My first day of work was a little nerve wracking. The new grad program started off feeling a lot like high school (not my favorite). For the first two weeks you're in a classroom with your cohort going over different policies and procedures (a nurse's best friend) and getting a variety of lectures on subjects such as body mechanics, Rapid Response Team, Dialysis, Wound and Skin and more. At lunch my cohort sits together and its during this time that it really feels like high school.
There's a member of the cohort who's first words to me were "I'm surprised they hired YOU because you only have an ADN. I thought they were only hiring BSNs." It kinda set my teeth on edge. Like I said before, this is a hot topic. And those of us with ADN's are stuck having to prove just how wonderful we are even though we only had 2 years of nursing school. Needless to say-those first few weeks of the program I would go to my boxing gym and beat the crap out of a punching bag just to let the frustration out. *Arnold would listen to my stories and in the end he always said "Just wait until you get on the floor. You're going to show them just what an ADN is made of." And as usual-he was right (just don't tell him I said that). I would like to take this time to point out a very important tip for new nurses (and veteran nurses!). I can't tell you how important it is to exercise. I don't care what type of exercise you do-just do it! It helps with the stress. I highly recommend hitting things, but that's just me. I also like hiking. One of my professors who worked in pediatrics and oncology is an avid hiker. I think she considers a "short" hike to be ten miles. I'm more of a one to three mile hiker. It's just great to be sweating outside in nature and it helps clear your mind before your next shift. Let me guess- you have excuses right? You're tired, can't afford it, hate sweating, can't find something you like? My advice to you...suck it. Just suck it up and do something, anything! Do you have back/neck/knee problems? Go swimming! There's classes offered by the community college for $27 for about four months. Don't know how to swim? They teach you! There's really no excuse for not working out. Look at it this way-90% of our patients are in the hospital because they chose NOT to exercise or make good eating choices. You don't want to end up in that bed. Do yourself a favor and start this habit now while you're starting your career. I work out four to six times a week. I have a boxing membership to the best damn boxing gym there is-Xplicit Fitness (my trainer doesn't pay to say this-in fact he just makes us suffer more in the gym). These people care so much about your health and mind while at the same time their realistic. They understand the challenges of work (a lot of their clients are nurses) and scheduling and eating right. They guide you everyday to making those good choices. I also have a 24 hour membership and so does Arnold and some friends. If I feel like hanging out with someone I usually suggest a good kickboxing or weight lifting class together. This membership is also good for when we travel. Lastly, I have a trainer that I've worked with for years in Coronado. I love her when I'm not at the gym. While she makes me do 60 lunges on each leg I don't really love her that much. Arnold has started going to train with me too and our trainer says "The couple that works out together, stays together."
Moving on....after the two weeks of our new grad program we started our clinicals. Our cohort was split between two medical-surgical units: Oncology and Orthopedics. Three of the new grads in my cohort have been hired directly onto a floor. So that means they won't rotate to the different units-just stay where they are for the four months of training. We still have classes we attend but not as frequently (thank goodness-sitting in the classroom for eight hours is hard for me).
I started on an oncology floor doing twelve hour shifts (YEA!!!). This was good for me because my externship had been on an oncology floor so I was hoping I'd still remember a few things. My first preceptor's name was *Matt. Our first shift together was just me shadowing him. At the end of that shift I was pretty disappointed. I had this feeling that my preceptor thought of me as a nasty little fly. I kept getting the sense that I was bothering him and he wasn't explaining how to do anything and I felt really lost when it came to charting. I went home feeling deflated. I had been so excited to learn and I have a people pleasing personality and I was worried that I wouldn't know how to do anything if my preceptor didn't teach me. I'm telling you this because I want you to know how distressing it can be to start off in this program. There's a lot of information being thrown at you every single day and you're supposed to absorb it and apply it by the next shift-that can be very stressful for anybody. What I want you to know is that you can do it. And that's exactly what I told myself after I left work that day. I gave myself the time to feel upset and worried-then I worked out and started to get my head in the game. I reminded myself (like I always do when in a stressful nursing situation) that I had received a damn good education at San Diego City College. Thanks to my professors I know a lot and I'm a fast learner. I also know how to teach so if I had to teach myself how to navigate on the unit I could do it. Lastly, I told myself that I have a job and how lucky I am to work in a hospital. I knew going in that it wouldn't be easy and that I was going to face challenges. Now I just had to face those challenges head on and come out on top and do lots of learning along the way.
The good news is that Matt and I ended up getting along pretty good-more in my next post. But first, here are some general getting started tips that I've picked up from nurses, my mentor and friends.
1. Find a brain that you LOVE. Nurses know that a "brain" is not the one in your head. It's usually a piece of paper that you organize your patients information on. I found my brain while at Scripps Green Hospital during a clinical rotation in school. The nurses on the cardiac unit had a brain for the floor. We started using it and I love it. When we left I kept a blank copy (thank goodness!). When Darius started working at the hospital he asked if I had one and he's been using it all year. When I started last month I couldn't find any of my copies. Luckily, I'd kept one in my box at the rec center and used that to make plenty of copies. My favorite thing about it is that it has numbers at the bottom: 1 2 3 4.... and you circle the number to correspond with the time your patient needs medications.
2. GET ORGANIZED. If you didn't learn this in nursing school you shouldn't of graduated. Have a system and a way to do things that can become ingrained in your mind so that it becomes a habit. One clinical instructor told me to always have an area on my brain where I write down tasks that need to be done for a patient and then make a box. At the end of the shift if the boxes aren't checked off you know what needs to be done. Examples: Collect urine sample, give vaccine, call doctor about patients blood pressure, etc. Also, a different instructor taught me that if there is a lab value, treatment, procedure or medication that I don't know I should put a box around the world (preferably in a different color pen). This reminds me to look it up when I sit down in front of a computer.
3. Come to work prepared. On classroom days this means I bring a bag with paper, pens, highlighters, sticky notes, snacks and my New Grad binder. Some of the people in my cohort gave me crap for bringing all that stuff but then guess who borrowed my pens and paper when it was time to take notes? Don't be the person who needs to borrow something. Always come prepared. On clinical days I bring a bag that has all my supplies. I keep everything in this bag and put this bag in the same place at home. Here's what's inside:
-Stethoscope (get a good one-you're a real nurse now!)
-Pens (I have a few lucky pens and thanks to a friend I have a really cool multiple color bic pen)
-Sharpies to write the date on dressing changes, names on urinals or hats, to write my name on my lunch (so help me if I find who ate my hummus....)
-Hemp hand lotion (your hands get really dry from washing them so I use the Body Shop's hemp hand lotion after every wash and I love it-no skin breakdown for me!)
-Tape (paper and regular-I prefer to use the paper tape on elderly patients because their skin is really fragile)
-Epo-jet (sp?) It's this injector thing that lets you give your IV narcotics without having to draw the medication out of the syringe this means faster med passing and save some time. You do have to clean i after each use.
-I have this special pocket protector thingy that I keep my pens and scissors in and just slide it in my pocket so I don't have to look for anything-it works for me.
-Notebook-one of my mentors told us in school that it's a good idea to keep a journal of your first year of nursing. It helps with reminders and special information. I have a section in the back that says "meds." Whenever I find a medication that I don't know I look it up and write it in my journal so that I can review it later. I also have a section for each unit with important numbers, etc
-Multiple copies of brains
-Stickers and a finger puppet-I used to work with kids at the clinic and these came in handy when giving shots. Now I use them to give to patients children or visiting kids. I haven't used my finger puppet at the hospital yet but you never know.
-Book-I like to read on my lunch break. I'm reading a book called Trauma and I absolutely love it.
-Lunch box-I always pack a ton of healthy snacks. One girl in my program has a special diet and allergies and she loves my snacks because there's always something she can eat in there. Nurses don't have a lot of time to eat or drink so I always try to stash my water bottle somewhere nearby and I can eat a string cheese really fast along with dried apricots and almonds.
-Water bottle-I hydrate all shift long.
-A bag of hershey's kisses-I use this as bribes, give to my patients (non-diabetic) and to say thanks to fellow nurses who help me out.
-Once I get to work I stuff my pockets with alcohol swabs, sterile caps, sterile 2 x 2 gauze and flushes.
4. Research your patients. This was something I learned in school and it was mandatory. You had to do research before starting your shift and I assumed all nurses do this. Guess what? They don't. I feel that's how mistakes happen. I understand-it's hard enough to come to work, let alone early to do the research. AND you don't get paid to do it. But guess what? If you make a mistake that can hurt a patient it puts your license on the line. I worked too hard to get that license and I'll do everything I can to protect it. So if that means I show up early to work every day and research my patients-so be it. I try to get a clear picture of my patient before stepping into the room. I look at their patient summary, medications (and look up meds at this point that I don't know and know WHY their getting the medication in the first place), labs and orders. It's taking me awhile to understand orders because it wasn't always something we looked at in school and we weren't allowed to order anything. I'm working to make this a habit. It can be confusing having all these orders listed for one patient and you do have to sort it out but ultimately it's one of the most important sections there is. I always check a patients diet and last vital signs and blood sugar if their diabetic. This lets me formulate questions to ask the nurse who had the patient before me at report. Do NOT rely on report as your research. I like to think of report as a time to confirm everything I've researched. I've had nurses tell me things that are the complete opposite of what the orders say should be done. It's usually because someone told them to do it that way but no one looked at the order.
5. Don't be afraid to make mistakes. I'm still working on this. In school we're expected to be perfect, no mistakes allowed whatsoever. At least that's what it felt like. However, here's the thing-if you don't make mistakes you won't learn. Whenever we do something wrong we learn how to do it right and our chances of doing it wrong again decrease substantially. Now, this doesn't mean make catastrophic mistakes. I'm NOT encouraging that. What I'm talking about is those moments where you're not sure if you should do something for a patient (take off their SCD's because they say they can't sleep with them on) because it doesn't spell it out for you in the orders and there's no one around to ask-in those instances you have to trust your best judgement and make a critical thinking decision. I always ask myself "Will the patient die if I do this or don't do this?" If the answer is no I do it. Then I follow up with my preceptor. Have I been wrong? Yes. There have been times where I chart something incorrectly and then I have to fix it or it's charted in the wrong section. I've learned that it's ok. In fact, I've become a better charter because of it. I know where almost everything is supposed to go because of those mistakes I made early on. I pray no one reads this section of my blog then gives someone a deadly medication and says "Well you told me I could make mistakes." I do not condone those kinds of mistakes. In fact-when it comes to medications I still try to be perfect. I do double, triple, quadruple checks. It's just something I learned in school and it's not a bad habit to have.
6. Don't be afraid to ask for help. I learned this one from Darius. At our externship we rarely had nursing assistants to help us. So the nurse did everything-vital signs, bed baths, ambulating, assist with feeding, everything. However, the hospital we're at now has great assistants and more of them. Try your hardest to build good relationships with your CNA's so that when you ask them to get another set of vital signs they don't give you the death glare (this is where the bag of hershey's kisses comes in handy). There are plenty of assistants who DON'T want to help you and their always "busy" with a different patient when you need them. But there's plenty of those who will go out of their way to help you if you treat the with respect and bribe them with candy. Also, never underestimate the powers of being a nerd/geek. I have a Star Trek lunch box (my Wonder Woman one broke) and even though I'm not a Trekkie I like the new movies and watched the old show and Next Generation. The floor I'm currently on has a limited supply of helpful CNA's. Well, as it turns out one of them is a die hard Trekkie and when he saw my lunch box a bond was formed. He is always willing to get a patients weight, transport a patient to ultrasound during shift change or get anyone some water when I ask him nicely. Now if only I could find a CNA that loves Star Wars....
7. Always volunteer to help other nurses-this is what opens you up to new experiences. Everyday I go to work I learn a ton of new stuff because I ask other nurses to let me know if I can help them with any of their special cases. I never knew how to use the PCA's (for pain management) well now I'm a pro and I've had tons of patients on these machines. Same thing with feeding tubes and TPN. If I don't have any patients with any special issues I try to seek out someone who does and offer to assist so I can learn how to do it. That's what's great about this program. It's all about learning. It's best to learn it all now while I have the help than when I'm on my own.
8. Have fun. I love to make my patients smile. I look up stupid jokes to tell them online so that I can make them smile. I always include the family in my patients care. If there is someone at the bedside visiting them then that means their important because they took time out of their day to come to the hospital and sit with their loved one. Try to make them feel important too. Those of you who have heard my "gun show" jokes should know that my patients love them or their really good actors. I usually sing some random song when walking down the hallway or charting and by the end of the shift I hear at least one other person singing it too.
9. Don't treat doctors like their God's. I see so many nurses do this. Guess what? Their HUMAN beings just like you and me. Do they do great things? YES! They do some amazing things-especially those surgeons. But if we treat them like their above the rest of us down here on Earth then they start to act like it. And some of them already believe their wonderful so why feed the ego? I treat all the doctors with the utmost respect and I expect them to treat me in the same manner. Some of the doctors are unbelievably kind and love to teach and will ask for your input (what?!? Unheard of, I know). And others want nothing to do with you and will yell and scream at you if you even think of suggesting something to them let alone call/page them. Those are the doctors you just gotta deal with. I was spoiled in the last year working at a clinic. The doctors, PA's and NP's were the nicest you've ever met. Even when I made a mistake they were always willing to help you out. I miss my interactions with them. But the doctors in the hospital aren't too bad. I don't care if a doctor is mad or yells at me. I just remind myself that I'm doing the best I can for my patient and that's what is most important. Again, this is where boxing comes in handy for the stress relief. I haven't had a doctor yell at me yet. But hey-there's always tomorrow...
10. Treat the housekeeping, nutrition staff, lift team members like God's. These guys do the hard work. I use that bag of hershey's kisses with these people too. I always say hello to them and make eye contact. I try to learn all their names. I see most people ignore them completely. But guess what? When your patient has thrown up all over the floor (or worse) or clogged the sing with their chunks housekeeping is who you call and they can choose to come quickly or take their time. Also, if your demanding patient wants more chicken soup nutrition is the one's who will find it or say "sorry but there's no more." If your 600 pound patient needs to be turned the lift team is the one who is going to help you and in my book this deserves a truckload of hershey's kisses-although that might make them weight 600 pounds. These people are good at their job and support you in your job so treat them with the respect they deserve.
I'm sure I'll have more tips to add later but for now this is a great start.
*Names have been changed to protect identity.
Sunday 8 September 2013
Getting the Job
ADN vs. BSN: This is the constant battle for new graduate nurses and since it's a hot topic I'd like to add my two cents (has anyone seen my soap box?). The main difference between these degrees is the amount of time you spend in school. An Associate Degree in Nursing graduate will go to school for about two years and a Bachelor's of Science in Nursing grad will have had four years in school. However, those four years a BSN grad spends in school includes undergraduate work (that are prerequisites for an ADN grad to get into the program) and they will have had a few additional classes in theory and leadership. An ADN grad tends to have more clinical hours by the time graduation rolls around. I think this is the most important difference between the degrees. When you have more time to spend in the hospital you get to actually see the pathophysiology at work and you can apply the theories you learn in school directly to your patients. Also, you have more experience with organization, time management and critical thinking. In my book, those are the skills that nurses need more than anything when first starting out their career. Since starting the RN to BSN program through Grand Canyon University I've met students with an ADN from around the country. I can see why some people have a negative view on the degree. San Diego City College does not just put a regular ADN graduate. Their program is intensely rigorous and so hard core that by the time graduation rolls around its really hard to spot any difference between an ADN and BSN graduate. They pour so much work and assignments into those two years and the requirements placed on the students are so immense that in the end we end up covering almost three and a half years worth of material in two. While I was in school I didn't appreciate this fact. The stress level was like nothing else I had every experienced (and I didn't think anything could be worse than UCSD Finals week). However, in the end I'm thankful to all the instructors we had for sharing their knowledge and passion of nursing. I still keep in touch with my professors and consider some of them to be my mentors. Not a single shift goes by that I don't have to use some insight or information I was taught by one of them and it makes me smile. I currently go back to the San Diego City College new graduate panel and speak to the upcoming graduates about taking the board exam, finding a job and experiences. I love going back and seeing the look on the students faces. I remember that look-that feeling of "this is never going to end!" And I enjoy talking to them and trying my hardest to lift their spirits and say "it's all worth it in the end."
The reason I bring up the whole degree thing is because in San Diego it is VERY hard to get a job in a hospital without the BSN. Things are getting better-the current graduating class from City College received more hospital jobs out of graduation then the year before. Yet most hospitals still only have about 100 open New Graduate Nurse positions a year and yet they receive thousands of applications. When it comes to selecting candidates to interview the type of nursing degree a candidate has can make the difference between an interview or not. I couldn't get an interview in a hospital to save my life after my first year of graduation. It was a very depressing experience. I applied to 20 or 30 jobs a week and would always get the email "thanks but no thanks" or hear nothing back. I did my best to stay positive but it wasn't easy. After all the suffering with school and no interviews made it hard to wake up every morning. But I didn't give up. With every new season of new graduate programs that became available I applied. I finally got lucky and got a call from my current hospital. *Darius says it wasn't luck he said it's meant to be. However, he works at this hospital and for the last year has spoken to almost every nurse manager at the hospital about me and had me email each and every one with my resume. I personally think the managers were sick of getting hounded with emails that they finally thought "might as well interview her." Little did they know that I was going to bring my A-Game. I spent weeks preparing for my interview-researching and studying and doing mock interviews. It all paid off.
The interview itself was intense. It was a panel interview with seven people and lasted one hour. Each person asked me three very difficult questions and I answered them to the best of my ability. At one point, while talking about nutrition I made the interviewers laugh and that made me feel good. When I left the room I felt that I'd done everything that was in my power to make a great impression. Then I played the waiting game....for THREE WEEKS!!! That's a long time to wait. It honestly felt like three months. I had my cell phone on my 24 hours a day. Whenever I'd get a call from a number I didn't recognize my heart rate would increase and I'd get all sweaty-only to answer the phone and hear "Can we interest you in a seven day cruise to the Bahama's?" When the call finally did come I almost passed out. I was shaky and sweating and I felt like I couldn't breathe. My dream to work in hospital was becoming a reality. And not just any hospital-the same hospital as Darius. While we were in school and doing our externship we always said how cool it would be to work together-now that it was going to happen made this dream an even better reality.
The program I'm in is called a New Graduate Nurse Residency Program. They include clinical hours and classroom hours as a part of the program. It's honestly a lot like nursing school except you get paid for everything. I have a preceptor on every unit I rotate too and the classes we take relate directly to the unit we're working on. There are ten people in this New Grad group-we call it a cohort. My next post will be about the basics of the program and getting started.
The reason I bring up the whole degree thing is because in San Diego it is VERY hard to get a job in a hospital without the BSN. Things are getting better-the current graduating class from City College received more hospital jobs out of graduation then the year before. Yet most hospitals still only have about 100 open New Graduate Nurse positions a year and yet they receive thousands of applications. When it comes to selecting candidates to interview the type of nursing degree a candidate has can make the difference between an interview or not. I couldn't get an interview in a hospital to save my life after my first year of graduation. It was a very depressing experience. I applied to 20 or 30 jobs a week and would always get the email "thanks but no thanks" or hear nothing back. I did my best to stay positive but it wasn't easy. After all the suffering with school and no interviews made it hard to wake up every morning. But I didn't give up. With every new season of new graduate programs that became available I applied. I finally got lucky and got a call from my current hospital. *Darius says it wasn't luck he said it's meant to be. However, he works at this hospital and for the last year has spoken to almost every nurse manager at the hospital about me and had me email each and every one with my resume. I personally think the managers were sick of getting hounded with emails that they finally thought "might as well interview her." Little did they know that I was going to bring my A-Game. I spent weeks preparing for my interview-researching and studying and doing mock interviews. It all paid off.
The interview itself was intense. It was a panel interview with seven people and lasted one hour. Each person asked me three very difficult questions and I answered them to the best of my ability. At one point, while talking about nutrition I made the interviewers laugh and that made me feel good. When I left the room I felt that I'd done everything that was in my power to make a great impression. Then I played the waiting game....for THREE WEEKS!!! That's a long time to wait. It honestly felt like three months. I had my cell phone on my 24 hours a day. Whenever I'd get a call from a number I didn't recognize my heart rate would increase and I'd get all sweaty-only to answer the phone and hear "Can we interest you in a seven day cruise to the Bahama's?" When the call finally did come I almost passed out. I was shaky and sweating and I felt like I couldn't breathe. My dream to work in hospital was becoming a reality. And not just any hospital-the same hospital as Darius. While we were in school and doing our externship we always said how cool it would be to work together-now that it was going to happen made this dream an even better reality.
The program I'm in is called a New Graduate Nurse Residency Program. They include clinical hours and classroom hours as a part of the program. It's honestly a lot like nursing school except you get paid for everything. I have a preceptor on every unit I rotate too and the classes we take relate directly to the unit we're working on. There are ten people in this New Grad group-we call it a cohort. My next post will be about the basics of the program and getting started.
History of Me
My main reason for starting this blog is because I'm currently working an evening shift and I need something to do after work to unwind before going to bed.
I'm a new nurse-I graduated with my Associate Degree in Nursing in May 2012 and passed my NCLEX the same year. I spent my first year as a nurse working in a clinic setting. As educational as that experience was I was dying to work in a hospital. My chance finally came this August 2013 when I was offered a position at a hospital in San Diego in their New Graduate Nurse Residency Program. The program gives you four months of training. You float to a different unit each month: Oncology, Orthopedic, Stroke/Telemetry and Cardiac. At the end of the program you become a part of the float pool and are able to apply to positions on all four units or apply for training programs in the critical care units.
Educational Background: I currently have a Bachelor's degree in Psychology from the University of California, San Diego. I graduated from San Diego City College with my Associate's in Nursing. Currently my boyfriend, *Arnold and my best friend *Darius and I are working on our Bachelor's in Nursing through Grand Canyon University.
Important People: I consider myself a very lucky gal to have met the love of my life in nursing school. I met one of my best friends in school, *Darius, and we're still very close with other friends from school too. I've heard from different nurses that the friendships they made in nursing school have lasted a lifetime-so far they are absolutely correct. One great thing about having a boyfriend and friends that are nurses is that when we all gather together at the bar our conversations tend to include the following: descriptions of what a GI bleed smells like, bowel movements (for the record my non-nursing friends and I talk about this too), new medication names we've never heard of and "what would you do if" situations that we've experienced.
Philosophy of Nursing: My nursing philosophy is centered around the patient. I'm a big believer in treating all the patient's needs-physical, psychological and emotional. I also try hard to incorporate cultural sensitive care into all my interactions with patients. You'd be surprised how much culture plays a role in nursing. Also, I'm a big believer in alternate methods of treatment-especially when it comes to pain management. I love it when patients are willing to try non-pharmacological treatments to deal with their pain management. Overall I pride myself in always advocating for my patients and making them laugh and smile at least once during my shift.
My goal for this blog is to share the adventures I experience during the beginning of my nursing career. There's plenty to learn and I'd love to share it with anyone who reads it. Even if you're not a nurse and just want a good laugh-I recommend this blog. My other reason for writing about these adventures is because nursing is not an easy career. It's rewarding and I love it, but it's hard work. And maybe one of the challenges I write about will motivate another newbie nurse to get through their next long shift.
*Name has been changed for identity protection
*Name has been changed for identity protection
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