t’s fair to say I am a straight-A student; haven’t always been in high school or my earlier college years, but now that I’ve chosen an actual career and have a family to support, I am definitely working hard to earn good grades.
From the beginning of nursing school, I decided to read every assigned chapter and spend lots of time and energy gaining as much information as I could. Being in an accelerated program, with each class lasting from 1 to 2 months, time management was of the utmost importance. I would spend nights studying, since my days were filled with classes, my full-time job, and taking care of my three kids. I would say I was doing everything right as far as being a nursing student was concerned.
Then hit Med Surg I & II – easily the hardest four months of my life. I was not prepared for how intense of a class this would be, both in lecture and clinical. For the first time in nursing school, I straight up failed a midterm exam. I was embarrassed, ashamed, flabbergasted – I couldn’t understand how my study habits that had carried me thus far, some seven months or so, had gotten me A after A in classes, tests and assignments, then suddenly I had the lowest score I’ve ever seen with my name on it.
At our school we have what are called “LSPs,” or Learning Support Programs, which require that we maintain at least a 76% percent on all tests and quizzes. When I first heard about this remediation program, I haughtily told myself, “I will never be on a LSP. In fact, I’ll make it a personal goal to get through nursing school without a single LSP.” Well, I must have either jinxed myself or was simply never prepared for what Med Surg would be like until that midterm in the first Med Surg class. It was a complete eye-opener, and it humbled me, that no matter what kind of student you are, there will be struggles and obstacles that will make or break you.
I certainly had my breaking points over the four months of Med Surg. I spent more hours studying away from home, sometimes more than 6 hours even after class going to Barnes & Noble or Starbucks. I found comfort in my friends and mentors who knew the struggle I was facing and could relate to my inner turmoil.
If I could share the top lessons that I learned from that first failed test, it would be this:
1. Study smarter.
If the way you’ve studied in the past doesn’t seem to be working, be willing to ask others their study habits and try to incorporate some new ideas into your routine. Don’t try to read everything, like I had before, but rather find ways to absorb the content in a way that makes sense to you. Watch more videos on topics you don’t quite get and hopefully they have visuals to help if you’re that kind of learner. Find “cheatsheets” online from nursing-related websites to help you memorize better. Don’t highlight everything even though everything seems important (trust me, someone called my textbook a “coloring book for adults”). Find questions from NCLEX-prep books or online to help test you on the content; read the rationales whether you got it wrong, know the answer or guessed and still got it right. It’s always best to know the “why” behind every answer, and I have found this to be most helpful in trying to approach NCLEX-style questions on tests.
2. Use this experience to grow.
Re-evaluate your study and test-taking abilities. Meet with your professors during their office hours. Don’t be afraid to ask more questions in class and clarify something during lecture. Don’t try to wear yourself out more from failing, but utilize your time and energy more efficiently. Most of all, get plenty of sleep; I thought that burning myself out with late-night readings and study sessions would help me but it only hurt me in the long run. I learned the value of sleep and how we remember information better when we get a long night’s sleep after studying. Give yourself a daily To Do list and stick with it, but make your goals manageable so as not to overwhelm yourself. Most of the classes in nursing school, like Med Surg, will cover a lot of material every week, so try focusing on one topic at a time instead of a bunch so you can better retain the information.
3. Everyone struggles in nursing school.
Because I failed one test, I felt like a failure. But, that isn’t true. Because nursing school has a wide range of topics that it focuses on, from theory and leadership to pharmacology and specialty areas, we are all bound to get to a subject that challenges us. While I found pharmacology and obstetrics to be fairly easy, others did not; same with Med Surg being my weak spot whereas others found it to be a breeze. Just because you fail one test doesn’t make you a failure or less than your peers; take this opportunity to not be discouraged but rather to push yourself more and test your abilities of what you can do. Two of my favorite teachers I’ve had in nursing school have shared their stories of struggling when they were in school and how they have retaken classes only to come out stronger in the end because of it.
The American Nurses Association urges health care to eliminate all forms of bullying and incivility from our workplaces. Nursing and health care leaders, including the ANA, often leap immediately to declare that facilities follow a “zero tolerance” policy when dealing with bullying thinking that it will eliminate the behavior. The literature, however, reveals that this implementation rarely succeeds when used in isolation. One reason is that those enforcing the zero tolerance policies are bully’s themselves. In other words…zero tolerance may have zero effectiveness.
When nurse leaders are silent in the face of bullying and uncivil behavior, they unknowingly (or knowingly) condone the behavior. If staff observes leadership tolerating bullying and uncivil behavior, then they feel they have no recourse and no one to turn to for help; staff does not feel that they can safely report being bullied. The bully sees this silence as acceptance and continues the behavior. Those that bully have a supportive atmosphere to continue terrorizing their colleagues. They are supported as they move ahead in their career and to various job postings within the facility, thus reinforcing the fact that a bully is very often in a leadership position. This is compounded if the bully-leader is also productive and meets the goals of the facility. Very often leaders may not approve of the behavior or even be aware that it is occurring, but the staff understands that silence is acceptance.
It is a well-known fact among staff nurses that many of those in nursing leadership do not belong in their positions and that many in hospital or facility administration don’t belong there ether. Whether it is a lack of education in organizational leadership or a lack of experience, many nurse managers and administrators have difficulty dealing with day-to-day issues let alone bullying on a unit or within the facility. It is also well-known that managers often ignore policies on bullying because they feel that they are ineffective or that bullying itself is not an issue.
Many nurse managers unfortunately see their staff only as employees there to get a job done. Staff presence or absence affects patient care and the bottom line. The victim is not seen as a person with rights.
Nurse leaders should:
- Receive evidence-based education regarding bullying, incivility, and workplace violence.
- Be aware of their own actions and words…are they a bully?
- Name the action of a perpetrator as “bullying” or “horizontal violence” – get it out in the open and freely expressed.
- Take the opportunity of staff meetings to speak on the issue. Use this as a teaching moment and to express that bullying will not be tolerated.
- Ensure that there exists facility policies in place to deal with bullying, and if not, be a part of team that creates them.
- Be fully committed to eradicating bullying from a unit/facility.
- Avoid moving a bully from unit to unit in order to avoid removing a productive employee. This sends a signal that bullying is condoned.
- Create and enforce a culture of respect.
- Immediately acknowledge staff concerns and complaints, but act on sincere, accurate information.
- Actively listen to concerns of staff.
- Be on the lookout for the formation and existence of cliques.
- Ensure that self-governed staff decisions are fair, accountable and responsible.
- Be supportive of all staff.
- Ensure that those staff that precept students or new staff are educated as to how to do so.
- Be fair and consistent in dealing with all staff.
- Be aware, at all times, of unit culture – has anything altered the emotional atmosphere of the unit? Be aware of morale.
- Be sympathetic and empathetic.
- Be a champion of open communication.
- Be supportive of those continuing their education.
- Don’t blame the target of a bully.
- Ensure that staff are accountable for their actions.
- Encourage assertiveness, discourage aggression.
- Ensure adequate, safe staffing levels.
- Make bullying victims aware of employee assistance programs.
The CDC states Lyme disease is the most common vector-borne illness in the United States, and each year, an average of 329,000 new cases are reported. As we approach the month of May and Lyme Disease Awareness Month, it’s hard not to take notice of the articles by scientists and ecologists across the country warning that 2017 is poised to be the worst year for Lyme disease yet.
As incidences of Lyme disease grow, nurses play a critical role in helping patients obtain an accurate diagnosis and proper treatment. “Lyme patients are sick, they are complicated, and they have lots of ongoing complaints,” says 30-year, veteran nurse practitioner and Lyme specialist, Ruth Kriz. “They don’t fit in a nice, neat medical textbook where you have symptoms ABC. Therefore, you have a diagnosis of illness X. There are too many things that it mimics,” she says. In fact, Lyme disease is known as the “The Great Imitator” because it mimics conditions like multiple sclerosis, fibromyalgia, lupus, and chronic fatigue syndrome (to name a few).
Knowing some key pieces of information about the complexities of the illness can increase a patient’s chance of early detection. Moreover, a nurse’s knowledge of the disease could assist a previously misdiagnosed patient with accessing the appropriate medical intervention to improve their symptoms and quality of life. When left untreated, Lyme disease can have permanent, irreversible consequences for patients. Here are four things you need to know to help your patients achieve the best possible outcomes.
1. The two-tiered testing process for Lyme disease may be inaccurate.
Most nurses are probably familiar with the ELISA screening test and Western blot test–the two-tiered testing process that is often used to diagnose Lyme disease. The International Lyme and Associated Diseases Society (ILADS), a nonprofit organization dedicated to understanding Lyme disease through research and education, states, “The ELISA screening test is unreliable. The test misses 35% of culture proven Lyme disease (only 65% sensitivity) and is unacceptable as the first step of a two-step screening protocol. By definition, a screening test should have at least 95% sensitivity.” Furthermore, “Of patients with acute culture-proven Lyme disease, 20–30% remain seronegative on serial western blot sampling. Antibody titers also appear to decline over time; thus while the western blot may remain positive for months, it may not always be sensitive enough to detect chronic infection with the Lyme spirochete.”
Although test results may be negative, patients can still be infected with Lyme disease or other tick-borne illness. As Kriz points out, it’s important to understand the symptoms of Lyme disease because, “We want to treat people, not just the lab work.”
2. As the illness sets in, a patient may complain of a broad set of symptoms.
In the initial stages of the disease, a patient may report nothing more than flu-like symptoms. But as the infection disseminates throughout the body, a host of issues could arise that may seem unrelated to one another. Some of the more common complaints a Lyme patient may have include (but aren’t limited to): unrelenting fatigue, joint pain, widespread muscle pain, disordered sleep, depression, brain fog, fevers, chills, sweating, and Bell’s palsy.
3. Not all patients will remember a tick bite or rash.
ILADS reports less than 50 percent of patients with Lyme disease remember seeing a tick bite or a bull’s-eye rash (erythema migrans). If a patient presents with a bull’s-eye rash, the rash is indicative of Lyme disease.
4. There is more than one school of thought when it comes to the diagnosis and treatment of Lyme disease.
The diagnosis and treatment of this illness are contentious points that divides many healthcare professionals. As a result, two philosophies have emerged on how to diagnose and treat this disease–the IDSA and ILADS. The IDSA maintains a strict adherence to their guidelines that those who test positive for the illness should undergo antibiotic therapy. On the other hand, ILADS believes that due to inadequate testing, a clinician’s clinical judgment can assess who needs to be treated and with what means. While the IDSA has expressed concern regarding the overuse of antibiotics, ILADS believes the decision on how to treat patients should be based on factors such as the risks to patients, their quality of life, and financial costs. It should be noted that the ILADS treatment guidelines are the only guidelines currently listed on the National Guideline Clearinghouse (NGC), a public database of evidence-based treatment guidelines for healthcare professionals and insurance companies.
In conclusion, the more information you have regarding signs, symptoms, and treatment options for Lyme disease and associated tick-borne infections, the more you can advocate in the best interest of your patients on this controversial issue.
After all that’s said and done, the most exciting part of finishing nursing school is getting hired as a ‘real nurse,’ am I right? Trading in your tuition statements for a paycheck, your non-uniform scrubs in for some Grey’s Anatomy scrubs and Danskos, and actually getting to care for your own patients each day, developing trusting relationships with families and coworkers.
But, what’s the catch? For some it may be the hours. Precepting on nights in nursing school might have been all fun and games, but after the third major holiday you’re stuck working (especially at night), the real world hits.
A substantial amount of new nurses report being dissatisfied with the hours and holiday schedules. Some state that the paycheck was simply not as high as they were expecting, and others are consumed with the stress of being responsible for such significant aspects of care under high stress.
However, a significant amount of new nurses have stated that the hardest part of adjusting to a new job is being so excited, happy, and fresh in the field that our more aged coworkers are quick to ‘take us down’ with their negativity and own ill will towards the profession. Statistically speaking, it is more likely for nurses to be dissatisfied with their job if they are in an inpatient setting providing direct patient care, which is typically the type of job that most new grads are seeking, making us more vulnerable to a stressful environment.
It is not unfamiliar to hear the words “just wait until you’ve been here 20 years,” or “you’re just happy because you’re young, you’ll find out.” These statements are enough to scare anyone into wondering whether they chose the right career path. And for what? Why are these nurses so dissatisfied?
While it is understandable why much of the nursing workforce experiences burnout from many years on their feet, long hours, odd shifts, and missing plenty of family milestones, it is also our right as new nurses to enter a job and feel welcomed in that position. New nurses experience stress in many other aspects, and being surrounded by negativity should not be a normal part of a new career.
The important thing to do when confronted with these statements is to take a deep breath and smile. While it’s easy to feed into the negativity, it’s better to slide past it, acknowledging it and expressing your concern, but staying above it and staying away from it. A key aspect in staying in love with your job that you just recently worked so hard to get is to find out where the negativity is at. Is it specifically in the break rooms? Ask if you are allowed to go downstairs for lunch. Is it before morning huddle? Maybe there’s a free computer where you can begin looking up info about your patients. Be sure to still socialize with your coworkers, but find the best times to do so. Holiday parties, positive action committee meetings, etc. Surround yourself with the nurses that are a positive influence on you and consider asking a fellow nurse to be your mentor to guide you through the tough times and encourage you to stay positive as well.
Most importantly, know when you can help your coworkers. If there is a particular coworker in distress, know who you can speak to if you feel they are unsafe in the work environment. If you are doing well and you feel confident, maybe try using your “young” and “fresh” attitude to bring some joy to your coworkers. Gently remind them how honored you feel to work in your position or tell them why you specifically chose this job over another job. Talk about why you enjoy your job. Kindly redirect negative conversations to more positive subject matter.
Lastly, know when it is OK to be negative and with whom you can share those feelings. Finding a buddy or a mentor that you trust and can vent to behind closed doors is something that every nurse should certainly have access to, but do respect your colleagues’ right to a positive, healthy work environment of their own. Ultimately, balancing stress involves staying in touch with your own feelings and your own needs. Journaling, blogging, or just talking with a close friend are good ways to recognize when you are stressed and perhaps feeling negative. As nurses, we cannot provide the best care to others unless we care for ourselves first.
Established in April 2006, Transplant Nurses Day was created by the International Transplant Nurses Society (ITNS) in order to raise awareness about the tremendous contributions that transplant nurses make in the lives of their patients and the people with home they work. It’s held every third Wednesday in April—this year on April 19.
“The celebration recognizes the skill and commitment of transplant nurses around the world,” says Allison Begezda, senior marketing manager, ITNS. “Transplant Nurses Day is an opportunity to celebrate the contributions our nurses make to patient care, patient and public education, nursing research, and the profession of nursing.”
As part of the Transplant Nurses Celebration, ITNS holds an annual Transplant Nurses Day essay contest. They ask transplant patients to nominate their ITNS Transplant Nurse. This year’s theme was “My Transplant Nurse: Champion of Care,” and six patients submitted essays for consideration.
There are many types of transplant nurses, including transplant coordinators, surgical nurses, post-operative care nurses, research nurses, and more.
ITNS honors its nurses in other ways besides just on Transplant Nurses Day. The society also honors its members each year with two awards that are presented at the Transplant Nursing Symposium.
As Begezda says, with the Transplant Nursing Excellence Award, ITNS “recognizes that the role of the transplant nurse is unique and dealing with patients through the transplant continuum is often complex and challenging. ITNS recognizes a special nurse whose career has exemplified ITNS’s mission: ‘…promotion of excellence in transplant clinical nursing through the provision of educational and professional growth opportunities, interdisciplinary networking, collaborative activities, and transplant nursing research.’ The purpose of this award is to recognize an individual outside the nursing profession who has supported the efforts of ITNS and made an impact in the field of transplant nursing.”
With the Friend of Transplant Nursing Award, ITNS “wants to recognize a friend of the organization who has made an impact in the field of transplant nursing. ITNS recognizes that you do not need to be a nurse to make a difference. The purpose of this award is to recognize an individual outside the nursing profession who has supported the efforts of ITNS and made an impact in the field of transplant nursing.”
This year’s symposium will be held June 24-26. For more information, go to www.itns.com.
Orientation or preceptorship is the introduction to your new career and job and may be long or short in duration. Depending on the area in which you are working, it may encompass several days of classroom learning followed by unit orientation. If you are expected to float, you may also be expected to orient on several different units. No matter the length of orientation, there are several things you can do to make your orientation as smooth an experience as possible.
- Know prior to your first day what type of uniform to wear or the organization’s dress code, what time to show up, where to show up, and what supplies to bring.
- Many areas of nursing, particularly subacute and rehabilitation, may expect you to bring your own thermometers, blood pressure cuffs, and pulse oximeters. Question whether this is the case in your work area.
- Have access to unit specific (i.e. medical surgical) information, skills instructions, and patient drug information in case your facility does not have skills, policies, procedures, and other resources online.
- Complete all necessary paperwork and/or online educational offerings as required.
- Review a unit specific text. This will help to refresh your member on basic concepts.
- Review your nursing skills text.
- If your facility uses electronic medical records, you must still be aware of how to properly author a narrative note and what information is important to include in your documentation. Review documentation guidelines.
- Consider adding an application to your cell phone to access key references. Be aware, however, that some institutions will not allow you to access your phone during work time
Meet and Greet
- Arrange to meet your preceptor (and some of your fellow staff) prior to the start of your orientation or work experience. When you return for your first day of work, seeing a familiar face will help to reduce your stress level.
- Take the time prior to your first day to meet with the staffing coordinator. Obtain a copy of your schedule. Negotiate for any days off you are aware of needing for preplanned vacations, school, or other circumstances.
- Seek out new learning opportunities. It can be a way to introduce yourself to other members of the team.
- Practice good communication. Be an active listener.
- Inquire whether you will be orienting on the same unit and on the same shift. New nurses are often moved from unit to unit during orientation to learn in multiple areas and from multiple nurses.
- If you are moving throughout the facility during orientation, be sure that you will be with one nurse during that time on a specific unit. If you are inconsistently supervised by your preceptor, the documented or actual outcome may not be ideal or fair.
- If your preceptor takes time off during the preceptorship, your orientation may not go smoothly. If his or her time off is excessive (say a week or more), inquire whether you may be assigned another preceptor.
- If you are off an excessive number of days, you will not have a complete orientation and may be ill prepared to work. Plan your vacation accordingly and give yourself plenty of time and opportunity to complete orientation.
- Be honest about your limitations, your skills ability, and your knowledge base. Think about enrolling in an RN refresher course prior to your job search. Make your preceptor aware of any limitations in skill level so that they can be addressed during orientation.
- Don’t perform nursing care outside your scope of practice. Know your limitations with regard to what you have been taught and basic nursing practice.