Posts Tagged ‘nursing school’


To Be a Nurse Is a Powerful Thing: Thoughts on Graduation

May 12, 2014

By Karen Roush, PhD, RN, FNP, AJN clinical managing editor

Photo by Karen Roush.

Photo by Karen Roush.

After years of work and sacrifice, last month I successfully defended my dissertation. In the weeks leading up to my defense I found myself overcome with emotion each time I imagined that moment when I would hear myself called “doctor” for the first time. And my breath did catch in my throat when the questioning was over and the chair of my dissertation committee turned to me and said those magic words, “Congratulations Dr. Roush.”

But then something funny happened. There was no incredible high. I wasn’t walking on air. For so many years I’ve been focused on the goal of achieving a doctor of philosophy in nursing. But now that I’ve accomplished that, I am faced with a new and no less difficult challenge—what I do from here and how I make those words, Dr. Roush, mean something.

Many of you graduating this month may have similar feelings. It is a powerful thing to be a nurse. What we’ve learned in the classrooms, in hospital halls, in the connections that pass between us and our patients in moments great and small, has given us tremendous knowledge. But it is what we choose to do with that knowledge and how we do it that gives meaning to our hard-earned credentials, not the other way around. Read the rest of this entry ?


What Advice Would You Give a New Nursing Student? Our Readers Respond…

April 9, 2014

KarenRoushBy Karen Roush, MSN, RN, FNP-C, AJN clinical managing editor

My daughter Kim is starting nursing school next month, so last week I asked AJN’s Facebook followers for the best piece of advice I could give her. The response was overwhelming: over 600 people offered wisdom, encouragement, and tips for success. I went through and read them all and the following is an attempt to synthesize the advice.

Of course, with so many responses, there were many valuable pieces of advice I had to leave out, from the practical to the profound, such as:

sit in the front of class, stick to your principles, invest in good shoes, choose clinicals that push you out of your comfort zone, be early for everything, celebrate the small victories, get a really good stethoscope up front, believe in yourself, pick the hardest patient you can at clinical, audiorecord the lectures, be truthful and committed to your work, eat healthy, get to know your instructors, coffee and chocolate!

And finally: look into the eyes of your patients and be sure they know you care. Every patient, every time.

(Oh, and not to leave out the lighthearted—Don’t hold your nose in clinicals. The teachers frown on that.)

Below are five areas of advice that stood out:

1) “Take a good picture of your friends and family and put it on your desk, because that’s all you’ll be seeing of them for the next two years.” There were many variations on the idea that nursing school “takes 100% dedication.” You need to warn your family and friends that they won’t be seeing you for a while, get rid of your TV, sleep when you can, learn good time management, and be prepared to spend Saturday nights with your books . . .

2) “Study, study, study, and study some more.” Respect the quantity and degree of difficulty of the material you will have to learn. There were a lot of ideas about how to optimize your studying—chief among them was to get in a study group and to study NCLEX questions from the beginning. Others were to read ahead, not procrastinate, use flashcards, attend practice and review sessions, and have a study partner or buddy system. Having a study buddy, though, is only a small part of the importance of friendships with your fellow students . . . Read the rest of this entry ?


Don’t Write Off Community College to Start a Nursing Career

March 26, 2014

By Karen Roush, MSN, RN, FNP-C, AJN clinical managing editor

KarenRoushMy daughter is about to start her nursing career. She’s got all her prereqs out of the way and she’s waiting to hear from the half-dozen colleges she applied to. Among them is the community college where I started my career 35 years ago. That’s right—a community college that confers an associate degree.

I hope she gets in.

Community colleges are seen by many as the bottom of the ladder of desired schools of nursing. Not only do they offer only a two-year degree, but they’re not seen as being as selective as four-year colleges and they don’t have the big name professors.

But community colleges can and do produce great nurses. Programs are rigorous, so a more liberal admission standard at the onset doesn’t necessarily change the caliber of student who graduates at the end. And once they graduate, they must meet the same standards as students from four-year schools to attain licensure as an RN—everyone takes the same NCLEX. At the time of my graduation, my school had a 98% pass rate, one of the highest in the country.

Community colleges even have some advantages over a lot of four-year programs. They may not have the big names—but really, how many of those big name professors actually teach full courses? At community colleges, teaching is the focus. Community colleges are affordable; students don’t leave burdened with astronomical debt to start a career that, while setting them down firmly, and often permanently, in the middle class, can also saddle them with a burden of debt on top of all the expected financial struggles. And in many places, community colleges are truly embedded in their community; this can provide a level of support and open up opportunities for students that is not possible at larger detached universities.

I agree that all nurses should have a BSN, eventually. There is a lot of evidence that it improves patient outcomes. But the two-year community college can be a great place to start—two years of reasonably priced education that gives you a solid base of skills and knowledge to practice while you continue to take courses toward a bachelor degree. I remember when I returned to school for my bachelor’s: the wonderful sense of discovery that I was not just a nurse but a professional, and part of a profession with its own history and body of knowledge.

We need more nurses. All the experts agree that there is a shortage just waiting for the rest of the Baby Boomer nurses to hang up their stethoscopes. An education that starts at a community college can take a nurse far. I know mine has, from acute care staff nurse to long-term care educator, from oncology to urgent care to the IV team. Here in the U.S. and in India and Africa. As a nurse scholar at the WHO in Geneva, Switzerland, and as an NP in the Adirondacks of upstate New York.

Read the rest of this entry ?


Preventing Delirium, The Luxury of Time, Things We Get Right, More: Nursing Blog Roundup

March 7, 2014

By Jacob Molyneux, senior editor

Here are a few recent posts of interest at various nursing blogs:

karindalziel/ via Flickr Creative Commons

karindalziel/ via Flickr Creative Commons

In the throes of nursing school: An intriguing little pastiche of a poem (does it qualify as a ‘found word’ poem?) can be found at a newish blog, adrienne, {student} nurse, in a short post called anatomy of a bath. In another post, she makes the following observations: “In nursing school, you are not driving the train…You absolutely must keep telling yourself that there is nothing wrong with you.”

Preventing delirium in the ICU: At the INQRI blog (the blog of the Interdisciplinary Nursing Quality Research Institute), a post summarizes some recent research on implementing a “bundle” of practices to increase mobility and reduce sedation in the ICU, all in order to prevent patient delirium, which is known to have many short- and long-term negative effects.

The luxury of time. At Love and Ladybits, the author gets a tantalizing glimpse of the quality of care she’d be able to provide if she had more time to spend with each patient. Of course, this “alternative reality” can’t last, but perhaps it can serve as a touchstone of sorts during more hectic times.

The past is present. At Head Nurse, there’s a somewhat rueful post about an unexpected encounter, years later, with the author’s least favorite nursing professor (“Everybody has one of those instructors–the ones whose classes make you yearn for the sweet release of death, or at least a nice case of vascular dementia”). Read the rest of this entry ?


Chemical Attack Response, Posts for Nursing Students, Ethical Agonies, Blog Carnivals, More

September 6, 2013

By Jacob Molyneux, AJN senior editor

You’re working in the ED of a 300-bed metropolitan hospital one Sunday morning when you receive a radio transmission from a paramedic whose ambulance is en route with a casualty of a suspected nerve gas attack. The paramedic reports that two additional ambulances are also on the way. Nerve gas? You’re stunned. What should you do first?

quinn.anya/via flickr creative common

quinn.anya/via flickr creative commons

That’s the start of our 2002 article (free for a month, until October 5) about chemical attacks and their aftermath. Such an event is not an impossibility here in the U.S. Remember the 1995 attacks in Japan, in which sarin gas was released at several points on the Tokyo subways by members of a radical cult, killing 12 and injuring thousands? And there is now convincing evidence (not to mention horrific photos of the many children killed) that the Syrian government used nerve gas on its own people last week despite widespread prohibitions against its use. In fact, USA Today reported that a number of the nurses and physicians who treated the victims of the gas attack may have subsequently died themselves from exposure to the patients’ clothing and skin.

Our 2002 article describes how nerve gas works on the body, the main types of poison gas that are known to exist, the history of chemical warfare, hospital preparedness, the drugs that are used to counteract the effects of poison gas, how to undertake patient decontamination, and other essential facts providers should be aware of.

Blogging - What Jolly Fun/Mike Licht,, via Flickr Creative Commons

Blogging – What Jolly Fun/Mike Licht,, via Flickr Creative Commons

Since many nursing students recently returned to school for the fall or started their first year, this seems a good time to trot out some greatest hits from our posts by or about nursing students or some aspect of nursing school:

“On Euphemism and Learning to Be Present”

“Notes of a Student Nurse: A Dose of Reality”

“That Acute Attention to Detail Bordering on Wariness”

“Well On His Way: A Nursing Professor’s Humbling Experience”

“‘My Professor Said to Submit My Paper’ (We Hope They Also Told You This)”

“Don’t Cling to Tradition: A Nursing Student’s Call for Realism, Respect”

“One Instructor’s Updated Nightingale Pledge”


“The Priceless Clarity of Inexperience”

Tell us: what can we do to better address the needs of nursing students? What do you want to hear about from veteran nurses?

Remember the aftermath of Hurricane Katrina? There’s an enthusiastic and nuanced review in the New York Times of a new book by journalist Sheri Fink called Five Days at Memorial. It’s about Memorial Medical Center in New Orleans in the days following Hurricane Katrina, when nurses and physicians found themselves on their own in making agonizing decisions about the treatment of a number of critically ill patients. The situation and its legal aftermath, in which several providers were charged with murder, raises complex and important ethical questions with no easy answers. The facts of this awful episode remain both disturbing and riveting, and are certainly worth learning from. Read the rest of this entry ?


Differentiating Nurse Burnout From Boredom

August 22, 2013

Julianna Paradisi, RN, OCN, writes a monthly post for this blog and works as an infusion nurse in outpatient oncology.


Nurses frequently discuss burnout. Sometimes it’s called compassion fatigue. Regardless of which term, nurses are at risk because our work requires complex technical skills, an expanding knowledge base, physical endurance, and critical thinking, since a patient’s symptoms often do not present in a manner described in the textbooks studied in nursing school.

Above and beyond this, nurses are expected to display warmth and caring towards their patients, even ones who are rude and argumentative. This alone requires character and self-discipline. Add inadequate staffing ratios to the mix, and it’s easy to understand that at some point, a nurse may become susceptible to burnout or compassion fatigue.

Nursing school graduation and passing NCLEX don’t make you a nurse. These milestones earn you a place at the starting gate. It’s up to the individual nurse to navigate her or his career towards growth and longevity. I clearly remember, several years into my practice, recognizing that I’d reached a point of expertise in which I might not know exactly what to do in any emergency, but whatever intervention I chose would be safe and maintain a patient until the doctor or code team arrived. This was around the same time I stopped feeling nauseous every time I pulled into the hospital parking lot for work.

Lately, however, I’ve wondered if sometimes what is labeled burnout might actually be boredom?

This sounds crazy, I know. How can someone be bored in a fast-paced profession in which lunch breaks, if they exist at all, are short, and holding one’s urine for an entire shift is a worn-out cliché?

The answer: Even tasks requiring complex technical skills become repetitious once the nurse masters them. I think this happens more often than burnout. The nurse loses interest in the job and then becomes disengaged. Not finding the same fulfillment she or he used to have, this nurse is labeled burned out, when in fact what they’re experiencing is boredom.

Boredom explains the phenomenon of why some nurses, rather than taking restorative leaves of absence, go on to start businesses and second careers as bloggers, fitness experts, artists, writers, photographers, life coaches, radio show hosts, novelists, improv comedians, etc. Many accomplish dual careers while attending school for advanced practice degrees. Or, nurses step away from the bedside and become hospital supervisors, department managers, clinical instructors, nursing school instructors, members of their state’s board of nursing, or officers of a local professional organization.

Even new age nurses, authorities on the subject of burnout, become yoga instructors, massage therapists, or experts on herbal medicines and complementary therapies in conjunction with their nursing practices. Read the rest of this entry ?


The Heart of a Nurse

August 14, 2013

By Diane Stonecipher, BSN, RN. The author lives in Texas. Her forthcoming Viewpoint essay in the October issue of AJN, “The Old Becomes New,” will consider aspects of nursing that may be obscured or lost due to overreliance on technology.

Heartstudy by James P. Wells, via Flickr

Heartstudy by James P. Wells, via Flickr

I am somewhat embarrassed to admit that my initial interest in nursing came as a 10-year-old Yankees baseball fan. I could not get enough of The Mick, Elston Howard, or Mel Stottlemyre on my transistor radio, during televised games, or in my baseball card collection. I decided that I could be the team nurse—take their vital signs, set their broken bones, assess their injuries, and best of all, travel with the team.

This rather irrational desire was solidified when my aunt had a face lift. I was 14 at the time, and she recovered at our house, specifically in my room. She was swollen like a prize fighter, with bloody bandages that needed changing, pain medication to be dispensed, meals to be fed—I was hooked. I am not sure I even knew what a nurse really did, but my heart was stirred.

I sailed through high school, graduated with honors, and left for one of the three state universities that had a nursing school in Florida. With a limited number of spots, I discovered admittance required more than just grades. You needed some kind of hands-on experience, a family member in the medical field, or some reason to stand out among others. The latter my only option, I simply persevered by doing well and wanting it more. On my third try, I was accepted and my life education really began.

Nursing school was both exciting and terrifying. I was seeing things that I’d never seen before, and I now felt privy to a world of wonder. Babies brought forth; precise incisions, neatly sewn, healing almost magically; and all sorts of “conditions” for which there were treatments.

About the time I was alight with the goodness of this profession I had chosen, I also began to witness the losses, the sadness, the unfairness and the pain that is the flip side of the body amazing and life. Read the rest of this entry ?


Practically a Nurse: Life as a New Graduate RN

September 25, 2012

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 ?


To the Nursing Class of ’12 (and ’84, and ’96, and ’01)

June 15, 2012

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.

via Wikimedia Commons

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.

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That Acute Attention to Detail, Bordering on Wariness…

November 21, 2011

via Wikimedia Commons

By Kinsey Morgan, RN. Kinsey is a new nurse who lives in Texas and currently works in the ICU in which she formerly spent three years as a CNA. Her last (and first) post at this blog can be found here.

It seems that nursing schools across the world subscribe to certain mantras regarding the correct way to do things. Different schools teach the same things with utmost urgency. Hand washing is one of the never-ending lessons that comes to mind. How many times do nursing students wash their hands while demonstrating the correct way to perform a procedure? I vividly remember actually having to be evaluated on the skill of hand washing itself.

Another of the regularly emphasized points of nursing school is double-checking. One of my first clinical courses required students to triple-check patient identification before giving medications. We were to look at the medication administration record, the patient’s wristband, and then actually have the patient state their name.

As a new nurse learning several new computer systems for charting, etc., I’ve noticed that the old attention to detail, ground into my soul during my school days, now seems easy to overlook, since computers do so much of the work. Of course, computer charting and electronic MARs* have simplified tasks and made time management much less daunting. But sometimes I worry about the hidden cost of such improvements.

I intend, vow, resolve to make an effort to remain aware of how easily errors can happen when we don’t double- and triple-check things. I want to always retain that astute attention to detail, bordering on wariness, so that I can practice as safely as possible, even with the advent of electronic methods.

*MARS = medication administration records

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