Reality Check: Being a New Grad in the ED

Hellloooooo! It’s been a hot minute. Since I last wrote, I graduated from nursing school, started my residency, and passed my NCLEX! Woohoo! I wish I could say that the NCLEX was the last stop on the nursing struggle bus, but really starting to feel like it’s stop number 5 out of 100.

I accepted my dream job. I had a picture of how it was going to be. I spent over 300 hours in the ED during nursing school, so I thought that I would have *somewhat* of a smoother transition into practice. I WAS SO WRONG. Being a new grad in the ED has proven very difficult for me.


Canboc Stethoscope Carrying Case for 3M Littmann Classic III/Cardiology IV Stethoscope – Extra Storage Taylor Percussion Reflex Hammer, Reusable Medical LED Penlight

One, the ED I’m working in now is a little bit over twice the size that I had experience in, plus, it’s a Level 1 Trauma Center. New grads don’t really touch the trauma bay, and I didn’t expect to for a couple of years anyway. However, my coworkers are super great and are very supportive of learning opportunities! So I have spectated in the trauma bay a few times for some interesting cases.

Secondly, I don’t know where the heck anything is. I’m still getting lost, it takes me twice as long to find supplies, and ALL OF THE EQUIPMENT IS DIFFERENT — The pumps are a different brand and can only handle one primary line and a piggy back – no adding channels…gotta get another pump…????, the tubing is different (as well as the way to prime), the IV angiocaths are different (I do need way more practice with sticks, though), the blood culture bottles are a different shape and color, the medication dispensing system is different, the labeling process for specimens is way more complicated (the hospital recently transitioned to EPIC, so I’m not sure they’ve caught up with what other hospitals are doing), labs are drawn from different colored tubes and therefore the order of draw is different, mixing antibiotics is more complicated, requires an extra step, AND an extra piece of equipment that I’m not used to either. I could go on…but all of these little things are slowing me down immensely.

Thirdly, I am getting different instructions and directions from each nurse I interact with, so if I do something that isn’t quite what that person does, I am also slowed down because they want to explain what they are doing and why. Most of the time, I learn something new and am very excited to have a more efficient way of doing a task! But sometimes I just want to tell them that my preceptor instructed me a certain way and I would like to keep that habit. For example, I am already familiar with EPIC, but this hospital just transitioned. There are a dozen different ways to find information in the EHR. I have my favorites saved and my hands literally have two years of muscle memory to find certain pieces of information very quickly. I’m having trouble finding the balance here. I love and appreciate each piece of advice, but in the end I am responsible for my license and charting, and as long as it accurately reflects the patient’s condition and care within facility policy and the board, it’s six of one and half a dozen of the other. If you’re reading this and have advice–let me know!!

Let me get to the fun parts!!

Yes, the transition has been tough, the patient load is insane, and I feel like I got hit by a train. But I have learned SO MUCH in the three weeks I’ve been in patient care. I’ve seen a lot of new cases such as Cushing’s triad, clamshell emergency thoracotomy, ROSC, subarachnoid bleeds, and open fractures. I’ve also been able to reenforce and improve my knowledge and skills when it comes to the common cases I saw in my internship such as RSI’s, STEMI’s, strokes, and sepsis.

Being a registered nurse is really, really fun. I love seeing immediate improvement in a patient from an intervention or medication that I gave. Everyone is so supportive, and although I am a new grad, I feel like a part of the healthcare team. No one has treated me poorly or looked down on me (at least not to my face or that I know of). I’m really struggling with time management and clustering care, but my preceptors are supportive and patient.

The skill that I feel most confident in right now is my “customer service” skills. I can talk to anyone. I can stay calm in front of patients and do my best to explain what is going on. I can grab that extra blanket or take 15 seconds to take deep breaths with my patient. But I can’t wait to get better at it!

The only advice I feel qualified to give right now as a 3-week-in new grad in the ED is:

  • Don’t be afraid to ask questions! I feel like I ask a question every 5 minutes…
  • Be confident in what you know, but have the attitude that you can always, always improve and learn something new.
  • You can advocate for your patient right away! If something doesn’t seem right, grab someone for a second look.
  • You are going to feel like you are drowning, but my supervisors and preceptors have been telling me that it is a normal feeling.
  • Write things down (checklists, SBAR, questions, etc.).
  • Write out goals for each shift and take 2 minutes to share those goals with your preceptor.
  • Be appreciative of every learning opportunity and be respectful!
  • Learn some positive phrases such as, “Could you clarify this for me?” or “Could you remind me how to _____?” instead of “I don’t know.”
  • If you need to cry, do it in the bathroom or in your car!
  • Get to know your techs because they know more than you and can help you. I can’t tell you how many times a tech has saved my butt already.
  • ASK QUESTIONS. I already said that, but I feel that it is the most important for me right now.

I wrote this post about the transition before I graduated nursing school. It talks about some of the barriers new grads have with adapting to their new role. I re-read it today from a new perspective and thought it was really interesting. I am most definitely in that “first 3-4 months” where the grad nurse feels anxiety and self-doubt in the new role of a registered nurse.

I also grabbed this pocket guide called Emergency & Critical Care Pocket Guide. It’s a cute little flipbook that fits in any of my scrub pockets. It has basic information about common emergencies, ACLS charts, medication compatibilities, and more! I love being able to just grab it and learn something new.

Check out my previous post about essential emergency room supplies. Not much has changed about what I brought during nursing school versus what I bring to work now!

I also highly, highly recommend Hoka One One shoes. Listen, y’all. I had constant foot and back pain during and after my clinicals in nursing school. These shoes were recommended to me while I was in school, but I couldn’t afford them. After I got my first big girl paycheck, I ordered these shoes, and I feel like I am walking on a cloud. My pain has decreased and I can last much longer without feeling pins and needles.

Save up some money, buy some good nursing shoes and compression socks, and save your back and feet. You’ll thank me later!

Long story short, ER nursing has been a wild ride so far. I could go on and on. The bottom line is, if you are going straight from nursing school to the ED, get ready! It’s a lot. I’m only three weeks in, so please take anything I say here with a grain of salt. Not everyone will have the same experiences and I am not trying to portray that I am an expert.

Happy nursing!

Skyanne, BSN, RN


This page may contain affiliate links. This means that, at no cost to you, I may make a commission if you click through and make a purchase. Contact me with any questions!

WordPress.com

The Transition – Nursing Student to New Grad

As I countdown the days until graduation, and even more so count down the days until I take the state boards, the mix of nervousness and excitement running through my veins is increasing at an exponential rate. I am beyond thrilled that I accepted my dream residency position at a level one trauma center. I’m having nightmares about the NCLEX and I lay awake at night fantasizing about what my life is going to be like in six months.

I know it’s been a while since I’ve posted, but I wanted to talk about something that I feel is extremely important, but neglected in the nursing programs. I want to talk about the transition. I came across an article in the Nurse Education in Practice journal from 2016 written by Jennifer Ortiz. It talks about professional confidence during the first year after graduation and the common setbacks that graduate nurses experience.

Transition Theory

There is a theoretical framework for the phenomenon that new grad nurses experience. To keep it short and sweet –

Doing: First 3-4 months – The grad nurse feels anxiety and self-doubt in the new role of a registered nurse.

Being: Next 4-5 months – Competency is increasing, but self-doubt and anxiety continue as the transition between dependence to independence solidifies.

Knowing: Final 8-12 months – The new grad has established him or herself as a professional and feels like a contributing member of the field.

I don’t know about you, but knowing that these stages have been studied and written about makes me feel better that soon I will be sharing these feelings with my colleagues.

Communication

Ortiz found that a huge lack in nursing programs is communication with other healthcare providers. In my school clinicals, I seldom interact with doctors, and I was never given the opportunity to give report or SBAR for a change in condition or critical lab result. The only experience I have with this is through the nursing internship that I applied for. Only a handful of students from my school participated in an internship; it was not a regular part of the baccalaureate program.

I have about 70 hours of clinical left for nursing school (out of almost 900), and each time I have offered or asked to pick up the phone and page the mid-level, pharmacist, or respiratory therapist, I was rejected with, “no, I need to do it,” by my preceptor. Many of those times, I was fully prepared and confident to deliver a concise SBAR. I am not bashing clinical preceptors. They need to protect their license and I fully understand that, but as Ortiz mentions in the study, “new graduates nurses recounted many difficult experiences which involved communicating with other members of the healthcare team,” even after six months.

If you are a nursing student reading this, I encourage you to elicit the help of your instructors to be more involved in multi-disciplinary communication. I regret not speaking up for myself more often. Although we practice communication in lab and with each other, I am not 100% confident in this skill.



Mistakes and Errors

Another challenge reported in the Ortiz study that has “a negative effect on professional confidence” is the occurence of mistakes. I already feel guilty for making small mistakes, like leaving too many air bubbles after priming IV tubing, or grabbing the wrong size Foley kit for my patient as a student, so I can’t imagine having a license and making larger errors. Throughout nursing school, they nearly tattoo the rights of medication administration on our foreheads, yet we always hear stories about lethal medication errors.

The fear is real. Will I ever make a mistake that results in a sentinel event? If I am being completely transparent, I’m a major people-pleaser. Years of retail experience toughened me up, but some days I feel like a failure if one little thing goes wrong. I’d like to think that I would never make a huge mistake, but it would definitely dampen my professional confidence.

One time in clinical, I put a dirty pillow in the wrong place, and my preceptor reprimanded me in front of a patient. I felt humiliated! I wanted to go home after that, and the relationship between that preceptor and I was effectively ruined.

I hope that I have a preceptor who stays on the positive side and encourages learning instead of punishment. I hope that my preceptor encourages autonomy early in the game. If you are a new grad or a preceptor of a new grad, I would love to hear your feedback on communication and errors!


Ortiz, J. (2016). New graduate nurses experiences about lack of professional confidence. Nurse Education in Practice19, 19–24. doi: 10.1016/j.nepr.2016.04.001

This post may contain affiliate links. This means that, at no cost to you, I may make a commission if you click through and make a purchase. Contact me with any questions!

Shock: NCLEX Review

Shock – What is it?

Shock is a generalized systemic response to inadequate tissue perfusion. The major types are hypovolemic (absolute and relative), cardiogenic, distributive (neurogenic, anaphylactic, and septic), and obstructive shock. While they all generally have the same end result if not treated, the signs, symptoms, and interventions can be different for each type.

Shock is a complex process that can be explained down the the cellular level. We could get into cytokines and neutrophil entrapment, but this post is going to focus on nursing interventions rather than detailed pathophysiology.

As usual, I will be using my favorite textbooks/resources to write this post! Clicking on the links below will take you to an affiliate website where you can purchase them for yourself or browse around for other books.

Phases of Shock

Initial: Decreased cardiac output, decreased perfusion, anaerobic metabolism, lactic acidosis. You want to catch any signs and symptoms before it progresses any further.

Compensatory: The body is responding to the problem by increasing cardiac output and increasing oxygen delivery to tissues. (Sympathetic nervous system is in action here!)

Progressive: Compensation is not working and cells are starting to die off because anaerobic metabolism is not enough. (Systemic Inflammatory Response System)

Refractory: Shock is unresponsive to treatment and death is the probable outcome. (Multiple Organ Dysfunction Syndrome)

Hypovolemic Shock

This is the most common type of shock. It is caused by either a loss of volume (hemorrhage) or a displacement of volume (burn patients).

Signs/Symptoms/Assessment

  • Weak and rapid pulse
  • Hypotension
  • Restlessness/Altered mental status
  • Tachypnea
  • Cool, clammy skin
  • Oliguria
  • Sluggish capillary refill
  • Absent bowel sounds
  • Poor peripheral pulses

Interventions

  • Treat the cause!
  • If hemorrhage, hold pressure, replace fluids/blood
  • Insert 2 large bore IVs
  • Notify the HCP/rapid response team
  • Administer oxygen (high flow if necessary)
  • Maintain patent airway
  • Monitor vital signs
  • Monitor I/O
  • Assess skin color, temperature, turgor, moisture
  • Assess lung sounds
  • Elevate the legs (contraindicated if patient has spinal anesthesia)

Cardiogenic Shock

This is defined by a failure of the heart to pump adequately, which reduces cardiac output. This means that tissues are not being adequately oxygenated just as in hypovolemic shock. Some causes are myocardial infarction, valvular problems, and ventricular failure (reduced ejection fraction).

Treatment goals are to support cardiac output and improve coronary artery blood flow.

Signs/Symptoms/Assessment

  • Same as above
  • Pulmonary congestion
  • Chest discomfort

Interventions

  • Administer oxygen
  • Administer morphine
  • Administer vasodilators
  • Maintain patent airway
  • Administer vasopressors and positive inotropic medications
  • Treat problem–prepare for cath lab, IABP, CABG
  • Monitor I/O
  • Assist with insertion of Swan-Ganz
  • Monitor CVP, PAWP, and MAP
  • Monitor circulation (cap refill, pulses, mucous membranes)

Review Cardiac Medications Here!

Anaphylaxis

This type of shock is different from hypovolemic and cardiogenic shock. You will see that the assessment data, signs and symptoms, and interventions are also different. Anaphylaxis, or anaphylactic shock, is a sudden, severe cascade response (hypersensitivity) to an allergen. Antibodies combine with antigens and set off mast cells and histamines and cause massive vasodilation.

Signs/Symptoms/Assessment

  • Pruritus, angioedema, erythema, urticaria
  • Headache, dizziness, paresthesia, feeling of impending doom
  • Hoarseness, coughing, wheezing, stridor, dyspnea, tachypnea, sensation of narrowed airway, respiratory arrest
  • Hypotension, dysrhythmias, tachycardia, cardiac arrest
  • GI cramping, abdominal pain, N/V/D

Interventions

  • Remove the suspected allergen (stop blood transfusion, stop iodine contrast, etc.)
  • Assess respiratory status, maintain patent airway
  • notify HCP and/or rapid response team
  • administer oxygen
  • infuse normal saline (try for 2 large bore IV’s)
  • Medications: epinephrine, antihistamines (benadryl), steroids (hydrocortisone), beta-agonist
Image credit: Lonnie Millsap (lonniemillsap.com)

Neurogenic Shock

This is another type of distributive shock that impairs perfusion from vasodilation. It is most common in patients with recent injuries above T6. This can lead to pooling of blood in blood vessels.

Signs/Symptoms/Assessment

  • Hypotension
  • Bradycardia
  • Decreased cardiac output
  • Inability to sweat below the level of the injury (skin is warm and dry)

Interventions

  • Monitor vital signs
  • Notify HCP/rapid response team
  • IV fluids
  • Administer vasopressors
  • Administer atropine for bradycardia
Image source: Wikipedia

Septic Shock

Septic shock is the most extreme reaction to an infection; it is a subset of sepsis in which there is profound circulatory, cellular, and metabolic abnormalities. It is vasodilation caused by endotoxins from microorganisms.

Signs/Symptoms/Assessment

  • Tachypnea > 22 breaths/minute
  • Altered mental status – GCS < 15
  • Systolic blood pressure < 100
  • Lactic acid > 2 mmol/L
  • Unresponsive to fluid resuscitation
  • symptoms of infection – fever >100.2 F or <96.8 F

Interventions

  • Assist with placing central line
  • Monitor CVP
  • Fluid resuscitation
  • Vasopressors
  • Monitor urine output
  • Ensure cultures have been sent
  • IV antibiotics

Knowing the signs and how to manage different types of shock is essential for any nurse! I hope this review helps spark your memory for the NCLEX! Check out some of my other NCLEX review posts below:


WooCommerce

This post may contain affiliate links. This means that, at no cost to you, I may make a commission if you click through and make a purchase. Contact me with any questions!

Stages of Labor NCLEX Review

Stage 1

Defined as the first onset of contractions through the complete dilation of the cervix, with 3 separate phases. Stage 1 is the longest phase. Throughout this phase, keep in mind the following interventions:

  • Monitor maternal and fetal vital signs.
  • Continually assess FHR before, during, and after contractions.
  • Assess fetal descent, cervical dilation, and effacement.
  • Assess fetal station presentation and position.
  • Encourage frequent position changes and/or ambulation if not contraindicated.
  • Involve patient and support person in labor process and what to expect.

Latent Phase

To start, I will add another definition here, prodromal labor. This is latent phase labor that has lasted several days.

The latent phase is usually defined by:

  • Cervical dilation is 1 to 4 cm.
  • Uterine contractions occur q15-30 mins and last 15-30 sec.
  • Lasts an average length of 5-8 hrs
  • Contractions are of mild intensity

In this stage, mom’s will most likely be feeling a variety of emotions. They are also usually able to participate in their own care and may not quite ask for pain control interventions at this time. Keep in mind that each mom is unique and requires individual assessment!

Active Phase

This phase consists of:

  • Cervical dilation of 4 to 7 cm.
  • Uterine contractions q3-5 min and last 30-60 sec.
  • Lasts an average length of 2-5 hrs.
  • Some fetal descent.
  • Contractions are moderate-strong intensity.

During this phase of labor, mom’s behavior will start to shift. She will start breathing heavier and may not be able to talk through contractions. She will benefit from a quiet environment and pain control interventions. Pain interventions do not have to be medication, as promoting comfort with back rubs, sacral pressure, and position changes can be effective and beneficial.

Transition Phase

This phase is arguably the “most difficult” phase of labor.

  • Cervical dilation is 8 to 10 cm.
  • Uterine contractions occur q2-3 min and last 45-90 sec in duration.
  • The contractions are of strong intensity.
  • Fetal descent.

During this phase, mom may have increased anxiety, apprehension, and discomfort. She will experience increased pressure, bloody show, and may verbalize the urge to push. Contrary to the active phase of labor, she may not want to be touched. Rest is encouraged between contractions.

Stage 2

Stage 2 is defined as the period from complete cervical dilation and effacement to the delivery of the fetus, or “Expulsive” phase.

  • Contractions continue to occur q2-3 min lasting 60-75 sec.
  • Increase in bloody show occurs.
  • Mom will experience voluntary or involuntary urge to “bear down.”
  • This stage can last minutes to 4 hours.

Sources of pain during the 2nd stage of labor change from pain in a more generalized area to localized to the distention of the vagina and perineum and pressure on adjacent structures.

It is important to complete assessments every 5 minutes. Normal FHR is 110-160 bpm before, during, and after contractions.

Cardinal movements of labor:

  • Descent
  • Flexion
  • Internal Rotation
  • Extension
  • Restitution
  • External Rotation
  • Expulsion

Stage 3

The process of labor does not stop once the baby has been born! This 3rd stage is from the delivery of the infant to the expulsion of the placenta. Contractions continue to occur until this is completed.
Image source: https://www.newlifeblessings.com/blog/category/placenta

  • Schultze Mechanism: “Shiny shultze” – center of the placenta separates first, and the shiny portion of the placenta emerges first.
  • Duncan Mechanism: “Dirty duncan” – the margin of the placenta separates first and the dull, rough, red portion of the placenta emerges first.

Signs of placental separation:

  • Uterus becomes globular shaped
  • Rise of the fundus in the abdomen
  • Sudden gush or trickle of blood
  • Further protrusion of the umbilical cord out of the vagina

Be sure to continue involving the mother and support person in this stage about the steps of delivering the placenta while also promoting parental-neonatal attachment. The uterine fundus should be firm and should be located 2 fingerbreadths below the umbilicus.

A placenta is considered retained if more than 30 minutes has elapsed since the birth of the infant.

Stage 4

Stage 4 is known as the Recovery Stage. This stage is defined from the delivery of the placenta to the immediate recovery of the mother.

It is important to perform maternal assessments q15min for 1 hour, q30min for 1 hour, and hourly for 2 hours, or according to facility policy. Apply ice packs to the perineum, and massage the uterus as needed to keep it firm.

The mother may also experience chills, a hypotonic bladder, and a variety of emotions related to the birth process. Encourage continued bonding between the infant and parents, and provide breast-feeding support as needed.

References and Additional Resources

All image sources are linked near or under the image on this page. I do not own the rights to images posted on this page.

Continue your NCLEX Review Journey by checking out some of my other NCLEX Review posts!


This post may contain affiliate links. This means that, at no cost to you, I may make a commission if you click through and make a purchase. Contact me with any questions!

How to Answer Priority and Delegation NCLEX Questions

Everytime I see one of these questions, I want to pull my hair out! They intimidate me and I often feel the least prepared for these types of questions. Here I will break down how to answer NCLEX-style priority and delegation questions.

A lot of this material comes from the Saunder’s Comprehensive NCLEX Review. If you’ve seen any of my other posts, you have probably run across this book. I wish I would have purchased this book my first semester of school. I bought it my third semester and kicked myself for not getting it sooner. It has been worth every penny to me!

Another great resource is the Brilliant Nurse Course for NCLEX prep. It has practice questions, detailed rationales, videos, strategy sessions, and case studies. The prices are very competitive with other similar online NCLEX-prep websites.

Priority

Prioritizing patient care is an essential nursing skill. It will determine who gets care first, and the order in which you perform your tasks. Often in the clinical setting, it can be easier to spot your priorities because you have access to a lot of information. NCLEX-style questions can be tough simply because you are given 1-2 sentences of limited information with which you must make the decision.

These types of questions can be multiple choice, select all that apply, ordered response, exhibit questions, etc. Any type of question is game!

Priority Guidelines

  • ABC’s – Airway, Breathing, Circulation
  • Remember Maslow’s Hierarchy of Needs
  • Consult your patients about their priorities and needs
  • Use the nursing process to guide you

When you are given a set of choices, read them all before making your decision. Hopefully you can eliminate 1-2 choices right off the bat. After that, use your ABC’s. If any answer choices fall into that, it is probably your answer.

Delegation

The key to answering delegation questions is understanding the scope of practice for yourself and each of your colleagues. You must also analyze the tasks that need to be done and the importance of completing them. Then, assign tasks to a competent individual.

When you assign a task to someone else, the nurse who owns the task is accountable for it.

Always ensure patient safety when delegating tasks. In general, non-invasive interventions such as ambulation and hygiene measures can be delegated to UAP’s (Unlicensed Assistive Personnel). An LPN or LVN can do some invasive procedures such as catheterization and suctioning.

Remember that a Registered Nurse is responsible for assessment, planning care, initiating teaching, and administering medications intravenously.

Never assign an unstable patient to UAP’s or LVN’s.

I hope this helps explain how to approach these questions! Practice makes perfect. Use one of the resources listed above to do practice questions! The more you expose yourself to these tough questions, the better you will get at it!


WooCommerce

This post may contain affiliate links. This means that, at no cost to you, I may make a commission if you click through and make a purchase. Contact me with any questions!

Changing Careers (or Majors) to go to Nursing School

When I graduated high school, I wanted to be an Aerospace Engineer and work for NASA. I applied and got accepted to some of the top engineering schools in the country like University of Texas at Austin and Colorado School of Mines. I eventually chose a scholarship at the University of Colorado Boulder. My engineering journey lasted three semesters, and then I discovered that I was entirely unhappy with my life. I had a fancy engineering internship, I had great friends, and I lived in a beautiful city. What on earth could be wrong with that?

The bottom line is that engineering was not for me. It wasn’t God’s plan for me. At first I was upset that I had wasted so much time in that field, but looking back, I have used a lot of those skills in my daily life and my new nursing career.

A Diversion is Not A Waste of Time

There are so many people out there who choose nursing as a second, even third career. Some of my thoughts getting accepted into nursing school at age 24 were, “It’s about time,” and “I can’t believe I didn’t think of this sooner.”

It has taken about three semesters of school for me to be content with all of the other life choices I’ve made. I had a really rough patch, and I made a lot of choices that I regret.

If you have those types of life experiences, deal with the emotions, and use it to your advantage. I’ll use the cliche, learn from your mistakes. I am better able to handle the monstrosity of nursing school because of what I went through to get there. I would not be able to handle nursing school if I went right out of high school. I know that and I am thankful for it.

Tip: Write out your biggest life regrets/bad choices. On a separate piece of paper, write out positive lessons you learned from them. Then burn the first page with your regrets.

Have a Plan Before Quitting Your Current Job

This is something I did NOT do. Although there were many other factors in my quitting engineering school, I did not plan anything out. I left school for about a year before going back. I knew I did not want to do Aerospace, but I wanted to finish a degree. I decided to take some biology classes.

Some more life stuff happened and I switched to online, part-time school. By this time, I knew I wanted to be a nurse. I had spent so much time in the hospital that I fell in love with the art of nursing.

If I had a plan after the first time I left school, I would have been better off. But that didn’t happen. I had no idea how to start. I did zero research. I straight up just quit.

Tip: If you aren’t sure which major you want, take your basics first. Each state has different requirements, so check those out. Get your English, Math, and electives out of the way.

Do Your Research About Nursing

Nursing is a one-of-a-kind career. Nursing school is rigorous and life-changing. You will lose sleep. You will have less time with your family. You will cry. You will want to quit.

Do your research about nursing. There are a lot of misconceptions about what the job entails. If you have friends or family in nursing, ask them questions.

Listen To Your Heart

If you have a passion for it, go for it. If you are 100% sure you want to be a nurse, go for it. Any roadblocks along the way just makes it more fun when you get to your goals.

If you do all of this research and soul-searching and you still aren’t sure, you are an adult and can make your own decisions. However, I can tell you from personal experience that you need your whole heart to make it through nursing. Even when I hate school, I love it. Wouldn’t trade it for anything.

Take some time to better yourself. Read some personal development books. They are not all “if you believe it you can achieve it” cheesy. Take a look at some of my favorites below –>

Thanks for reading!



This page may contain affiliate links. This means that, at no cost to you, I may make a commission if you click through and make a purchase. Contact me with any questions!

How to Study Health Assessment in Nursing School

Assessment is one of the skills that set you apart from a lot of other medical careers. CNA’s, MA’s, Techs, and other UAP’s do not have the assessment skills that registered nurses have. It is one of those skills that is pounded in nursing school, but never truly mastered until years and years of practice. This guide will hopefully give you a better idea of how to study Assessment in Nursing School and answer HESI and NCLEX style questions.

Your textbook may be different, but we used Jarvis’s Physical Examination and Health Assessment, 7th ed.💎

Anatomy & Physiology

Most programs in the United States require A&P I and II. I’ve rarely seen some programs squish all of that in one class. You need to be a master at your anatomy and physiology. Review cardiopulmonary, abdomen, and neuro anatomy before school starts. You will need to be able to pretty much label and/or draw from memory most of your body systems. A lot of people in my class had trouble with Assessment most likely because they were weak in anatomy. I personally had trouble with the cardiovascular system for this very reason.

Vocabulary

There will be a lot of big medical terms that you’ll need to know! Hopefully you’ve picked up a lot from A&P, Patho, and your other Biology classes. When you study, make flashcards of all of the terms you do not know and study them every single day. These words WILL be on your exams, HESI, and NCLEX. Learn them now.

Normal vs. Abnormal

Assessment is all about knowing what you are supposed to be seeing, hearing, and feeling (namely inspecting, auscultating, and palpating). Establishing this foundation is very important! I took notes in two columns. One side was “normal” findings, and the other side was “abnormal” findings.

In your practice, you should be able to tell when something is wrong. You may not know 100% what is going on, but you should be able to tell your doctor over the phone what your findings are.

Study Habits + Repetition

Assessment is a tough subject. It is a lot to chew, especially with your other classes. You need to establish excellent study habits. This means no more going out every weekend, no more binge watching TV. You gotta get up earlier and go to bed later. Check out my Top 10 Study Tips to get some more tips on how to establish excellent study habits!⬇️

Repetition is key with Assessment. I probably studied each set of material more than ten times. I rewrote notes, drew pictures, and answered plenty of practice questions. I made it a goal to know the material inside and out. I probably spent the most amount of time studying for the class during my first semester.

Practice

As much fun reading out of a book is, nursing isn’t all about reading a patient’s chart. You need to practice! Practice on everyone that will let you. Friends, family, strangers (JK, that might be weird). Get used to going through your full head to toe on different people. Talk through your assessment, even if the other person has no idea what you’re saying!

Patience

These skills will come to you. Like I said in the beginning, you will not master these skills until you’ve been in practice for a long time. Don’t be too hard on yourself and don’t be afraid to seek help! As always, I am here to answer your questions!



This post may contain affiliate links. This means that, at no cost to you, I may make a commission if you click through and make a purchase. Contact me with any questions!

FIVE Things I Wish I Knew Before I Started Nursing School

1) Straight-A …Student

If you are/were a straight-A student, get ready to get knocked down a notch or two. I don’t know anybody in my class of about 100 people who have gotten all A’s. I know there were maybe two in the class ahead of us? Point is, get ready for that not to happen.

I came in head-strong thinking, “I know everyone has been saying this but I can do it. I get can all A’s.”

The first round of exams went through and I thought, “Okay. That’s doable.” But then the second and third round came and eventually I was just doing everything I could to stay afloat.

My advice is this: do your best, do not compare yourself to your classmates, and ask for help when you need it. Your grades are not reflective of your capabilities as a nurse.

2) Mental Health > Study Time

“Don’t pound yourself into the ground with studying because self-care is just as important.”

My mentee

Don’t get me wrong, you need to study hard and make it a good habit. But you also need to realize that if you wear yourself out, no amount of studying is going to help you.

Make a study schedule and stick to it. Study every day, schedule breaks and rewards, and do not study outside of your allotted time. I stop studying around 8-9pm every night, and I always get my 7-9 hours of sleep.

3) Roll with the Punches

I had an expectation that nursing school would be organized, the instructions would be clear, and that there would always be a strict schedule. Boy oh boy was I wrong!!

You will have to learn to “roll with the punches.” Don’t sweat the small details. Be ready to adjust and readjust your schedule. Nursing school is very fluid!

I remember one week last semester where they said, “Oh by the way, this small group of people needs to put together a project and present it at this location. And you have five days.” I remember thinking, you want me to do that and my million other things I have going on?

I go to class every day expecting that something else will be thrown our way. That way, I’m not surprised.

4) Nurse-Administrator

The administrative/paperwork stuff added another level of stress to nursing school. The beginning was extra stressful because you have to submit a lot of paperwork to the state board of nursing. It helps to become ultra-organized with your vaccine records, identification documents, health insurance, CPR certifications, background check documents, drug screen, etc. There are 32 separate documents I have submitted JUST to be eligible to register for classes.

You will most likely also submit additional paperwork for each of your clinical sites. You will also be expected to keep up with your resume and portfolio.

If your school tells you to start working on paperwork before school starts, DO IT RIGHT AWAY. If you wait until school starts, you will be stressed out about the administrative stuff and that will cut into your study time.

5) Tick-tick-tick-DONE

When I got my acceptance letter for school, I thought that the two years would take forever, and I questioned whether or not I wanted to commit to two years of my life.

Now I’ll be starting my last semester of school and I cannot believe how fast time has gone by! When did I get here? I feel like I just woke up and now it’s time for me to apply for big girl jobs!

Nursing school keeps you so busy that time passes by really fast. Each week is so jam-packed that seven days don’t seem like enough time.

Don’t forget to enjoy life in those little moments!



AbeBooks.com. Thousands of booksellers - millions of books.

This post may contain affiliate links. This means that, at no cost to you, I may make a commission if you click through and make a purchase. Contact me with any questions!

Nurse Skyanne is a participant in the AbeBooks Inc. Affiliate Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to http://www.abebooks.com.

How I SAVE 💰MONEY💰 as a Nursing Student

If you live in the United States, you know that college tuition is an expensive hot button issue. If you have been to college, you most likely have student loans. While loans can be helpful while you’re in school, it can get really scary to think about paying them off. Loans do not typically cover the cost of living, utilities, car notes, etc.

I wanted to put together a little post about a few things I do to save here and there. It may not be much, but hopefully you can find something here that saves you a few dollars!

Honey Gold

I don’t remember how I heard about this website, but it has saved me a lot of money over the years, and I’ve even been able to redeem the points for gift cards. The best part is that the program is free, and there is a super convenient Chrome extension. To be honest, I am NOT an affiliate of the Honey Gold program. But I do have a referral link just in case you want to try it. (I may in the future become an ambassador, but I need more followers. 😀)

Let me show you how it works!!

Just go to www.joinhoney.com, or click on my referral link. It is recommended to install the extension for your browser. I believe it works for nearly any updated browser (Chrome, Safari, Firefox, Microsoft Edge, etc.). Then as you do your regular shopping, Honey will shop for the best price for you! It will automatically apply different discount codes in the shopping cart. If there are no discount codes available, it will most likely give you some sort of “cash back” in the form of points. The little extension icon will turn orange:

All you have to do is click on it, and Honey will do the work for you!

I have yet to find an online store where Honey does not work. You can also add items to a “Droplist,” and Honey will alert you when the price goes down. That way you don’t have to worry about finding the best deal. I’ve used this on many of my textbooks and school supplies.

You can even use it while ordering pizza! Which is pretty cool. I’ve redeemed most of my points for Groupon and Target gift cards.

Textbooks

Don’t pay full price for textbooks. Please don’t do it. We were offered an $800 package for just our first semester books and I am so glad I did not take it. I ended up spending about $315 instead by doing my research and looking for deals.

The first thing I do when I get a textbook list is I google the name of the textbook and PDF. So for example, I would search “psychiatric mental health nursing 8th edition pdf”

I have found several textbooks this way. If I didn’t find the textbook, sometimes I found the supplemental study guide or other resources that accompany the book. ALWAYS search for your books like this first, unless you absolutely 100% need a physical copy of the book.

One of my favorite websites is Book Depository. They have very competitive pricing and free shipping. I have never run into any stock or customer service issues with them either. Use this website when you need to keep your books. They are an Amazon company but they do not offer rentals or Kindle versions.

We all know and love Amazon. You can find new, used, Kindle, rentals, etc. If you have been told by upperclassmen that they did not keep the book, I would go ahead and rent it. With Amazon, if you rent a book and then decide you want to keep it, you can buy the book and the cost of the rental is applied toward the purchase.

Abebooks is also another great website. They have low prices and a very large inventory including rare books and fine art. I also enjoy using their advanced search feature that allows you to search by price, publisher date, and edition.

Find Cheap Textbooks - Save on New & Used Textbooks at AbeBooks.com

One last helpful tip is that a lot of school libraries have these textbooks on reserve. If you are really in a pinch, you can head to the library and look for your book. You could probably make photocopies (or use your phone camera) for the pages you need.

School Supplies/Organization

I reuse binders, folders, dividers, anything else I can repurpose. I seldomly purchase brand new supplies for a new semester, unless I know I need it. I buy pens and pencils because I lose them.

I have also started to “go paperless” with my notes. I was getting so frustrated with how much paper sat on my floor at home. Nursing school powerpoints are no joke. Last semester, I created folders on my Mac for each class, exam, and clinical. It’s good for the environment and your back! Our school has printing included in the tuition, but I know many schools who do not.

Some people really need those handwritten notes in order to study. I am one of those people! So instead I bought a cheap whiteboard from Wal-Mart and installed it on my wall. I study on my white board and it wastes zero paper. When I fill it up, I take a picture of my notes with my phone and upload it to the appropriate folder!

My whiteboard at home!

Any papers or notes that the instructors give us are scanned and put in my computer. If I need a paper copy, I keep it in a binder or folder on my bookshelf. This is what my folders look like on my Mac—

Budgeting

Love it or hate it, you gotta do it. Listen, y’all. I rarely spend money on things I don’t need. When I do, it’s because I’m rewarding myself (after finals, getting a new job, winning an award, etc.). To be honest, I AM in a lot of debt. Should I be the best source of financial advice? No. But I am a real nursing student with real life problems, and I just want to share how I’ve managed to stay afloat.

I use excel to break down my income and bills. I give myself a little bit of spending money (for vending machine snacks or the occasional post-test celebratory adult beverage). My opinion is that you still need room to live your life. Just don’t spend $300 on shoes you don’t need if you cannot afford it.

We don’t have cable TV, I’m on the cheapest phone plan my service offers, I make my lunches/dinners 95% of the time, and I only purchase new clothes when the ones I have get so worn out that I have no choice.

I always make a grocery list, I shop at Dollar Tree and Aldi, and our house is barely decorated. I’ve switched (reluctantly) all of my luxury or non-drug store makeup brands to drugstore brands. I even tried to grow some of my own vegetables and herbs, but it turns out I do not have a green thumb. 👎🏻

Some of you make think I’m crazy for having this type of lifestyle, but I am doing what I need to do to make it through school. I know that it is temporary. I know that when I start making a better salary, I’ll have a different budget!

I put a certain percentage of my paychecks toward school. That savings account is non-negotiable and I use it to pay for various school expenses from supplies to scrubs.

I hope you found something here of value to you! What do you do to save money?



This page may contain affiliate links. This means that, at no cost to you, I may make a commission if you click through and make a purchase. Contact me with any questions!

Nurse Skyanne is a participant in the AbeBooks Inc. Affiliate Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to http://www.abebooks.com.