share you would prefer they not hang out in groups even if they are "charting" or working on their client's plan of care. 2. Suggest they volunteer to do some activities they have been passed on that might help the staff - even if they think little of the task they will always take something away from the experience and improve interaction skills. First, though they must be on target with their assigned patient's care. Example: tell staff they will do vital signs on all the patients in the unit at a particular time (including charting of the vitals). Have students volunteer to assist the nurses in little task like re-positioning patients, spending time talking or sitting with patients, answering any of the ringing "call bells" not just their patients....whatever you can think of to give students learning experiences. Some students might gripe but other will be happy the day goes by quickly and they are helping both patients and staff. In time I have found nurses will come to appreciate your students and be glad when they know your students are coming on. 3. If the staff member is agreeable assign students to shadow nurses or other disciplinary members that interact with patients on your particular assigned unit - example med nurse, charge nurse, an IV nurse, a physical therapist, play therapist (great for peds rotation), social worker...There is alot of take away for their own future practices by sharing in such interdisciplinary activities. Their future patients might benefit. 4. Most in-patient facilitates still have physical libraries. If a question comes up or there is an "interesting patient scenario" (even if not one of the students assigned clients) assign 1 or 2 students to go to the library, if reasonable close. If only an e-library is available have them use this. Be sure and have another student/s cover the leaving students patients. Have the students look up related information and plan for them to share what they found in a post conference. 5. Ask students for ideas of how they think they might be able to add to the units functioning. Even if they work in pairs for moral support. 6. Ever think about having students go in the unit's supply closet/shelving area and ask themselves "what might this item, tube, instrument...be used for? Do I know how to use it? Can I explain the use/purpose of everything here. By encouraging students to check these kinds of items out when they have down time imagine how much quicker they might retrieve those tubes or instruments in emergency situations. They would know where it is and what it is. Think about all the wasted time in emergencies because people have no idea how to use or operate a needed item. Just remember - any activity is a teachable moment for students. Even if it isn't obvious to the student at the moment. You might have to remind them of this when you come up with a creative idea that no other instructor has encouraged them to do. Just remember they have to meet their assigned patient's needs first.

So many options of how this evolved. WIll probably take several years to even figure out the truth. What always amazes me is the number of people who jump on the band wagon and go along with such dishonesty.

Very interesting article. The unassuring take away from this information is this is just one of the fraudulent operations that got caught - after much investigation too, and years of pumping out "fake" nurses before they got caught. Hope the take away is policing needs to continue and checks of qualifications/backgrounds tightened.

Reflecting on those patients who have touched my life. I think of those patients who have caused me to pause and recall something special about our encounter. Not what I left them with, but rather what they left me with. Those special stories I have within me - compliments of those special people I have met.

I was glad to see this article. Leaving loved ones and heading off to work is challenging on holidays. But as you pointed out, coming up with creative strategies can help make heading into work a little bit easier on these days. I worked in Obstetrics and Pediatrics for many years. Of course, the approach for children was to try and get them physically better before the Christmas holiday so they could be home for the holiday. So the pediatric census would often dip and the kids left to spend the holiday with us were often very sick. So we tried to make whatever Christmas wonder (dressing up, Santa visiting, elves...) we could for the children. This also lifted our spirits. Obstetrics like anytime was always unpredictable. Heading in you never knew if your holiday shift would seem extra long because few came in laboring and delivering, or if you would never sit down the whole shift and end up having your Christmas potluck dinner on the run. In one unit where I worked they had a tradition that I thought was nice and helped eased some of one's pre-holiday baking. A few days before the Christmas holiday everyone would bring in a predetermined number of baked cookies. Then everyone swapped so at the end of the day everyone headed home with a large batch of different cookies to add to their holiday treats and decrease their baking workload.

Thank you for sharing this information. As a nurse, as well as a person who has dealt with this issue in a family member, awareness and education is so vital. I think so often nurses do learn about Sundowning at least sometime in their schooling, but thinking something so practical could be "that hard-to-manage" patient's issue gets overlooked. Instead, we have a tendency to think something bigger is the causative variable. I think this is where really stopping to consider the patient, maintaining continuity of care (to recognize changes), and looking for patterns in patients (e.g., personality changes about same time every day).... becomes vital to diagnosing and addressing Sundowning in individuals. If we then utilize some of your interventions and (as you stated) report the Sundowning interventions to the next shift, perhaps the patient will fare better and the shift in general will flow smoother for everyone.

First congrats on passing the NCLEX and becoming a new RN. Nursing school is a challenging major - no easy way through. Your article interested me because I have many nursing years under my belt. So I was curious what you would perceive as a major challenge. I can understand why you say the long shifts and long hours are so disruptive in one's everyday existence and emotionally/physically depleting. In my earlier years the eight hour shift was the norm then the profession moved into twelve hour shifts. When twelve hour shifts were evolving many articles were written related to adverse responses on behalf of those engaging in twelve hour work days....fatigue, increased errors, physical and mental sense of imbalance.... Despite these warnings and due to demands of short-staffing twelve hour shifts became the norm. And now the work day has even extended with doubles and overtimes. So it doesn't seem surprising many nurses of today are expressing some of these same feelings you did in your article. Not just new grads either - hope that helps to know your not alone. I would just add one variable that I have heard many nurses doing twelve hour shifts complain about, particularly during Winter months when it gets darker outside earlier. That is they can go days at a time without seeing light outside - and we all know how lack of sunshine can have both physical and mental effects on us. They "go to work in the dark....and come home in the dark." Doesn't even sound good! So this thought leaves me with one piece of advise I did not see mentioned in your terrific list of recommended self-care measures. So I would add... make sure you leave the building during your shift and go for a walk even if you do so on your lunch or dinner time. Take something you can eat while you walk or sit outside. Don't think your department is going to fall apart if you leave the unit. Don't convince yourself you are better off eating on the go in your department while you continue working or worse yet not even stop for breaks or to eat. Those nurses who do take these short breaks away (and outside) feel somewhat more positive and refreshed when returning. Best wishes - you have some good self-care measures figured out.

This feeling of loss and sense of death is the part of nursing that I believe makes you human. When you develop that connection with a patient that you sense is different from your relationship with your other patients, you will feel a sense of heaviness/loss when he/she does die. If you didn't that doesn't seem normal. Don't be afraid to talk about the person to your colleagues and to think about the good memories or just about the person in general. It seems no matter how many years you will be in practice there will be these extra meaningful patients you will always recall. Likely there will be times some incident/action... will trigger a memory of this person and you will be struck again by that heavy feeling. Could be years later - but it will have a different degree of intensity. Just like any loss - you will always remember - just over time the pain won't aways be in the forefront as it is now. It will find a place in your being and once in awhile surface. Hopefully surfacing as something that made you feel good about the person and brings a smile or sigh of contentment from you. Most of all don't let anyone make you feel your feeling are exaggerated and such feelings should be held in check. Glad you recognized you needed to talk about your feelings and reached out. That in itself is healthy!