My First Code.

I am still processing my first full code experience. I had previously been involved in a “chemical” code in which the family chose no intubation and no compressions. The patient did not survive, but he was in his 90’s and probably ready to go. I had another code called during seizures, but the patient’s heart never stopped. This was my first full on ER code blue experience. There are some potentially gross details in this story. Read at your own risk. Portions of this story (i.e. room numbers, times, names, etc.) are adjusted and no private information is given in this scenario.

All Emergency Departments have that phone. Some are red, some are white, all of them are loud enough to pierce through the chaos of a busy shift. There’s a phrase that makes everyone stop what they’re doing and prepare for the worst–“CPR in progress, ETA 10 minutes.

Room 1? Room 1. Let’s go.

In our city, ETA 10 minutes via EMS usually turns into 15-20 minutes. Our preparation was like clockwork. The intubation box was set up and opened. Crash cart plastic ripped off. Body bag placed under the sheets. We didn’t want to use it, but EMS reported asystole and 4 rounds of epi at the scene. I grabbed a handful of gloves, pocketed my stethoscope and badge, tightened the drawstring on my scrubs, and set up the stool. I was set to begin compressions upon arrival.

Upon arrival EMS is vigorously performing CPR on Mr. X. He is easily twice my size and no more than 10 years older than me. “Who else is rotating compressions?” I ask. I have help. We transfer the patient and I immediately begin compressions. It’s a whirlwind. Something came over me. I’m pushing as hard and as fast as I can. I’m exhausted after a minute. But I kept going and had excellent quality compressions.

My team is organized. Methodical. Everyone has a job and knows their job. Hands and arms are working around me, placing stickers and pads, getting lines and blood. The patient’s torso is wet from whatever he vomited before arresting.

Two minutes! Time for a pulse check!” Our recorder says assertively.

I stop compressions and check a carotid pulse while other team members check for radial and femoral pulses. Nothing. The code leader calls for another round of epi. My colleague knows I need to switch out. Five seconds later, compressions are resumed and I snap out of “compression mode.”

This guy is laying here and we don’t know anything about him. We have little to no history. We don’t even know his name.

I look at each person in the room. Everyone is hyperfocused on their task at hand. One nurse is documenting. Another nurse is keeping track of time with that person and giving medications. Another nurse is at the crash cart drawing up everything imaginable. Respiratory is bagging the patient. Another tech is standing near the door. The doctor is setting up the ultrasound and attempting to get a gown on. Two minutes goes by faster when you’re not the one doing compressions. It’s already time for another pulse check. Nothing.

I’m resuming compressions and I notice that the second time around is much harder. My upper body is already exhausted from the first round. I readjusted my position so that I was nearly on the bed. I need as much leverage as I can get. The doctor says that at the next pulse check he will check for movement with the ultrasound. This requires that three of us move our position, one person takes the front pad off, and another person squirts the ultrasound jelly on the patient’s chest. We only have 15 seconds to coordinate.

Two minutes! Time for another pulse check!

To me our movements seem choreographed. To an onlooker it probably looks chaotic. But the job gets done. No heart movement. More medications are pushed. My colleague is resuming compressions and the team gets ready for rapid sequence intubation. “This should have been done at the scene,” I thought.

Two minutes. Time for a pulse check and more epi.

Mr. X is having PEA. It’s not really a rhythm. It’s not shockable. It’s my turn for compressions again.

By the third round, I feel like my whole body is going to give out. My hands are slipping around everywhere because of the vomit and ultrasound jelly.

I can’t continue compressions!” I yell.

Do you need to switch?

No, I need friction!

I lift my hands up for half a second and someone geniously throws a towel over the patient’s chest. Perfect. This is perfect. My compressions are now high quality again. Everyone is ready for intubation. A mask. I need a mask. This guy probably aspirated and I don’t want whatever that was all over my face, too.

Can someone please put a mask and shield on me?

I continue my compressions as my colleague places a mask on me. He did a great job considering I was half on the stool, half on the bed, hair astray, and using all of my body strength to try to bring this guy back. I’m exhausted. I’m thinking to myself, “How much longer can I do this?” It isn’t about me. Everyone in this room is busting their ass for this patient. I’m not going to be the one to give out.

Two minutes. Pulse check!

Asystole. No pulses. No sign of life. Intubation is done and there is a significant amount of fluid coming out. CO2 monitor said 7 but now there are just dashes. No movement on the ultrasound. The doctor wants to resume compressions but he says it will probably be our last round. It has been a total of 45 minutes counting EMS time.

My colleague resumes compressions. He and I are both dripping in sweat.

We have given everything we can. H’s and T’s are checked. Bicarb, calcium, D50, fluids, etc. We have exhausted everything. As a team we were thinking massive pulmonary embolism which is very hard to come back from, if not impossible. I don’t think he was really moving any air.

Are there any objections? Does anyone have any other ideas?” The doctor asks the room.

We all look at each other and realize there is nothing else we can do for Mr. X.

Time of death 1148.


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Emergency Room Essentials

I know what you’re thinking – there’s no such thing as a “typical” day in the ED. In fact, the only thing you can rely on is that your day will be unpredictable. As a nurse intern in a busy adult ED, I have quickly figured out which items are essential during my shift, and which ones I really do not need. I do not currently work in a trauma center–we see most of the city’s STEMI’s, CVA’s, and transplant patients. We also see minor fractures, lacerations, dislocations, etc.

Our ED is divided into “Stations,” and each station has somewhat of a different category of patients. The “front rooms” are the most critical, we have a special room for eye trauma, and we have about 40 beds.

My job as a student intern involves shadowing/helping an Emergency Room RN. I’ve gotten to the point now where I am a helpful partner to my preceptor. When we get a new patient, I know exactly what my role is!

My first day, I showed up with a pocket full of extra supplies that only weighed me down throughout the day. I’ve narrowed down my everyday essentials to just 7 items!

  1. Stethoscope. My beautiful Littman III Classic in matte black is my closest friend in the ED. When assessing ABC’s, lung sounds can give you a clue as to what someone’s respiratory status is. It also isn’t uncommon to uncover distant heart sounds indicating cardiac tamponade.
  2. Retractable badge Sharpie. This is my second most used item! It takes out the possibility of setting your pen/marker down somewhere and losing it forever. I use it to label lines, specimen tags, patient belongings, sign EMS handoff, write down vitals on my glove, and the list goes on.
  3. Pen light. Neuro checks are important for ANY type of patient. If a patient comes in with a sprained ankle, I still do a neuro check. No matter what the patient tells you, they could be making something up because they don’t remember what happened. I also use my pen light for Foley placements and quick airway checks.
  4. Trauma shears. Mine can cut through thick leather! Although we are not a trauma center, I have still cut my fair share of clothing. It is also useful for cutting tape, medication packaging, and during wound care.
  5. Saline flushes. Not something you bring from home, but I always grab a handful at the beginning of my shift. You’ll find that you always need one or two when your hands are already full doing something else.
  6. White board marker. Our rooms are supposed to have their own whiteboard markers. We all know this doesn’t happen. Updating the boards aren’t necessarily the top priority, but I try to update them when I can. It helps patients feel more comfortable if they know the names of their care team.
  7. Black pen. This is probably my least used item, and I often lose it, but it’s good to have!

I hope this can help some of my fellow students. I was so nervous on my first ED shift and I had no idea what I would need! I ended up filling my pockets with 4 pens, a small notebook, and all of my other regular clinical supplies. It was just too much.



Brilliant Nurse NCLEX-RN® Test Prep!💎

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Top 10 Study Tips!

1. Make a study schedule and stick to it.

2. Pace yourself. Study every day, even if it’s just for 30 minutes.

3. If you don’t understand something, find a different resource (ask a friend, find a YouTube video, email the instructor, etc.).

4. Study for 50 minutes at a time and take a 10-15 minute break in between.

5. During those breaks, don’t just be on your phone or computer. Get up. Move around. Get your blood flowing!

6. Make time for yourself. If you like to read leisurely, do it. If you work out, do it.

7. SLEEP. for the love of God. Get 7-9 hours of sleep a night.

8. Find a method that works for you. Flashcards, outlines, Quizlet, recording yourself, drawing pictures, etc. It’s all trial and error.

My less than artistic attempt at understanding the cardiac system.

9. DON’T CRAM. If you don’t know the material the night before the test, chances are you won’t know it for the test.

10. Studies show that you need to review material 7 times to retain 90% of the information.


Brilliant Nurse NCLEX-RN® Test Prep!💎

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Pharmacology: Seizures and Epilepsy

Definitions:

Convulsion: abnormal motor phenomena (jerking, movements, tics, rigors)
Seizure: a sudden, excessive synchronous electrical discharge of neurons in the brain that can spread to other foci
Epilepsy: group of chronic neurological disorders characterized by recurring seizures

Main Types of Seizures:

Simple Partial: discrete motor, sensory, autonomic and psychoillusionry symptoms. No loss of consciousness. Persists 20-30 seconds.
Tonic-Clonic: major convulsions characterized by a period of muscle rigidity (tonic phase) followed by synchronous muscle jerks (clonic phase). Immediate loss of consciousness. Followed by postictal state. Lasts 90 seconds or less.

Therapeutic Goals:

  • Enable patient to live a normal life.
  • Ideally eliminate seizures, but may not be possible

How do Anti-Epileptic Drugs Work?

  • suppress discharge of neurons within a seizure focus
  • suppress the spread of seizure activity from the focus to other areas of the brain
  • decrease in sodium influx, decrease in calcium influx, increase in potassium influx

Traditional AED’s

  • Phenytoin (Dilantin): Therapeutic range: 10-20mcg/mL, can cause gingival hyperplasia and nystagmus
  • Carbamazepine (Tegretol): Also treats trigeminal neuralgia and bipolar disorder. Contraindicated if patient has bone marrow depression or hypersensitivity. Avoid grapefruit juice!
  • Valproic Acid (Depakote): Also treats migraines and bipolar disorder. Therapeutic range: 50-100mcg/mL. Highly teratogenic! Can cause hepatotoxicity, pancreatitis and hypersensitivity.
  • Ethosuximide (Zarontin): Treats absence seizures. Therapeutic range: 40-100mcg/mL. Generally devoid of adverse effects.
  • Phenobarbital: Older drug, long-acting. Toxicity can cause nystagmus and ataxia. Overdose can cause respiratory depression and possibly death. Has a sedative effect, cognitive/learning impairment, CNS depression and drug dependence. May make children hyper.

Status Epilepticus

A MEDICAL EMERGENCY in which a patient is continually having tonic-clonic seizures for 20-30 minutes and is not conscious the whole time.

Immediate treatment includes: turning patient to the side, administering oxygen, removing objects that could potentially harm, having padded bedrails, suction secretions, and DO NOT restrain the patient or put anything in their mouth. Administer one of the following medications:

  • Diazepam (Valium): Used for emergency treatment of status epilepticus. Short half-life. May develop physical dependence and withdrawal symptoms.
  • Lorazepam (Ativan): Drug of choice used in status epilepticus because of prolonged effects. A rectal gel is available for out of hospital use.

Source: Lehne Pharmacology for Nursing Care, 9th Edition, Chapter 24💎



Pharmacology: Parkinson’s Disease Quick Sheet

Parkinson’s disease (PD) is a chronic and progressive movement disorder, meaning that symptoms continue and worsen over time. Nearly one million people in the US are living with Parkinson’s disease. The cause is unknown, and although there is presently no cure, there are treatment options such as medication and surgery to manage its symptoms.

Parkinson’s Disease Foundation, 2016

Parkinson’s Disease:

  • Idiopathic degenerative disorder of CNS from loss of dopamine-secreting neurons in the substantia nigra
  • – Clinical presentation: resting tremor, rigidity, bradykinesia, postural disturbances
  • Therapeutic goals: Improve ADL’s

Dopaminergic Drugs:

  • Activates dopamine receptors, increase dopamine levels, inhibit actions of ACH
  • LEVODOPA: metabolic precursor of dopamine that crosses the BBB, converted to dopamine once in the brain. Disappointing long term effects such as “wearing-off” and “on-off” phenomenon. 2% reaches the brain
  • CARBIDOPA-LEVODOPA: carbidopa prevents levodopa from getting destroyed by decarboxylase enzymes in the peripheral blood. Allows for lower dose of levodopa and less side effects
  • Major side effects: N/V, dyskinesias, orthostatic hypotension

Anticholinergic Drugs:

  • Decreases effects of ACH
  • Can reduce tremor, possibly rigidity, but not bradykinesia
  • Less effective than dopaminergic drugs
  • Most used: BENZOTROPINE (COGENTIN) and TRIHEXYPHENIDYL (ARTANE)
  • Major side effects: dry mouth, blurred vision, tachycardia, constipation, urinary retention, decreased sweating, increased body temp

COMT Inhibitors

  • inhibit metabolism of levodopa in the periphery
  • have no therapeutic effects of their own
  • ENTACAPONE and TOLCAPONE

MAO-B Inhibitors

  • inhibit inactivation of dopamine in the brain
  • when combined with levodopa, can reduce “wearing off” effect
  • SELEGILLINE (ELDEPRYL)

Source: Lehne’s Pharmacology for Nursing Care, 9th Edition. Burchum and Rosenthal, Chapter 21.💎 | Medical-Surgical Nursing : Assessment and Management of Clinical Problems, 10th Ed (Lewis)💎



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NCLEX Review: Fluid and Electrolytes

Sodium (135-145 mEq/L)

  • The major cation in the ECF. It has a water retaining effect. When there is excess Na+ in the ECF, more water will be reabsorbed by the kidneys.
  • Functions: maintains body fluids, conduction of neuromuscular impulses via pump, regulates acid-base balance by combining with Cl- or HCO3-.

Hyponatremia

  • Causes: vomiting, diarrhea, NG suction, excessive perspiration, kidney disease, water intoxication, IV D5W, SIADH, burns
  • Signs and Symptoms: apprehension, muscular weakness, postural hypotension, N/V, dry mucous membranes, tachycardia
  • Treatment: water restriction, normal saline IV

Hypernatremia

  • Causes: excessive salt intake, dehydration, CHF, hepatic failure (excess aldosterone secretion), diabetes insipidus
  • Signs and Symptoms: extreme thirst, sticky mucous membranes, dry tongue, fever, postural hypotension, restlessness/agitation/irritability, increased fluid retention/edema, decreased urine output, convulsions
  • Treatment: stop IV normal saline, replace water loss

Potassium (3.5-5.0 mEq/L)

  • The major ICF electrolyte, 80%-90% is excreted by the kidneys.
  • When tissue breaks down, K+ leaves the cells and enters the ECF and is excreted by the kidneys
  • The body does not conserve K+
  • Influences both skeletal and cardiac muscle activity

Hypokalemia

  • ** The most common electrolyte imbalance
  • Causes: vomiting/diarrhea, renal disorder, sweating, crash diets, diuretics
  • S/S: fatigue, anorexia, N/V, muscle weakness, decreased bowel motility, cardiac dysrhythmias, paresthesia or tender muscles
  • Treatment: administer KCl (never give K+ undiluted or IV push. concentrated solutions should be administered through central veins. Use IV pump!)

Hyperkalemia

  • Causes: renal failure, potassium supplements, digoxin toxicity, potassium sparing diuretics, acidosis (DKA), fluid volume deficit. 
  • S/S: anxiety, cardiac arrhythmias (bradycardia, heart block, peaked T wave, widened QRS), muscle weakness, abdominal cramps, diarrhea
  • Treatment: dialysis, Kayexalate, stop supplements

Calcium (4.5-5.3 mg/dL)

  • Ionized (free Calcium) is Calcium not attached to proteins.
  • 99% is located in skeletal system, 1% in serum
  • Necessary for bone and teeth formation
  • Necessary for the transmission of nerve impulses and contraction of the myocardium and skeletal muscles
  • Causes blood clotting by converting prothrombin into thrombin
  • Strengthens capillary membranes

Hypocalcemia

  • Causes: lack of Ca and Vit D in diet, extensive infection, hypoparathyroidism, pancreatitis, chronic renal failure (Phosphorus rises/calcium declines)
  • S/S: Related to diminished neuromuscular and cardiac function – positive Trousseau’s sign, positive Chvostek’s sign, numbness of fingers and around mouth, hyperactive reflexes, tetany, convulsion, spasms/muscle cramps, arrhythmia/ventricular tachycardia. (CATS: convulsions, arrhythmias, tetany, spasms)
  • Treatment: Oral/IV replacement, correct underlying cause

Hypercalcemia

  • Causes: hyperparathyroidism, neoplasm, osteoporosis, prolonged immobilization
  • S/S: anorexia, N/V, lethargy, flank pain from kidney stones, cardiac arrhythmias (heart block, eventual cardiac arrest), muscle flaccidity
  • Treatment: Calcitonin, discontinue antacids, treatment of underlying cause

Phosphate (2.7-4.5 mg/dL)

  • buffer found primarily in ICF
  • functions: acid-base regulation, phosphate and calcium help with bone and teeth development, promotes normal neuromuscular action and participates in CHO metabolism, conversion of glycogen to glucose
  • normally absorbed in the GI tract, regulated by diet, renal excretion, intestinal absorption and PTH

Hypophosphatemia

  • Cause: excretion
  • Symptoms: disorientation, bruising, numbness, bone pain, muscle weakness
  • Treatment: increase dietary intake, IV replacement

Hyperphosphatemia

  • Causes: decreased intake or increased excretion
  • S/S: same as hypocalcemia
  • Treatment: limit phosphate intake, administer aluminum-based antacids.

Chloride (98-106 mEq/L)

  • anion found mostly in ECF, maintains body water balance, plays a role in acid-base balance, combines with H+ to produce acidity in the stomach
  • follows Na+ up or down

Hypochloremia

  • Causes: vomiting, diarrhea, excessive NG drainage, hypokalemia, hyponatremia, adrenal gland deficiency
  • S/S: hyperexcitabilty of the nervous system and muscles, tetany
  • Treatment: treat underlying cause

Hyperchloremia

  • Causes: dehydration, hypernatremia, kidney dysfunction, head injury, hyperparathyroidism
  • S/S: deep, rapid, vigorous breathing, lethargy, weakness
  • Treatment: decrease intake, correct underlying cause

Magnesium (1.5-2.5 mEq/L)

  • Most plentiful in the cells
  • Needed for neuromuscular activity
  • Responsible for the transport of Na and K across the cell membrane

Hypomagnesemia

  • Causes: protein malnutrition, alcoholism/cirrhosis of the liver, aldosterone excess, inadequate absorption (chronic diarrhea, vomiting, NG drainage)
  • S/S: muscle tremors, hyperactive tendon reflexes, confusion, tachycardia
  • Treatment: treat underlying causes, IV replacement if necessary.

Hypermagnesemia

  • Causes: severe dehydration, renal failure, leukemia, antacids/laxatives
  • S/S: flushing, muscular weakness, increased perspiration, cardiac arrhythmias (bradycardia, prolonged QT intervals, AV block)
  • Treatment: treat underlying cause

Helpful Tidbits

  • 4 electrolytes that impact cardiac functioning: K, Mg, Ca, Ph
  • 3 imbalances that contribute to digoxin toxicity: hypokalemia, hypercalcemia, hypomagnesmia
  • 4 imbalances that contribute to seizures: hyponatremia, hypocalcemia, hypomagnesmia, hyperphosphatemia
  • Electrolytes associated with alkalosis: hypomagnesemia, hypokalemia
  • Clinical Dehydration = ECV Deficit + Hypernatremia

Source: Texas Woman’s University College of Nursing, Fundamentals of Nursing – Perry & Potter 2016💎




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Nursing Student Summer Tips!

Off for the summer? Here are some productive things you can do! ⛱🌻

1. Do practice NCLEX questions. Yawn. Who wants to do work over the summer? Start by setting a small goal such as 10 questions/day. You’ll find that it won’t take up too much of your time! By the time summer is over, you’ll have done hundreds of questions. I use Saunder’s NCLEX-RN Comprehensive Review for every class and it works wonders! Get a copy of it here💎!

You can also use Brilliant Nurse NCLEX-RN® Test Prep!💎, which is an online interactive experience to prep you for the NCLEX!

2. Update your resume. This can be difficult during the busy school year! Take some time to really go through your resume and send it to a few trusty people for advice.

3. Look for internships and jobs. Set aside some time to gather up information about internships and jobs. Apply for what you can and get your name out there! What is your ideal unit? What is your ideal salary? 

4. Review tough topics. Did you have a hard time with the endocrine system? Cardiac? Psych? You’re not alone. Look over some of these topics in a stress-free environment. No pressure, no due dates, no exams! You may remember more material this way. Go with 20 minutes a few times a week.

5. Relaxxxxxx. You’ve been working so hard. Plan time to treat yo self! 

Happy Summer!⭐️⛱



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The Ultimate Guide to Surviving Nursing School!

Congratulations for getting into nursing school! I put together a list of supplies you may need. There are also a few tips for surviving that no one else will really tell you until you’ve been through it. Keep in mind that every one’s experience is different. What applies to me may not apply to you.

MUST HAVES:

  • Blood pressure cuff (was provided to me through school via lab fees)
  • Compression stockings/socks
  • Bandage/dressing scissors
  • Drug handbook (pocket size – Lippincott💎 is a great way to go!)
  • Lab coat (ordered through the school)
  • NCLEX-RN Study guide (Saunders💎 or Kaplan💎)
  • Tote bag for clinical/hospital/lab (separate from your lecture backpack!)
  • Nursing shoes
  • Watch – simple, waterproof, inexpensive!
  • Penlight (was provided to me through school via lab fees, but I purchased extra)
  • Scrubs (ordered through the school)
  • Stethoscope
  • Retractable badge holder
  • Nursing care plan book (we were given a specific one to order, this one saved me time and time again!💎)
  • Clipboard and BLACK pens
  • Extra hair clips/bobby pins, hair ties
  • Medical dictionary💎

Lecture Supplies!

  • Binders
  • Looseleaf notebook paper
  • Black pens (or colored if you are the type to color-code notes)
  • Highlighters
  • Drug guide (App available if lecturer allows electronic devices)
  • Textbook (IF you need it)

Tips for Surviving LECTURE:

  • Read the assigned text BEFORE class. I don’t mean skim. Understand it. Make this mandatory in your homework routine.
  • Come to class with questions. Mark down the answers as the lecture goes on. If there are unanswered ones, get them answered before class ends. If you don’t understand something, don’t be afraid to raise your hand and ask. Chances are that there is someone else with the same question.
  • Star, highlight, underline, circle, etc. any topic that the professor repeats. I usually put a star down for each time it is said. I can’t tell you how many times they put this information on exams.
  • Avoid using electronic devices. I always use pen and paper. I have e-textbooks, but I only pull my tablet out when I absolutely need to. Silence your cellphone and only use it during breaks or emergencies.
  • Keep your energy up. Eat a high-protein breakfast and drink plenty of water. Snack on nuts or other nutrient dense food. I usually eat almonds and/or apples with peanut butter.
  • Be courteous to your neighbors. Avoid opening loud snack packaging, using your phone, talking, or doing another classes’ work during lecture. Anything abnormal that you do during lecture is a distraction to others around you. Don’t be afraid to move seats during break if you can’t concentrate.
  • Wear comfortable clothes. Nursing school is not a fashion show. I wear sweats most days because I am sitting for 6+ hours at a time. I usually have a jacket because I get cold very easily.
  • If you are given a break, USE IT! Go walk around, go outside, walk up and down some stairs, etc. Just get your blood flowing.


Tips for Surviving LAB:

  • Lab is for PRACTICING skills, not learning. Usually you will be assigned a video or reading assignment that explains how to perform the skill. The professor will demonstrate the skill, but you are more than likely expected to already know the steps. Don’t make a fool out of yourself by not preparing. We were given step by step instructions for most skills. If your school doesn’t provide these, then make your own.
  • Come to lab in uniform and with all of your supplies. Make sure you wash your hands before beginning.
  • Try performing the skill on your own before asking too many questions. You will learn more by making mistakes than by avoiding them.
  • Don’t overthink anything. You are practicing skills to perform them on a human being. Put yourself in their shoes. Practice compassion. Talk to your mannequin as if it were a real person. It will feel silly at first, but it will help you in clinical.
  • Explain every step out loud in lab. This will not only help you, but it will help your lab partner and others around you. It is also easier to catch mistakes this way.
  • Take advantage of open lab hours if your school provides it. Get together with a study buddy and spend an extra hour or so each week practicing.

Tips for Surviving CLINICAL:

  • Congrats, you’ve made it to clinical! You will probably be nervous, but that’s okay. I was nervous AND excited. That is normal. Take some deep breaths and go with it!
  • Eat a high-protein breakfast. You will probably have to wake up at an hour you’ve never been awake for. If you’re like me, I can barely eat in the mornings to begin with. Force yourself to eat. Don’t go for a high-carb breakfast. You will crash before 9am. Bring snacks for the commute. I usually eat egg/bacon/potato breakfast burritos and I bring an apple to eat on the way.
  • Be prepared. Your school will have different requirements for pre-clinical. If you are assigned a patient the day before, make sure you know which drugs they are getting and WHY.
  • Stay busy. If there is a lull in the day, ask your nurse if there is anything you can do. If he/she says no, then that’s the perfect time to go talk to your patients.
  • Ask to perform skills you have already learned. Already learned how to put in a Foley? Ask your nurse if you can do the next one. Injections? IV starts? ASK!!! You will never learn if you don’t ask. The worst they can say is no.
  • Talk to your patients. You will learn more about them through conversation than by reading a chart.
  • Don’t think of yourself as a shadow. You are a student nurse who is there to help, not follow. Although you will be “shadowing” a nurse, your confidence will give your nurse more confidence in letting you take the reign!
  • When it’s time for lunch, eat something healthy. You already know how high-carb/high-fat meals make you feel. Plan accordingly. Take the full break. If you get 30 minutes, try to sit and rest for that full amount of time. Make sure you wash your hands before and after, and use the restroom before going back.
  • Enjoy yourself! This is what you’ve been working hard towards, right??
  • We always had a debrief with our instructor after clinical. It was an open “round-table” discussion about our day. Be honest about how your day went. Not every clinical day is unicorns and rainbows. Other students will appreciate your honesty.

Tips for READING your textbooks (BEFORE lecture):

  • Turn off your phone, TV, etc. I have a classical music station that I listen to when I study.
  • Skim the chapter and pay attention to titles/subtitles. Count how many pages you have to read and allow yourself enough time accordingly.
  • Start reading from the beginning. Look up any words that you don’t know. Read slowly and carefully.
  • Take breaks every 30-50 minutes.
  • Write down any questions or unclear topics.

Tips for STUDYING material (after lecture):

  • Review the lecture notes from each class when you get home that day. Make sure everything is organized to make studying easier.
  • Go through the assigned reading again and highlight or underline the main topic/sentence of each section. This will make it easier to find information.
  • If you have a homework assignment for this chapter, do it now.
  • The next day, review your notes and skim through the book again. Look for different sources of information for main topics. I like to find YouTube videos that explain topics.
  • Rewrite important information on notecards or in a notebook.
  • If you can, on a different day, get together with a study buddy or group to discuss the information. Don’t do the homework together unless there’s a question that you couldn’t answer on your own. Study groups are not for learning, they are for discussing and solidifying concepts.
  • Notice that now you have reviewed/heard the material 5 times.

Tips for studying for an EXAM:

  • Although I study every day, I usually start my “exam” studying a week before the test.
  • Practice NCLEX-style questions.💎
  • Answer the questions at the back of the chapter.
  • Get any unclear topic resolved at least 48 hours before an exam.

I hope that this information is useful! Feel free to reblog and add anything I may have missed. Also feel free to message me with any questions!


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