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

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 […]

2016-11-21T13:05:03-05:00April 9th, 2014|career, healthcare social media, nursing perspective, students|7 Comments
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Don’t Write Off Community College to Start a Nursing Career

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 […]

2016-11-21T13:05:07-05:00March 26th, 2014|career, nursing perspective, students|12 Comments
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More Than a Headache: Migraines and Stroke Risk for Women

Photo by author. All rights reserved. Photo by author. All rights reserved.

By Karen Roush, MS, RN, FNP, clinical managing editor

I used to think I was lucky. Most of the women in my family have migraines—awful, vomiting for three days, intense pain migraines. Not me. Oh, I have migraines. But no pain, no vomiting, just a visual aura—squiggly lines and loss of part of my visual field for about 45 minutes and then I’m good to go.

I was thankful that I just had the aura instead of the pain and vomiting. But now the evidence shows that migraine with aura, especially when there is no vomiting involved, is an independent risk factor for stroke, as much as if I were overweight, smoking cigarettes, and walking around with my blood pressure through the roof.

And it’s not just having migraines that places me at greater risk for a stroke. […]

2017-07-11T14:42:45-04:00February 12th, 2014|nursing perspective|1 Comment
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Patient Decisions: When You’re Just Not Up to Making the Call

By Karen Roush, MS, RN, FNP, clinical managing editor

Photo by the author Photo by the author

For most patients and in most clinical situations, decision making is and should be a shared process between the patient and the clinician (and often the family). But there are some cases when we, expert clinicians versed in scientific and experiential knowledge, need to make a decision for the patient—not out of some paternalistic idea of our authority or superiority, but because the patient really wants or needs us to take on that burden.

I was six months pregnant with my second child. The pregnancy had gone smoothly, which was a blessing after having delivered my first child 10 weeks premature following two weeks spent in a tertiary care center. That pregnancy had been problematic from the beginning—early bleeding, and then a hemorrhage at five months, at which time they’d diagnosed me with placenta previa. It was one of those pregnancies where you were thankful for each additional day that brought you closer to the nine-month mark.

But this time, everything was going smoothly—no bleeding or cramps, an active baby that ultrasounds confirmed was growing well . . . until one morning in February, when I started with cramps that progressed to pain and a lot of pressure. An hour later, I was in the labor and […]

2016-11-21T13:05:37-05:00January 17th, 2014|career, nursing perspective, patient engagement, patient experience|1 Comment
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What Ever Happened to a Good History?

ky olsen/via Flickr ky olsen/via Flickr

By Karen Roush, MS, RN, FNP, clinical managing editor

What ever happened to a good history? We were taught as NP students that the history portion of the exam was as important as the physical. In fact, in most cases it’s what you learn in the history—from asking the right questions and really listening to the patient’s answers—that gives you the information you need to figure out what is going on. The physical findings either support what you’re thinking or lead you to ask more specific questions.

A good history isn’t just listening to the patient’s answers to your questions; it’s listening to all the information they offer. Take for example, the middle-aged construction worker who takes his lunch hour to come in to the clinic complaining of a cold. He lists the usual symptoms, cough, fatigue, a little shortness of breath, and then as you’re starting the exam he casually mentions that he hasn’t been to a doctor in 15 years.

Someone who’s managed to stay out of a doctor’s office for 15 years and now shows up, on his lunch hour, because of a simple cold? So, you ask some more questions and learn about some chest pressure he attributes to the coughing he’s been doing and about […]

2016-11-21T13:05:39-05:00January 10th, 2014|nursing perspective, Patients|4 Comments
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Tightly Scripted: One NP’s Experience with Retail Clinics

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

Retail health clinics (walk-in clinics that are in a retail setting such as a drugstore or discount department store)KarenRoush have become an effective mode of providing increased access to care for many people and a growing source of employment for nurse practitioners (NPs). Their place in the health care arena may take on even more significance as the Affordable Care Act (ACA) increases access to care for previously uninsured people.

I worked as an NP in a retail clinic for about six months while working on my PhD. I left because of concerns I had about the model of practice. It didn’t have to do with the fact that I had to mop the floor at closing time or collect the fees and cash out the “drawer” every night. Nor because I spent eight hours alone in a small windowless room tucked away in the back of a drugstore. Those aspects were not great, but they weren’t deal breakers.

What was a deal breaker was the rigid programming of my practice. The computer was in control. From the moment the patient checked in at the kiosk outside my door, every action was determined by the computer.

The organization I worked for prided itself on following […]

2016-11-21T13:06:09-05:00November 1st, 2013|career, nursing perspective|2 Comments
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Domestic Abuse Patient

By Karen Roush, MS, RN, FNP-C, clinical managing editor

All rights reserved. Photos by author. All rights reserved. Photos by author.

It’s the end of October—Domestic Violence Awareness Month. I want to tell you a story about a patient I had in the Adirondacks in upstate New York.

The young woman was back for the third time that month. The previous week, complaints of vague abdominal symptoms had brought her in; this time, it was frequent headaches. Even as I performed a neurologic exam, I suspected I wouldn’t find  anything.

“So, how’s everything at home?”  I asked, after assuring her there was no sign of a neurologic issue.

“Same,” she told me. “Yesterday I forgot to get his cigarettes and [expletive]! you’d a thought I killed someone.”

“Did he hurt you?”

“No. Just twisted my arm a little. I’m fine.”

But she wasn’t fine. She suffered from anxiety, headaches, chronic back pain, and irritable bowel syndrome. She had been through numerous diagnostic evaluations, including invasive procedures, and had tried multiple medications.

She was 25 and had three children. I’d brought up the subject of intimate partner violence after her second visit, but it wasn’t until she’d been seeing me for a few months that she felt safe enough to talk about it. Her […]

2016-11-21T13:06:11-05:00October 29th, 2013|nursing perspective|2 Comments
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It’s Starting Again

Some Notes on Pink Ribbons and the Primacy of Breast Cancer Advocacy

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

Breast cancer awareness giveaways/Wikipedia Commons Breast cancer awareness cornucopia/Wikipedia Commons

It’s starting again. October is less than a week away and already they’re everywhere. But then again, they never really go away. Those darn pink ribbons.

Breast cancer is a terrible disease. My family has experienced its share and I know the anxious—it’s going to be fine, oh my god what will happen to my kids if I die—feeling of waiting for a path report after a lumpectomy.

But there are other terrible things that happen to women—and happen more frequently. And we don’t pay anywhere near the same attention to them. Take heart disease, for example. Heart disease is the number one killer of women. In 1999, according to the CDC, 24% of deaths in women were from heart disease, while 22% were from ALL types of cancer combined. Or consider domestic violence, experienced by one in four women during their lifetime while one in eight women will experience breast cancer.

So why is it that breast cancer garners so much of the public’s attention, and along with that, a disproportionate amount of its resources? It collects more funding than any other type of cancer. For example, […]

2017-04-21T22:20:27-04:00September 25th, 2013|nursing perspective|6 Comments
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When Loved Ones and Patients Don’t Choose Life

By Karen Roush, AJN clinical managing editor

Photo by the author Photo by the author

This isn’t the blog post I started out to write. That was a more personal story about someone close to me, let’s call this person Jess, who died after years of chronic illness worsened by self-neglect—after years of being that person Olsen talks about in this month’s article (free until August 15) on helping patients who don’t help themselves (and in his related blog post from last week).

But as I wrote, I realized that it wasn’t fair, that I was leaving out the complex story behind their persistent unhealthy behaviors, behaviors that eventually led to a lingering, awful death.

And without that background knowledge, it was too easy to be judgmental—as it is sometimes too easy for us as nurses to be judgmental of patients who don’t help themselves, who even seem to be willfully destroying their own health: the obese person who keeps drinking those giant sodas, the smoker who lights up another cigarette. As a nurse it can be very frustrating to care for a patient who ignores health recommendations, to their own detriment. As a family member or friend, it can be heartbreaking and infuriating.

There are limits to what we can do. We cannot force patients to eat well, take necessary medications, quit smoking, modify their alcohol intake, wear their seatbelts . . . the list goes on and on. Yes, we […]

2016-11-21T13:07:02-05:00July 15th, 2013|nursing perspective|4 Comments
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Using Evidence-Based Practice to Reduce CAUTIs

By Karen Roush, AJN clinical managing editor

Using evidence-based practice to . . .

Fill in the blank. There’s something on your unit that could be improved—the rate of ventilator-associated pneumonia (VAP), the engagement of family in care, the readmission rate of patients with heart failure, patient satisfaction with pain management. Whatever it may be, you have the ability to improve it. This month we have a CE article (link is below) about an evidence-based practice (EBP) project to reduce catheter-associated urinary tract infections (CAUTIs).

Scanning electron micrograph of S. aureus bacteria on the luminal surface of an indwelling catheter with interwoven complex matrix of extracellular polymeric substances known as a biofilm/ CDC Scanning electron micrograph of S. aureus bacteria on the luminal surface of an indwelling catheter with interwoven complex matrix of extracellular polymeric substances known as a biofilm/ CDC

The really interesting thing about this article, and what makes it especially helpful for beginner quality improvers out there, is that it doesn’t just describe an effective project to reduce CAUTIs. It also describes how to do an EBP project, step-by-step. The author, Tina Magers, a novice EBP mentor, followed the seven steps outlined in AJN’s Evidence-Based Practice series and describes the actions involved in each step. It’s a great how-to on applying evidence to practice. Here’s the overview/abstract of this useful June CE article, “Using Evidence-Based Practice to Reduce Catheter-Associated Urinary Tract Infections”:

Overview: In […]

2017-05-27T10:29:02-04:00May 31st, 2013|nursing perspective|0 Comments
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Views expressed on the blog are solely those of the authors or persons quoted. They do not necessarily reflect AJN’s views or those of Wolters Kluwer Health/Lippincott Williams and Wilkins.
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