New to Nursing

The Art of Listening

2013-05-13T12:13:00Z

I learned a valuable lesson at work last week.

As an orthopedic operating room (OR) nurse, my manager constantly has to remind me that we have schedule to keep. I’ve only been working for a few months, but I’ve already been asked the question, “What was the delay in transferring the patient to the room?” multiple times. Though I usually try to make up a logistical excuse, the reason is always the same: because I love talking to the patients and their families in the holding area.

This day, as the holding nurse gave me report, she rolled her eyes as she whispered to me, “This one’s just a doll.” I smiled slightly and nodded in understanding of her warning. Nurses do this for one another. We forewarn to prevent disaster. We urge each other to put on protective gear. I understand there are positive sides to this, but as I approached the patient bed, I made a decision. From this moment on, no matter how high maintenance, loud or angry this patient was I would not roll my eyes. I would be open and honest. I would advocate for her.

As I pulled back the curtain, there was no giant green monster laying in that bed. Instead, there was a sixty year old woman, scared to death about having surgery; a woman probably scared to death about a lot of things. I performed my usual routine assessment. A story began to unfold. The way that she fell was so unfair, she said. So sudden. So debilitating. She was still mourning her accident and humiliated from being completely dependent. I listened actively, said nothing. After a lengthy soliloquy, the patient looked up at me. Her eyes found empathy in mine. That was all she was looking for. After I simply listened, without judgement, the patient decided, all on her own, that she was “ready to get to the next stage of convalescence.” I smiled and said, “then it looks like it’s time to make our way into the OR.”

I was late into the room, again. The anesthesiologist looked impatient. I knew my manager would be on her way. I didn’t care. The patient looked content. There was a look of peace on her face as she drifted off into her unconscious. This is the reason I became a nurse, I thought: to assuage anxiety, alleviate pain, mitigate suffering. If the clock can’t slow for me to do that, the schedule will have to wait. A few minutes of tardiness can cost the hospital a few dollars, but taking the time to listen, really listen, to a patient in need is priceless.

Respecting Patient Differences

2013-05-04T21:11:00Z

Almost halfway through my new graduate RN program now and I am getting more and more comfortable with the routine of an RN at my hospital. I am enjoying the culture of the ICU and the independence it brings. I have enjoyed the constant assessment of critically ill patients and the fine attention to detail that is required on my unit. It amazing how you see similar types of cases and you begin to predict what might happen. These instances have definitely helped me to be much more aware of potential complications, which is extremely important in the ICU.

One thing I have learned recently is the differences in care that are required when dealing with individuals from different generations. Many of the elderly people I have care for, those in their 80s and 90s, like to be independent. They grew up during the great depression and in a time where American ideals were different then they are today. I have had a number of little elderly women who have undergone heart surgery and have been as feisty as ever during their recovery. They have healed better and faster than younger individuals with the exact same procedures. The strength of the people from this generation is something to admire.

All my experiences thus far have switched my though process so that I can give people the care they are comfortable with. Many times caring for someone is a compromise. Although you know the best way to do something, it might not be that for your patient. Patient/family centered care is so huge in the ICU. I am also finding that sometimes the rules need to be broken to make your patients and their families comfortable. I remember in school reading about the road from novice to expert nurse. They talked about how the novice nurses always followed the black and white rules of their unit. On my unit, the best nurses break the rules (or slightly bend them), better accommodating the patient, while at the same time ensuring safety for everyone.

The 24/7 Nurse

2013-04-22T23:38:00Z

In the past weeks, there has been much discussion surrounding the nurse who allegedly denied an elderly woman CPR at an independent living center in California. The 87 year old resident passed away while the nurse argued with a 911 dispatcher about the facility's policy about (not) administering CPR. The story has raised passionate debates, which float ubiquitously among major news casts and healthcare communities. Though the woman may have been a licensed nurse, she was not practicing as one at the senior living center-- and the facility had a rule: no CPR was to be started by any employee for any resident. The (lack of) action by this woman has raised an ethical question: What is the responsibility of a nurse--not just as an institutional employee--but as an independent, licensed entity?

Living in NYC, I notice people every single day in desperate need of compassion, connection and care. As one of the world's largest cities (and, ironically, containing the most isolated people), I've been fortunate enough to experience my role as a nurse outside of my hospital job on a daily basis. In my view, it is a nurse's priority to connect with people, regardless of hospital policy. Whether it be on the subway, the sidewalk, or at the grocery store, it is my responsibility to pay attention. It is my chosen duty to take note of suffering and attempt to mediate it in whichever way I am able. This is my career. Not a job. Every single day. Not just for the duration of my shift. I must serve the patient's of the world. It may be simply an empathic smile to a despairing stranger. It may mean giving up my taxi for a man looking desperate. It may be helping a woman carry her stroller up the subway stairs during rush hour. No matter how difficult the day has been, how utterly exhausted I feel, I must continue to be aware. It is my lifetime responsibility, as a nurse, to help.

The point of the this recent event in California does not lay in the verdict of the case. Whether the institution or the individual is fined is merely another legislative ruling. The point, instead, is more pervasive. The definition of nursing is at great risk. If nurses are hindered by institutional protocols, unable to perform their duties as professionals, there will be more harm than good (the antithesis of the Hippocratic oath). If nurses are not motivated and encouraged to take action, our whole profession will continue to suffer. Nurses must be trained and empowered to take charge in emergency situations. We live in turbulent times. The world is filled with suffering. In California, in Boston, and in the tiny town where you grew up, confident, courageous, assertive nurses are needed. We need nursing schools and institutions to propagate these values. After all, if we can't act who else will?

Being the Nurse Your Patient Wants and Needs You to Be

2013-04-22T19:50:00Z

Generally speaking, I try to be a friendly conversationalist when taking care of patients. I’m a big believer in the personal touch nurse’s can add at the point of care, so I do my best to make connections while providing nursing services.

Most patients I’ve come across seem to enjoy being engaged on the personal level. They like talking about their grandkids or hobbies, and they seem very keen to hear about my schooling or how long I’ve been married or whatever. Not only do such niceties temporarily take patients’ minds off the hardships they may be experiencing, but they also make for a pretty effective ice breaker during some of the more vulnerable activities like sponge baths and bathroom assists. And, I’ve found acting this way can often increase compliance.

That’s the way I prefer to do things, but I’ve come to recognize that adaptability is key to providing quality nursing care. While some patients may appreciate this approach, others are not interested in conversation and would prefer as little staff interaction as possible. And really, that’s not a bad thing. It’s important to try to give the patient the level of care they want.

However, it’s also important to remember that it’s not just about what the patient wants, but also what the patient needs. Sometimes these things don’t align. A patient may not want you there to help them wash up or be repositioned and turned, but realistically, skin breakdown is going to occur if they aren’t. A patient may not want to take a medicine, but it may be vital to their well being.

It can sometimes be a tricky balancing act. Patients have rights, but, at the same time, we have certain obligations. Navigating the waters on this topic is one of the hardest aspects of this job – perhaps even more so than all the skills we have to master and knowledge we have to amass.

Assuming the Role of the RN- Trials and Tribulations

2013-04-19T04:55:00Z

After 5 weeks on the unit in my new job I am realizing just how steep the learning curve is as a new grad. I am proud of my progression thus far, but I have to say that with this pride comes a great deal of frustration. Nursing school taught me so much, but seemingly not enough. A great deal of what I have learned I have been able to implement, however, my frustration comes from the procedures and paperwork at a new institution that could not have been taught in school. Documentation is a killer as well. In a paper charting system redundancy is the name of the game and threatens to beat you down over the head again, and again, and again. Ouch.

Along with these obstacles, the complications arising from nurse-physician relationships are a completely new concept to me. I have met and collaborated with physicians that have been patient and respectful, but I have also had the pleasure of experiencing the other end of the spectrum. Somewhere along the line these individuals have lost the concept of "interdisciplinary team" and inserted into the job descriptions the right to demean others. At this point I am rolling with the punches and trying to stay positive.

My preceptor has been excellent. I can't begin to explain how thrilled I am to be in a new graduate RN program. I have a tremendous amount of respect for nurses who have been thrown into the deep end straight out of school and forced to keep their heads above water. Hats off to all of you.

Attending classes at the hospital twice a week definitely provides a smooth transition from school into the busy life of an RN. It's nice to have a close group of people experiencing the same challenges. My fellow Versant class "the crazy eights", have been complimented for our unique camaraderie by many of the staff. With a laugh, a smile, and a good story I know my new grad colleagues are people to be trusted.

I had an emergency department day last week that was assigned as a skills day, so I experienced a completely different perspective of the hospital. The ED forces you to collaborate with the staff more than I have seen on any other unit. I loved the nursing independence and nurse-physician interactions. After getting some skills practice I floated around helping the staff with different tasks. Another interesting thing about my program is that we have the opportunity to have a few rotations within the hospital similar to emergency department experience

As far as my experience in the Cardiovascular ICU, I have soaked up so much knowledge in a short amount of time. I know I chose the right unit and I can't wait to see my growth each week. My unit does a lot of post-op open hearts, so I can't think of a better place to learn the intricacies of the cardiovascular system.

The Perfect First Job: Reality or Illusion?

2013-04-01T20:09:00Z

One of the most distressing times of my life was the interim between nursing school graduation and obtaining my first job as an RN.I shudder with the pressure I put myself under.After merely one year of study and clinical rotations (I graduated from an accelerated RN/BSN program), I was sent out into the world to be a nurse.Needless to say, I had no idea what I was doing.

The faculty at my University, though with good intention, gave me terrible advice after graduation.The recommendation was simple:my only choice was to find a solid hospital job in a medical/surgical unit.How hard could that be, I thought.As any new graduate nurse knows, in this economy, that's about as easy as running a marathon...backwards.As I reflect, I realize that not one of my professors asked me anything about my passions, my inherent skills, or what I dreamed of doing as a nurse.Not one conversation.Subsequently, after months of arduous searching and mass resume sending, I was granted a job offer at a hospital.I accepted the offer without a second thought.This job neither accentuated my skills nor ignited my passions, but inmy self-induced state of desperation I didn't even hesitate.

As I reflect on my post-graduate choices, I realize that it's okay if I am not, as of yet, living the dream. I work with great people; the job provides me with great experience. This is an avenue for me to earn money and benefits and amp up my resume. It's a chance to practice working in a large healthcare setting and work with a team of diverse providers. All good things. It's also proved to me that while I was in school my definition of a "nurse" was quite nebulous. In reality, I didn't even know what being a nurse meant. It's one thing to sit in a classroom and talk about nursing. It's another thing to shadow under the wings of a professional nurse during clinical rotations. It's a completely different thing to practice as a licensed RN on an understaffed floor for twelve hours straight. Thanks to my first job I have learned the difference. Though I do wish I had given myself more time to browsedifferent optionsbefore jumping into the sea of full-time employment, this job is an opportunity to bring me closer to defining what being a nurse means to me, and I'm grateful for that.

I don't believe that new graduates need to find the perfect fit on the first shot.I do insist, however, that every new nurse at least try.I insist that every new nurse take a good look inside themselves and decipher what exactly it is they're good at and what it is that fuels their consciousness.Did pharmacology make you contemplate gauging your eyes out?Are you really going to enjoy that ICU job that requires you to manage multiple medications (and their interactions) for multiple patients all in a day's work?I happen to love pharmacology, but pediatrics made me want to jump out the window. I don't want to jump out the window.Neither do you.You can have a decent job with decent pay and decent vacation time, but if you're not really invested and engaged the value of these securities are low.No one should tell you differently.

Therefore, I implore all new nurses (who have the means and opportunity) to take some serious time to find a decent-fitting first job.Believe me:it's going to take time.And you will need help.That's okay!No need to rush.After all, dangerous things happen when nurses are disengaged at work.Use this interlude to do things to grow as a person.Volunteer.Start learning a new language.Tutor nursing students.Speak with high school adolescents interested in going to nursing school.Even if it means moving back in with Mom and Dad, no worries!Be patient.There are so many exciting changes in healthcare happening.Don't be afraid to think outside the box and take a leap.Some say the perfect first job is an illusion, I say make it a reality.

Time for a Study Run

2013-03-29T18:58:00Z

As the end of nursing school creeps closer and closer, I'm continuously trying to improve my study regimen in the hopes of being well prepared for the NCLEX. This isn't exactly news, as I've written about honing my study habits several times in the past (most recently about the value of practice tests).

My latest strategy involves multitasking. I believe I've mentioned in this space before that I enjoy running quite a bit. Usually I listen to music or comedy podcasts during my runs, but I recently realized I could kill two birds with one stone by listening to recorded versions of my notes.

As a result, I've begun recording my notes for later audio use, and I've found the benefits are numerous. For starters, it has been helpful to say my notes out loud. Secondly, this strategy has afforded me the opportunity to study at all sorts of times, not just while running or when I have the opportunity to read. I have recently listened to my notes while driving, doing chores around the house, and grocery shopping.

And, perhaps most importantly, I have found that listening to my notes on repeat has lead to a sort of learning by osmosis. Sometimes, I'm not truly plugged into what the audio track is communicated, but I'm always hearing it.

I've been doing this for a few weeks now, and I've already seen improvements in my study recall and test scores. As a result, I'd fully recommend using this strategy if, like me, you have a hard time fitting studying in with all the other tasks you may be trying to do in a given week.

First Week As An RN

2013-03-24T01:52:00Z

After going through a week of hospital orientation at Dameron Hospital, I started and completed my first week on the unit for my new job. The new-grad program at our facility is a Versant model, so it is an 18 week-long program. During this time I will be working with a preceptor and will have two days a week of class time. The classes, which will usually be twice a week, consist of refresher material from nursing school, but include many additional components unique to our units. In one of the classes this week we learned about the various settings and rhythms of pacemakers, something that was new and informative for me. Certainly I will have a good amount of experience working with pacemakers since my unit is the cardiovascular ICU. Coincidently, one of my patients later in the week had a pacemaker placed while I was caring for her, so I saw the direct application of this material.

Case studies found their return into my life as part of our class material. Detailed discussions on various cases have increased my learning thus far and I expect to find them increasingly useful as the weeks go on. Thursday and Friday were my first days on the unit working with patients. It was a really incredible feeling to be signing charts with the words RN at the end of my signature. Throughout our 18 week training program we will be working with three different preceptors as we transition from beginner to medium to advanced skill levels. The idea of having a good resource person to allow for a more smooth transition makes me extremely thankful for this position. I truly believe that this style of new nursing position is the wave of the future to ensure competent nurses fresh out of school. With health care getting increasingly complex, throwing a new grad into a system with no support seems almost cruel.

All in all I am very excited about the start of my career. The people I have worked with on the unit have been great and my preceptor has been awesome through the first two days. I just want to focus on continuing to improve each day on the unit and incorporate the class skills as much as possible.

ADVANCE Welcomes New Blogger to New to Nursing

2013-03-19T12:05:00Z

ADVANCE welcomes the newest blogger to New to Nursing, Mia Ross. In search of the next generation of bloggers, ADVANCE asked students and new graduates to tell us where they saw themselves as nurses in 10 years. Our winner shared her personal experiences and how they have shaped her future nursing career. Look for regular posts from Mia coming soon. Here is her winning essay.

Last time I met the acquaintance of the notorious interview question "Where will you be in ten years?" I was in the pending stages of nursing school acceptance. I answered the question in hopes of placating the administration and replied, "in ten years I hope to be practicing with the highest standards of quality care using evidence-based practice and have a master's degree."

I had done my research. However, just two short years later I've realized that becoming that stand-out nurse I've always dreamed of will take much more than a hospital job and an MSN after my name.

Today, that same probing question lends a much different response; a response more holistic and genuine. Last year I watched my grandmother struggle for weeks in a hospital bed, under headache-inducing fluorescent lights, while she drowned slowly in her own lungs. This experience was so unshakable, I began writing a journal and questioning the way we die, trying to make sense of her abhorrent passing.

These questions ignited an internal flame. Conversations with family and friends ensued, and soon I was researching the subject intensely. While my grandmother suffered, we were consoled by the hospital staff, reassured that because she had a DNR order, there was nothing left to do to ease her grapple out of life. This alleviated none of my misery. I began to read in various healthcare publications complaints of a similar nature: loved ones were constantly lost so painfully, so unnaturally, almost barbarically in hospital settings.

That's when I came across Palliative Care. And I've been hooked ever since.

It is an undeniable truth to become a palliative care NP, in the next ten years I will need to go back to school and gain hospital experience. However, I am no longer an 18 year old girl without conception of the actualities of our healthcare system. This time, I forge ahead with unclouded eyes and a determined heart. I will cultivate my burning passion, stay focused in the present and continuously examine and question the way things are done.

I can no longer accept the statement, "there's nothing left to do." My ability to articulate an answer to the broad, expansive question "Where will you be in ten years?" in this dynamic stage of my life gives me confidence and strength. Writing in my journal saved me from severe psychological anguish after losing my grandmother in such a horrid way. For that I am grateful. It would be a cause for great joy to have the opportunity to share my writing and cultivate my professional linguist skills with ADVANCE, in whatever topic presents itself.

If I can help others better understand this enigma of healthcare, I am content. If I can help others muster the confidence to question the conventional way it is carried out and demand evidence, I am delighted. If I can do it through writing, I am absolutely thrilled.

Remember to Educate

2013-03-10T12:26:00Z

In my brief time as a nursing student, I've come to realize most patients are not highly informed when it comes to health matters.

With healthy people, this makes sense some sense. For instance, if a woman doesn't have high blood pressure, I can understand why she wouldn't know the ins and outs of hypertension.

However, I've come to realize that many patients don't know much about their ailments they do have, and while it would be easy to blame the patient due to a lack of interest, I think the blame for that lies largely on our community of medical professionals.

During one of my clinical rotations, I took care of a patient who received an order for a thoracentesis. When meeting with the patient and his family, the doctor told them about the order but gave them no further information about the procedure or even what it would accomplish. As a result, they all became extremely worried after the doctor left. The fear in that room was so palpable that he might as well have told them a lobotomy had been ordered.

In another instance, I found myself taking care of a patient whose blood pressure had dropped severely. The nurse seemed alarmed, and sensing this, the patient also became worried. The hospital put her on 30-minute blood pressure checks,
hooked up a bag of saline and ordered a hemoccult, but gave the patient absolutely no information on what was happening. As a result, I later found her pacing around the room nervously unaware of how much of a fall risk she had become.

I know it can be easy to assume patients know certain things, but I've come to realize it's better and safer to err on the side of unawareness as the general baseline. Of course, in doing so, we need to be tactful and not create an aura of superiority, but otherwise, a simple explanation can go a long way in ensuring quality service and improved outcomes.

Sterile, clean, or filthy... the Options of Human beings

2013-03-04T01:22:00Z

After two recent backpacking trips (Point Reyes National Seashore and Henry Coe State Park) I have a new understand of what it means to be dirty. Over twenty-five miles and two gallons of sweat later, I have a new understanding of the challenges of human beings. I never have been one to care about being dirty. All my life I have been an athlete and avid outdoorsman, so none of this was new to me. However, my recent nursing life changes have made me think more about what is sterile, what is clean, and what is not. My most recent trip was a 5 day, 4 night backcountry backpacking trip through Henry Coe State Park. It was my first time exploring this jewel of a park located along the coastal ranges south of San Jose. The landscape of the park featured rolling hills covered with thick oak forests and steep elevation gains, so I was aware of the challenge that laid ahead. Each day was filled with several miles of hiking on trails that slithered up-and-down and side-to-side, constantly testing our physical limitations and the 50 pound packs we carried. Hydration was of the utmost importance as each day we hiked we lost liters of fluid through perspiration. It was nice to be cooled by evaporation when the wind wooshed through the trees, but at the end of each day the sweat had dried and a not so comfortable feeling was left to stay. In this backcountry, clean water was not available, so all of our water needed to be purified by a special pump we carried with us. Everything here was a process. Most of the streams had dried up and the only water available was still water in some of the large ponds. Using water to clean meant less water to drink or more time, so I decided to keep my body as nature intend and skip the bathing. Unfortunately, before the trip began I had become sick. Since the trip had already been planned, I figured the sickness wouldn't be an issue and it would resolve on its own. So sickness, lapses in hygiene, and sweat, a wonderful combination for a healthy adventure.

Now at the conclusion of my trip, and with a completely absent voice, I have a new understanding for the needs of my patients. One day without a good bath, a period of exertion when ill, or even improper hydration can lead to adverse outcomes, regardless of how healthy a person is prior. I tried to use hand sanitizer as much as possible, but in this instance the sickness was already inside me, the host. The only thing I could do was to manage my disease process. I was able to see firsthand the consequences of improper management. Even though my physical illness may have slowed me down somewhat, it was no comparison to the mental bliss I gained from the trip and I would not regret one mile of sweat, strain, and filth. The trip also made me reflect on the power of the mind. Many times distraction, happiness, or another positive emotion can divert attention away from an illness. I think this is another valuable principle I can bring to my patients. So be clean, be rested, be hydrated, and most of all, be happy! I start orientation for work in one week! Let's see if I can bring this knowledge along with me.

Some Thoughts on Care in Nursing Homes

2013-02-16T23:12:00Z

A few months back, I wrote about the bad rap psychiatric nurses get amongst other specialties, resulting in a line of thinking that goes "psych nursing isn't real nursing." It's an unfair bias for sure, but it exists nonetheless.

Recently, I've begun to realize there is another peer group that the bulk of nurses seem to look down upon - the nursing home nurse. Once again, the derision is understandable. It is common to see admits from nursing homes with severe pressure ulcers, hygiene issues, and a slew of other "preventable problems." And infections like MRSA or C. diff are usually just assumed for such patients, as they almost always seem to go on immediate contact isolation.

At the same time, although I've never observed or rotated into a nursing home, I expect it must be a very difficult working environment. Many of the patients I've cared for in the hospital who have come from nursing homes are very dependent and often immobile, and, assuming nursing home staff are as understaffed as hospital nurses can often be, I imagine it can be quite a difficult experience.

There probably aren't many easy patients in nursing home facilities, and while I'm not naïve enough to think some of the care in such facilities is lacking, I'm also not jaded enough to outright assume a nurse is solely to blame just because a 300 pound immobilized patient gets a bed sore after two or three months.

In the end, it just seems like a really tough job, and I feel bad for the good, hardworking nurses in those facilities who get a bad reputation. I know it can be very easy to point fingers at those men and women for certain things, but they are doing vital work for a needy and often difficult-to-care-for population, and so I think there's something to be said for that.

The conclusion to the prologue

2013-02-08T20:15:00Z

After checking the Board of Registered Nursing (BRN) for days on end, I am finally Lorenzo Ortega, RN, BSN. I feel like a super hero with that title, or better yet, a secret agent. The wait for my results was nerve-wracking. Although I felt like I did well, I had taken my NCLEX on Jan 8^th and I checked nearly every day to see if the title RN could be added next to my name. Finally, two days ago, I got the news I had been waiting for more than two years now.

This news was followed up by something even better: a job offer. I had previously mentioned a job that I had been applying for in my last blog. After my third interview, I was offered a position in a new graduate ICU program. I couldn’t be more thrilled to be offered such a position, especially since it is in my home town of Stockton, CA. This occurrence has made me reflect a great deal on my path to get to this point. I have had such supportive family, friends, and professors. None of this would be possible without them.

The start date for the program is in early March, so I have a little time to enjoy myself before I begin. The position is a return to the interesting life of night shift that I had during my senior preceptorship. At least this time I am experienced with the flip-flop schedule and actually prefer night as my first nursing position.

When I look back on my nursing education, I feel extremely fortunate to have had the financial support of my parents. I know many people have to take the journey through school alone and for these people I have the most respect. People working, those with kids, people from difficult socioeconomic backgrounds, and individuals from other financial situations have a ton of distractors in their field of view. Many times these distractors can keep them from focusing or can simply discourage them all together, making their goals seem distant and impossible. It is these people, and their struggles, that I have learned exponentially from in the past two years. I sincerely thank them for their motivation. They have shown me, and many others, that perseverance is the true skill of a nurse.

The Middle of the Puzzle

2013-01-24T13:56:00Z

I celebrated my birthday on Tuesday, and, as I'm sure many do on their birthdays, I took a moment or two of self-reflection. I'm 27, half-way through my third year of marriage, and, during this past year, I became a homeowner for the first time. Having finally found a bit of stability, my wife and I are entertaining the idea of starting a family. There's certainly a lot to be happy about.

That, of course, is my personal life. Professionally, I'm far more of a... project. I'm nearly five years removed from college graduation, and I'm still not in a fulfilling job, let alone a career. Three years ago, I made the decision to go back to school, and here I am with roughly a year left to go in nursing school. The end is in sight, and yet I feel mostly unprepared for what lies ahead. And, given that, periodic feelings of dejection can (and do) creep up on me.

That said, I'm predicting a big year for myself professionally in 2013. Over the last three years, I've learned so much that it's often felt like I couldn't possibly retain the onslaught of information. But, now that I'm well into the 400-level course work, I'm finally making connections as my classes start to come around on all the things we just left hanging in the lower levels.

It's like I've been working on a complicated jigsaw puzzle, but really all I've been doing is turning over the pieces and constructing the ends. Until recently, I hadn't begun working on the middle, but now that I am, it all seems to be coming together very quickly. Thankfully, I might add.

A few weeks back, in discussing his preparation for the NCLEX on this blog, Lorenzo Ortega wrote "I am finding that a lot of information seemed to stick during my last two years of school." He's even further along on the puzzle, and reading his observation was certainly encouraging for me, as I hope it was for those like me who are following him into the field.

Learning a Thing or Two About Evidence-Based Practice

2013-01-19T00:04:00Z

After slaving for hours putting together my portfolio, I am happy to say that I was passed on to the next stage of interviews for the job I spoke about last week. There are a few more interviews to go, but I am doing the best I can to stay focused on the big picture.

Now that I am out of school, I have been trying to connect with nursing on a different level. Here and there I have been reading different online journal articles about various nursing topics. I find it a great way to stay informed on new clinical findings, as well as brush up on old information previously learned.

One article I read was about blood administration. It was interesting to see that a great deal of research was done on transfusions at different hemoglobin levels. Surprisingly enough those patients transfused with hemoglobin levels less than 7 actually had better outcomes than patients transfused between 8 and 10 (who were expected to decrease to even lower levels). These studied were based on pathological decreases in hemoglobin and not from acute blood loss. Resilience was the first thing that came to my mind after I read these findings. The body really doesn’t need any help unless it is completely overwhelmed. Sometimes a certain system or group of organ systems may be weak, but there is often a strong shift back towards health that the body can make on its own.

Another article I read was about total parenteral nutrition (TPN). Although TPN can dramatically improve a patient’s situation, it was amazing to see all of the associated risks. The one I most remember was dumping syndrome. When a patient is too rapidly switched from TPN back to normal gastric feedings, the stomach can go through a dumping process, empting its contents too quickly into the small intestine. This can cause extreme discomfort and diarrhea, leading to adverse outcomes such as hypovolemia and acid/base imbalances.

It was nice to get an opportunity to plug my brain back into learning mode. I think this whole article reading idea will continue, especially since I can use most of the information in my own practice. I mean, isn’t that was nursing is about, life-long learning through evidenced-based practice… I think I might be on to something!