Our Nurses of the Week are the nursing students of the University at Buffalo (UB) who spent a week in Haiti treating over 800 patients. Ten nursing students were assisted on the mission trip by a group of UB faculty and several Western New York physicians, pharmacists, and health care professionals.
The mission trip was led by Molli Warunek who traveled to Haiti for the first time 20 years ago as a nursing student to deliver medical care. That experience spurred her to begin taking part in mission trips around the world, and the April trip with UB nursing marker her 15th mission trip.
Warunek is now a clinical assistant professor and global initiatives coordinator for the UB School of Nursing. She tells Buffalo.edu, “The significance of the journey is incredible, as the students and providers learn to always have an endless amount of compassion for their patients, whether they are rich, poor, healthy or unhealthy. That is something you cannot teach in a classroom.”
The UB Nursing mission trip to Haiti was completed in partnership with the community organization, Servants in Fellowship. The group served at a mobile medical clinic in Galette, Haiti, a rural settlement where access to care is difficult and poverty is commonplace.
In one week, the team treated more than 800 patients ranging in age from 19 days old to 91 years old. The nursing students and medical professionals cleaned and dressed wounds; treated respiratory illnesses, burns, and scabies; provided antibiotics and other medication; and administered fluoride varnish to 250 children. UB nursing students also provided hygiene education sustainable in Haitian culture to help prevent future illness.
Overall, the experience exposed the students to diverse cultures and raised awareness of the health challenges faced by people around the world. To learn more about the UB nursing school’s mission trip to Haiti, visit here.
You’ve read my thoughts on being a preceptor, but now it’s time to explore things from the other side: as an orientee. In the last two years, I’ve had the opportunity to orient as a student in nursing school, as a precepting practicuum student, and as a new graduate orienting to my current position in the NICU. It certainly doesn’t take much to channel these inner thoughts from what was not so long ago timewise, but feels like ages ago when I think back to where I was with my nursing skills. Here’s what I learned from the student experience.
1. I’m sorry for a lot of things.
“I’m sorry! I’m sorry! I’m sorry!” is all I can think. I’m sorry I didn’t remember to run a flush, I’m sorry I just kicked the back of your foot. I’m sorry! I know it’s annoying to keep apologizing, but I’m just very nervous and I’m sorry! I feel like I’m annoying you, I’m really worried you’re gonna tell my professor I did something wrong, and they’ll tell the hospital and then I won’t get hired and I won’t have a job! Point being, I’m a nervous wreck and I’m sorry I keep saying I’m sorry.
2. My preceptor is a bear tonight.
I get that it’s not always the most exciting gift to be given a student or a new grad to orient, especially when you’re not expecting it, or if your baby kept you up all night and you didn’t sleep, or if you had extensive plans to Facebook message and Tinder all day long. But… I’m here and I’m excited to learn…. and my preceptor is being a bear! If you could please try to not hate me and teach me something I would really appreciate it. Also, when you answer my question with an attitude I can’t help but feel like I shouldn’t ask any more questions, so please try to be understanding! P.S. We all know the look of a nurse that didn’t want a nursing student so please don’t think it’s not visible! Also, feel free to tell me to go sit at another computer while you’re charting if I’m not needed to help. Odds are that I want a break from you, too, and I could probably use some time to look things up!
3. I’m not as smart as I think.
I’m definitely not as smart as I think or act. I definitely don’t know all (or any) of the acronyms you’re using so please treat me like I know nothing and I can tell you if there’s something I’ve already learned. Further, please don’t leave me alone in a patient room while drawing labs off a central line for the first time (not that that’s happened to me or anything…). There will also be times when I’m acting like a know-it-all, but it’s probably just me overcompensating for realizing how little I actually know. If you work in a specialty unit, AKA anything other than med/surg, don’t forget that nursing school wasn’t focused on your specialty! So, no, I don’t know anything about your 23-week-old baby! Specialties are just that, specialties, so help me learn them!
4. These uniforms will never be less humiliating.
I feel like whenever anyone sees me in my student nurse uniform it’s a shout-out like “hey, ask me to come position your patient” or “I’m free to help transport patients—pick me!” When in reality, I’m here trying to learn. I do enjoy understanding that nursing isn’t all exciting procedures and numbers and diagnoses to learn; half the battle is balancing all of those things and still having time to turn your patients and meet their psychosocial needs, but my time is valuable and if I’m still in school I’m technically paying to be here, so I want to learn the skills I don’t know! Also, my uniform definitely does not mean that anyone can make jokes about what I don’t know or treat me like less of a person. I trust you and you are my guiding light for the day. Knowing that you have my back will help me relax and forget about the sign hanging around my neck that says “student”!
5. The elephant in the room: Lunch!
I promise it’s really OK if you don’t want to eat lunch with me. If you don’t and you do it out of obligation, I’ll know and feel uncomfortable, especially if it’s me, you, and eight of your friends all talking about your weekend plans that I’m not apart of. I’d honestly rather go eat with a fellow student at that point. Plus, I may be a vulnerable student, but I’m also an adult and can handle and enjoy eating on my own. And likewise, I’ll let you know if there’s a night when I really need to sit down with you and talk something through or talk about my experiences.
Ultimately, I’m stoked to be with you as a student, intern, or new grad. I look up to you, trust you, and likely want to be just like you. I know it’s hard having a student, but it’s hard to be one, too. Work with me so I can work with you. After all, nurses eating their young is so prehistoric, don’t you think?
I had the opportunity to precept a nursing student this month and I thought it would be a perfect blog post to share with you all, from my perspective as a nurse, and that as a student who not too long ago completed the preceptorship process myself. As it turns out, both parties have a lot to teach, a lot to learn, and a lot in common.
Here are six things I learned from my precepting experience.
1. I am tired.
No matter how hard I tried to be wide awake and energetic for my student, I realized I am just exhausted. My life is exhausting, my job is exhausting, and frankly, my student is exhausting. Lesson to be had from this slew of exhaust: space out your days when precepting a student. There are sacrifices to be made when precepting, and giving up the 3 on, 4 off perfect schedule is one worth making. The weeks where I was 2 on, 2 off, 1 on were refreshing for both my student and myself, even if we had different patients. In all reality, my student needed more variety in patient load anyhow, so it’s a win-win.
So, if you’re shadowing me and I’m visibly exhausted, hold me accountable! Don’t let me slack on teaching, but do realize there are times when you can use your resources to look things up, too. Sometimes I just need my morning coffee, too, so don’t worry if at 6:35 am I’m not bright eyed and bushy tailed—I’ll get there by 9, I promise!
2. I will never get to bed “early.”
All that being said, I will not and cannot get into bed as early as I wish every night. I definitely have my nights where I go to town and make it happen, but that’s not going to be every night before precepting, and that’s OK. I spent so much time beating myself up about not getting into bed early enough and not packing my lunch ahead of time so I could get more sleep that I could’ve just been taking a power nap. Chances are, students probably don’t go to bed before midnight, either.
3. I’m not that smart, and I probably won’t ever be, and that’s OK.
Nope. I don’t know. I don’t know the obscure gene correlation between the microorganism and its vectors or whatever mumbo jumbo there is to know. But you can absolutely ask! Please ask me, but please don’t judge me when I don’t know! Let’s look it up together and learn together. I would be a bad nurse if I told you I knew every single thing.
Further, quite honestly, there is nothing worse than a know-it-all, and we all know that. When you come into work with the idea that you know more than me, need to teach me, and want to point out in rounds that you know more than me, it just turns me off to teaching. I do believe you really know more than me and have lots to teach me, just remember that there is a time and a place for everything. Let’s have a “think through” discussion where we sit down and get a break, instead of debating in front of a family. Even a healthy debate about medical treatment can come across as inconsistency and lack of confidence to a family who doesn’t know the terms that we’re speaking about.
You are smart—this I know—but I am also here to teach you about my experiences, and that I do have more of, so allow me to help you put all of your awesome knowledge into clinical experience, too!
4. I make a lot of mistakes. And I don’t enjoy having those pointed out to me.
So if I dial up the IV pump for 35 ml instead of 36 ml, please don’t say so very dramatically in front of the patient or the patient’s parents. Instead, calmly remind me when we step to the side or calmly suggest adding an ml to the pump. If I make an urgent mistake please tell me immediately, but handle all with caution. Patients, especially children, pick up on the mood in the room. If you look worried, they will too. Confidently and calmly reminding me is a good way to keep everything under control.
5. I should’ve taken it easy on my teachers when they didn’t sign that form in 24 hours.
Let me tell you, it’s hard. I already get 15 emails a day from work, and when I get another email asking me to sign and fax a form, sometimes it just gets lost in the virtual pile. Don’t be afraid to remind me, and please be forgiving! I would prefer to be asked about these things while I’m at work, but if I’ve forgotten something you need immediately, you can absolutely reach out when I’m not at work. I would double check this with all of your preceptors, though, to make sure they are comfortable with being reached off the clock. Point being, it’s never malicious if we forget to respond to your email, forget to fill out your paperwork, or sign a form. That being said, there’s nothing worse than waiting till the last minute to hand it all to me and tell me it’s due tomorrow!
6. Learn, learn, learn. . .and then learn some more.
The experiences you’ll have as a student, a new graduate nurse, or an intern are some of the best experiences. We intentionally put you with patients that present learning opportunities. So please take them and love them! Your day isn’t over at 7 pm; you should go home and look up 3 things you didn’t know—just 3! Don’t study medical textbooks for hours on end, but google things, read opinions, read facts. In nursing we don’t always have to know down to the microbe, but we need to know the big picture. Ask yourself: Could I teach a parent how to feed through a g-tube? Could I explain necrotizing enterocolitis to a friend? Save the specifics for nursing school exams; focus on learning how all of the systems work together and the bigger picture when you’re at clinicals or with your preceptor. Always ask yourself why while you’re learning. Why are we doing this? Why does this child have this condition? Why is the doctor changing this order? Try to look things up on your own when you can, or ask me while we are charting or breaking!
Overall, having a student is an awesome experience. It is refreshing to have such a bright, eager mind, it is humbling to have someone remind you that you’re not that far from when you were a new grad, either, and it’s invigorating to watch your student grow and succeed. I am happy to have you, but every student has a different learning style and that takes me time to learn, too. Be patient with me, be kind to me, and let’s conquer this together. Understand that I’m human too—I get stressed, overwhelmed, and tired, too. With open communication we will be able to get to know each other and grow together!
Stay tuned for Precepting, Part 2: Inside the Student Experience for my perspective as a student!
The NCLEX: the ultimate goal for every nursing student—and, the source of constant anxiety, stress, and sleepless nights. Nursing school exams are supposedly modeled after it, giving us multiple-choice questions where there are always two good answers, and we “have to choose the better of the two.” We are in a constant state of studying and memorizing hundreds of facts at a time, trying to retain as much information as we can for the time when we will eventually take “the big one,” the NCLEX. As a former student and current registered nurse, I can tell you that, with plenty of preparation and planning, you too can pass the NCLEX as I did.
1. The Tools to Use
My school offered an accelerated BSN program that was 22 months long. Each class lasted about 4-8 weeks depending on whether there was a clinical component. We had an exam every other week, and our program required that you meet a 76% benchmark for all of your tests to stay in the program. While I hated studying for hours on end day after day for those two years, it did teach me how to study smarter. My notes focused on “the big picture” for what we were learning, such as body systems or major nursing concepts, then I re-read and focused on what particular information stood out about that disease or medication, etc. Our program had incorporated ATI into it, so we had this learning tool that taught us content throughout the program. If your school does not use it, I highly suggest using something like this to help you with practice questions, then read the rationales for each question as to why the answer is this one and not the others. When my program was completed, there was about a 2-3 month lag time between when our conferral date was and when I should have gotten my Authorization To Test for the NCLEX, or ATT. In that time, I made myself keep studying; I never took a break because I knew that I would have a hard time remembering things for when I would sit for the NCLEX. I am someone that needs constant exposure to material for it to be fresh instead of cramming beforehand. The NCLEX prep tool that my mentor had suggested, and the one I used for 2 months prior to the NCLEX, was UWorld. There are various NCLEX-RN packages to choose from, ranging from 60 days for $139 up to 730 days for $299. I purchased the 90-day $159 package, which included access to the 2,000-plus practice questions, as well as two 75-question self-assessments that gauged my readiness for the NCLEX.
2. It’s All About Strategy
Since I learned mainly content for nursing school using ATI while I was in the program, I felt that UWorld was the only tool I needed to help me with test-taking strategies. It’s impossible to know everything there is to know in the nursing field, but if you have already been exposed to the major concepts during school, all you need is to know how to apply what you’ve learned in practice questions. What I liked about UWorld was that you can create quizzes for yourself, up to 75 questions at a time, and choose from a variety of subjects and systems. I was averaging at the 68th percentile, and the average for users was about 48th percentile. I loved how, after I answered each question, it would show me the percentage of people who got that question correct—it helped me to keep track of what areas I needed to focus on when I was studying. I would take plenty of time to read the question, sometimes more than once to really grasp what the question was asking, and I did a process of elimination to narrow it down to at least two answers. I always applied the various prioritization tools, such as ABCs, “life over limb,” acute vs chronic, systemic vs local, etc. Most of the time, questions deal with what is the priority. I tried to always go with my gut and not change my answer, since I knew that with the NCLEX you cannot go back and change any answers. The questions sometimes give you clues, such as what the medication is for, or how the disease process works, which was nice for me to stop stressing out about knowing all the content I could. I did at least 75 questions a day with a mixture of different subjects, sitting down and finishing the entire block at once with as little interruption to mimic the NCLEX, and felt that this was the best way to prepare.
3. The Night Before (and Day Of)
I kept a notebook at my side when I studied and took practice tests and kept a running list of the things that I knew I was struggling with. I studied for two and a half months before I finally took my NCLEX. The day before I took my exam, I didn’t do anymore practice questions. I had completed about 80% of the QBank on UWorld, and did the two self assessments the week prior to my NCLEX date. Again, it showed I was in the 68th percentile, with a “Very High” chance of passing the NCLEX. When I was in a nursing school, my ATI comprehensive exam said I was 97% likely to pass my NCLEX on the first try as well. The night before I took my NCLEX, I went through every single note I had set aside for review, roughly a few hundred pages. I am a visual learner, so I made sure I at least looked at the material I struggled with one more time to make sure it was fresh for the next day. Once I finished that, I made sure I had a healthy dinner and went to bed early, since I knew I wanted to get to the test center at least one hour beforehand (when you register for the NCLEX, they say to be there at least 30 minutes before). The morning of, I brought with me only my ID, phone, keys, and some healthy snacks and a water to bring with me (our test center had a locker where I could put my stuff). I ate a healthy breakfast and drank plenty of water beforehand, and used the restroom just before going into the test center so that I didn’t need to take any breaks. My exam shut off at 75 questions, so my test took just over an hour to complete.
The single most important thing I told myself over and over again for months on end was: “You know this; just trust yourself.” Anxiety is the greatest threat to thinking clearly, so if you were able to pass nursing school, you already have all the tools you need to do well. Just keep your anxiety level to a minimum and you will do just fine!
Our Nurse of the Week is Emma Strong, a University of Georgia (UGA) nursing student who pulled over to help the victims of a vehicle crash. Strong was assisted by two others, Vicki Bishop and Michael Derricotte, and all three citizens of Athens, GA were later recognized for their lifesaving efforts.
After two vehicles engaged in a head-on collision that resulted in one of the vehicles catching fire and a child who had stopped breathing, Strong and the others knew they had witnessed a very serious accident. Bishop, a nurse, began performing CPR on the child until emergency services arrived while Derricotte, a husband and father, pulled the injured driver out of the inflamed vehicle. Strong jumped in to help jam open a car door to rescue the people inside.
Strong is also CPR certified and recalls that the main thing running through her mind at the scene was thankfulness for her CPR training. She tells RedandBlack.com, “I knew that they needed my help, so I brushed my fear aside and sprang into action.”
Following the incident, Strong, Bishop, and Derricotte were all recognized by the mayor and the local fire and emergency services chief. Members of a community are often the first ones to arrive at the scene of an emergency, and they deserve recognition for the lifesaving acts they perform while waiting for emergency services to arrive.
To learn more about UGA nursing student Emma Strong’s experience helping the victims of a vehicle crash, visit here.
Oncology is a challenging but rewarding nursing specialty. With May being designated as Oncology Nursing Month, it’s a good time for nursing students to learn more about becoming an oncology nurse and connect with oncologists who have made the great big specialty leap.
Is Being an Oncology Nurse Right for You?
All nurses should be compassionate, precise, and resilient. That said, oncology is a particularly challenging subset of nursing due to the nature of the disease. As an oncology nurse, your days may include monitoring a patient’s physical condition, handling medication, and administering chemotherapy and other treatments.
Alene Nitzky, a certified oncology nurse and author of Navigating the C: A Nurse Charts The Course for Cancer Survivorship Care, emphasizes that the work can be very demanding. “Make sure you are really driven to do this work and that you have a true passion because it is extremely physically, mentally, and emotionally demanding,” she says.
Since oncology can be so emotionally exhausting, it’s important to practice good self-care. Stepping back and focusing on rest and rejuvenation will help you return to the job with even more sensitivity, empathy, and emotional resilience. Nurses of all sorts need to be able to dig deep emotionally, physically, and mentally to persevere through tough shifts.
A small mistake in medication dosage or timing can have devastating effects for an oncology patient, so attention to detail is important. Good oncology nurses will notice even small changes in their patients’ charts and are the first line of defense if something is amiss.
Diving into the world of oncology nursing also means that you’ll have to be comfortable with end-of-life issues, including grief and loss. Oncology nurses have to hone the psychosocial side of their role in addition to the highly technical aspects of monitoring their patients. Knowing when to listen to patients and their families versus offering consolation or advice is a key challenge for oncology nurses.
Keep in mind that pediatric oncology comes with the additional emotional challenge of helping young children and their families. A keen ability to navigate emotionally-charged groups is a must.
If you think that you have the emotional resilience, technical precision, and compassion to pursue oncology nursing, this field is incredibly rewarding.
Words of Wisdom from Oncology Nurses
If you’re thinking of pursuing a specialization in oncology nursing, you’ll want to explore the various types of positions available.
As an oncology nurse, you may find work in a variety of settings. You can get outside the hospital to work in a nursing home or health care center. This is ideal for nurses who may enjoy getting out to work in the community.
Oncology nurses can also work in the private sector or be nurse entrepreneurs to expand their horizons beyond the traditional health care setting. Nitzky adds, “Nursing students should seek opportunities to talk with oncology nurses who have left traditional health care and work in the community or public health settings, because they will give you a much more well-rounded look at the value you bring to your patients and clients.”
It’s always smart to reach out to a variety of experienced individuals in your chosen field. Track down several oncology nurses who work in traditional health care, in the community, and in public health settings. This will give you a better idea of the field you’re pursuing.
You’ll do a far better job of helping patients if you’re comfortable. Take care of yourself with good compression socks and comfortable nursing shoes.
The same goes for your mental health. Compassion fatigue or emotional burnout is a real challenge for many health care professionals. Since oncology nurses often work with very sick patients, they need to take extra care to not take work home. It’s easy to constantly think about that particularly charming patient or worry about parents who are on shaky emotional ground.
Just remember that you can’t do your best work if you’re emotionally and physically exhausted. Find ways to disengage from your patients and their families when you’re away from work and ensure that you have healthy self-care routines of diet, exercise, and rest.
The Joys and Challenges of Oncology Nursing
The oncology nurses we spoke to all named the patients as their favorite part of the job. Even when a patient’s cancer is quite advanced or a prognosis is poor, oncology nurses love making a difference in quality of life. Every day that you work with a cancer patient is another opportunity to make their lives better, which makes the job worthwhile.
When asked about the hardest part of being an oncology nurse, Nitzky said, “The most challenging part of the job is not what you’d think. It is difficult to lose patients after you’ve gotten to know them and bonded with them and their families, but the most challenging thing about the work is that you don’t have enough time to do all the things you know would make much more of a difference because you have too many administrative demands on you coming from your employer. Nursing is more about computer screens and documentation than it is about patient care, unfortunately.”
How to Become an Oncology Nurse
Becoming an oncology nurse requires extra schooling after nursing school, like any specialty. After getting an RN license, a prospective oncology nurse will need to meet specific eligibility criteria and pass an exam. The exact parameters vary state by state, but advanced certifications generally require a master’s degree or higher in nursing as well as hundreds of hours of supervised clinical practice.
The Oncology Nursing Certification Corporation offers a variety of certification options that you can pursue to stand out in a hiring pool and to further your knowledge of cancer care. Most certifications last for four years before they must be renewed with a recertification test or continuing education credits. To qualify, you have to spend at least one year working as an RN, work 1,000 hours in an oncology setting, and pass an exam. You can rotate into oncology units in many hospitals without extra certifications, but the knowledge gained with continuing education is worth its weight in gold to help patients further.
Checklist of Traits of a Great Oncology Nurse
- Emotionally resilient
- Adept at reading social situations
- Good at discerning when to listen and support
- Competent at self-care skills
- Comfortable with end-of-life issues, grief, and loss