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  1. Nursing school is full of dosage calculations, clinicals, and writing assignments. You were probably prepared for the first two, but writing might not be your strong suit. If your palms get sweaty when you hear things like term papers, capstones, or dissertations, no worries! This list of 7 writing tips will have you succeeding on those dreaded assignments in no time - here's how. Understand the Goal of the Assignment When you're preparing for a written assignment, be sure you understand all the details. There is nothing worse than pouring your heart into an assignment to be later told that you missed the purpose and won't receive full credit. According to Walden University, there are five common goals of nurse assignments: Demonstrating critical thinking skills Documenting your knowledge Expressing ideas or opinions Showing your understanding of nursing literature Demonstrating your understanding of activities Know Your Audience Writing requires you to know and understand your target audience. In school, you're writing for your professor with the express intent of demonstrating your knowledge about a subject. But, don't be mistaken - even though you are writing for your professor - be sure to express your thoughts openly and don't assume they fully understand the subject. Here are a few things you need to know about the professor's expectations before you begin your assignment: Should you write in first, second, or third person? Do they have a sample of a paper or writing style they prefer? What style of citations do they prefer? Is there a preferred format for papers? If you have multiple audiences, how do you meet the needs of everyone? Do Your Research Research in nursing school is essential to your success. You will need to become very familiar with the online library and how to perform a search for topics. Many of the library systems have multiple ways to search for articles, save them for later reference, download and print them. When you search for nursing research, be sure the information is: Current - You professor might provide guidance on this, but if not, always try to find research no more than 10 years old and preferably within 5 years. Credible - Credibility is essential in nursing research. Be sure to know the author, journal, and publisher. Always steer clear of websites like Wikipedia, blogs, and magazines for academic papers. If you want to search the web for articles, try Google Scholar for academic sources. Peer-Reviewed - Nursing is founded on evidence-based research, which means that finding articles that have been peer-reviewed is critical. If you haven't heard of this term before, it means that the item has been reviewed by a board of experts on the subject matter. Peer-reviewed articles are considered to be a high quality of research and adhere to strict editorial standards. Execute a Brain Dump There's nothing scarier than a blank page, especially, when you know that you need 10-15 pages filled with stellar content in a short amount of time. But, as scary as it might be to get started, that is precisely what you need to do. As someone who writes often, I have learned that you must do a draft to "get the garbage out," as I say. Once you get all of the garbage out and onto a document, cleaning it up and adding to it is easier than creating those first few sentences. Keep the Fluff to a Minimum Nursing school assignments are not like writing poetry. You want to be very clear in your writing. There is no need for a lot of descriptions and flowery wording. Do your research and be sure you understand the material thoroughly. Write using clear language. Once you're finished with your paper, read it aloud, which will help you to identify areas of flowery wording that isn't necessary for nursing school. If you need extra help, find a classmate who is good at writing and have them read over your work. Another option is to use an online editor such as Grammarly or Hemingway. These tools are not perfect, but they can help find common errors and offer solutions. Avoid Passive Voice This takes practice. If you struggle with passive voice, just know that most writers struggle too. Limiting passive voice is very important to academic writing. It's a simple guide to keeping your language simple and easy to understand. So what is passive voice? According to the Writing Center at The University of North Carolina at Chapel Hill, passive voice is when you make the object of an action into the subject of the sentence. For example: Active Voice: The chicken crossed the road. Passive Voice: The road was crossed by the chicken. When you write in active voice, the ideas you are expressing are clear and easy to understand. In passive voice, it might be a bit more challenging to understand the meaning. Practice, Practice, Practice If you're struggling with assignments and your papers are coming back with lower scores than what you want, try practicing. Now, this might not sound like much fun, but you don't have to do extra term papers. Try writing a journal or start a blog about nursing school. The more you write, the easier it will become. If you need a bit more discipline to get this practice, take a writing class. It might not be required, but it will help you throughout your college and professional career. Do you have other writing tips for nursing students? Are you a student and have found something else that seems to be helping? Let us know your thoughts.
  2. lkeller27

    11 Things That Helped Me Study

    1. Help from a tutor If you have the opportunity to have help from a tutor, take it! 2. Quizlet It's amazing. I learn best by testing myself and Quizlet lets me do that. I highly suggest making your own flashcards, because then you'll learn the material better. But there are plenty of great sets on the website. 3. Khan Academy This site is great for a multitude of things. They have practice on several topics and a ton of videos on so many topics. 4. Crash Course This is a Youtube channel hosted by Hank Green. This channel helped me study for Anatomy and Physiology 101 and the TEAS VI. He goes a little fast but if you take notes of what he just said after pausing the video it's really helpful. Because he explains things in a simple manner and is funny about it too. 5. Time Management This should probably be number one. You need to be able to study enough but not so much that you tire yourself out and stop retaining information. Studying for an hour then taking a 10-minute break is great when you need to study for a long period of time. You can't always be staring at the computer screen, or constantly writing either. Your mind and body need a break. However, This doesn't mean go and binge watch Stranger Things (or whatever show you're into right now. Who can't wait for season 2? ). Just keep your time well managed. 6. DO NOT PROCRASTINATE This goes along with #5, but I'm bad about this, so it helps if I break things into smaller chunks that I can complete each day. Then by the time the due date comes I'm done! Get those little chunks done in one sitting or throughout your day. Just get it done before you go to bed. 7. Get enough sleep I know this is difficult with work, school, and possibly kids. But sleep is essential for your well-being. Obviously, don't sleep in till noon, but don't go to sleep at 1 or later in the morning every night. Try to make it before midnight. (Unless your job prohibits you from doing that.) Really just try to have a set bedtime. Mine happens to be around 11/11:30 and I tend to wake up around 7/7:30 depending on the day. 8. Keep your things organized and stay up-to-date on your due dates Google calendar is great if you are annoyed by writing everything out. 9. When studying for multiple classes rotate which ones you're studying for Don't neglect the one you don't like and don't neglect the one like because you're focused on something else. If you like none of them, just do your best to learn the material and get everything done in a timely fashion so you can think about it as little as possible. 10. Write keywords on your hand If you have to memorize a bunch of stuff try writing keywords on your hand and practice them while going about your day. Doing this a memorized the last chapter and a half of the Matthew (from the bible) for a speech in about two weeks while memorizing things for anatomy and physiology 101. 11. Remember what you're doing this for Remember that you're awesome and can do anything you set your mind to. (Although also remember that you may not be cut out for things. Like I could probably write a story if I set my mind to it. But it probably wouldn't be great, I'd hate the whole process, and would probably want to burn it afterward. But I still did it.) Best of luck to y'all!
  3. Sarah Matacale

    Psst...New Nurses

    I realize that there are so many articles, blogs, books and inspirational bookmarks, coffee cups, and laminated lanyard tags that tell you how to be a great nurse. You learn throughout nursing school how to calculate BMI, use your posture to leverage a patient, "therapeutically communicate" and to give an orange the proper dose of insulin for the blood sugar you just checked with fake sugary blood. Not surprisingly there are some "real life, hands on, I have been there in the trenches for a few years and lived to tell a tale or two ", pearls that I want to share that work. These few tips will save you time, frustration, tears (yours), and will increase your job satisfaction and patient satisfaction. Before you leave the patient's room, ask if there is anything else they need This one is huge! Listen up people...you will save yourself tons of time and frustration in the long run each day if you do this. I can promise you that when you are rounding with you're 8am meds, if you just go in and hand the patient their meds and leave, the call bell WILL go on as soon as you are 2 doors down! Here's the rest of how this scene plays out..."Susie, your patient in 202 needs fresh water." You bring water and leave again to continue with med rounds..."Susie...your patient in 202 is out of straws"....head to pantry, grab straw, deliver and leave......"Susie, your patient in 202 needs to use the bathroom"......"Susie, 202 would like sheets straightened"..."Susie, 202 has family here and would like to ask you some questions".....AHHHHHHHHHH! Multiply 202 times the 10+ patients you have today. Here is my "go-to" of how to work with 202's. When you go into the room, smile and boldly and cheerily say good morning! Ask about the patient's night as you clean up their bedside table. Check on straws, cups, and tissues. Dump old pitcher of water. Tell patient you will be back in second as you get them a pitcher of fresh water with ice (people love that hospital ice), grab straws, cups etc while you are there. When you come back in and put it all on bedside table, chat with your patient about your crazy kids this morning, your animal's antics , really anything personal to open communication. Tell your patient what pills they are taking and for what. Discuss medical plan for the day, tests, labs, time doctor is expected in etc. Any questions 202? Ask if patient needs to use restroom, if yes, straighten sheets or change them if needed while out of bed. If no, straighten the sheets out. Ask if patient is warm enough or cool enough. Place the bedside table, call bell, and channel changer in reach, ask if patient wants blinds open......and last but not least, "Is there anything else I can do for you? I will be back to do an assessment at (such and such) time." Bam! Five to 10 minutes and the patients will love their attentive nurse and not want to bother you knowing you will be back soon. Bonus is that you visually did a pretty thorough assessment of 202 while you were in there. Know Where To Go When You Don't Know Yet another biggie. You will NEVER know all you need to know. However, if you know where to go to find out then you'll be in good shape. On any unit, you will soon figure out who the seasoned staff are. There are always those with special "skills sets". Some are great with inserting IV's; some foleys; some know a ton about cardiac rhythms. Call pharmacy as a resource for any and all questions related to medications or interactions, allergies etc. Use your drug reference handbooks. There are always a few super awesome easy to talk to physicians, nurse practitioners, or physician assistants that love to share information and answer questions. Be friendly, ask questions about disease processes, medications, patient histories or whatever you may have questions about. Be a sponge with any knowledge you can get your hands on. Never be afraid to ask.....I have always been bold and outgoing with questions and I stick my nose and ears on primary physician and specialist conversations. I butt in on wound care during dressing changes, radiology during procedures etc. Let me share a little story of my own. When I came out of nursing school, I went straight to work as a hospice nurse for 5 years. Nothing more unnerving than coming out inexperienced and working in a location where you are autonomous and have no other nurses with you. So one of my first patients had a colostomy and I was to do her ostomy care and assessment for her during my visit. I never had the ostomy experience in my 4 years of nursing school. I read about it, passed the test doing care on a "torso mannequin", but real life is something different. OK, I can think critically, figure this out somehow, right? What did I do? "Mrs. XYZ, why don't you show me how you care for your ostomy so that I can see that you and your family know how and also it will allow me to do it the same way you do when I come". Yup, Mrs. XYZ unknowingly taught me ostomy care! Education opportunities come from many angles. Be Prepared! As a seasoned nurse and the wife of a physician, I can tell you that no doctor wants you to call them with a question or wanting a new order if you don't have all of the information necessary together, and IN FRONT OF YOU. Let's say your patient is in respiratory distress. When you call, you better know: your patient's lung sounds, respiratory rate, amount of oxygen on, medications given, allergies, changes in the patient's overall condition, pertinent labs, etc. Have your computer up and running, logged on. Have paper to jot orders on. Most importantly be by the phone! Most hospitals now have nurses carrying their own phones. If you do put out a call and have to go care for your patient, tell everyone around that you are waiting on Dr. PQR to return your call. Don't go potty then, do not get on the phone with pharmacy on the number the doc is supposed to call you back on. If your patient is in distress, call in your team to help while you talk with the doctor, after all you know the most about your patient. Another area to be prepared for is talking with patients and families. First of all, know who you can talk with (permission) and what you can share. Be aware of who is in the room with the patient if you are sharing personal information about their care. Know what will be going on with your patient thru the day, including labs, tests etc. Explain in common, non-medical language what is going on with their care or diagnosis. I always consider myself the translator between the doctor and the patient. As nurses we bridge a lot of gaps and the medical jargon is just one of those areas, so be prepared to explain what's going on. It is OK to tell the patient that you are unsure about something and need to look into it further, just make sure you provide an answer before you leave for the day. That builds trust in you and for the nurses coming after you. Remember Why You Are a Nurse Everyday start fresh. On your way to work, remind yourself of the reasons you became a nurse. I like to say, most of us were born nurses. We are caring, compassionate, smart, quick thinkers, adaptable, team players and we want to make a difference in someone's life or death everyday. Some days that happens, some day not, but take the few extra minutes when you are in a patient's room to get to know your patient. Small talk about things unrelated to being in the hospital. I live in the south, so when meals come and I help set up, I ask about grandma's biscuits, or if my patient likes to cook. Food is the universal leveler y'all...everyone can small talk about food. In these small things, you get those moments that you went to school for. These small moments make the day brighter for you and your patient. I can't tell you how many chin hairs I have plucked (Btw...designate a family member to tend to that renegaid if you are in the hospital...they pop up when least expected), hair I have curled, faces shaved etc. All to make a difference to that one patient and watch their family glow when they walk into the room and mom has her famous red lipstick on. In other words, humanize your patient. In the current healthcare world, everything is technology, task, and chart. Nothing touches your heart there. Your patients can feel very lost and scared in that world. Bring it back to the basics of biscuits, small talk and hand holding. I do want to stress that as a good nurse, your skills will be picking up subtle changes in your patient during those times too. Skin changes, bowel and bladder habits, confusion, dyspnea, new onset weakness, etc. To wrap it up, I hope you can tell that I love the art of nursing on so many levels and always have, despite any role I have taken in this field. You make all the difference. Somedays you may leave crying in frustration and failure, but many other days you will leave feeling like you mattered to someone. You gave that patient a piece of you. Hopefully this will help some of you with the down and dirty, tips to survive your shift! Nurse on my colleagues!!
  4. ZenRN181

    How to call a provider at 3 am

    I've worked nights on and off for about 10 years- I have many stories from calling providers in the middle of the night, good, bad and funny. Bad story: My patient status post-GI surgery complains of chest pain at 4 am, I call the intern and no response, CP worsens so I call the rapid response team. I was yelled at for not calling the intern first and wasted rapid response time. After I persisted something was wrong I did a repeat EKG and she was having an MI. Good story: After accidentally calling an attending he laughed and said I made him feel young again! He advised me on what to do and asked I pass it along to the intern covering. Ugly: Being screamed at for calling an on-call Dr and waking up his baby... Worst: When I called to get a med order corrected, a Dr told me "how dare a nurse question a physician's orders" Here is my simple list of what to do at 3 am 1. Know who is on call. I once paged a surgical attending at 3 am instead of the intern! Luckily the attending thought it was funny and was very kind about it. 2. Have your data ready when you call: Why you are calling, last set of vitals, last labs, I/Os, etc. Don't assume the person you are waking up at 3 am is instantly going to know which patient you are talking about or if they've ever seen the patient 3. Check your orders to ensure you don't have what you already need- PRNs, labs, NPO etc 4. If you're not sure about something check with a more senior colleague, they are a wonderful resource 5. If you are not getting a response from a provider don't be afraid to go up the chain of command, it's there for a reason! 6. NEVER apologize for calling a provider; everyone is on the same team and caring for the patient, it does not matter what time you're calling with patient care concerns 7. ALWAYS repeat back what the provider says to confirm; you can hear some funny things after you woke someone up, I've even had a doctor fall asleep on the phone with me!! It's always awkward if you have to call back 10 minutes later to clarify an order. 8. SBAR- it works, use it, love it, and it cuts down on communication errors. 9. If someone is being inappropriate when you called- screaming, swearing, berating or refusing to call back; report the person to the appropriate person. This behavior should never be tolerated 10. If dealing with the person mentioned above in #9 remain calm and professional and report them to the appropriate management 11. Creativity and problem solving can go a long way on night shift and prevent the need to call anyone. If your patient is constipated and has not GI meds ordered, take them for a night time stroll, give them prune juice, etc. If your patient is anxious, sit down and talk to them for a while. Sometimes talking can go a lot further than any meds. Even if it's asking your patient about their kids or dogs or their job. Patient care and safety always come first, never be afraid to call the provider. To make everyone's job easier and for the best possible patient care. The night shift is there for a reason. Patients crash on night shift and have unexpected needs, don't feel bad, take care of your patient. From your friendly neighborhood night shift nurse practitioner
  5. vadushkas_nurse

    Tips for Human Nursing

    REALLY LISTEN AND REFLECT, THEN YOU WILL LEARN: First of all I was very fortunate to have the opportunity to complete a grad initiative in acute care. This was an experience where I am paired with staff RN's for six months and in a way be mentored by them. At the time, having a new RN with me every shift was somewhat stressful until I opened my eyes and realized that I was actually very fortunate for this change. Each shift the nurse I was with would start out by saying "I start my shift by..." and it was then that I realized these nurses were sharing with me their best practice and their experience. I finally came to the conclusion that I was lucky to be a recipient of so much knowledge. I then developed my own best practice and nature of nursing from these professionals. TREAT PEOPLE HOW YOU WOULD WANT YOUR FAMILY TREATED: As an ER RN you see a variety of patient populations. This can sometimes be very challenging when you are caring for someone that makes poor lifestyle decisions. In nursing they teach you not to be judgmental and treat everyone equal. But this should be taken one step further. Treat people how you would want a health care professional to treat you or your family. With this in mind, it is easier to remove yourself from your judgments and bias. Every person is human and deserves respect, care and dignity. ITS THERE IF YOU WANT IT TO BE THERE, GOSSIP THAT IS: Gossip seems to coincide with the nursing profession. At least from my experience it seems to be there if you are looking for it or starting it. Each nurse makes a conscious decision when contributing or refuting gossip. Everyone you work with deserves the benefit of the doubt. You never know what someone is dealing with outside of the workplace. So next time, before you start contributing to the gossip train, think twice, maybe that energy is better off somewhere else. EMBRACE THE INTRODUCTION: The first few minutes of meeting your patients are crucial. This interaction sets the tone for how the rest of the shift will go. If you can get eye level with your patient, introduce your self by name and find out what their expectations are things will go smoothly. These first few minutes makes a difference. It shows respect and initiation of rapport with people. It wouldn't hurt to try and proof its effectiveness. DON'T SAY IT: "I'll be back in a minute". This phrase can be a real turn off to patients. A minute to you may feel like a minute. But in reality, it's probably been five or ten minutes. In the meantime, you have probably answered call bells, been interrupted, finished off another task you working on or who knows what, while your patient is still waiting. The truth will go a long way. Let them know you will do what they need as soon as you can. Most patients have a pretty insightful idea to how busy you really are. DO THE LITTLE THINGS: Little things go a long way in the clinical setting. Brushing care, giving back care, warm blankets and tea can really have a positive impact on your patients experience. Time is a commodity for everyone, but these things don't take long and make a world of a difference for those needing some human connection and attention. DO THE BEST YOU CAN: Lack of everything is probably a big concern for all departments. Staff, resources, time, room etc. These are system issues and they are long term issues. It is important that you go to work and do the best that you can. There is no point in going home guilty or feeling upset because you couldn't do this or that. Just always keep in mind, that if you do the best you can with what is available, that is all you can do. Patients appreciate you doing what you can, not complaining about what you can't. LEARN AND USE NAMES: Being able to address people by them is a form of respect. It doesn't take much time, especially if people are wearing name tags, but this one will go a long way in the workplace. EVERYONE MATTERS: Treat all those you work with, with respect. If it weren't for the janitor, lab tech, volunteer, unit clerk, or student the setting wouldn't be what it is. Clinical areas are a place for caring, healing, teaching and respect. It takes a large diverse group of people to care for patients. Everyone plays a role and deserves a smile or helping hand. BE CREATIVE: Textbook interventions may not work for everyone. Clinical settings are full of wonderfully creative scenarios. From call bell set ups, to oxygen placement to gown closures. It really can make a big difference if you find a unconventional but effective way to assist with caring for your patient.
  6. homehealth20

    10 Tips for Home Health Nursing

    1. Have a good sense of humor. You have to learn to laugh at yourself. This is a good practice for most aspects of your life. But if you take yourself too seriously, no career will be enjoyable. 2. Be open minded. Toto, we are not in the hospital anymore. In the patient's home, you are no longer in a controlled environment like a hospital or doctor office. You still have to follow your agency's policies, safety rules and perform procedures correctly, but if the patient requests you enter their home and take your shoes off because of religious reasons, you do. The beautiful woman that presents as your patient, turns out to be a man. (You learn this without warning when they drop their drawers for the dressing change you came to perform. The scheduler thought it would be funny if you were surprised.) Diversity is one of the wonderful aspects of home care, you learn how other people really live. Learn to appreciate different cultures. 3. Learn to modify. You have to hang an IV. It's after hours and the pharmacy forgot to send the IV pole. The hanger over the door may work, or the broom handle strapped on the upright vacuum suddenly creates a wheeled IV pole. But always make sure that your modifications are safe and appropriate, otherwise, it will come back to bite you in the .... 4. Be flexible. The day you planned will change, guaranteed. There is an accident on the freeway, now you are late. The patient has a doctor's appointment they forgot to tell you about and now they aren't home. Someone called in sick so now you have 5 extra visits. If you can't be flexible, home care may not be your bag. 5. Be prepared. Sure enough, the dog ate the patient's box of dressings, or the patient has a bed sore that did not show up on the hospital discharge information. Your car trunk should look like a supply closet. 6. Be organized. For those home health nurses that drive a car between patient visits, your car is your office. It should contain supplies, paperwork, computer and cell phone battery chargers, pens, marketing flyers, etc., etc., etc. Learn to plot your visit route. With the cost of gas nowadays, you don't want to have to drive needless miles. 7. Have basic computer skills. If you don't have them, learn them. Many home health agencies have already gone to field staff carrying laptop computers into the patient's homes. It is the way of the future. 8. Be alert and be safe. You may be presented with many new dangers that you won't see in the hospital. Take a self-defense class. Learn what areas are the "unsafe neighborhoods" in your territory. Visit those places early in the morning. Always be alert to your surroundings. Don't talk on your cell phone while driving. Follow safety rules. 9. Don't be afraid of paperwork. If you work for a home health agency that performs Medicare visits, YIKES, what paperwork (thanks in part to the Medicare Paperwork Reduction Act?)!! An OASIS is not a desert paradise. Those agencies that have laptops for their field staff have part of this licked. However, the questions still need to be asked and documented. Practice does help speed up the documentation process. 10. Keep your skills up. Take continuing education classes online. Attend seminars. Read articles. Knowledge is power. You are very autonomous in the patient's home and good skills and quick thinking are mandatory to survive. In closing, home health is a wonderful way to care for patients. You are able to interact with the family and really do one-to-one education. Whether it be with a Medicare agency, Hospice, private duty or other home care venue, it is an enjoyable and full-filling division of nursing. Remember, many home health nurses believe: A bad day in home health is better than a good day in the hospital.
  7. Though this general insider advice from our customer service team should be applicable to any board, be sure to check your specific board's policies. Understand The Timelines for Your Board. Testing window How long does it take your board to assign your testing window? How long is that window? Knowing these two timelines helps you plan ahead. If you have a 90-day window, don't wait until day 80 to schedule your test. Testing centers are used by many organizations, and seats fill quickly. Set your exam date/time soon after receiving your window notification, even if you plan to test later in the window. Extensions If extensions are allowed, they typically start counting from the day you pay for an extension. So if you're on day 10 of a 90-day window and order a 90-day extension, you don't receive a 180-day testing window. You only bought yourself 10 extra days to test. Also, be aware how late in your window the board allows an extension. Rescheduling or cancelling Testing centers often have timelines (and fees!) attached to these changes. Your board does not reschedule or cancel for you, and does not receive any part of these fees. Even Before You Decide To Apply, Get Familiar With Available Study Resources. What exactly is tested? Download the exam's content outline (sometimes called a test blueprint). Our staff sometimes hear that applicants aren't aware of this essential tool. Read it carefully to understand the full scope of the exam and identify any weak areas. This will help you structure a study plan with SMART goals and timelines. Reference lists Your board should list the textbooks or other resources from which exam question content is developed. Does your unit, hospital, or public library have the latest edition to save you money? We don't recommend buying all of the books listed. Instead, focus on one book familiar to you or recommended by a colleague who recently tested. Especially use it when going line-by-line on the content outline to support your weak areas. Sample questions free sample questions from the board's website should demonstrate the level of complexity for their questions. Many applicants think the exam will use a lot of knowledge recall questions, but most certification boards want you to analyze a question and apply knowledge. Practice tests If you order your board's practice tests, don't wait to use them right before your test day. Use them early to uncover weak areas and study more in those areas. Many practice tests let you retake the same questions repeatedly. One strategy is to take an entire practice test in one sitting. Consider not grading the questions as you go, especially if the practice test offers correct answer rationales. Then on your next attempts, focus on a few questions in one sitting, grading as you go. That first attempt gives you a baseline for strengths and weaknesses. The future attempts in short bursts can hone your critical thinking skills. Ask yourself, "What are the board's exam writers really testing in that question?" Thinking ahead to test day logistics, "know before you go," is the safest approach for your upcoming appointment. Take a trip to the center before your test date, on the same day/time you plan to go. And don't forget these tips for a great testing experience: The exam candidate handbook We know the handbook isn't an exciting read, but we remind candidates repeatedly in important notifications that this resource is, well, important. Candidates get turned away at the test center because they were late for their appointment or didn't bring the correct types of ID. Don't forfeit your exam fees due to a test center policy. Read and understand your handbook. And don't rely on tips from someone who tested five years ago. Policies change, so stay up to date for when it's your turn to test. Identification The handbook will describe the IDs required to enter the testing center. Do you need one with a photo? A signature? Both? Do you need two IDs? All this information with examples should be spelled out in the exam candidate handbook. Again, don't rely on hearsay from someone who may have tested at the same center for a different exam. Different boards may have different ID requirements. Name changes A first or last name not matching your ID or the application continues to be our team's number one customer conversation. Candidates will not be able to test if the correct ID(s) with the correct names are not presented for entry into the testing center. Put your formal first name on the application. Make sure names match your IDs, especially if you recently had a marriage-related name change. If you need to request a name change, do it well in advance of your scheduled test date. Exam security Testing centers prohibit more items than ever for exam security, even down to jewelry and hair clips. Your glasses might be inspected. After the exam, you can't share a brain dump of the test content. Exam questions must stay confidential. We're often asked by testers to share which questions they got wrong. Again, a board can't expose the exam content under any circumstance. ADA accommodations If you are requesting Americans with Disabilities Act exam accommodations, do so when completing your exam application. Your accommodations must be sent to the computer-based testing administrator via your board when they send your exam eligibility. We hope these tips help clarify the process when pursuing certification. If in doubt about any aspect of applying or testing, contact your board for answers. No matter which credential you're considering for the future, we wish you success on exam day!
  8. spunkygirl1962

    Let It Go and Relax

    You think your stressful morning is finally over once you make it out of the house, into the vehicle, and off to work. However, as many of us know, that is usually not the case. You merge onto the road thinking all is good until you get behind another driver who drives consistently 10 mph under the speed limit, you catch every red light possible, and the morning traffic puts you twenty minutes behind schedule. When you arrive to work, there is no parking and the unit where you work is short staffed. I could go on, but I think we all can relate one way or another. You have just begun your day and already have experienced a substantial amount of stress. As a Post-Anesthesia Care Unit nurse, I have experienced countless mornings like the one mentioned above. I have thought to myself plenty of times," How can I reduce this inevitable stress and anxiety?" I have read numerous articles, talked to fellow nurses, and discussed stress relieving methods with my Primary Care Physician Assistant. Through my research, I have developed some techniques in which you can successfully decrease stress and anxiety before entering the hallways to your unit. Morning time stressors will always be there, but these five stress relief methods are sure to make those mornings just a little bit easier. 1. EXERCISE A wonderful way to start your day is with exercise. Exercise guides you into a state of well-being. In addition, exercise lowers your stress levels and kick starts your feel-good boosters (endorphins). Here are a few suggestions to start your day: push-ups (sets of 10), wall-sit (as long as you can), taking the stairs, and walking whenever you can. 2. YOGA My Primary Care Physician Assistant suggested that I do yoga every day before work. Performing yoga helps you relax, improve heart health, and flexibility. M. Mala Cunningham PH.D., counseling psychologist and founder of Cardiac Yoga states: "Yoga is designed to bring about increased physical, mental, and emotional well-being." (1) You can select a Yoga class to engage in through the internet, cable, your smartphone, gym, and work. The lists of yoga resources are endless. 3. DEEP BREATHING There are many different approaches of deep breathing techniques adopted in the art of Yoga that may assist you in decreasing anxiety and relaxing you on the drive to work. As a PACU nurse, I encourage patients to take deep breaths in order to relax and to help control their post-surgical pain. I instruct the patients to breathe in slowly through their nose and then to slowly release their breath out through their mouth. It is a great ideal to replicate this deep breathing exercise on the way to work. Deep breathing may assist in you in calming the mind, reducing anxiety and calming worries. I typically suggest that patients close their eyes while taking deep breaths, but I do not recommend this while driving! 4. MUSIC William Congreve stated: "Music hath charms to soothe a savage beast, to soften rocks, or bend a knotted oak."(2) Listening to music before work, whether at home or in your vehicle, can definitely "soothe the savage beast" of your hectic morning. There are so many different types of music to choose from, so choose the music that best suits you. My daughter listens to what they call "Screamo" music, but I personally love listening to instrumental movie theme songs on the drive to work Whatever type of music you enjoy, as long as it relieves your morning time stress, go ahead and give it a listen, and sing it at the top of your lungs! 5. COFFEE There is plenty of research on the subject of the benefits or hazards of drinking coffee. Some researchers say coffee is good and others say it is bad. I have a Master's in Health Services with an Emphasis on Wellness Promotion. Throughout my studies, there was one statement that I encountered frequently, "everything in moderation." If coffee is what you need to relax and jump-start your day, then have a cup, but in moderation. There are so many ways to help reduce stress and anxiety. The above suggestions are only a few ways to relax and calm that morning time anxiety. The World Wide Web offers a vast amount of information to assist you in finding ways to de-stress before work as well. If you follow these five suggestions along with doing some of your own research, you will be well on your way to a stress-free morning. Remember, always check with your physician before starting any new program. ABOUT THE AUTHOR: I have 27 years of nursing experience specializing in Post-Anesthesia care and Emergency Room care. I received my Bachelors of Nursing from Florida State University and my Masters of Science in Health Services with an Emphasis on Wellness Promotion from Independence University. The combination of the two degrees and my interest in fitness and wellness have inspired me to continue to write articles to help others in my profession find a way to keep healthy and decrease stress. REFERENCES 1. "Yoga and Heart Health." heart.org. n.d. January 19, 2018, American Heart Association - Building healthier lives, free of cardiovascular diseases and stroke. 2. "Phrases." Phrases.org.uk. n.d. January 29,2018, The meanings and origins of the English Phrases, Sayings and Proverbs we use daily.
  9. As the country moves toward a value-oriented healthcare system, there is a growing need to devise methods for better understanding how nursing costs and resources are expended for each patient and how these relate to the quality and outcomes of care. When hospital leaders empower nurses with a value-based nursing care framework, they see better patient outcomes and a more satisfied staff. Getting there is the hard part. Hospital training programs that help nurses relieve their stress and deal with ethical dilemmas are a good start. Here are 10 ways hospitals can help administrators pay more attention to what nurses have to say about their work environment, support nurses in striking a work/life balance, and help nurses in the pursuit of advanced education and career advancement. 1. Shared Governance In today's healthcare market, hospital leaders strive to meet the challenges of maintaining a professional practice in a cost and resource constrained environment while focusing on achieving positive outcomes for patients, nursing staff, and the organization. Facing a competitive, value-based purchasing (VBP) environment and potential staffing shortages, hospitals endeavor to promote a culture of engagement among nursing staff. One strategy to increase nurse engagement is through shared governance (SG). This is a participatory decision-making model that empowers nursing staff to make decisions about clinical practice standards, research, quality improvement, and staff and professional development. Hospitals can create a nursing council to act as a decision-making body for hospital nurses. SG recognizes that the primary focus of nursing is at the unit level where direct patient care is provided. Ideas and recommendations generated at the unit level flow inward via unit representatives to the councils empowered to act on these issues. Councils consult and collaborate with each other to achieve the best decisions to successfully facilitate and ensure quality patient care and outcomes. All nursing council participants can be invited to attend a boot camp to learn decision-making skills and the meaning of shared governance. With the current focus on VBP and cost-containment, increasing nurse engagement is an organizational-level approach. The knowledge and insights of staff nurses are critical to hospital administrators trying to optimize efficiency and resources to promote safe, quality care that meets patient needs. Higher levels of nurse engagement are associated with higher Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores which are tied to hospital reimbursement. Improving nurse engagement also affects nurse retention. Nurses employed hospitals with higher levels of engagement are less apt to report job dissatisfaction, burnout and intent to leave, causing turnover. 2. Offer Training and Support for Dealing with Ethical Dilemmas Nurses can find themselves in ethically questionable situations that conflict with their personal and professional morals. When unable to do what they consider the correct action, nurses may experience moral distress. It is critical hospitals find ways to successfully deal with ethical conflicts to improve outcomes, as they can adversely affect patient care. Moral distress is associated with employee burnout and job turnover. Organizational culture sets the stage for how individuals respond to unethical behavior. Hospital leaders are in a key position to defuse ethical conflicts and create an environment that allows nurses to practice ethically. Several strategies to achieve this include: Supporting the ANA Code of Ethics Hospitals should incorporate behavior consistent with the ANA code of ethics by adding them to job descriptions and considering professional ethics during annual performance reviews. Offering ongoing education This can be presented in the form of workshops on specific ethical subject matter or case presentations, role-playing activities, web-based learning modules, commercially prepared videos with a follow-up discussion led by an ethics committee member. Creating an environment where nurses can speak up Hospital policy that takes nurses' needs into account is imperative to enhance nurses' ability to respond appropriately to unethical behaviors. Leaders must recognize the importance of moral courage. Hospital policies should support nurses in demonstrating moral courage without fear of reprisal. Bringing different disciplines together Many hospitals employ ethics rounds and ethics conferences. Ethics rounds typically address a single case, either actual or hypothetical, and give participants a chance to see how ethical problems can be resolved. Ethics conferences usually address the entire hospital community while ethics rounds are intended to attract a smaller audience. Offering employee counseling services Nurses struggling with an ethical issue can benefit from individual sessions with a counselor from an employee assistance program (EAP). 3. Staff-to-Patient Ratios and Mitigating Staff Shortages A recent Kronos Incorporated survey found that 90% of nurses are thinking about leaving their hospital for another employment opportunity due to poor work/life balance. Most of the survey respondents (83%) reported that hospitals are losing good nursing staff because of this issue.The financial cost of losing a single nurse has been calculated to equal approximately twice a nurse's annual salary. As hospitals across the country experience staff shortages, nurses are expected to pick up more hours and work overtime. Staff shortages result in increased patient-to-nurse ratios and evoke a whole host of negative implications. The most frequently cited factor causing nurses to quit is feeling overworked and not being able to manage the workload. Staffing shortages caused by nurse turnover can lead to an increase in accident rates and higher absenteeism levels. As nurses work with a higher patient-to-nurse ratio, the chances of patients getting infections, being injured, receiving delayed care, or being sent home without adequate at-home care instructions increases. This can result in extended hospital stays and rehospitalizations due to complications. Hospitals can reduce nurses' stress levels while improving patient care by enacting lower nurse-to-patient ratios. Establishing a staffing committee allows a hospital to take a collaborative approach to staffing. The committee provides input on scheduling procedures as well as staffing guidelines. This helps lower the chances of an unsafe nurse-to-patient ratio. 4. Encourage and Support Nurse Wellness Promoting health and reducing costs related to acute and chronic illness is of great concern to all healthcare organizations. Systemwide solutions are required to address issues such as absenteeism and presenteeism, which occurs when employees report to work impaired by illness and unable to work to their full ability. Presenteeism costs hospitals more than absenteeism. One solution is the implementation of a positive wellness program to encourage work-life balance. Popular wellness solutions include exercise incentives, food and snack programs, counseling groups, and team building activities. On-site wellness programs have been successful in increasing compliance with evidence-based wellness guidelines for care. This compliance has been ascribed to an effective patient-provider relationship and timely follow-up. Another method to encourage and support nurse wellness is the placement of on-site, workplace clinics that provide cost-effective, quality healthcare to employees. Providing preventive care and treatment to employees at their place of employment increases their work attendance. Prevention activities, including immunization and management of chronic conditions, result in fewer acute episodes of disease. By promoting wellness, hospital leaders may affect employee-associated costs by reducing the costs of sick leave and presenteeism. 5. Teach Self-Care Strategies and Compassion Practices Nurse burnout refers to the emotional, mental, and physical exhaustion caused by excessive and prolonged stress. Nurses experiencing burnout are more likely to make poor decisions and experience poor patient engagement. Patients and their families can sense when a nurse is burned out, which leads to lower patient satisfaction. In addition to hindering job performance, burnout can change how nurses view their role and put patients in danger. The Occupational Safety and Health Administration (OSHA) has found that caregiver fatigue and stress are linked to a higher risk of medication errors and patient infections. Job satisfaction is always about the individual nurse and how he or she responds to the work experience. Compassion practices refer to organizational practices that recognize and reward caregiving work. They incorporate resources to cope with stress and provide pastoral care. In healthcare organizations where compassion practices are the norm, nurses report less emotional exhaustion and more psychological vitality. Patients report better interactions with nurses and gave higher evaluations of their patient care experience. Hospital management must watch for signs of stress such as changes in engagement and attendance, then develop initiatives that directly address areas of concern and most effectively enhance well-being. This is achieved when hospitals offer in-service education that emphasizes self-care as a priority and teaches various self-care activities. Programs can assist employees in developing a personalized wellness plan that they will use to practice positive self-care. Systematic efforts should support the development of positive, proactive health care behaviors and coping strategies. The importance of positive self-care must be at the forefront of discourse within the healthcare organization. When a hospital provides a dedicated space to reduce and alleviate the consequences of stress, it sets the tone of management's intention to reward self-care. Leaders could utilize creativity to introduce self-care and self-healing and to make it a daily focus. Examples to raise awareness about self-care and self-healing include: Acknowledge people at each shift change, team meeting, or huddle when they have done something to promote self-care Reference self-care and self-nurturing daily in all appropriate conversations Cultivating an attitude of gratitude by starting a gratitude-a-day practice among coworkers or creating a gratitude journal for the work unit Rewarding self-care and self-healing behavior Ensuring nurses receive their scheduled breaks each shift Creating a comfortable space dedicated to peace and quiet where nurses can get away from the stress during their shifts 6. Tuition Reimbursement and Assistance Many healthcare organizations offer some form of tuition reimbursement or assistance. Tuition reimbursement, also known as tuition assistance, is an employer-provided employee benefit that is a win-win for both hospital and employee. In a hospital-based tuition assistance program, the hospital pays all or part of an employee's cost to attend college classes. Tuition reimbursement helps further employee empowerment, loyalty, and longevity. It serves as an employee retention tool as well as a recruiting tool that benefits employers with high potential employees who are focused on growth and learning. Tuition reimbursement makes sense for hospitals because it enables employees to continue to develop their knowledge and skills. Tuition assistance can be offered in several different formats. Some hospitals cover the cost of any class an employee takes even if the class is unrelated to the employee's job. Other hospitals cover only the cost of classes that are directly related to their positions or to prospective positions. 7. Employer Partnerships with BSN Programs Healthcare organizations are partnering with online RN to BSN degree programs more frequently as respectable nursing schools launch online options. Through partnerships, nursing schools may offer discounted tuition and a simplified application process to hospital employees in return for the hospital hosting virtual networking and recruiting events. Sometimes hospitals even provide input on the curriculum to ensure the program is current and aligned with the organization's needs. When healthcare organizations partner with colleges they offer special benefits that can make furthering education easier while employees remain on the job. Online classes allow nurses to complete their program without travel or having to rearrange work schedules. Hospital partners provide students with support services such as mentors and flexible scheduling options. Forward-looking hospitals realize advancing the education of their staff is a competitive advantage for them. With hospitals facing a critical nursing shortage, partnership programs can provide a pathway to fill specific workforce demand by producing more registered nurses from within the hospitals' own employee base. In return for financial support covering tuition, books, and fees, the employee signs a contract to work as a nurse within the sponsoring hospital for a set length of time. This effort results in loyal employees who are familiar with the hospital's culture and work environment. 8. Nurse Residency Programs The ever-changing healthcare environment presents challenges to new nursing graduates, as well as those changing specialties or worksites, regardless of their clinical background. These include a lack of confidence, difficulty with work relationships, frustrations relating to the work environment, high levels of stress, lack of time and guidance for developing organizational and priority-setting abilities. These factors likely contribute to the high turnover rate among new nurses, estimated at 35-60% within the first year. Hospitals have the opportunity to implement appropriate training that will benefit nurses and the patients who depend on their care, as well as the hospital itself. Nurse residency programs can transform nurses' professional development and improve healthcare quality and affordability. Residency programs put qualified nurses through an intense training that accelerates their transition into specialty practice. Organizations should strive to improve nurses' work experiences, to increase retention of new nurses, and to show financial return for organizations investing in nurses as resources. Residency evaluations show increases in leadership and communication skills, increases in core competencies resulting in higher levels of patient-centered care, and decreases in stress levels and turnover rates. 9. Reimbursement for Certification Some hospitals offer reimbursement for certification courses and exams as well as offering higher pay and incentives to specialty certified nurses. Certification, and the continuing education required to maintain it, serve as a benchmark for success and excellence. Certification is a way for nurses to validate their mastery of skills, knowledge, and abilities. Patients, employers, and nurses all benefit when nurses attain specialty certification. Three-quarters of Americans prefer hospitals that employ a high percentage of nurses with specialty certification. In today's complex healthcare environment, it's essential that facilities assure the public that their healthcare professionals are competent. A growing body of research shows certification contributes to better patient care. Nurse certification also benefits hospitals by creating a positive work environment, one that embraces professionalism and promotes a culture of retention. Nurses who derive high job satisfaction from a supportive and professional work environment are less likely to change jobs. By becoming certified, nurses are positioned for recognition and advancement. They experience an increased sense of pride, fulfillment, and empowerment. Nurses whose clinical judgment has been validated through certification make decisions with greater confidence and feel more satisfied with their work. 10. Job Perks and Incentives Sometimes it's the little things that make nurses feel like valued employees. Nurses appreciate perks and incentives that can make life easier and help improve their work environment. These benefits can range from time-saving conveniences to investments in employees' education and/or home life. Perks include, but aren't limited to: Self-scheduling and a compressed workweek Extended sick leave Classes and seminars Leadership programs Education awards to attend national and international conferences Free concierge service Shuttle service and parking Rideshare incentives On-site child care and back-up childcare for emergency situations Employee health club on campus or subsidized gym membership On-site credit union Legal assistance Weekly farmer's market on campus Discounted tickets to movies, theme parks, sporting events, and local attractions College scholarship for children Adoption assistance Relocation expenses (FranU provides online education opportunities for nurses who want to do more with their drive to make a difference. Contact us to find out more about our online RN-BSN. Learn more here.) References American Nurses Credentialing Center (2010, March 5). Why certify? The benefits of nursing certification. Retrieved from Medscape: Medscape Access American Association of Critical Care Nurses (n.d.). Certification benefits patients, employers and nurses. Retrieved on April 26, 2018 from https://www.aacn.org/certification/value-of-certification-resource-center/nurse-certification-benefits-patients-employers-and-nurses Blum, C. A. (2014). Practicing self-care for nurses: A nursing program initiative. The Online Journal of Issues in Nursing, 19(3). Retrieved from Practicing Self-Care for Nurses: A Nursing Program Initiative Consult QD (2015, September 24). The importance of shared governance in achieving nurse excellence. The Importance of Shared Governance in Achieving Nursing Excellence - Consult QD Consult QD (2017, January 25). Hospital study looks at impact of shared governance: Nurses look at structures, systems and processes. Retrieved from Hospital Study Looks at Impact of Shared Governance - Consult QD Dallas County Community College District (n.d.). Grow your own nursing programs. Retrieved on April 27, 2018 at Grow Your Own Nursing Programs : Dallas County Community College District Farrington, R. (2017, August 6). The ultimate guide to nursing student loan forgiveness. Retrieved from The Ultimate Guide To Nursing Student Loan Forgiveness Friedman, J. (2017, January 12). Consider employer partnerships in online degree programs. Retrieved from U.S. News & World Report website at https://www.usnews.com/higher-education/online-education/articles/2017-01-12/consider-employer-connections-in-online-degree-programs Heathfield, S. M. (2018, March 2018). Tuition assistance: How tuition reimbursement usually works for employees. Retrieved from https://www.thebalancecareers.com/tuition-assistance-1918278 Joyner, J. (n.d.). Do hospitals pay for you to go back to school to become a nurse? Retrieved on April 26, 2018 from http://work.chron.com/hospitals-pay-back-school-become-nurse-27111.html Kosman, S. (2011, October 13). Nurse residencies: Building a better future for patients and nurses. Retrieved from https://www.rwjf.org/en/blog/2011/10/nurse-residencies-building-a-better-future-for-patients-and-nurses.html Kutney-Lee, A., Germack, H., Hatfield, L., et al. (2016). Nurse engagement in shared governance and patient and nurse outcomes. The Journal of Nursing Administration,46(11). Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5117656/ Lachman, V. D., Murray, J. S., Iseminger, K., and Ganske, K. M. (2012). Doing the right thing: Pathways to moral courage. American Nurse Today, 7(5). Retrieved from https://www.americannursetoday.com/doing-the-right-thing-pathways-to-moral-courage/ Med + ED web solutions (n.d.). Nurse burnout: Everything you need to know about nurse burnout. Retrieved from https://www.mededwebs.com/nurse-burnout Nock, B. (2017, April 25). 3 benefits of creating a nurse residency program at your hospital. Retrieved from https://www.gebauer.com/blog/nurse-residency-program-at-your-hospital Prats, R. B. (n.d.). HCA's clinical ethics manual. Retrieved on April26, 2018 from https://hcahealthcare.com/util/forms/ethics/Clinical-Ethics-Manual.doc Rice, S. (2017, July 4). Why a north Texas hospital system pays full fare to send its staff to nursing school. Retrieved from the Dallas News website at https://www.dallasnews.com/business/health-care/2017/07/04/medical-city-pays-staff-nursing-school-shortage University of Arizona (2018, January 30), For better patient care, prevent nurse burnout. Retrieved from https://www.futurity.org/nurses-compassion-practices-patients-1667712/ Welton, J. M., and Harper, E. M. (2016). Measuring nursing care value. Nursing Econimic$, 34(1). https://www.nursingeconomics.net/ce/2018/article340107.pdf Wood, D. (2014, March 3). 10 best practices for addressing ethical issues and moral distress. Retrieved from https://www.amnhealthcare.com/latest-healthcare-news/10-best-practices-addressing-ethical-issues-moral-distress/
  10. Midlife and Mid-career can be an exciting time for nurses. You know your skills, values, and worth. You have experience that goes beyond the bedside and you are ready to use it for a new employer. But, do they value the skills you have? Can their budget support the dollar amount you have in your head as you interview for new opportunities? Job search and interviewing can feel a bit different when you are in the midlife years. The hiring manager may be younger than you expected. The company may have a mission, vision, or values that are different than your own. How do you prepare for these situations? Let's explore 8 ways to prepare for interviews for the mid-career nurse: 1. Identify Your Priorities Before you ever begin the job search, know what you want in a new job opportunity. If weekends and night shifts no longer work for your family, mind, or body, don't entertain jobs with those responsibilities. Know what you are looking for and where your areas of flexibility lie. This will help you communicate honestly during the interview. Create your resume to reflect your skills and priorities for your next nursing adventure. 2. Do Your Homework Research the company. Understand what they do and how you can fit into their mission, vision, and values. Study the job posting and know the core responsibilities. Consider how your skills will help you meet the job duties. Even if your skills are not an exact fit, show your flexibility and willingness to learn by understanding the business even before they offer you the job. 3. Practice the Hard Questions Why are you looking for a new opportunity? Do you really want to make this big of a career change? When will you retire? Consider hard questions before you sit down in front of the interviewer. Have an idea of how you will answer these questions to showcase your skills, experience, and goals for the future. 4. Prepare Your Own Questions Interviews are a great opportunity for you to find out if the company is the right fit for you. Be sure to ask questions. Prepare 2-5 questions to take with you. During the interview, take notes and write down other questions as they come to your mind. Ask some tough questions of the hiring manager. Some possible questions for you to ask are below: Do you feel I am a good fit for this job? How do you think I would fit in with the other people in this department? What is the culture of the company, department, or unit? What career growth and development opportunities will be available to me? 5. Consider the Age of the Hiring Manager If you are in the mid-career years, you are probably in the mid-life years too! This means, there is a good chance the hiring manager will be younger than you. Younger managers value innovation, technology, and problem-solving. Be ready to answer questions about your computer skills and innovative approaches to workplace problems. 6. Prepare Your Resume Many people believe that showing up with a resume that shows what you were doing 30 years ago is irrelevant. This is simply not true. While you don't have to put every job ever held on your resume, you also don't want to ignore an entire decade of your work. Write a paragraph to summarize your job experiences that are older than 15 years. Focus on your skills and successes. You have probably been through acquisitions, multiple management styles, and business changes. Capitalize on these experiences and how they have contributed to your success as a nurse. 7. Consider Your Age an Asset Many people feel that having a little age and experience can be a liability when entering a job interview. Don't place biases on others before you have ever met them. Be sure to discuss your energy and ability to stay current with trends and technologies. Discuss how your experiences add value to your job performance. Age can equate to wisdom and others may appreciate what you bring to the table. 8. SoMe If this acronym confused you, you may need to do a little research before you start interviewing. Social Media (SoMe) is a huge part of getting hired and being successful at interviews these days. You need to be on LinkedIn and understand the basics of your profile, InMail and messaging. Recruiters and hiring managers love LinkedIn. It can be a valuable place to find new job opportunities too. Understanding the basics of LinkedIn and having a profile shows that you are in touch with the high tech times of today. Age and experience bring wisdom. Be yourself because you are great! Are you a midlife nurse looking for new opportunities? Have you been to a job interview lately and were surprised by the questions, feel of the interview, or how you felt afterwards? Share your story in the comments, we would love to hear about your experiences.
  11. Melissa Mills

    30 Safety Tips for the Home Care Nurse

    Home care nurses have a unique and rewarding job. You provide skilled care where the patient lives. You get to experience their everyday life and impact their overall health and well-being. But, there are dangers when traveling all day in and out of homes and in new neighborhoods. This isn't just anecdotal, consider stories like the New Orleans home health nurse who was abducted at gunpoint in 2012. Safety concerns for home health nurses are real. As a former field nurse in home care and hospice, I have had my fair share of stories of family members that gave me the creeps, "tomato plants" that looked very much like marijuana plants, and patients with guns hidden under mattresses. Even though there were times I felt unsafe, I loved my patients and the unique perspective I was given into their lives. But, you do need to implement simple ways to stay safe. Safety Tips and Tricks for the Home Care Nurse Keeping yourself safe doesn't take a lot of work, but it does require intention. Here are a few easy ways to increase your safety knowledge. 1. Know your workplace policies for safety and violence prevention. Don't wait until you are in the middle of a crisis to understand how to activate your company's safety program. 2. Report any unsafe situations as soon as possible. Even if it is just a feeling, be sure to report it to your supervisor. You may not be the next staff member in that home. It is your responsibility to keep others safe too. 3. Be active in your agencies safety committee. 4. Map out your visits so that you know where you are going. Wandering around new neighborhoods looking lost is not safe. 5. Be sure your car is full of fuel and in good working condition. 6. Create a car emergency kit that includes: Candle to keep you warm Band-aids, hand sanitizer, antibiotic ointment Road flares Rain poncho Rags Duct Tape Baby wipes Whistle to signal for help Non-perishable foods or snacks Water Ice scraper Kitty litter for slick roads Blanket and warm clothing Flashlight and extra batteries 7. Park on the street if possible. You don't want to be blocked in if you need to leave quickly. 8. Trust your gut. If a situation feels unsafe, it probably is, and you need to get out quickly. Make sure the patient is safe, leave the home, and call your supervisor. 9. Set boundaries. If a patient or family member starts saying things or acting in a way you do not like, tell them. Be polite and direct. Avoid being argumentative. 10. Keep your cell phone on you at all times. Make sure it's fully charged before you leave in the morning and charge it throughout the day. 11. Know your company's policy on joint visits and behavioral contracts. Contact your supervisor if you need to implement either of these interventions. 12. Start your visits early. Avoid nighttime visits if possible. 13. Take a self-defense course. 14. Don't carry large amounts of cash on you. 15. Always wear your agency badge and carry your driver's license or other ID. 16. Watch your step. Be sure to pay attention to the ground and floors in homes so that you don't fall, trip, or become injured in other ways. 17. Be alert, but not nosey. You're there for the patient. If you are unsure what others in the home are doing, don't go snooping around. Do your job and leave the home. Remember, if the patient is in their right mind, they have the right to live however they desire. 18. Ask your patient to contain any aggressive pets before you enter the home. 19. Keep your sharps container in your nursing bag for easy access when you are in the patient's home. 20. Carry spray or 91% alcohol to fight against bed bugs and other critters you may come in contact with in patient homes. Wipe down the bottom of your nursing bag, soles of your shoes, and any equipment that may have come into contact with surfaces in the patient's home. 21. Always have hand sanitizer in case the patients home doesn't have running water. 22. Document in the patient's home when possible. Don't sit in their driveway or on the street for long periods of time finishing up your charting. 23. Know your service area. Learn the unsafe neighborhoods and find out where the closest police stations are in the areas that you serve the most. 24. Be prepared. Set up your visits and supplies the night before. If you must take supplies into a home, put them in bags and label them with the patient's name the night before. This allows you to gather your supplies and get into the home quickly. Don't make multiple trips back and forth to your car and don't rummage through your car getting ready for the visit. You must be alert at all times. 25. If you are confronted by someone who asks for your money, nursing bag, or other belongings, hand it over! 26. Make sure someone in your company has your schedule, just on the off chance that someone can't find you. 27. Keep trash bags in your trunk. If you go into a home that you suspect may have an insect infestation, don't take your nursing bag into the house. Place the necessary equipment into a trash bag and only carry in what you need. 28. Buy a plastic stool that you can keep in your car. During your visit, set your bag on the stool use it to take a seat. This prevents you from sitting on plush furniture that may be soiled or infested. 29. If there are safety concerns in a patient's home or building, call ahead and let them know you are coming. Most patients will be more than happy to open the door or keep an eye out for you if possible. 30. Don't talk or text while you are driving. If you are a home care nurse, do you need other resources for safety? Check out this great list of OSHA resources specifically for home healthcare workers. Do you have other safety tips that you use when making home visits? Put your suggestions in the comments below. You could save someone else just by sharing the things you do every day to keep yourself safe.
  12. When it comes to anything having to do with scholastic endeavors, I have always taken pleasure and excelled. As I would tell my professors when they asked me how I did so well, the realm of academia has always been my happy place; I have some modicum of control when it comes to bringing to fruition desired outcomes (I.e. studying and hard work lead to good grades). Applying to nursing school, however, felt a lot like an exercise in futility. Some might say that I should have taken the rejection letters as a humbling experience; I would have taken the rejection in stride and learned something from it, except for the fact that I have spoken with faculty members from various nursing schools and have witnessed practices that I do not consider ethical at all. Furthermore, speaking with peers, while anecdotal, revealed a lot as well. There is a dark underbelly to the admissions process and I would even hazard to say that applying to medical school would have been a more streamlined, less harrowing experience. What follows is my own personal experience with the admissions process and what has led me to believe that nursing school admissions is murky, clandestine bog of uncertainties and questionable practices. Prior to applying to nursing school for the first time, I conferred with a member of the college's faculty (who was close friends with someone on the nursing admissions committee), asking if I should try out for sponsorship since my grades were so good. Having insider knowledge, he advised me not to because they preferred to grant sponsorship to hospital employees, applicants from disadvantaged backgrounds, or relatives/favorites. He also mentioned that sponsorship applicants who were rejected were not then put back into the general pool of applicants for nursing school; essentially, the coveted six sponsored seats were chosen and the remainder of sponsorship applications were thrown in the garbage. Nobody knew of this practice, including one of my good friends with a stellar GPA, who had repeatedly applied for sponsorship but had been rejected for the past three years (only when she threatened with a lawsuit was she suddenly accepted). When I finally applied for nursing school in 2015, I heeded the faculty member's advice and would not touch sponsorship with a ten foot pole, even though I had the grades for it. The following Spring, I received my first rejection letter, which cited that there were far too many qualified applicants, blah, blah, blah. Fine. I was well aware of the fact that hardly anyone I knew was accepted the first time, so I decided to patiently bide my time until the next application period, enrolling in an EMT course in order to have clinical experience. I knew many friends and acquaintances who had gotten in on the second try. The second time that I applied for nursing school in 2016, I decided to turn in my application in person. The administrators took my new application, but then proclaimed that they could not find my initial application. The dean of the nursing school came forward and asked me what my rejection letter had said and I informed her of its contents. She personally looked me up in their system and found my application under the category of applicants scoring below eligibility requirements (pre-requisite validation cut-score of 75% and/or composite score of 62% on the assessment test). Frowning, I informed her that that simply could not be possible since a counselor had calculated that my GPA placed me at 89%. This was no mistake or error in calculation, as the faculty knows me well (the dean herself knows that I have a bachelors degree from the same school that she attended for her MSN). The dean calculated my percentage herself on the spot and corrected the "error," assuring me that I would get in on the second try. Which brings me to where I am today: holding a letter informing me that I am an alternate so far down on the waiting list that I wasn't even invited to their in-take meeting (code for surprise drug test). Once again, as told by a member of the admissions committee over the phone today, I have to bide my time until the next application period. Many nursing programs openly state that their programs are impacted and that waiting to get into a program can take as long as three years to finally be accepted. At least such programs are being honest and while I think it somewhat preposterous, I respect their candor. The two schools that I have had dealings with, however, have no such officially impacted statuses, instead opting to artificially impact their programs with, for lack of a better word, shady practices. For example, the Microbiology professor at one school informed me that the nursing department actually frowns on him awarding A's to students, encouraging him to give B's even if the students rightfully earned A's. Why are nursing schools trying to lower students' scores? To stem the flow of applicants? I was under the impression that there was a nursing shortage. Another equally troubling practice is when nursing schools give deference to applicants based on factors not having to do anything with academics. From whether the applicant was a CNA first to what ethnicity box the applicant places a check mark in, there are numerous unofficial factors that influence admission into a program. I cannot tell you the number of times that I have congratulated friends who were accepted with C averages or had to go through remediation programs but also happened to speak a foreign language predominantly spoken in the state that I live in. While I am happy for my friends, I also think that politics have no place in nursing. If a nursing school wanted for students to be able to speak that foreign language, why wasn't it indicated on the application? I would have gladly learned the language instead of squandering three years of my life waiting to hear if I was accepted into the program. As much as I love the field of healthcare and very much enjoyed patient interaction during clinicals, I do not love the hoops that nursing schools ask students to jump through. I'm not talking about the prerequisite courses (I actually really liked taking those). I'm talking about the unofficial profiling that admissions committees inevitably take part in when they consider applicants for admission into their program. One faculty member told me that I was not getting in because I already have a bachelors degree in another discipline, stating that I was already equipped to get a job and that the school's vetting process was a form of social justice. What does that have to do with anything? Medical and law schools accept people with diverse majors, so why is nursing school holding my possession of a prior degree against me? Yes, I do have a degree, but I also have $50,000 in student loans that accrue interest on a quarterly basis and my unemployed status only exacerbates the debt. I don't mean to sound bitter or disgruntled, but I originally decided to pursue nursing for all the right reasons (I like helping humanity, I enjoy interacting with patients, and I like medicine). After being rejected multiple times from nursing school, however, I feel like all my original zeal has been wrung from me and I am now simply left as a husk of regret and frustration. I almost feel like my time would have been better spent pursuing another degree in healthcare and maybe that is something else to consider for the future. My final thought on this matter is that I think many qualified potential future nurses are being sieved out for the wrong reasons and doing so is a disservice to patients. As one patient told me at his bedside when I was completing clinical hours, he preferred a nurse who earned A's in her courses over a nurse with C's and D's. I couldn't agree more.
  13. Anyone who has worked in nursing, around the nursing field, or in anything even remotely related to nursing is well aware that it can be a stressful occupation. While it's a highly rewarding job, and nurses have the privilege of watching their patients heal as a direct result of their compassionate care, there are also many challenges. The saying that "those who care for others must first take care of themselves" is true. Those whose own needs aren't being met will have difficulty coping with the stress of nursing and are prone to becoming burned out. As a nurse, it's necessary to be your own advocate in addition to being your patients' advocate. Stress management skills are a must-have in order to survive and resist burnout. Some naturally cope with stress better than others, but fortunately, it's easy to add more stress-management skills to your repertoire. Here are a few suggestions to give your coping skills an edge. Take a Few Minutes to Keep Emotion in Check Nursing is an inherently emotional field. Nurses often are on the frontlines of highly stressful situations. Caring for the sick (who also have various levels of coping abilities) requires patience, and keen assessment and prioritization skills to be able to manage the workload. Add in the possibility of needing to assist with rapid responses and codes of various types, and you have a recipe for a high-adrenaline day. While compassion and empathy are important characteristics for nurses to possess, it's also necessary to be able to distance yourself emotionally from situations. Stressful situations activate the "fight-or-flight" response, which causes the brain and body to release a cascade of hormones, including adrenaline and cortisol. This is the body's response to a stressor, and for better or worse, it's easily triggered - even by minor events that don't warrant such a response. It's important to be able to take a step back, take some deep breaths, and look at a situation logically because sometimes the brain likes to tell us that a situation is worse than it is. A poorly balanced emotional state has also been shown to decrease reasoning performance, whether emotions are more negatively- or positively-focused. Those in a neutral emotional state tend to perform better in reasoning - yet another reason to take an emotional step back and distance yourself. It's not necessary to lock yourself in the bathroom in order to find a better balance. Simple techniques, such as taking a few slow, deep breaths, or focusing on a repetitive saying or word, called a mantra, are helpful for mitigating stress. Emotional Support for Yourself and Others Strong emotional support has been shown to promote recovery after a stressful event. Emotional support needs vary from person to person. Some people need more social and emotional support than others. If this person is you, it's especially important that you recognize that need. Reach out to a close friend, or family member that you feel comfortable talking with. In-person communication tends to be more effective at providing emotional support satisfaction. In our technological world, it's easy to rely on text messaging for communication. However, make sure you're getting enough real-time with your loved ones. While it's important for you to make sure your own emotional needs are being met, make sure that you are also offering emotional support to those around you. If you see that a co-worker is feeling stressed, or is in a stressful situation, take a few minutes to listen sincerely. Creating a culture of emotional support on your unit at work will help boost teamwork and reduce stress levels. Consider Changes to Your Schedule In some cases, it might be worthwhile to consider making changes to your work schedule. If you tend to work multiple days in a row without a break in between, investigate the possibility of breaking your work week up; that way you have a day off in between work days to rest, decompress and recover. If you find yourself especially stressed and fatigued on your last day of work in a row, breaking your schedule up may help relieve some stress. When looking into a new job, be sure that you and your new manager are on the same page regarding scheduling and your workload. Know what your weekend and on-call requirements will be (if this applies). This will help alleviate some schedule disillusionment. Pursuing Higher Education If you find yourself having trouble coping with work-related stress, consider advancing your education. Nurses have the option of obtaining the education to become a nurse practitioner. If you enjoy being a nurse and performing direct patient care, earning your BSN may help give you a broader perspective. Furthering your nursing education does require investment, especially in time, but this can be alleviated by pursuing an online RN-to-BSN program. Earning a BSN can afford a nurse greater autonomy, a broader perspective when it comes to decision making, and better outcomes for patients. Higher nursing education has been linked with lower patient mortality rates in hospitals, as well as fewer occurrences of failure-to-rescue events. Earning a BSN also positions you for career advancement. With many hospitals seeking to earn Magnet status, you'll have an advantage as a holder of a BSN: Magnet hospitals must maintain a certain percentage of BSN-educated nurses. You may also enjoy a higher salary and better job benefits with advanced education. Improve Your Diversity Mindset A change of mindset works wonders for reducing stress levels. Remember that different age groups, personality types, generations, and cultures all have different ways of approaching situations, including the stressful ones. Embracing this diversity and improving your emotional intelligence work together synergistically. You may not understand why a co-worker wants to approach a certain situation one way, or why a patient has a firmly-rooted daily ritual that they must go through. Disagreements regarding approaches to situations are bound to happen. However, the importance of the situation is that you acknowledge and respect your differences. Focus on What You Can Control When absorbed in the job, especially during busy times with a list of tasks that need to be done, it's easy to form expectations of how the day is going to go. Prioritization is a necessity. You plan on treating this patient first, administering those meds second, and you know you're going to have blood ready for a transfusion soon. However, there are always happenings that we can't control - surprise critical lab results, rapid responses and code blues, being short-staffed, the tube station being out-of-order, etc. Sometimes things happen that interrupt your mental plan for the day. Many of these things are out of our control, and we must focus on what we are able to control. Try to maintain a more fluid mindset when planning for the day. Expect ahead of time that some things will not go according to plan, and it is in your power to accept this and work around the happenings of the day. Nursing is not a profession for the weak of heart or mind. Those who care for the sick must be empathetic, compassionate, and resilient. As a nurse, you must also be sure to care for yourself and be aware of your stress levels. There is plenty that you can do for yourself to help mitigate stress and avoid burnout. Remember that you are important too, and deserve to relax! (Franciscan Missionaries of Our Lady University (FranU) provides online education opportunities for nurses. Contact us to find out more about our 100% online RN-BSN. Learn more here.) Sources: Blegen, M.A., Goode, C.J., Park, S.H., Vaughn, T., Spetz, T. (2013). Baccalaureate education in nursing and patient outcomes. Journal of Nursing Administration, 43-2, 89-94. doi: 10.1097/NNA.0b013e31827f2028. Holtzman, S., DeClerk, D., Turcotte, K., Lisi, D., Woodworth, M. (2017). Emotional support in times of stress: Can text messaging compete with in-person interactions? Computers in Human Behavior, 71, 130-139. Redirecting. Harvard Health Publishing. (2011). Understanding the stress response. Retrieved from Understanding the stress response - Harvard Health. Jung, N., Wranke, C., Hamburger, K., & Knauff, M. (2014). How emotions affect logical reasoning: evidence from experiments with mood-manipulated participants, spider phobics, and people with exam anxiety. Frontiers in Psychology, 5, 570. Frontiers | How emotions affect logical reasoning: evidence from experiments with mood-manipulated participants, spider phobics, and people with exam anxiety | Psychology National Communication Association. (2015). Providing emotional support that facilitates stress recovery. Retrieved from Providing Emotional Support That Facilitates Stress Recovery | National Communication Association.
  14. UM Review RN

    The Value of Transfer Boards

    When I asked why they were not covered by Medicare or Medicaid, I was told that a sliding board is a tool that helps the caregiver 's back more than the patient. While it is true that a transfer board does cut down on back strain for caregivers, sliding boards are certainly a good option for those who take care of a loved one at home. Like handrails for bathrooms and raised toilet seats, these patient assists help prevent falls and increase independence for the wheelchair-bound patient or for those patients who are wobbly on their feet or who have a "trick" knee that can give out without warning. They can range in price from less than $50 to hundreds of dollars, depending on the type of materials used and the style of the board. The transfer board is usually a piece of highly lacquered wood. One end is positioned under the buttock of the patient and the other is placed onto the seat they will move onto. The patient slides across the board from one place to the other without the need to stand. The patient can also learn to get from the bed to the chair, wheelchair, toilet, or bath seat, by himself. Transfers to car seats are a little trickier because of the difference in height between a car seat and a wheelchair, but with practice, they can also be a great tool for getting in and out of a car. An example of the type of patient who benefitted greatly from the use of a sliding board was a patient I had once who was recovering from Guillain-Barre syndrome and was not quite strong enough to stand long enough to transfer. The patient felt more secure using the transfer board for a few weeks. As her mobility increased with the use of the transfer board, her muscle strength increased, and she was able to move more confidently. The caregiver's back is spared because the caregiver only makes sure that the board is placed properly and that the patient can slide over while still seated. The patient enjoys freedom from the fear of hurting the caregiver or himself. The patient must have the muscle strength to be able to accomplish the slight lift of the buttock and strong sideways maneuver. The caregiver must learn to simply guide and "spot," not lift, the patient. Sometimes a little dusting of powder can help keep the board slippery enough to effect the transfer smoothly. There are a few types of transfer boards. Some are made of wood and are a simple, straight piece of wood with tapered sides so that the piece can fit under the buttocks more readily. Other types are made of plastic. Some types have a seat that can swivel, making it even easier for the patient to transfer. All of these types are sturdy and made to last. I have found that they can be well worth the money for certain patients and I wish that they were used more often.
  15. To say that the first semester of nursing school is overwhelming would be an incredible understatement. Between being assigned to read 20 textbook chapters a week, skills checkoffs, and your first clinical shifts (not to mention, care plans!), studying can be a pretty daunting task. Throughout my first semester of nursing school, I developed a study method that helped me to not only maximize my time, but to minimize stress and achieve grades I was proud of. ✔️ Determine your learning style. We are all unique and, that being said, your professor's 250-slide PowerPoint presentation might not necessarily solidify complex disease processes for you. The VARK assessment is a great tool to help pinpoint what kind of learner you are. With this information, you can formulate a more effective study method to ensure you're not wasting your time. The VARK Questionnaire | VARK ✔️ Create your own notes. Nursing lectures are notorious for being complex...and oftentimes, too much so. Trying to retain too much information is only going to overwhelm you. Whittle down your lecture notes to the "meat and bones"--the core concepts. In example, when looking at a disease process, oftentimes if you understand WHAT is taking place physiologically, you can deduce the S/S and treatment modalities. Aim to UNDERSTAND, not memorize! ✔️ Adequately plan to maximize preparedness. Allowing yourself a few days to prepare for a major test isn't going to cut it. Start studying immediately following your lectures to ensure new concepts stay fresh in your mind. ✔️ Keep it cumulative! Just because you feel like you understand a certain topic doesn't mean you can simply set that information aside. Continue to review this information while you're learning new concepts to make sure you don't lose it! ✔️ Do as many practice NCLEX-style questions as possible! Check out books from your school's library, rent them online, or purchase. Not only will this help you apply the new concepts that you're learning, but it will also give you a good indicator of where you are in your NCLEX preparedness. Davis and Saunders make great comprehensive NCLEX review/Q&A books and the Success series makes subject-specific Q&A books. You can further reinforce concepts by reading the rationales for both correct as well as incorrect answers. If I could provide you with one last tip, it would be to remember to enjoy the ride. Cherish the friendships that you make and remember to take time for yourself. Always remember your WHY and allow that to fuel your passion and propel you into this incredible, rewarding career!
  16. love2banurse89

    How to be a Team Player

    Be positive! Even when you're short staffed, getting admissions (even if at the end of the shift, on a Friday, with incomplete orders), and charting on falls and condition changes, a positive attitude can make the shift bearable. The situation remains the same whether you are positive or negative, so keep a smile on your face-even if it's through gritted teeth! If others complain, simply say, "But we will get through it!" or, "Remember that time when...if we can survive that, we can survive anything!" or, "Yep, this will be one of those days we look back at and are amazed that we made it through! We are super nurses!" Offer to help Whether answering a call light, making a bed, getting someone off the toilet, starting an IV, assisting with a room change, or any other of the countless tasks we do in a day, helping when you can is beneficial to the team-and almost assures that you will get help when you need it. Share tips and (safe) shortcuts When you share a newly-discovered shortcut for computer charting, a tip for a procedure frequently done where you work, or the research you did on the new IV antibiotic for your patient, you are helping others do their jobs more efficiently and strengthening the team as a whole. You're also encouraging others to share their knowledge, strengthening the whole team. Share your knowledge and skills Whether it's reviewing peri-care with a CNA or teaching a new nurse the procedure for a piggy-back IV antibiotic, you're increasing their knowledge and general knowledge of the whole team. In the long run, this makes everyone's job easier. Do a little extra for the next shift Re-fax a medication request that hasn't been replied to. Stock the med cart. Put a new bag of IV fluids in the patient's room. Pick up the garbage in your patients' rooms. Fill the printer with paper. The nurse who follows you will be thankful to start the shift ahead. Welcome new staff I once started working at a facility in which a constant complaint was that they were chronically short staffed. In just a few weeks I realized that whenever someone new started, they were made to feel very unwelcome; current staff criticized new staff within hearing distance, left the most difficult tasks for them and refused to help, ignored questions from new staff...it's no wonder they were always short staffed! Don't gossip People will know you are to be trusted and follow your example (most people want to work in a positive, safe atmosphere). If gossip starts, a simple, "Let's not talk about her when she's not here to defend herself" or "I don't know that any of that is true...how about this weather?" will usually change the subject. Embrace change Most of us are skeptical of any changes, especially when the "higher-ups" are dictating it. However, many times change does turn out to be positive (after the painful period of implementation). And if it does not turn out to be positive, the harsh reality is that when "higher ups" dictate a change, we usually have no choice...so might as well accept it. If you've given the change a chance and it's just not working, don't just complain about it-do something! Talk with your charge nurse or the DON or even the administrator. Support your supervisors and the administration... ...or at least give them the benefit of the doubt until proven otherwise. I've been in management and there are many, many factors that go into decisions...sometimes the supervisors/administrators don't like the decisions they are forced to implement by those above them. If you don't agree with the decision, talk with your supervisor and try to get it changed, don't just complain. Being a part of a strong team makes going to work rewarding in both a professional and personal sense. When you follow these tips you will be part of that satisfying process of building and being a part of a strong team!
  17. jeastridge

    Can We Talk? End of Life Discussions

    Jan busied herself at the bedside of her patient, a woman she had seen before during a similar admission for COPD. As the woman struggled to breathe, Jan could easily read the panic in her patient's eyes. She changed a sweaty pillowcase, put the head of the bed up slightly and readjusted the fingertip pulse ox that beeped repeatedly. She started to back away to look at the patient's med list and see what was due, when the patient caught her hand, "Can we talk?" Jan's mind raced ahead to the other patients she was responsible for, before settling back into place and focusing in on her struggling patient's face. She knew, in her heart, what this conversation would be about. It was important and not the kind of talk that could be rushed. She pulled up a chair and sat up to maintain eye contact. She held the woman's fingers and asked, "What have you got on your mind? How can I help?" "I don't want this," the woman said, while rolling her eyes in an arch to indicate the bedside with its surrounding drips and machines. "I want to go home." Broaching the subject of death is hard for anyone. Sometimes, being at the bedside, we are the ones that patients open up to. How do we handle it when it happens? Whether we are at the bedside in the hospital, or in home health, and even in an office setting, we can be at the front lines of a critical discussion. Do we know what to say and do? Here are some points to consider when we face a similar discussion: Be fully present Eye contact, physical touch, body posture all play an important part in sending the message that we are really here, ready to listen and help. Many of us feel distinctly uncomfortable about having end of life discussions-after all we work to make life better, to prolong active life, to maximize function. But there are times in our profession when we need to be the midwives that help our patients find their way forward when they feel they are at a dead end. If we are able to allow them to talk, help them express their wishes, we can help them find a way toward peace and hope even in the face of death. Listen and ask questions In nursing school we all learn about asking "open-ended questions." This is the time to employ that skill, allowing the patient to say what they need to say, even if it's not pleasant or even if it's not what you are hoping they will say. Being a good listener is hard work, especially when the person is struggling to express themselves or when we feel hurried by other pressures. Help define goals Goals can engender hope and focus. At this stage, the goals sometimes seem rather small-to get home and sit in a favorite recliner with their dog, to hold a grandchild, to enjoy some time on the porch. Knowing what they want can help us know how to proceed. But what if their wishes seem completely unreasonable given their fragile condition? Again, listening is key. Sometimes simply verbalizing their goals is enough to satisfy the longing for reality to be different; it can be enough to help them get through this day. Know your resources As nurses, it is important to know the resources we have available to us, whatever our setting might be. Whether it is a palliative care team, the hospice liaison nurse, the case manager or a physician, having a solid knowledge of how to proceed from this point can be valuable to our patients. Do you know the difference between Advance Directives and the POST form? Do you know what qualifies as a hospice diagnosis? Do you know what services are available at home for those who want palliative care while continuing to pursue treatment? Can we be gentle guides along the way as we help our patients understand what "Full Treatment" means vs. "Limited Additional Treatments?" Being well versed in this subtle, but important aspects of end of life care can make us even better nursing professionals. Gently direct Sometimes having this conversation can take a long time. It is important, critical really, to know how to direct the conversation and begin the process of referring the patient to the doctor or the case manager. Depending on the setting, we may need to continue to help the patient clarify their wishes or we may need to introduce the concept of another person who can discuss this fully with them, at length, and fill out the appropriate forms to document their wishes.[/indent] In a few minutes, Jan was able to ascertain that her patient would need further counseling and the opportunity to fill out paperwork. She outlined the steps she planned to take in calling the doctor to come in and discuss next steps. Then she went on to offer some medication for symptom management before moving on to her other patients. As she left with her cart, she looked back to see the woman breathing more easily and dozing off. End of life discussions need to happen, and sometimes we are the ones who are there. Being prepared and willing to listen, we can provide valuable care to our patients who desire to make choices about their end of life care. Joy Eastridge, BSN, RN, CHPN Reading a recent news article about a man who was found with a Do Not Resuscitate message tattooed on his chest prompted me to write this article. To read more about that news story, go to Living Will Tattoo
  18. EmilyCatherine

    Advice for new RNs, from a new RN

    I am by no means a seasoned nurse, but I have learned a few things during the beginning of my career that have saved me time and made my work more efficient. I work on a fast-paced MedSurg/Trauma/Orthopedic unit in an inner city teaching hospital. I hope that these tips can help some of you! STAY ORGANIZED Being organized with patient's medications, charts, to-do lists, etc., will make everything feel less chaotic. Find a way that works for you and stick to it. MAKE A TO-DO LIST My suggestion is if you cannot do something at the exact moment, write it down. It is so easy to forget that a patient requested pain medication, or a new pitcher of water, if you are in the middle of something else. START YOUR DAY PREPARED Glance through your patients' charts and become familiar with their orders. Things especially important to pay attention to are code status, diet orders, PRN medication orders, and parameters when to call the physician. ALWAYS HAVE A BASELINE ASSESSMENT You need to have a focused assessment at the beginning of your shift to monitor for any changes throughout. I can't stress enough the importance of this! KEEP YOUR POCKETS STOCKED Keep your pockets and your cart stocked with items is a HUGE time-saver. There is nothing worse than realizing you don't have IV tubing when you are about to hang a med, and having to run across the floor to grab supplies. Things I always have in my pockets are: a. Alcohol swab (it can double as a piece of paper in a pinch) b. Something to write on c. Pen and pencil d. Saline flushes e. Tape (I keep around my stethoscope) f. Gauze Things always in my cart: a. Syringes (all sizes) b. Gauze and Band-Aids c. Cups, straws, spoons d. IV tubing (primary and secondary) e. A bag of normal saline and LR f. Blood draw sets and IV kits g. A suture removal kit (docs are always coming up to me asking me to grab them one!) Anything else you reach for frequently! DON'T BE AFRAID TO DELEGATE At the beginning of my career, I was always scared to ask the aides or other nurses for help with small tasks because I didn't want to bother anyone. That said, do not abuse your aides or make them feel like they are doing all your "dirty work." Don't think that because you are an RN now, you are "too good" to put a patient on a bedpan or assist them to the bathroom. Work together and always thank your aides for their help. Don't forget, they are a second pair of eyes and hands for you. BE A TEAM PLAYER If you have some free time (rare I know!) ask other nurses if they need help with anything. Even seasoned nurses can use an extra hand. The act of offering to assist others creates a positive work environment and hopefully others will return the favor. BE PREPARED BEFORE YOU CALL THE DOCTOR Think before you call and imagine how the conversation may go. Think about the important information you will be asked about. ALWAYS have a RECENT set of vitals!! Other important information includes pertinent lab values and medications, including PRNs. Have a piece of paper and a pen ready for new orders. Have your patients chart up and ready for quick glance. It definitely takes practice to effectively communicate with physicians, so rehearse in your head what you are going to say if you need to. BE ON TOP OF WHEN THE NEXT DOSES IS FOR PRN PAIN MEDICATION Patients who are in pain get very frustrated when having to wait for pain medication. Knowing when the next dose is due can keep you from feeling rushed and it will also keep your patients happy. BUY A PULSE OXIMETER It comes in handy in more instances than I could imagine! If you are in your patient's room, and you find an opportunity to stick the pulse ox on them for a moment, do so. PREPARE FOR NEXT SHIFT If you see the fluid bag is going to run out soon, grab another bag to have ready to go. Don't leave an almost-empty bag for the next shift to have to change right away! Also, always do a quick rounding within the hour before shift change to make sure your patients are comfortable, have everything they need, are medicated, and that the room is clutter free. BE ON TOP OF THE NURSES AIDES Some are great, and others are not. You will quickly learn the ones you can trust and the ones you cannot. Give them specific parameters to report to you if necessary. There have been times aides have not reported abnormal vital signs and complications were not caught right away. That said, always stay on top of your patient's vital signs, especially if someone else is taking them. AVOID MEDICATION ERRORS As nurses, it feels like we are rushing and getting interrupted all day, but you need to be 150% focused when it comes to medication administration. Luckily with scanning technology, medication errors are less prevalent but they do happen. Do not put more than one patient's medication in front of you at a time. Scan the medication, put it in a cup, and go directly into your patient's room. If you get interrupted, start over and double check. Taking extra precaution to avoid an error is SO important for your patient's safety as well as your job security, especially as a new nurse. Also, be extremely careful with narcotics and dosages. QUICK GLANCE NOTES I have one piece of computer paper with all my patient's information including: diagnosis, IV fluids and rate, pain medication and dosing, abnormal or pertinent lab values, antibiotics, recent vitals, etc. (I find it is best to write when you are getting report from the previous shift RN.) If a physician stops you in the hallway and asks you a question about the patient, having this information at a quick glance not only shows you are prepared, it is also a huge time-saver. It takes time and practice to know what the "important" information is that you will be asked about. TAKE A MINUTE TO REGROUP We have all had times where our heads are spinning, we are bombarded with things to do, a patient is angry, and you don't know where to start. Take a deep breath, regroup, and prioritize what needs to get done. Being a new nurse can be so overwhelming, and everything feels like it is an emergency. In due time, you will be able to figure out what really is the priority. The most important thing to due when you feel overwhelmed is to stay calm, regroup, and focus. Don't let the feeling of being overwhelmed send you into a panic. One step at a time! DOCUMENT, DOCUMENT, DOCUMENT Cover your butt. I know you learned this in nursing school, but it really is so important. If you report something abnormal to a physician, document it, especially if you get no new orders. If you have placed multiple calls to a physician, but have not received a callback, document it. DON'T BEAT YOURSELF UP IF YOU HAVE TO STAY LATE TO CHART As a new nurse, you may feel discouraged when your coworkers are leaving on time and you still have charting to do. This is normal, and your time management skills will improve. SOCIAL MEDIA & DATING COWORKERS Be very careful with who you decide to be friends with on social media. Also, as a new RN, there will be many new people you meet with opportunities to date. I am sure you are all smart enough to figure this one out, but be very careful!
  19. Would you like to have an advantage going into applying for your first, or next job? Even though a nursing shortages exists, many positions still have competition for those positions. There is a free way to "enhance your resume" that will make you stand out from the others. Did you know that employers are granted certain tax advantages for hiring different groups of people (ie veterans)? I first started in medicine over 40 years ago, as an EMT at a level one Trauma hospital, then transitioning to Nursing (ER for over 30 years) - finding a job was NEVER an issue. Most of the time I was "over-qualified", and as my years of experience grew, I was always a strong candidate for any position for which I applied. However, as HR departments started taking over all aspects of the hiring process, it became less about your capabilities, and more about what you looked like on paper. Another downfall, after a certain point (typically around 15-18 years of experience), one's years of experience were more of a disadvantage for hire, because of the starting pay for a facility for those years of experience. It was less expensive to hire those with less experience, even if the acuity in the position being sought, was extremely high. As I got older, there were several times when I was unable to find the job I desired, and had to "settle" as a result. I learned to never leave a position, unless I had another to take its place - or... many of the years in my tenure as a nurse, I worked agency. As I am transitioning out of active nursing, I have been made aware of the fact that there are Federal Hiring Incentives, or tax credits, given to those employers that hire people with certain qualifications. These credits are part of what is called WOTC, or Workers Opportunity Tax Credit. WOTC is NOT just for nursing, but ANY position or business for which one might be making an application. Often times, employers do not take advantage of these credits, due to lack of knowledge about them, or the paperwork and time constraint placed on the appropriate paperwork. There are multiple companies throughout the country that try to alleviate the complexity of the process. I have stumbled across this particular one that makes it simple for both applicant and employer to facilitate and receive the appropriate credits. This is done via a confidential questionaire given during the hiring process, in which qualifications are determined according to answers to the questions on this questionaire. The level of tax credit varies, for example, any veteran is eligible for a $9600 credit to the employer that hires them ... IF the paperwork is handled properly during the hiring process, and filed with the IRS. It is important to note that due to the personal component of some of these questions, by being performed by an independent third party, confidentiality is maintained on the part of the applicant from the potential employer. *Not every applicant qualifies, but research is done to assist in finding every local, state, and federal incentive for each profile received. So happy hunting! When multiple applicants are applying for the same position, this could truly be YOUR Advantage! Carol Ansley, RN, BSN
  20. What do you believe are your strength and your weaknesses. What interests you most in our organization statement? What can you tell us about an organization? Where do you see yourself in 5 to 10 years? What aspects work are difficult. Your direct feedback would be valuable to me. I really need some fresh ideas as I feel I am beginning to dwell on my interview experience. Dear Not Comfortable, Interviews are stressful, and being prepared helps you to be confident. It's good to anticipate commonly asked questions and be ready with a response. Remember employers are looking for a good fit for their organization. Interviews are not about you- they are about what you can do for the organization. What problem do they have that you can help solve? For example, if your interpersonal skills are good, speak to that as all hospitals are challenged to improve their patient satisfaction scores. What do you believe are your strengths and weaknesses? What the employer is looking for: Insight, honesty. That your strengths match the strengths they are looking for (read the job posting description) and that you are taking actionable steps to work on your weaknesses. How to answer: The key is to frame your answer positively in a manner that reflects well on you. The interviewer wants to hear about strengths that would be assets in the workplace. Be prepared with at least 2 strengths and 2 weaknesses because they may respond with "Good. And what's another strength/weakness?" Avoid cliches. Do not say "I'm a perfectionist" because it's been overused as an example and you will come off as having googled your answer. Which, of course, you may have but they don't need to know that. When choosing your weakness, pick something work-related and fixable. Make sure that it's not something critical to the job, but that it is something germane to the job. For example, don't say"I struggle with math calculations" because you are going to be passing medications and your aptitude and safety will be brought into question. Don't say "I'm no good with Power Point" because this is not a skill for a bedside nurse. It will be seen as avoiding or skirting the question. Your goal is to present a genuine weakness that does not damage your potential for the position but also does not come across as unrealistic or staged. "I don't always delegate as much as I should, because I always want to do everything myself! I've come to see that delegating is important in order to work as a team and get everything done. Every shift on my last rotation, I made it a point to delegate more each day. It's still out of my comfort zone, but I'm improving daily." What interests you most in our organization statement? and what can you tell us about our organization? They are looking to see if you'll be a good fit. Do this by knowing their mission statement, and the culture, if possible. For example, if it is a faith-based organization, you would speak to that insofar as your values align with theirs. Where do you see yourself in 5 years? "I'm looking forward to growing with the organization and taking on more responsibilities as my skills increase" What aspects of work are difficult? "Currently I am working on my time management skills, and I am making progress.'m learning to batch my duties whenever possible, and to carry enough needed supplies with me. When I anticipate what my patients might need, I'm better prepared and save time." Tell us when you had a conflict at work and how you resolved it Variations of interview question: Describe a time when you disagreed with your boss. Tell me about a difficult patient and how you handled the situation Describe a conflict with a coworker, and how you resolved it. What the employer is looking for: Conflict resolution skills. Interpersonal skills. Team work. That you can interact well with others. How to answer: Have 3 examples ready, one of conflict with your boss, one with a co-worker, one with a customer/patient. Segue if needed("While I haven't had that particular experience, I have had...."). Then give them a similar example that shows your ability to communicate with others and come to a working agreement. They will go with it. Healthcare facilities prefer to hire people who work well with others, have good social skills, get along well with patients and visitors, and can pull together as a team for the sake of patient care. To tell your example, follow this helpful formula: Conflict resolution skills. Describe the situation Identify the challenges you encountered Explain the action steps you took Share the outcome Summarize what you learned and will apply moving forward Patient Scenario Question Variations of interview question: You will be given a clinical scenario describing a patient is some form of distress. They are not trying to trip you up, or throw you a curve ball. What the employer is looking for: That you ask for help (no lone rangers), you provide basic nursing interventions (assessment, vital signs), that you are a safe practitioner, and that you anticipate interventions (labs, ekg). How you handle stress. That you don't panic or freeze. They are not looking for clinical expertise if you are a new grad, and not looking for a diagnosis or in depth understanding of labs or diagnostic test. How to answer: Call for help (call RRT or charge nurse) - shows your understand your role Stay at the bedside - demonstrates safety Assess the patient (take vital signs, finger stick, etc.) - knows to apply the nursing process and doesn't panic Perform an appropriate intervention (Raise the head of bed, apply oxygen) - shows critical thinking Call the MD - good Call the MD and anticipate what he/she will order (cardiac enzymes, EKG, CXR, etc.) - better Hope these help, friend!
  21. Melissa Mills

    9 Communication Tips for Nurses

    Communication is an integral part of life. In its simplest form, communication is the act of transferring information from one person to another. In healthcare, a large portion of the responsibility for communication falls on nurses. According to one study, effective communication by nurses may reduce stress, promote wellness and therefore improve the overall quality of life of patients. As a nurse, you are responsible for relaying information to many individuals. You must be able to communicate clearly, especially during times of stress. Your ability to communicate effectively in both written and verbal communication is just as important as your clinical skills. Let's explore 9 quick communication tips for nurses. Clear, Slow Speech Speak in a clear, slow manner to give the person receiving the information the best possible chance of understanding. This sounds simple. In reality, nurses have 100 things on their minds at all hours of the day. So, this can take some practice. Just remember, louder is not always better. No Slang, Cursing Raise your hand if you have ever heard a nurse drop the "f" bomb in a patient care setting. Go on! Raise your hand! We have all heard it and many of us have even been the one doing it. But, it is okay? Nursing is a trusted profession. Along with trust comes responsibility. Patients rely on you for ethical, honest treatment. Cursing can change how people perceive you, ultimately changing how much they trust you. The professional setting is not the place for slang or cursing. Know Your Audience If you are speaking with colleagues, you can use medical terminology, acronyms and all of the big words you like. When speaking with patients and families, remember that those words may not mean much and may even be scary or intimidating. Listen Well Most of us listen to respond. As a nurse, you must learn how to listen to understand. Your patient holds important information about their symptoms and ultimately, the treatment they need. Give your full attention. Ask questions. Give the patient plenty of time to talk. Listen as though they are your mother, father or other loved one. When we allow the patient to touch our heartstrings, we are more likely to act and listen with empathy. Reflection If you are having difficulty communicating with a patient, try using the therapeutic communication tool of reflection. Reflection is the process of paraphrasing and restating both the feelings and words of the patient. This allows the patient to "hear" their own thoughts and to focus on what they say and feel. It shows the patient you are trying to perceive the world as they see it and that you are doing your best to understand them. Reflection encourages the patient to continue talking. Body Language Have you ever consciously paid attention to your body language when you are in stressful situations? If not, try it. You will learn a lot about how your body expresses your feelings. You will likely notice that your muscles are tense. Your arms may be across your body. Your hands may be balled up into fists. And, your face, well it can be scrunched up into any number of positions! This is a form of communication. When you consciously consider what you're communicating through our body language, you become a more effective communicator. Know Your Own Weakness We all have them. In order to be a better communicator, you must know your biggest barriers and consciously work to improve. Maybe you shut down during times of confrontation. Maybe you talk all the time and listen minimally. Whatever it is, don't beat yourself up about it, just work on it. Keep Your Word One of the simplest ways to inspire trust in your relationships is to keep your word. If you tell a patient you will be back in 10 minutes with pain meds, be there. If an unforeseen event has occurred, pop in for 2 seconds to let them know you are tied up but have not forgotten them. Keeping your word allows others to know they can trust you. Make Eye Contact OK, this one is super simple! But, very effective. Have you ever told your patient that you are listening while you are charting? Of course, you have. We all have! But consider what you may be missing by not maintaining eye contact with your patient. These are all simple communication tips you can start today! In our society of multi-tasking and technology, we are losing the art of verbal and written communication. Take a few minutes to consider these tips. Which one could you use during your next shift?
  22. I originally wrote this guide for family and friends who have been asking me about the steps to become an RN in the UK. I am currently on the process of acquiring my Tier 2- Visa and will be updating this as I go, and only when I have free time to do so. I'll be as concise as I possibly can. I may miss a few details, just remind me if I do! If you have any questions you may post on the comments box. This is mainly an account of my personal experiences and not an authoritative guide, so I disclaim any liability that may be incurred by information found here. 1. Make sure you have passed the Philippine Nurse Licensure Exam (local boards) first, and have a Registered Nurse license awarded by the Professional Regulation Commission (PRC). The NMC requires that we're licensed in our home country, as well as all of the countries we've practiced in. So make sure you have your Board Certificates in your possession, as you will need to submit these, among other documents, during the Assessment stage. 2. Make sure you have at least 12 months of post-registration nursing experience. The NMC requires that we have at least a year of post-registration experience, and has to be related to the area of nursing we'll be applying for. For Filipino nurses, I think it's almost always Adult Nursing. Both volunteer and employed work will be considered. 3. Get Academic IELTS scores acceptable to the UK Nursing and Midwifery Council. You'll need a grade of at least 7.0 (out of 9.0) in Listening, Reading, Writing, and Speaking. Presently though, two IELTS test certificates may be submitted to meet the above requirements, but you must not have scored below 6.5 in any categories, in either of the test sittings. The two test sittings must be taken within six months of each other to be considered. Make sure you take the Academic module, not the General Training one. I also recommend getting the UKVI one if you are feeling confident about getting 7.0 on everything right off the bat. It's hitting two birds in one stone, since you will be needing a UKVI Academic IELTS test result later when processing your UK Tier 2 visa. It's more expensive though, and UKVI only requires IELTS scores of 4.0 on all tests for the visa. I paid SAR 925 (approx. PHP 11,500) for the regular Academic IELTS I took in Riyadh, and PHP 16,090 for the UKVI Academic IELTS I took in Manila. (Total of PHP 27,000++, my agency paid for my UKVI and reimbursed my regular one too.) I recommend preparing for the test, both through practice and also by becoming familiar with the IELTS test formats. You may be very confident about your oral and written English, but if you do not conform to these formats, I'm pretty sure your score will fall below the target score, which is 7.0. I found Clarity and Road to IELTS as invaluable guides to hurdling the tests. Make sure you go through them as they provide tips that will help especially the first-time IELTS test-taker. Never ever sit for the test without going through them. As for my own preparation, aside from studying Clarity and Road to IELTS, I downloaded a random Cambridge IELTS practice test online (I forgot where exactly, but you can Google for one). I have only practiced once for each test, but I feel that people will need to practice more to warm up and have a feel of what it's going to be like at the test center. The more you practise, the more confident you will feel. The confidence you get from practicing will help you overcome the anxiety you will be feeling whilst taking the test, as well as beat the time pressure, especially during the Writing test. You will also need to develop techniques such as skimming and scanning through paragraphs for the Reading test, as the full hour may not be enough for you to cover all of the materials. I also made sure I had a full meal and good coffee to keep me awake throughout the test day. (Although I was sleepless the night before the test, I would recommend too for you to have a good night's sleep! It will help keep you focused. ) I didn't find the Listening test hard. I would advise you to give full attention as the items will not be repeated. Take advantage of the few minutes provided at the beginning of the test to take note of the test questions, so you can anticipate the word/phrase you will need to jot down to fill in the blanks. For Reading, I took advantage of the margins on the test booklet and wrote keywords on it beside the paragraph I just finished reading. This will help you answer the questions later on and not take too much time looking for the information again (remember you are given only 60 minutes to finish, and I think I was asked to read 4 academic articles for this test). The keywords you make will help as a reference whilst you're answering the questions, so you can confirm that your answer is indeed correct. I would recommend speed reading, skimming and scanning, and not lingering too long on anything. I swear, I speed-read, wrote keywords, matched my test answers to the text, and read faster than average, but only finished the test just in time. I remember I took almost the full hour on Task 2 of my Writing test. I only had 5 minutes to do my Task 1, thankfully I still got a 7.0. I recommend writing Task 2 first because it's worth twice the points. Be careful not to exchange your answer sheets if you write Task 2 first. Make sure you have an introduction, body, and conclusion, and adhere to writing only 250 words. Writing a lot more than 250 words for Task 2 and 150 words for Task 1 will give demerits, so try to count words per paragraph as you go. The Writing test is notorious to almost every Filipino IELTS-taker. Many people fall short of 7.0 for Writing, (even end up re-taking IELTS six times!) so make sure you take this seriously and practice, practice, practice! Get accurate information with regards to format and guidelines to writing both Task 1 & 2 from Clarity and Road to IELTS, and adhere to them when you practice and when taking the actual test itself. The Speaking test will seem scary at first, but really it's just like talking to a close friend or family member. It consists of three parts, the easy, medium and difficult parts. Just kidding! You will be asked on the first part to talk about things you're familiar with, such as your home town, your family, your accommodation, etc. This will warm you up for the second part, wherein you will be given a full minute to prepare to talk for a few minutes about a topic that will be provided by your interviewer. You will be given a task card, make sure you cover all the tasks because if you skip some, you will not be awarded any points for it. Make use of the pencil and paper provided for you to, again, write keywords for each task to guide your talk. Lastly, you will be asked to talk at length about a topic related to the one you had on the second part. This is relatively easy because you will only be asked to give your thoughts and opinions about a certain topic. If you run out of things to say, make sure you don't have 'dead air.' Say something like, "Let me think for a few seconds." Do not say "uhmmm"or "ahhh" a lot in between words, when trying to think of things to say. I believe this also gives demerits. (If you're curious, my test scores are the following. For my regular Academic IELTS, I got 8.5 for Listening, 8.0 for Reading, and 7.0 for both Writing and Speaking. I think I scored better, had only one mistake I believe for Listening because they provided headsets in Riyadh, unlike in Manila where they only played the items through a loudspeaker. For my UKVI Academic IELTS (taken in Manila), I got 8.0 for Listening, 8.5 for Reading, and 7.0 for both Writing and Speaking. I did not need to rehearse or review because I already understood what I needed to do in the tests. I got an overall score of 7.5 on both tests.) 4. Declare your Eligibility on the NMC website. Congrats for hurdling the IELTS! It may have seemed so daunting already, but really you're just getting started. The first step of the process is the Eligibility stage. You will need to sign up on this website: NMC International Registration > Login. Here you will need to declare that you are eligible to take the Test of Competence 1, more popularly known as the CBT (Computer-Based Test). Tick all of the boxes that need ticking and input your IELTS scores. You will receive an e-mail confirming your eligibility and authorization to test (ATT) from the NMC. You will need to sign up here to register and pay to take the test with Pearson Vue. 5. Pass the Test of Competence 1, aka the CBT. The CBT is not the same as the PNLE or the NCLEX or the Saudi Prometric. It is different because the questions gauge your nursing knowledge based on UK practice. Do not attempt to take this test without preparation as it will definitely result in a fail, because UK practice is a bit different from everywhere else. For Adult Nursing, here is the NMC link for topics to review. I recommend taking serious notes on Standards and Guidelines, specifically The Code, Medicines Management, Safeguarding Adults and Children, Raising Concerns, Social Networking Guidance, The Professional Duty of Candour, and Infection Control. You may read The Royal Marsden Manual of Nursing Procedures and skim through the other readings outlined in the blueprints. You don't need to memorize things, you only need to understand them. You also need to know that out of the 120 questions in the test, there will be 20 critical questions that you will need to answer correctly. If you fail at one of these, you will get a failing mark, even if you scored 119/120 on the test. I don't know if this has changed now. You will find the test very easy, so easy you'll finish 120 questions in 2 hours. Do not be fooled! Try to re-check your answers at least thrice. Most of the time you will have a /failfish moment finding you answered one item incorrectly, and thank yourself after for being so thorough. Make most of the time given to you. There will be drug computations but these are very basic, so much you can get a correct answer with your eyes closed. Be very careful cuz you'll never know when a question is a critical one, so treat all questions as if they are. Most of the time it's questions about medicines management, safety, safeguarding, infection control. Do not rush, think about the £130 (approx PHP 8,000++) you will need to shell out again if you fail! 6. Have your documents assessed by the NMC. You will receive a congratulatory e-mail a few hours (to a maximum of 48 hours) after taking the CBT if you pass. If you fail, you will need to wait at least 28 days to resit the test. If you fail again, you will need to wait a further 6 months to take the test again. It's okay, you can try again. There may have been a few things on the blueprint you've skipped, so go through them again. Or read Marsden. The CBT isn't so impossible to pass anymore like it used to be. When you get a pass, you will progress to the Assessment stage. You will be asked to pay £140 (approx PHP 8,800+) to continue the application process. Then, you will be asked on the NMC website to fill out forms and upload scanned documents online with regards to Proof of Identification, English Language Skills, Professional Education and Training, Post-Qualification Registration, Work Experience, and Good Character and Good Health. You will also be asked to download barcoded forms, specifically a form to Accompany Transcript of Training, Reference forms for two Employers, a Registration Authority Verification form, and a Declaration of Good Health form to be filled out and couriered to the NMC office in London. These barcoded forms will be unique to you, and cannot be downloaded prior to passing the CBT. The documents you will typically need to scan and upload are: A Valid Passport Old Passports (if pertinent to your application) NSO Birth Certificate IELTS Test Result BSN Diploma (Qualification Certificate) PRC Board Certificate NBI Clearance (the yellow one, for abroad) For my application, I also included my old passport (as a reference to most of my scanned documents), PRC Board Rating and Passing, PRC ID, SCFHS Board Certificate and certified translation, SCFHS ID, and KSA Police Certificate with certified translation (since I practiced too in Saudi Arabia). As for the barcoded forms, you will need to send the form to Accompany Transcript of Training to the university where you got your nursing degree. The Employer Reference forms need to be filled up by anyone senior to you, whether physician or nurse. The NMC is very particular about the job titles you input in your forms. If senior nurses, they need to be your Chief Nurse, Head Nurse, or Nurse Supervisor. They won't consider any job title that isn't superior to yourself, such as Operating Room Nurse, or Medical-Surgical Nurse. The Registration Authority Verification form will need to be sent to the PRC (Professional Regulation Commission) in the Philippines (and Saudi Commission for Health Specialties, or SCFHS in KSA, if you practiced too in Saudi Arabia like me. You will need two forms filled up). The Declaration of Good Health form will need to be filled up by any GP or consultant that isn't your relative or employer. Make sure that the information you input on the forms at the NMC website match those found in your uploaded scanned documents and barcoded forms. You can not afford to be delayed after you hit the submit button or get refused because you have input wrong/different information, I.e. start and end dates of your nursing education or post-registration experience. I recommend accomplishing the barcoded forms as soon as you can download them from the website. I have normally had them couriered to London, which got received around 2-3 days. I have sent a set of blank documents once thru registered mail, which arrived after 7 days. So really, a courier service would be a worthy investment for this end, especially if you're running after time. I was informed by the NMC that once these documents get received, they normally get scanned and uploaded into their system around 8-15 days. In my experience, I have had all barcoded forms received in London, scanned documents all uploaded, and forms accurately filled out, but only got in assessment queue 20 calendar days after. So I really recommend accomplishing the barcoded forms as quickly as possible, because getting all of these up in the system typically takes a very long time. A reply to an e-mail you have addressed to overseas.enquiries@nmc-uk.org typically gets received around 5-11 days in my experience. Make sure you include in your inquiry your complete name, NMC candidate ID, and birthdate, or they may not be able to respond to your request. If they give feedback that they cannot verify your IELTS result, make sure you e-mail back the scanned test result to them to avoid further delays. You may also call the NMC when your 70-day processing time is almost due. The people who answered my calls were very friendly and helpful. If you're calling from the Philippines, you need to dial 0044 207 333 6600. I used Globe IDD card or my Globe sim to make calls, I usually get 12 minutes of talk time for every PHP 100 air time. This part of the process is the ultimate test of patience and required a lot of prayers on my end. My application got processed for the full 3 months, even beyond the 70-day target processing period. I felt like I will never ever get my OSCE invite, but I did. So don't lose hope! Your decision letter may come to you in 5 days, or more than 90. But it will come, don't worry. It's just a matter of time. It also pays to call NMC as often as you can, saying you are on your 70th ++ processing day. I got my decision letter that same night, UK time. 🙂 7. Acquire your Tier 2 Visa Congratulations on your long wait! Finally, your OSCE Invite is in your NMC portal and downloaded to your computer. Now it's time to book your OSCE. We'll need to fly to the UK so we can sit for the exam at the University of Northampton. For this, we will need a proper visa. I am sponsored by an NHS trust in London, so the visa I applied for was the Tier 2 Visa (General Migrant for 3 Years). In my experience, the entire application process has been quick and easy. I was completely clueless about the whole thing, thankfully I have Omanfil, my agency that helped me go through the entire process. Their support is priceless and I could not have gone through it right without their guidance. Firstly, I had my Certificate of Sponsorship (provided by my NHS trust sponsor), IOM (Tuberculosis) Certificate, UKVI Academic IELTS test result, and all original supporting documents ready. Then, I registered on this website, filled up the online application form with my Certificate of Sponsorship as my guide. When I was done with the application form and IHS section, my agency paid for my visa (USD 620.00, approx PHP 30,000) and IHS (Immigration Health Surcharge, USD 756.00, approx PHP 36,000++) fees. After this, I was able to make an appointment with VFS Global. Unfortunately, there were no appointments available for Manila, so I had to fly to Cebu. It was on very short notice but needed to be done ASAP, since visa processing takes about a maximum of 15 working days. So I flew there, stayed for a night, then flew back to Manila right after. The documents I've brought with me to VFS were: Passports, old and new (and photocopies of all pages, from beginning to end) 1 Passport Photo for the application form (take note of UKVI guidelines for passport photos) My KSA exit visa printout Printed out online application form Printed out appointment confirmation NMC Pass printout OSCE invitation printout Certificate of Sponsorship Tuberculosis Screening Certificate (IOM) UKVI IELTS Results BSN Diploma PRC Board Certificate SCFHS Board Certificate and certified translation NBI Clearance (Green one, for abroad) KSA Police Clearance Certificate and certified translation KSA Experience Certificate IHS Payment Receipt IHS Reference Number printout Photocopies of all supporting documents I paid PHP 525.00 to have everything couriered back to my agency in Manila. So far, I have (and my agency) paid something around PHP 150,000 (approx £2,000+ / $2,700+), including money spent for medical exams, courier services, transport and supporting documents, from Steps 1 to 6.