This is really pretty wonderful: a video showing a student nurse, Molly Case, addressing the Royal College of Nursing 2013 Congress with an eloquent poem that is the best response possible to the criticisms recently leveled at England’s National Health Service. Please take a minute and watch it. It’s worth it.
Archive for the ‘nursing students’ Category
By Maureen Shawn Kennedy, AJN editor-in-chief
It has been a hectic few weeks, as I’ve been traveling to the early spring nursing meetings (with still more to come).
First I went to Charlotte, North Carolina, to attend the National Student Nurses Association (NSNA) annual meeting (April 3–7). AJN has had a long association with the NSNA, supporting it in various ways since its 1952 founding, from hosting board meetings at AJN offices to producing the convention newsletter to convention scholarships for key contributors. In recent years, we’ve sponsored travel expenses to the annual meeting for the winner of Project InTouch, the member incentive plan. This year, the winner was John Gransbach, who graduated from the Goldfarb School of Nursing at Barnes-Jewish College in St Louis. He recruited 228 new NSNA members—an achievement certainly worth recognizing.
Future leaders. As I told the audience when I presented the plaque to Mr. Gransbach, this award isn’t just about growing membership in the NSNA—it’s about contributing to the future of the profession. Students who join the NSNA are already demonstrating a commitment to nursing by going beyond what’s required of them. They’ve joined an organization that provides considerable resources to help them begin their careers. Not only does it provide practical help with passing the NCLEX exam, writing a resume, and finding a job, but it informs them about what it means to be a nurse. NSNA members are the future of nursing and likely the future leaders of nursing. We’re pleased to support this award and NSNA.
NICHE. And this past week I was in Philadelphia for a meeting of the Nurses Improving Care for Healthsystem Elders (NICHE) initiative, a program based at New York University College of Nursing that seeks to provide education and resources to improve care for hospitalized older adults. It provides training curricula and tools to the 450 hospitals that are members of the NICHE network. Much of the agenda focuses on initiatives that NICHE members have successfully implemented to improve care.
AJN partnered with NICHE in a joint initiative, “Professional Partners Supporting Diverse Family Caregivers Across Settings,” funded by the Jacob and Valeria Langeloth Foundation in collaboration with the AARP Foundation. (Pictured in the photo are, from left: Liz Capezuti, director, NICHE; Susan Reinhard, senior VP, AARP Public Policy Institute; Rita Choula, program manager, strategic initiatives, AARP; myself.)
Helping family caregivers. We worked with NICHE to develop a series of articles and videos designed to teach nurses concepts and skills to help them better support family caregivers in assuming care for loved ones after hospital discharge. These materials were used in training staff and as a basis for developing family-centered practices, which were then piloted in five NICHE hospitals. Dennise Lavrenz, the NICHE coordinator on the project, presented some initial results that were encouraging. Overall, as measured by Hospital Consumer Assessment of Healthcare Providers and Systems (HCAPS) scores, caregivers showed increased satisfaction with their experience and with staff communication and felt more prepared to care for family members.
At the meeting, presenters from Carolinas Medical Center-Mercy in Charlotte, North Carolina, discussed their success in improving caregivers’ experience through employing a caregiver assessment tool, paying closer attention to caregivers’ information needs, and providing the caregiver with a tote bag of personal items for their use when their family member was admitted to the hospital. What started as a nurse-driven pilot on two units was now being rolled out hospital-wide—certainly a success story for the nurses who spearheaded the project and and the hospital, but most of all, a win for the caregivers.
The NICHE Web site offers a wealth of information; you can also find AJN-produced, foundation-funded resources for caring for older adults at this Web page; or access AJN’s family caregiver videos here.
By Martina Harris, EdD, RN, a UC Foundation assistant professor at the University of Tennessee at Chattanooga School of Nursing
It was 6 am and I was on my way to make patient assignments for my first semester nursing students. Inside the long term-care facility, the hallways were quiet, the majority of patients still in bed. I made my way to the second floor to begin identifying and assigning patients for my fundamental nursing students. Standing at the nurse’s station, my focus was on finding patients who would provide students varied opportunities to reinforce the basic skills they’d been learning at campus lab.
The charge nurse approached me and asked if I would be willing to assign a student to Mr. Hugh, an 84-year-old who was proving to be very “complicated.” Assuming that “complicated” meant that his care required lots of psychomotor tasks, I agreed to her request. She then explained that this patient had been using his call light frequently, but that each time the staff responded, he only wanted someone to sit and visit with him. Though this didn’t seem an ideal opportunity for a student to practice basic nursing skills, I felt the gracious thing to do was to take the assignment.
In the hallway, my group of fundamental nursing students huddled together, dressed in their white uniforms and nervously awaiting the start of their first clinical day. One by one, I went down the list, assigning individual students to particular patients and explaining to each what additional tasks needed to be done for their patient on top of taking vital signs and changing linen.
I decided to assign Mr. Hugh to James, the only male student in this rotation. I told him that there were not a lot of “interesting” skills to practice on this assignment, so he could basically just “hang out” with the patient.
After assignments had been made, I began working with individual students as they administered oral medications, performed subcutaneous injections, and assisted with dressing changes. After a couple of hours, I poked my head in the door to check on Mr. Hugh and James. They were engaged in conversation. “Are you doing okay?” I asked James, to which he emphatically replied that they were “fine.”
I was amazed that James had been in the room for two hours and not complained. When it was time for follow-up conferencing, I began with James, apologizing to him that he had to be stuck in that patient’s room the entire time, without a chance to practice any of the psychomotor skills learned in campus lab.
“No need to apologize,” said James. “I should thank you for this assignment. This was an amazing clinical experience.” He began to describe how the patient had told him all about his life, his world travels, and his time in the military. He’d heard stories about the patient’s beautiful wife of 50 years, who had recently died, and how much Mr. Hugh missed her. He said the patient told him he reminded him of his own son, the one he didn’t get to see as often as he would like. James told me that having a chance to listen to and “swap stories” with this patient had been very rewarding, far exceeding his expectations.
It was at this moment that I realized James was well on his way to becoming a nurse in the truest sense. He’d been able to see the patient holistically, while I’d focused on ensuring the student could perform tasks.
I felt humbled by this experience and determined I’d learn from it. The following week, I returned to the same long-term care facility, expecting to assign that same patient to a different student. This time, I eagerly approached the charge nurse to request a list of potential patients and to let her know I’d love to have a student work with Mr. Hugh. She looked at me with pained eyes and said, “I thought you knew. He died later that evening after your student left.”
I’ve never forgotten that clinical day with Mr. Hugh and James. I often wonder what Mr. Hugh was thinking when he was sitting and talking with James, and if Mr. Hugh in fact knew that he, too, was “well on his way.”
The January Reflections essay in AJN, “A Special Kind of Knowledge,” is a revised excerpt from a forthcoming book, Crossing the River Sorrow, One Nurse’s Story, by Janet L. Richards. (The book will be published in June by Vantage Press.) In the essay, the author remembers an encounter she had several decades ago as a nursing student caring for a newly paralyzed young woman. Here’s a paragraph from near the start:
I stood by Carrie during those first harrowing hours in the ICU as she awaited surgery, everyone still hoping for the best. As a brand-new student, I was a silent observer, unsure of how to participate. Her young husband also watched, slumped against the heater under the window at his wife’s bedside. His eyes blazed, wild with fear and disbelief as he struggled to make sense of his sudden immersion into the alien world of disability. I could identify. Pressure sores, urinary catheters, bowel programs, and spasms—these were now part of my new and ever-expanding medical vocabulary. A spinal cord severed at C6 meant life as a quadriplegic. Suddenly this book knowledge seemed all too real.
And here’s a few lines from near the end, to give a sense of the crucial insight the author gained as she struggled to bridge the gap between herself, her patient, and the patient’s husband:
Pain can be palpable as it moves across the space between two people, molten, unrelenting. Like joy and laughter, it’s quite contagious. This is the special kind of knowledge I wanted, even craved going into nursing, and yet it’s not at all what I expected.
But take a couple of minutes and read this short, powerful essay in entirety. Just click either the image above or the essay title (for the best reading experience, click through to the PDF version). We welcome comments.
By Medora McGinnis, RN, whose last post for this blog was “Don’t Cling to Tradition: A Nursing Student’s Call for Realism, Respect.” Medora is now a pediatric RN at St. Mary’s Hospital in the Bon Secours Health System, Richmond, Virginia, as well as a freelance writer. As a nursing student she was the Imprint Editor for the National Student Nurses Association.
Life as a new graduate RN has been . . . confusing. While my peers seem to have it all together, for the last five months since graduating I’ve been perplexed—what do I do with myself, if I don’t have to stress out and study everyday? Well, of course I have my five kids to keep me busy, an amazing new job as a pediatric RN, and my husband who almost forgot what I look like.
Still, I feel like I should be cramming for something, memorizing something, or at least triple-tasking. I’m stressed that I’m not stressing out. Maybe I just dreamt that I graduated . . .
Here is a little of my backstory: I graduated in May from a three-year diploma program, as part of the very last class in that historic Virginia program, Bon Secours Memorial College of Nursing. It is now a four-year BSN program. They are affiliated with the large health system of the same name, and one of the benefits of this type of program is the guidance provided to students and graduates during the job search.
I participated in the “early career decision program,” which started well before graduation, and it was an amazing experience. Nurse managers from all four area Bon Secours hospitals attended, and we were able to do a “speed dating”–style interview session with many of them. They then called some of us back for second interviews on their units, and we were on our own from there for the interview process.
Get involved. I worked very hard throughout school, and was blessed to receive an offer to join the unit that I had always wanted—pediatrics. The takeaway: If you’re currently a nursing student, my advice is to not only focus on schoolwork, but also participate in any and every additional student opportunities you can—join state and national organizations, especially the National Student Nurses Association; go to meetings and seminars, visit annual conventions, and keep a record for yourself. You will learn and grow, and it will come in handy when you are ready for the job search.
Now that I’m working on our peds unit, it has become clear to me that a lot of what I just learned in school is not part of everyday nursing care—perhaps that’s because I’m in such a specialized unit, but most units have a focus. As RNs, our education is so vast (general, but vast) that it’s probably not even possible to use it all in one specialty! If I don’t use my knowledge somehow, I’m going to lose it.
So as a new grad, how do I work to retain that nursing school knowledge? There is a big effort nationwide to support and encourage working nurses who want to go back to school—for me, the next step will be an RN-to-BSN program. For BSN grads, you might think about a master’s program or a doctoral program. All of these will require dedication and investment, but they will also propel us into the future of nursing and give us the tools to guide our profession.
Daily life as a new grad RN on the pediatric unit is exciting, and has its ups and downs. My fellow nurses and manager are supportive and encouraging, while also holding me to a very high standard. I’m comfortable working with families and little patients, and I’ve already learned that just when things feel “comfortable,” I get another admission—I’ve learned to always work as if there’s another patient on the way up. It’s true that nurses often don’t go to the bathroom or drink anything for hours on end—it takes a conscious effort to avoid dehydration! Read the rest of this entry ?
By Karen Roush, MS, RN, FNP-C, clinical managing editor. A version of this essay originally appeared in the 2008 AJN Career Guide, but we feel it’s still just as relevant to new nursing grads or even to seasoned nurses (and non-nurses, for that matter) who might need a sense of renewal.
On a rainy cold Saturday last May my son graduated from Rensselaer Polytechnic Institute in Troy, New York. As I sat shivering in my complimentary plastic poncho, listening to the commencement speaker doing his best to inspire the faces peering up from under soaked tassels, the thought came to me that we all need a commencement address every five years or so. Someone to tell us we can make the world a better place, that the possibility for greatness exists within us, that we may yet achieve our dreams. Someone to remind us why we chose nursing, and why we work so hard.
So, whether you are a new graduate or graduated 50 years ago, this is my commencement address to you.
Stay alert. Be vital. Sharpen your mind and your skills. Read journals for nurses and on health care in general. But don’t limit your knowledge to health-related information. Read political discourse, economic theory, and great literature. At the time of this writing, a book of poems, Slope of the Child Everlasting by Laurie Kutchins, sits on my desk at home. Each evening it pulls me into a deep reflection that informs my practice in a way clinical study alone can’t possibly do.
Keep moving. Learn, change, uncover, discover. There’s no other profession that allows you to do this like nursing. Whether it’s within your facility or as a travel nurse exploring the country, or perhaps going from clinical care to a policy-making position, movement will awaken the anticipation and excitement that you felt in the beginning of your career.
Look beyond your borders—whether they’re a shift, a hospital, a specialty, a state, a country. Reach outside of what you know. See yourself as part of something bigger than nursing. At the time of this writing, I’m about to leave for a trip to Uganda and Rwanda to see what it’s like to be a nurse in a place very different from home.
Act out. Be willing to anger people. Remember, you are valuable and necessary. Get your facts straight, then speak up loud and often. Make some noise and get some attention. And then be ready to back up your words with actions.
Become nursing’s biggest fan. Promote it. Boast about it. It will go a long way in making nursing what it should be—well paid, well understood, and respected. It will draw talented people to the profession. Nursing suffers from gender bias, this is important to recognize whichever gender you happen to be. It affects who goes into nursing, how your role is allowed to evolve, and how much you get paid. The answer isn’t in making the profession good enough for men; it’s in making the profession good enough.
Lastly, don’t let nursing define your whole being. Be a baker, a runner, a book club member, a father, a wife. Whatever it is, be it totally, ferociously, and separate from nursing. As a writer of poetry I am often referred to as a nurse-poet and I always protest. I am not a nurse-poet or a nurse-anything. I am a nurse and a poet . . . among other things. Nursing takes incredible mental and physical energy. Shelter that part of you that is away from nursing and it will energize your presence as a nurse.
Back in 2010, we ran a post by our then clinical editor, Christine Moffa. It was called “Prospects for New Nurses: Thoughts On Graduating During a Downturn” and it generated quite a few comments. Below is a sampling of excerpts. Some people were pretty distressed, wondering whether they should take jobs that separated them from their families, facing criticism from people who expected they should find a job easily. After all, they were nurses! And we all know they are always in demand.
We’ve been hearing anecdotally that the prospects for new nurses are getting better overall. Is this your experience?—JM, senior editor
“It costs a lot of money to train nurses, especially new grads. Many employers want experienced nurses. The best piece of advice given to me was to stay with same healthcare system/unit floor I worked with as a student nurse. Even that prospect, however, seems to be circling the drain for the same reason I hear over and over again: EXPERIENCE REQUIRED!!! Relocation may not be an option for some people….I’m sure I will eventually get a job, but it’s the uncertainty of my future that frustrates me. It’s quite aggravating to have worked so hard in school only to be disappointed in the end.”
“I just graduated in March and am really worried about getting a job. Thankfully I will be able to stay at my current job as a RN- I worked there as a LPN for almost a year.”
“I won’t give up; but I’m definitely discouraged. It has been a year since I graduated. I have followed all of the advice in the book – I’m volunteering, I’m looking for a job in a SNF, I network everywhere possible, I go to hospitals and shake hands with nurse managers, I follow up, I’m persistent with hiring managers to no avail. I’m desperate for some good advice regarding my circumstances and I’m not really sure where to turn.”
“No one has everything they need to be the perfect candidate, and many are far from it, because we are fallible human beings. We must keep the knowledge that we CAN do this! Someone will look at us and say, for whatever reason, that they want us. It will happen!”
“The difference between this downturn and previous year’s downturns are that there are 50% more new grads entering the market than previous years.”
“Certainly the recession is a major factor, but the lack of nursing leaders willing to demand that hospital administrators provide optimal staffing levels,is the primary problem. Only when nurses are able to provide the level of care that they have been educated to give, will retention improve. This would only be feasible with lower nurse: patient ratios. It seems that when most nurses achieve top positions in large hospitals, the staff nurse and the true quality of patient care is forgotten.”
By Maureen Shawn Kennedy, AJN editor-in-chief
I spent part of last week in Pittsburgh, attending the National Student Nurses Association (NSNA) annual meeting. This one was special—the 60th anniversary of the organization.
Despite the celebratory air (not only because of the anniversary, but because the organization had exceeded its membership goal of 60,000 members), the 2,700 attendees seemed very serious about the work of the organization and about learning skills to help them in their careers—there were few slackers in this crowd.
The approximately 500 students who represented their states in the house of delegates dealt with some 40 resolutions, on such diverse topics as increasing awareness of the effects of third-hand smoke on children to supporting the “BSN-in-10” movement (a push for legislation requiring all new nurses to get bachelor’s degrees within 10 years).
For me, the best part is meeting future nurses and speaking with them about career plans. I met many students in the exhibit hall, where I was demonstrating AJN’s new iPad app. Unlike last year, when jobs seemed to be scarce, many of the seniors I spoke with this time around had already secured jobs—and those who hadn’t seemed confident they would.
Finish this sentence . . . I asked several of those about to start their nursing careers to finish the following sentence: “I’m excited about starting my nursing career because . . .” You can listen to their comments in this short podcast.
Please pardon the relative quiet of this blog this week. All our in-house and far-flung occasional correspondents are otherwise engaged, it seems. Blame the nice weather, if it’s nice where you are. Our editor-in-chief, Shawn Kennedy, is in Pittsburgh at the National Student Nurses Association (NSNA) convention. She’s presenting this afternoon (I think) on the new AJN iPad app, among other things (no, we don’t yet have one for the Kindle, but that may be on the way).
Shawn should have an update on her adventures with the next generation in nursing sometime early next week. So for now, almost entirely avoiding nursing news and health care reform, here are a few items of potential interest:
The Respectful Insolence blog, in reminding us that “natural” doesn’t always mean safer, points to an AFP article that highlights research drawing a connection between a widely used herbal remedy and the unusually high incidence of urinary tract cancer in Taiwan. Says the AFP article,
A toxic ingredient in a popular herbal remedy is linked to more than half of all cases of urinary tract cancer in Taiwan where use of traditional medicine is widespread, said a US study Monday.
Aristolochic acid (AA) is a potent human carcinogen that is found naturally in Aristolochia plants, an ingredient common in botanical Asian remedies for aiding weight loss, easing joint pain and improving stomach ailments.
While the FDA issued an alert about products containing this ingredient last fall, it’s important to recall that the multibillion dollar supplements industry in the U.S., whatever its benefits, is not subject to the same regulations applied to the pharmaceutical industry.
And, in honor of the weekend and the blossoming trees, here’s something of proven health benefit: walking. It’s free, there seem to be new studies out all the time telling us why it’s good for our minds and bodies, but many have noted that Americans don’t do it anymore, and that in some places in the U.S. it can be downright dangerous to do so. Slate has a new series, “The Crisis in American Walking,” that explores the many facets of this issue, from how we got to this place to what we can do about it. It’s well worth a look, though maybe you’d be better off just turning off your electronic device and hitting the streets, paths, hills, mallscape, wherever.
OK, one nursing item, from the news department in the April issue of AJN: we look at two studies that highlight ways that nurse-led teams are helping bring about improvements in risk management, adherence, and perceptions of care for patients with chronic disease.
Enjoy the weekend!—JM, senior editor, blog editor
By Alicia Marie Hinton, who is a BSN student at the College of New Rochelle School of Nursing in New Rochelle, NY. This is her first post for this blog.
My senior year preceptorship was an assignment on a palliative and acute care unit at a busy medical center. When I received the assignment, I prayed that no patient of mine would die during my time on the unit. Every nursing student is afraid of their first patient death. Simulation and course work prepare students in various ways for this experience, but nothing can really prepare you for the emotions you’ll feel. Some students experience a patient death during an undergraduate nursing program, but for others it may not happen until their first year or two working as an RN. I hoped to never endure it, but knew it was inevitable.
During report, working alongside my preceptor, I listened anxiously to the status of the various patients. Since my first day on the unit, I’d practiced my therapeutic techniques and researched different cultural needs pertaining to the death of a patient. I felt culturally competent and well informed about what a nurse should do when a patient dies, but I couldn’t shake my fear. What would I say to the family? Would they value my presence?
Finally, during morning rounds on my third day on the unit, I was told that a certain Mr. P wasn’t doing too well and might “expire” that day. Our focus would be to provide comfort for him and his family.
How did they know he was to “expire”? Was that the politically correct term for dying? I was familiar with “passed away,” “deceased,” or “gone to a better place.” But the word “expire” didn’t feel right. I’d cared for Mr. P since his admission and interacted daily with his family, and news of his impending death hit me hard, increasing my anxiety about how I’d respond when it happened. While I was anxious about my own feelings about the patient’s death, I was preoccupied with my ability to comfort that family. Read the rest of this entry ?